IntroductionTo investigate the pattern of vancomycin-associated nephrotoxicity in children and to examine potential predisposing factors for nephrotoxicity, including average serum trough concentrations ≥10 μg/mL.MethodsPatients ≥1 week old to ≤15 years with normal baseline serum creatinine values who received vancomycin for ≥48 h between October 2010 and September 2012 were retrospectively evaluated. Nephrotoxicity was defined as a serum creatinine increase of ≥0.5 mg/dL or ≥50% baseline increase over 2 days. Patients with average serum trough concentrations ≥10 μg/mL were compared with a lower trough group.ResultsRenal toxicity occurred in 72 (27.2%) of the 265 studied pediatric cases. High trough vancomycin levels ≥10 μg/mL were presented in 59 pediatric patients suffering from nephrotoxicity. Using multiple regression analysis, cases admitted to the intensive care unit (ICU) and to whom aminoglycoside medication was administered concurrently with vancomycin medication showed a significant high renal toxicity incidence [odds ratio (OR) 2.91; 95% confidence interval (CI) 1.70, 8.61; P value <0.03)] and (OR 9.11; 95% CI 4.11, 24.13; P < 0.05), respectively.ConclusionRenal function tests and continuous monitoring of vancomycin trough levels for children receiving vancomycin therapy, especially admitted to the ICU and given other aminoglycoside medications, are essential.

Childhood poisoning is a major cause of morbidity in both developing and developed countries. In spite of the success of some interventions to prevent accidental poisoning in the pediatric population, toxic ingestions continue to be a common occurrence. The purpose of this study was to shed light on the problem of accidental poisoning among children, to determine the factors related to accidental poisoning by the most common medications and household agents in poisoned patients who were visited a pediatric ER department. A prospective study was conducted in the period from January 2011 until December 2013 at the Dammam Maternal and Child Hospital. The studied children were a mix of boys and girls, did not suffer from any mental disabilities, were aged below 15 years old, and were of variable nationalities. The findings of the study demonstrated that the most common toxic presentation in the reported cases were medications toxicity exposure (63.2%) followed by pesticides toxic exposures (16.3%). Acetaminophen exposure represents the most common toxic forum of medication exposures (27.6%). Age from 1-7 year is the most common vulnerable age of toxicity (74.8%). The most common pharmaceutical preparation involved in the toxic presentation was tablets and syrup forum 41.7% and 20.7% respectively. From the studied cases 64.5% of the reported cases were asymptomatic toxic presentation, and on the opposite site 6% were suffered from acute severe consciousness disturbance "Glasgow Coma Scale was less than 8". Effective health promotion programs for parents and careers regarding poisoning hazards are needed to increase awareness and reduce the incidence of poisoning among children.

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In this study we describe the transfer of a new and fully automated workflow for the cost effective drug screening of large populations based on the dried blood spot (DBS) technology. The method was installed at a routine poison control center and applied for DBS and dried urine spot (DUS) samples. A fast method focusing on the high interest drugs and an extended screening method were developed on the automated platform. The dried cards were integrated into the automated workflow, in which the cards were checked in a camera recognition system, spiked with deuterated standards via an in-built spraying module and directly extracted. The extract was transferred online to an analytical LC column and then to the electrospray ionization tandem mass spectrometry system. The target compounds were analyzed in positive multiple reaction monitoring mode. Before each sample batch or analysis day, calibration samples were measured to balance inter day variations and to avoid false negative samples. An internal standard was integrated prior the sample extraction to allow in process control. 28 target compounds were analyzed and directly extracted within 5 minutes per sample. This fast screening method was then extended to 20 minutes, enabling the usage of a Forensic Toxicology Database to screen over 1200 drugs. The method gives confident positive/negative results for all tested drugs at their individual cutoff concentration. Good precision (+/-15 %, respectively +/-20 % at LOQ) and correlation within the calibration range from 5 to 1000 ng/ml was obtained. The method was finally applied to real cases from the lab and cross checked with the existing methodologies.

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Background: The sudden emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and scarcity of the accurate information especially in the initial phase of the struggle presented a series of challenges to health systems. Objective: To evaluate the changes in poisoning cases regarding distribution, types, and characteristics for better framing and planning of the role of our field in responding to pandemics. Methods: Study of telephone consultation calls and toxicology analysis records of poisoning cases referred to the Dammam Poison Control Center in Saudi Arabia during the first half of 2020. Their distribution according to frequencies, causes, and other characteristics was compared to the first half of 2019. Results: Analysis of telephone consultation calls revealed that the proportion of exposure to disinfectants and hand sanitizers during first half of 2020 increased to 20.4% (n = 496) and 3.4% (n = 83), respectively, compared to 9.8% (n = 215) and 0.4% (n = 10) for surface disinfectants and hand sanitizers, respectively, during the first half of 2019. In 2020, exposure to disinfectants and hand sanitizers dominated in preschool children (0-5 years). The total number of cases suspected for drugs/drugs of abuse overdose during the first 6 months of 2020 (n = 783) showed a significant decrease (P < 0.001) compared to the first 6 months of 2019 (n = 1086). Conclusion: The increased availability and use of disinfectants and sanitizers significantly increased the risk of poisoning, especially in preschool-aged children. Public health education for prevention of such home exposures is urgently needed to avoid unnecessary emergency medical system use in such critical time.

Using hair as a biological specimen to analyze drug abuse has been receiving elevated attention during last years because of flexibility of collection procedure and because hair does not autolysis like other body fluids or tissues. Hair testing provides a broad-spectrum detection window after drug exposure than urine testing. Hair analysis has specific criteria that it provides a way of obtaining information that cannot be acquired by other commonly used forensic toxicology analytical procedures, such as blood or urine analysis. In the hair matrix, many xenobiotics are trapped permanently, in disparity to the situation with blood or urine where they are only identifiable for a few hours or days. Subsequently substance of abuse detection by hair analysis should be the target procedure in the clinical and forensic toxicology aspect when the evaluation of repeated or chronic exposure to a drug is indicated, e.g. in the case of pre-employment/workplace testing, criminal affairs or a driving license restoration. In the current study, seventy cases of the application of hair analyses using this technique for the determination of substances of abuse (opiates, cannabis, amphetamine, barbiturate, benzodiazepines, and cocaine) are investigated. Analytical toxicology procedure for detection of substance of abuse is critical important: Biochips array technology that confirmed with GC/MS has proved to be a highly sensitive and specific technique for the detection of substances of abuse at very low concentrations in hair except for cannabis.