J KAU: "'/~d.Sd.. vol. S, pp. 35-40(1415-1417 A.H./1995-1997 A.D.)

Social and Environmental Aspects of Kerosene Poisoning inChildren in Jeddah

ABED M. AL-HAZMI, ABPed.* and MOHAMMEDA. IBRAHIM.Dr.PH**

* Department of Pediatrics and

** Department of Commullity Medicine & Primary Health Care.Faculty of Medicine & Allied Sciences, King Abdulaziz University,

leddah, Saudi Arabia

ABSTRACT. The main objective of the present study was to identify the social

and evironmental aspects of kerosene poisoning in children, at King Abdulaziz

Hospital (KAH), Jeddah. An open-ended questionnaire to the attending mem-

ber of the family; by the attending physician in emergency was carried out in

the Emergency Department KAH, during the period from April 1992 .to May

1995. Kerosene poisoning was observed to be more common in children aged

1-3 years (86.5%), living in overcrowded homes (89.5%), with poor facilities(83.5%), and in homes where kerosene was stored in beverage containers easi-

ly accessible to the children. 80.5% of the families sought medical help with-

in the first 2 hours after ingestion. Knowledge of toxic nalUre of kerosene was

lacking in most of the families. The study indicated that kerosene poisoningwas common .in children of families living in overcrowded homes with mini-

mum facilities, in which kerosene was easily acc~ssible to children. Public

awareness is needed to educate the families of the hazards of kerosene poi-

soning.

Keywords: Kerosene poisoning, Emergency, Overcrowded homes, Jeddah.

J KAU; Md. Sci.. vol. 5, pp. 35-40 (1415-1417 A.H. /1995-1997 A.D.)

Social and Environmental Aspects of Kerosene Poisoning inChildren in Jeddah

ABED M. AL-HAZMI,ABPed.* and MOHAMMEDA. IBRAHIM.Dr.PH**

* Department of Pediatrics and

** Department of Community Medicine & Primary Health Care,Faculty of Medicine & Allied Sciences, King Abdulaziz University,

Jeddah, Saudi Arabia

ABSTRACT. The main objective of the present study was to identify the social

and evironmental aspects of kerosene poisoning in children. at King Abdulaziz

Hospital (KAH), Jeddah. An open-ended questionnaire 10 the attending mem-

ber of the family: by the attending physician in emergency was carried oUI in

the Emergency Department KAH. during the period fcom April 1992.to May

1995. Kerosene poisoning was observed to be more common in children aged

1-3 years (86.5%), living in overcrowded homes (89.5%). with poor facilities(83.5%), and in homes where kerosene was stored in beverage containers easi-

ly accessible to the children, 80.5% of the families sought medical help with-

in the first 2 hours after ingestion. Knowledge of toxic nature of kerosene was

lacking in most of the families. The study indicated that kerosene poisoning

was common .in children of families living in overcrowded homes with mini-mum facilities. in which kerosene was easily acc~ssible to children. Public

awareness is needed to educate the families of the hazards of kerosene poi-

somng. .

Keywords: Kerosene poisoning, Emergency, Overcrowded homes, Jeddah.

tf

PATTERNS OF ACCIDENTAL POISONINGIN CHILDREN IN JEDDAH, SAUDI ARABIA

Abed M. Al Hazmi, ABPed

~,.,

Childhood poisoning is a universal problem which isusually accidental, and is associated with low morbidityand mortality. 1-3 Observations of accidental childpoisoning from different regions of Saudi Arabia, with theexception of Jeddah, have been reported:I-8 The purpose ofthis study was to determine the pattern of accidentalpoisoning in children reporting to the King AbdulazizHospital (KAH) in Jeddah. Attempts were made todetermine related morbidity and mortality in affectedchildren and to recommend strategies for prevention ofaccidental poisoning in children.

Patients and Methods

Children up to 12 years of age reporting to theEmergency Department (ED) of KAH and admitted to thePediatric Unit or the Intensive Care Unit (ICU) during thetime period of January 1994 to December 1996 wereenrolled in the study. An open-ended questionnaire wasadministered in each case to obtain data, which includedage, gender and preliminary diagnosis. Furtherinformation was obtained on the type of poison, source ofpoison, time of ingestion, time of seeking medicalattention, clinical symptoms, duration of hospitaladmission and outcome in those children known to besuffering from accidental poisoning.

Results

A total of 1954 children were admitted to the MedicalPediatric Unit during the study period. Of these, 140(7.2%) reported ingestion of toxic materials with orwithout symptoms of intoxication. A slight downwardtrend in the incidence of childhood poisoning was apparentover the three-year study period, as noted by the 51, 49 and40 cases presenting in 1994, 1995 and 1996, respectively.The highest percentage of poisoning was in the 2-5-yearage group (61%), as compared to 27% in 0-2, 9% in 5-10,

From the Department of Pediatrics, King Abdulaziz University, leddah,Saudi Arabia.

Address reprint requests and cOITespondence to Dr. AI Hazmi:Department of Pediatrics, King Abdulaziz University, P.O. Box 9776,Jeddah 21423, Saudi Arabia.

Accepted for publication 17 May 1998. Received 10 March 1998.

and 3% in the IO-12-year age groups. The rnale:femaleratio of the 140 children was 1.4:I. This ratio remainedquite constant in the three age groups beIO'NI() years andincreased sharply to 3: I in the oldest (10- i2 years) agegroup.

Table I illustrales the types of poisons identified in the140 accidcntal child poisoning cases. Hydrocarboningestion accounted for the highest proportion ofjr)isonings (56 caiies, or 40%). followed by drugs in 48cases (34.3~.), and household chemicals in 23 cases(16%). Bleach-sodium hypochlorite, Chlorox-wasidentified as the causative agent in II (7.9%) of the cases,and rat poison (warfarin) and insecticides were observed in8 children (5.7%). No information on the nature of thetoxic substance ingested was available in 5 children 0.6%)presenting with symptoms of accidental poisoning.

Children ingesting pharmaceuticals were generallyrequired to stay in hospital for only short periods. Of the48 children with accidental drug ingestion, 30 (62.5%)were hospitalized overnight for observation, 38 (71.9%)stayed less than 48 hours, and all were discharged within72 hours. Six children who had taken anticonvulsant drugspresented with symptoms of drowsiness, somnolescellce.and dizziness. Another six (12.5%) who ingested anti-histamines presented with drowsiness and sleepiness.Ingestion of antiemetics (metoclopramide) resulted inmanifestations of oculogyric crisis in 5 children (10.4%) inthis group. Antipsychotic drugs, mainly hypnotics andsedatives, were ingested hy 5 children (10.4%), antibioticsby 3 (6.2%), antidepressants, paracetamol, iron andcorticosteroids in each of 3 children (6.2%), all of whoml..csented with only mild symptoms of intoxication uponmnval at the ED.

. Of the 56 children with hydrocarbon intoxication, 54reported having consumed kerosene. Of these, only 22(40.7%) had mild symphms, such as drowsiness, cough,vomiting, and tachypnea. Another 19 children (35.2%)developed pneumonic changes with respiratory distress,and these symptoms were further accompanied by fever ina group of 15 children (27.7%). The latter two groupsstayed in the hospital for more than three days.

It was determined that half of the 22 children admittedfor ingesting household chemicals had consumed bleach.Of these 11 children, 9 had hyperemia with mildcircumferential burns. These symptoms were sufficiently

Annals afSaudi Medidne. Vol/S. Na 5, /998 457

Med. J. Cairo Univ., Vol. 71, No.1, (Suppl.) March: 151-154,2003

Kerosene Poisoning in Children, Jeddah, Saudi Arabia

ABED M. AL HAZMI, AB (Ped.)

The Department of Pediatrics, King Abdu/aziz University, Jeddah, Saudi Arabia.

Abstract

Accidental kerosene poisoning is one of the most com-mon fOnTISof acute childhood poisoning in most develop-ing countries. In this study one hundred and twelve chil-dren age between JOmonths and 12 years were admittedto King AbduJaziz Hospital, Jeddah, Saudi Arabia, withhistory of kerosene ingestion; 93.8 percent were below ageof 5 years, with male to female ratio 1.9:1. Drowsinesswas the most common and early symptom occurring in 75percent and lasting for a short period of time (2-6 hours);while respiratory symptoms were predominant, fever oc-curred in 58 percent of the children and was not present onadmission but developed in the first 12 hours post inges-tion. Acidosis and cyanosis on presentation as signs of se-verity were seen in four children, two of whom were se-verely ill and died from respiratory failure. Changes in thechest X-ray were noted in 56.2 percent of children on ad-mission, with 28.6 percent perihilar infiltrate and 19.2 per-cent basal infiltrate. Others findings, such as pleural effu-sions, collapse of the lung, emphysema, pneumothorax andpneumomediastinum were seen on chest X-ray taken dur-ing the course of admission in ill patients. CNS manifesta-tions other than drowsiness included irritability in 14.7percent and convulsion in two children. Hospitalization ofchildren of kerosene ingestion is always necessary, al-though symptomatic and supportive treatment is all what isrequired to stabilize the patient. It is recommended thatthere is a strong need to implement procedures for the safestorage of kerosene including other products which may beharmful to children. The Primary Health Care Services ofthe Ministry of Health must include parental education re-garding the hazards of kerosene poisoning in children.

Key Words: Kerosene Poisoning - Childhood Poisoning.

Introduction

ACCIDENTAL kerosene ingestion persists asthe most common category of ingested poison-ing in developing countries [1-4J,particularly inregions where kerosene is used as fuel for cook-ing, heating, lighting and cleaning purposes; acommon practice in parts of Saudi Arabia [4-10J.Kerosene is a hydrocarbon product of petrole-um; its toxicity is related to its volatility and in-volves mainly the respiratory and central ner-

vous systems (CNS), although other systemsmay be involved [11J.

This is a prospective study with the aim toexplore the clinical manifestations and the out-come of kerosene poisoning in children. Thestudy also attempts to recommend optimal man-agement and preventative strategies to reducemorbidity and mortality in the affected chil-dren.

Patients and Methods

All the children of ages less than 12 yearsbrought to King Abdulaziz Hospital (KAH),Jeddah with history of kerosene ingestion fromJanuary 1998 to 31 July 2000, were included inthis study. Complete history was taken from theattendant on arrival and a full clinical examina-tion, chest X-ray, complete blood count (CBC),blood gases, urea and electrolytes, liver func-tion tests and additional tests were carried outaccording to the clinical indication.

Results

One hundred and twelve children were in-cluded in the study; 74 (66.1 percent) weremale and 38 (33.9 percent) were female, 46(41.1 percent) children were less than two yearsof age; 59 (52.7 percent) were between 2 yearsand 5 years and only 7 children were more than5 years of age.

The quantities of kerosene ingested wereless than 30 ml in 94 (84 percent) children. Thekerosene was stored in beverage containers,such as water bottles and glasses in 104 (92.8percent) of the children, with 69 (61.6 percent)placed in the kitchen and 38 (34 percent) in thecourtyard. In 74 (66.1 percent) children thefamily did not administer to the child any home

151

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IMIPENEM I CILASTATIN SAFETYANDEFFICACYIN NEONATE

A. Shaabat, A. AI-Hazmi, M. Farouq, R. Bader, S. Jaber

Department of Paediatric, King Abdulaziz University Hospitalleddah, Saudi Arabia

ABSTRACT

Objectives: To determine usefullness, efficacy and sideeffects of the imipenem in neonatal sepsis.

Design: Prospective study of 18 neonate from January 1995to December 1995.

Setting: King Abdulaziz Hospital (KAH) Jeddah, NeonatalIntensive Care Unit (NICU).

Subject: 18 neonate, 7 fullterm and 11 preterm, 9 male & 9 .female with mean weight 2.2 kg.

Interventions: AIl neonates admitted to NICU who

developed clinical signs and symptoms of sepsis were startedinitially on ampicillin or penicillin and gentamicin after allcultures had been taken. Those who had positive culture with anorganism resistant to the former combination of antibiotics butsensitive to imipenem were started on imipenem intravenous as asecond line drug.

. Results: AlliS neonates enrolled in this study recovered anddischarged except one who developed seizure on 3rd day oftherapy and died at age of two months due to underlying centralnervous system (CNS) malformations and infantile polycystickidney.

Conclusion: Imipenemlcilastatin is very useful second linedrug in treating neonatal infection, the risk of seizure is small andprobably related to the underlying CNS malformation.

Keywords: Imipenem; Neonatal; antibiotics.

INTRODUCTION prev6nts renal metabolism of

imipenem) (Mustafa and Me Cracken,

1989). It has a very broad spectrum of

activity that cover most gram-negative

and gram-positive organisms, aerobesand anaerobes and with marked

activity against species producing

Imipenem is an antibacterial

agent of the earbapenem class ofbeta-lactam, (Birnbaum, et. al. 1985),

it is combined with eilastatin (a renal

dehydropeptidose inhi~ttor that

J A C., Vol. 10, No.4, Dec. 1999 601

/

(

~,T

94

TRAUMATIC DIAPHRAGMATIC HERNIAWITH PERICARDIAL TEAR-LATE PRESENTATION

Daleel AIRahman IS., Jamal YS., AI-Hazmi,A.

King Abdulaziz UniversityHospital,Jeddah, Saudi Arabia

Traumatic rupture of the diaphragm occur in the left side. The diagnosis is usually late andthis can be either missed, overlooked, or due to a late rupture of the devitalized portion of thediaphragm. Symptomatic presentation can be either mild or severe. The tear usually singlebut double tear or associated pericardial, myocardial injury can also occur. In this paper Wepresent a caseof latepresentingpost traumaticdiaphragmatichernia associatedwith .

pericardial tear.

:{y;J\~. Egyptian Joumal of Surgery Vol. (19), No. (1), Jan., 2000

SYSTEMICCANDIDA INFECTIONAT KING ABDUL AZIZ UNIVERSITYHOSPITALJEDDAH.

By"4isha A.I Gha111di,Abed Al Haz111i,Faiza Al Sil1i,F~tma Al Zahral1i

KingAbdulazizUniversityHospital, J Eddah.

Candida injection in hospitalized patient is increasin:s significantly over the last 10 years. Particularly in the patientsil! tIle Intensive CaI'e Unit who have invasive monitoring lines. Candida infection leading to prolonged hospitalization andsignificant mortality which dictate the need to take all the possible measures to present this infection partiwlarly at the highrisk patients.lVe study 15 cases which developed this type of infection in King Abdulaziz University, Jeddalz over 5 yearsperiod aiming at identifyinp: the risk factor of candida infection in our patients with particular attention to the patient withhigh mortality, in tum we suggest the universal preventive measures for patients at risk of infection and additionalprophylactic treatment for the patients at lethal risk.

Key words: Candida,systemic, riskfactors, preventive measures,intensive careunit.

PREVALENCE OF HIP JOINT INSTABILITY (DDH) IN KAUHIN JEDDAH, SAUDI ARABIA

A CORRELATION BETWEEN CLINICALAND SONOGRAPHICSCREENING

Jaber, S.M (M.D.)*; F;1Sobki, M (M.D.)**; Sabber, H. (M.D.)***;Shaabat, A. (M.D.)*=;Fida, N. (M.D.)* and A1-Hazmi,A. (M.D.)*

ABSTRACTThe incidence of the hip instability due to DDH (Developmental dysplasia of the hip)

was studied in the nursery departmenl at K.4UH (KingAbdulaziz UniFersiryHospiLaOfrom November 1995 to October 1996. Eight hundred nine newborn babies with 1618hips were screened both clinicalf.v and withGraf's ultrasound techniques. Babies withneuromuscular disease or those referred with other medical problems were excluded.

The incidence was found to be 10.3 % with more prevalence infemale newbornbabies (6.6%) compared to male (3.7%) using ultrasound screening. Racial status had aninsignificant effect in DDH incidence (5.6% in Saudi, 4.7% in non-SaudZ). The higherincidences of DDH in the first 24 hours could be related to mother's relaxin hormone thatfades mvay within a short duration (i::.-I weeks). It could also be related to Graf'sultrasound type IIa- which usualf.v normalizes spontaneousf.v later in l{fe. Arecommendation for earf.vdetection is to carry out the screening for DDH by the age of 6-8 weeks.

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Journal of Arab ChildThe Association of Arab

Pediatric Societies

New Children's HospitalCairo Universitv..

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Abstract

Eczema is often the fIrst evidence of atopy in children with asthma. Theaim of this study was to verify whether eczema could influence severityof asthma.

We compared two groups of 20 children one affected with eczema andasthma (group!), the other by asthma only (group2), the 40 children werematched for gender, and were followed for 5 years in pediatric clinic. Allchildren were tested for atopic status (skin test), and severity of asthmaboth at enrollment, and at the end of the study.Severity of asthma was defmed according to number of hospitalizationsfor asthma, number of asthma attacks, and number of medications takenfor asthma (number of medications for number of day's therapy).We fmd that the eczema and asthma group showed more severe asthma,with more asthmatic attacks and hospitalizations at the time of enrollment(p=0.026), although the severity of the asthma symptoms was comparablein both groups with appropriate therapy during the study period.