مجله دانشکده پزشکی اصفهان
پیاپی 148 (هفته چهارم شهریور 1390)

This study was designed to evaluate and compare the effectiveness of three treating methods; namely mother’s behavioral education, Verbal self-instruction to the children, and Pharmacotherapy in children’s attention deficit hyperactivity disorder (ADHD).

In this semi-experimental study, 51 elementary students with ADHD were randomly divided to three treatment groups including mothers’ behavioral education, verbal self-instruction to the children, and control group. Moreover, 22 students with ADHD were selected among the patients referring to Hafez hospital and were put in pharmacotherapy group. Data collection tool was Child Symptoms Inventory (CSI-4). All of the subjects were evaluated by CSI-4 before and after the intervention and also 2 months later, i.e in follow up period.

The results show significant differences between the groups in mother’s evaluation of attention deficit (P = 0.04), the severity of hyperactivity-impulsivity (P = 0.005), and the general/total severity of the symptoms of disorder (P = 0.03).

The most effective treatment for the severity of attention deficit in children is verbal self-instruction. The severity of hyperactivity-impulsivity is best treated using mother’s behavioral education. Considering the result obtained in the case of general severity of symptoms in children’s ADHD, mother’s behavior education and pharmacotherapy _were the most effective and useful treatment methods.

Paraquat poisoning is one of the most common lethal poisonings in Isfahan, the central province of Iran. Due to the lower price and widespread usage of this potent herbicide for agricultural purposes, this kind of intoxication occurs almost frequently in this region. Paraquat is available here as a concentrated liquid, aerosol form or water soluble granules with different brand names. The toxicity of this poison is due to the creation of superoxide radicals through the electron transport system involved in intracellular conversion of NADPH to NAD. Superoxide anions and other free radicals are very toxic for the cell membrane. Paraquat poisoning affects the respiratory, cardiovascular, central nervous, endocrine, digestive, skin and almost all body systems, depending on the amount of ingestion. Toxic signs and symptoms of its poisoning would be appeared with the ingestion of at least 20 mg/kg or more in adults. Serum levels of 0.2 µg/ml 24 hours and 0.1 µg/ml 48 hours after ingestion, is usually associated with a fatal outcome. Immediate treatment is important for survival of patients. Supportive care, prevention of absorption of ingested poison, elimination measures and administration of antioxidants are all considered as the cornerstone of its treatment. There is no specific antidote for this toxin. High mortality rate of up to 75% in paraquat poisoning may be related to the amount of ingested toxin and the quality of medical care. Therefore, acute care physicians are supposed to have enough knowledge and skills for the supportive care and treatment of paraquat poisoning.