Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103030120180101Pretreatment with the Micro-alga, Spirulina Platensis Ameliorates Cyclophosphamide -Induced Hematological, Liver and Kidney Toxicities in Male Mice.171807610.21608/ajfm.2018.18076ENSabryEl-NaggarZoology Department, Faculty of Science, Tanta University, Tanta, Egypt.MahrousIbrahimForensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Forensic Medicine & Clinical Toxicology Department, College of Medicine, Aljouf University, Sakaka, KSA.HalaEl-TantawiZoology Department, Faculty of Science, Ain Shams University, Cairo, Egypt.
Biology Department, College of Science, Imam Abdulrahman Bin Faisal University, Dammam, KSA.IsmailAl-SharkawiZoology Department, Faculty of Science, Tanta University, Tanta, Egypt.
Faculty of Marine Sciences, King Abdulaziz University, Jeddah 21589, KSA.Journal Article20181031Cyclophosphamide (CTX) is used for the treatment of tumors however, it has several side effects which led to failure of the liver functions and significant reduction in the white blood cells total number (W.B.Cs). <em>Spirulina platensis</em> extract (<em>S. platensis</em>) has been found to restore the count of W.B.Cs to normal level with antioxidant properties. The aim of this study is to determine the prophylactic effect of Spirulina extract on CTX-induced hematological, liver and kidney toxicities. Thirty-two male albino mice were divided into four groups (8 mice/group). The first group (G1) was served as a control, the second group (G2) had injected i.p with 200 mg /kg CTX and the third group (G3) had orally treated with <em>S. platensis</em> extract (1000 mg /kg b.w.) for two weeks every day. Group four (G4) had treated orally with 1000 mg/kg of <em>S. platensis</em> extract, and then injected with 200 mg /kg CTX once. Three days after CTX injection, mice were sacrificed and blood samples were collected for complete blood count analysis and biochemical liver and kidney parameters. Liver and kidney tissues were harvested for histological examinations. The results showed that the injection of CTX reduced the total W.B.Cs number and did not affect the red blood cells and hemoglobin or hematocrit levels. Treatment with 1000 mg/kg <em>S. platensis</em> prior CTX treatment for two weeks did not lead to a restoration of W.B.Cs. However, the pre-treatment with <em>S. platensis</em> (1000 mg/kg/body weight) ameliorated the hepatic and renal dysfunctions and decreases the hepatic and renal histological changes which induced by CTX. In summary, the treatment with <em>S. platensis</em> for two weeks before CTX-injection led to a significant protection on both of the liver and kidney organs in mice.Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103030120180101Pattern of deliberate self-poisoning cases admitted to Poison Control Center Ain Shams University Hospitals during the years 2015-20169171813210.21608/ajfm.2018.18132ENHodaSalah EldinDepartment of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.0000-0001-8368-3019SamarAzimDepartment of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Journal Article20181101Suicide is one of the leading causes of death worldwide. Deliberate self-poisoning (DSP), is the most common method of attempted suicide and accounts for the majority of suicide-related hospital admissions. The incidence in Egypt tends to be under-estimated.<br /> <strong>Aim:</strong> Evaluating the pattern of deliberate self-poisoning cases who were admitted to Poison Control Center Ain Shams University Hospitals (PCC-ASUH) from January 2015 to December 2016.<br /> <strong>Method:</strong> An observational study was conducted including all patients deliberately self-poisoned throughout the study period .Recorded data in the present study included: age, gender, and residence, type of causative agent, severity of poisoning, and mortality.<br /> <strong>Results: </strong>A total of 10035 and 10758 self-poisoned patients were received in 2015 and 2016 respectively. Results remained similar in both years of the study. Cases were predominantly in the age group between 19 and 30 years, females 69% and were received from Cairo. Used substances were mainly drugs: centrally-acting drugs ranked first including Tricyclic antidepressants TCA, Benzodiazepines (BZD), antipsychotics and carbamazepine followed by analgesics and cardiopulmonary drugs. Among non-drug agents, organophosphorus insecticides were the most common .Lower number of cases used phosphides, corrosives and detergents, petroleum distillates, phenol and paraphenylenediamine (PPD). The majority of cases were mild (>70%) in both years of the study. Severe cases constituted 6.8% of DSP cases, with overall in-hospital mortality 0.6%. Organophosphorus insecticides topped the agents responsible for mortality followed by unknown drugs with small contributions by other drug and non-drug agents.<br /> <strong>Conclusion:</strong> Deliberate self-poisoning is a common presentation to PCC-ASUH .General trends show significant predominance of adolescents and young adults especially females, usage of drugs mainly centrally-acting agents, and low case fatality which is mainly in relation to organophosphorus compoundsAin Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103030120180101Serum Theophylline Level as Predictor for Complications in Adults with Acute Theophylline Overdose18261813310.21608/ajfm.2018.18133ENRababHafezDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Ain Shams University, Egypt.Journal Article20181101Acute theophylline overdose is a common medical problem in emergency toxicology departments, it causes serious complications that may lead to death. <strong>The</strong> <strong>Aim </strong>of this study is to explore if serum theophylline level is corresponding to development of complications and prolonged hospital stay after acute overdose .<strong>Methods</strong>: The prospective study included 510 cases admitted to the PCC ASU hospitals during the year 2016.The cases were categorized in two groups; group I(non complicated cases) and group II(complicated cases).All cases were subjected to full history, clinical data and detection of acid base status and ECG performance. Emergency interferences were evaluated. <strong>Results</strong>: All cases were suicide, 3 cases were died. There was significant difference between groups I and II regarding age, delay time, temperature, vomiting and grade III vomiting, high significant difference regarding hypotension needed IV fluids, very high significant difference regarding pulse, extreme significant difference regarding systolic and diastolic blood pressure, sinus tachycardia, respiratory manifestations and grade I and II vomiting. The frequency of complications during hospital stay was respiratory alkalosis then metabolic acidosis, hematemesis and /or melena, respiratory distress, arrhythmia, agitation, respiratory acidosis and seizures. Regarding ECG Changes in both groups, atrial fibrillation, ventricular tachycardia and cardiac arrest occurred in 3% of group II. There was extreme significant difference regarding admission to ICU and duration of hospital stay. Activated charcoal, multiple dose activated charcoal and IV fluids were given to all cases of group II with extreme significant difference between both groups regarding multiple dose activated charcoal, gastric lavage and IV fluids. Gastric lavage was done to most of group II cases with extreme significant difference from group I, there was very high significant difference between both groups regarding anticonvulsant administration. There washigh significant difference between group I and II regarding peak serum level of theophylline. Regarding relation between serum theophylline level and occurrence of complications, extreme significant difference was found between group I and II regarding metabolic acidosis and hematemesis and/ or melena, very high significant difference regarding arrhythmia and hypotension that needs vasopressor and high significant difference regarding respiratory distress. Regarding relation between peak serum theophylline level and duration of hospital stay, there was high significant difference between the groups for all periods. <strong>Conclusion:</strong> It was concluded that there was significant difference between the two groups regarding peak serum theophylline level and occurrence of complications and also duration of stay. <strong>Recommendations:</strong> Serum theophylline level should be considered to be one of the predictors of occurrence of complications, ICU admission and longer duration of stay in acute overdose cases.Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103030120180101Histological Study of the Effect of Semicarbazide on Testicular Seminiferous Tubules of Juvenile Albino Rat27371813410.21608/ajfm.2018.18134ENAsmaaMansourHistology and cell biology department, Faculty of Medicine, Tanta University, Tanta, Egypt.MarwaIbrahimHistology and cell biology department, Faculty of Medicine, Tanta University, Tanta, Egypt.EssamLaagHistology and cell biology department, Faculty of Medicine, Tanta University, Tanta, Egypt.Abdel MoniemZamzamHistology and cell biology department, Faculty of Medicine, Tanta University, Tanta, Egypt.Journal Article20181101Semicarbazide (SEM) is a by-product of azodicarbonamide used to improve the properties of the plastic seals of the glass jar lids of the canned food such as baby food. This work aimed to evaluate the effect of semicarbazide (SEM) on the morphology of testicular seminiferous tubules of juvenile albino rat. Twenty juvenile male albino rats aged 4 weeks were divided into two main groups: group I (control), group II (treated with SEM 40 mg/kg oral daily for 4 weeks). Specimens from the testes were processed for different histological examinations, histochemical staining with Periodic Acid Schiff (PAS) and immunohistochemical study using antibodies against Bcl-2 was carried out in addition to morphometrical and statistical analysis. SEM-treated group showed some vacuolated spermatogenic and Sertoli cells, discontinuity of germinal epithelium, some exfoliated spermatogenic cells in the lumen in addition to focal loss of the basement membrane. A statistically significant decrease in both mean epithelial height and area percentage was recorded in group II. A statistically significant decrease of PAS reaction of the basement membrane was observed. A statistically significant decrease in Bcl-2 positive cytoplasmic immunoreaction in cells of seminiferous tubules was detected. Electron microscopic examination revealed swollen mitochondria, dilated rough endoplasmic reticulum, vacuolated cytoplasm and areas of cytoplasmic loss in spermatogenicand Sertoli cells. The nuclei of some primary spermatocytes and spermatids appeared dark and shrunken or fragmented. Thickened basement membrane with collagen deposition was detected. It could be concluded that SEM causes significant structural changes in juvenile seminiferous tubules of rat testis.So, it is recommended to use alternative safe substance in the sealing process of glass jar lids.Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103030120180101Cyanamide-Induced Hepatotoxicity and the Potential Protective Role of Pomegranate Seed Extract in Adult Male Albino Rats38511813510.21608/ajfm.2018.18135ENNaemaElhosaryDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine,Tanta University, Tanta, EgyptDoaa ElgharbawyElgharbawyDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine,Tanta University, Tanta, EgyptAmiraKassabDepartment of Histology, Faculty of Medicine,Tanta University, Tanta, EgyptRMElgharabawyDepartment of Pharmacology and Toxicology, Faculty of Pharmacy.
Tanta University, Tanta, Egypt.Journal Article20181101<strong>Background</strong>: Dormex, which is used as agricultural fertilizer, contains cyanamide as an active ingredient. Pomegranate fruits enclose numerous polyphenols that guard normal cells against oxidative stress. <strong>Aim of the work</strong>: to study the hepatotoxic effects of Dormex and assess the protective capacity of pomegranate seed extract (PSE) in rats after 3 months of oral administration. <strong>Material & methods</strong>: Sixty mature male albino rats were distributed to; Group I, II: rats were given 0.1 ml distilled water/kg/day and 400 mg/kg/day of pomegranate seed extract (PSE), respectively. Group III: divided into two subgroups in which rats received 30 & 60 mg/kg/day Dormex, respectively. Group IV: divided into two subgroups in which rats were given the same dose of Dormex plus PSE. Body and liver weights, serum albumin, total bilirubin and liver enzymes were assessed. Hepatic malondialdehyde (MDA), glutathione reductase and catalase activities were evaluated. Liver specimens were studied with H. &E., Mallory's trichrome and caspase-3 immunostaining. <strong>Results</strong>: The hepatic index, liver enzymes, bilirubin, and MDA were significantly increased (P˂0.001), while albumin, glutathione reductase, and catalase were lowered significantly in rats of experimental groups compared to the control (P˂0.001). All these assessed parameters were within normal range in the protected groups. The histopathological changes included liver inflammation, degeneration and fibrosis, in addition to apoptosis. Treatment with PSE markedly prevented the occurrence of these abnormalities. <strong>Conclusion</strong>: Cyanamide prompts oxidative stress that compromises the liver function and eventually liver fibrosis results. These toxic effects are dose related. The PSE exhibits hepatoprotective effects and highlights the possibility of its use as a protective agent in individuals at high risk of Dormex toxicity.Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103030120180101Dermal Application of Silver Nano-particles on Adult Mice: A Histopathological and immunohistochemistry study of kidney and lung52591819610.21608/ajfm.2018.18196ENEmanHasanForensic Medicine & Clinical Toxicology Department, Faculty of Medicine- Minia University- Minia-Egypt.FatmaAbdelbakyAnatomy Department, Faculty of Medicine- Minia University- Minia-Egypt.Journal Article20181101There is an increasing public concern about possible side effects of manufactured nanoparticles because of increasing potential for their exposure. Silver nanoparticles (AgNPs) are one of the most commonly used nanomaterials. So, this research aimed to highlight on the effects of AgNPs (20 nm) on kidney and lung. Fifteen adult mice were divided into two groups: control group (5 mice), and silver group (10 mice) which were exposed to 25μl AgNPs (for each mouse) for four hours dermally. After 14 days, the kidneys and lungs of all mice of the two groups were investigated histopathologically and immunohistochemically. The evaluation of immunohistochemical findings was done by the measurement of immunoreactivity score (IRS) of inducible nitric oxide synthase (iNOS). Fourteen days post dermal exposure to AgNPs revealed histopathological changes of the kidney and lung in the form of congestion and inflammatoy cellular infiltration. Renal and lung IRS of iNOS had significant high score in silver group than control group. Our research concluded that dermal exposure to low dose of small-sized silver nanoparticles was not safe because it clearly caused histopathologic abnormalities of the kidney and lung tissues, and so we need further researches for protection suggestion against this toxicity. Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103030120180101The Possible Protective Effect of Alpha-Lipoic Acid against Acute Ricin-Induced Nephrotoxicity in Adult Male Albino Rats60721819710.21608/ajfm.2018.18197ENDoaaElgharbawyDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt.MarwaShahinDepartment of Forensic Medicine and Clinical Toxicology,Faculty of Medicine, Tanta University, Tanta, EgyptSadikaTawfikDepartment of Histology,Faculty of Medicine, Tanta University, Tanta, Egypt.AhmedZakiDepartment of Clinical Pathology,Faculty of Medicine, Tanta University, Tanta, EgyptJournal Article20181101<strong>Background:</strong> Ricin toxin is considered one of the most potent plant-derived toxins. It induces rapid and irreversible toxic effects through many mechanisms with special concern to inhibition of protein synthesis and oxidative stress resulting in cell death. Moreover, ricin could be used as a terrorist weapon which indicates the importance of finding a specific treatment. Alpha lipoic acid (ALA) possesses almost all characters of an ideal antioxidant; thereby it is suggested to be used against ricin toxicity. <strong>Aim of the work: </strong>The current study aimed at investigating the acute toxic effects of ricin on the kidneys of adult male albino rats and to appraise the possible protective effect of ALA in altering ricin-induced nephrotoxicity. <strong>Material & Methods:</strong> the present study was carried out on 60 adult male albino rats; they were divided into four groups. Group I<strong>:</strong> ten rats were intraperitoneally injected by 0.9% saline. Group II:tenrats were intraperitoneally injected by 100 mg/kg ALA. Group III<strong>: </strong>twentyrats were subcutaneously injected once with 25 µg/kg body weight of ricin solution. Group IV: twenty rats were injected by 100 mg/kg ALA, 15 minutes prior to single injection of 25 μg/kg body weight of ricin solution, and then reinjected with the same dose of ALA immediately after ricin injection<strong>.</strong> Survival time, renal function tests, renal malondialdehyde (MDA), renal superoxide dismutase (SOD) and catalase enzyme activities were recorded. Kidney samples were used for electron microscopic examination. <strong>Results:</strong> Ricin induced nephrotoxicity with significant increase of renal function tests, renal MDA and catalase activity with significant decrease of SOD. Also, the kidney samples of ricin-treated animals revealed focal ultrastructural changes in renal corpuscles, proximal and distal convoluted tubules. On the other hand, most of ricin-induced injuries were much improved after administration of ALA together with ricin. <strong>Conclusion:</strong> Ricin produces oxidative nephrotoxic effects that markedly improved by the effective antioxidant properties of alpha lipoic acid. Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103030120180101Could Licorice prevent Bisphenol A-Induced Biochemical, Histopathological and Genetic Effects in the Adult Male Albino Rats?73871819810.21608/ajfm.2018.18198ENWalaaAbdelzaherDepartment of Pharmacology, Faculty of Medicine, Minia University, Minia, Egypt.DaliaAliDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Minia University, Minia, Egypt.WagdyKhalilDepartment of Cell Biology, National Research Centre, EgyptJournal Article20181101Bisphenol A (BPA) is an ecological estrogenic endocrine disruptor used commonly in polycarbonate plastics. This study aimed to investigate the biochemical, histopathological and genetic effects of BPA at different doses and to evaluate the protective role of licorice against such effects. Thirty Wistar male albino rats were divided into five groups administered BPA daily at 2.4 µg/kg and 500 mg/kg orally with or without licorice (150 mg/kg) for 4 weeks. The results revealed that the high toxic dose decreased GSH, SOD and catalase levels and increased MDA level significantly. Serum TNF-α, testosterone and testicular cholesterol levels were significantly decreased while serum alkaline phosphatase was significantly increased. Histopathological changes were observed in testes, lungs and stomach. Alteration in the expression of NF-κB1 gene in lung occurred. These results suggested that BPA induced oxidative stress; resulted in its complication in the examined rats and treatment with licorice alleviated the toxicity induced by BPA.Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103030120180101Chronic Carrageenan Toxicity and the Possible Ameliorative Role of Diacerein in Experimental Animals881001819910.21608/ajfm.2018.18199ENShereenAbdelaleemDepartment of Forensic medicine and Toxicology,Faculty of Medicine- Minia University- Faculty of Pharmacy-DerayaUniversityEmanHasanDepartment of Forensic medicine and Toxicology,Faculty of Medicine- Minia University- Faculty of Pharmacy-DerayaUniversityNashwaEl-TahawyDepartment of Histology,Faculty of Medicine- Minia University- Faculty of Pharmacy-DerayaUniversity.DoaaAliDepartment of Biochemistry,Faculty of Medicine- Minia University- Faculty of Pharmacy-DerayaUniversity.Journal Article20181102Carrageenan, is one of the food additives and is used as a firming agent in healthcare products like toothpaste. The aim of this study was to analyze the chronic toxic effects of kappa carregeenan (k- CGN) on the thyroid gland and pancreas in experimental rats and to evaluate the possible ameliorative effect of Diacerein. This study was done on fifty adult male albino rats. The rats were divided into 5 groups (10 rats in each group) in the form of; control group, Carboxymethylcellulose group (1.2ml/Kg), Diacerein group (30mg/Kg), Carrageenan group (50mg/Kg), and Diacerein( 30mg/kg) + Carrageenan (50mg/kg) combination group All drugs were given orally for 3 months. By the end of the 3<sup>rd</sup> month, thyroid and pancreatic functions were assessed by biochemical, histological, and immunohistochemical investigations. Rats group that were given Carrageenan alone had significantly higher thyroid MDA (malondialdehyde), lower thyroid GSH (reduced glutathione) and serum T4 levels than the untreated control rats group, but co- treatment of Carrageenan- exposed rats with diacerein had an ameliorative effect on the previous results. Light microscopic examinations of thyroid gland sections revealed that Carrageenan caused significant marked hypothyroid changes, and significant mild hypothyroid changes were observed in the rats which received Carrageenan + diacerein combination. Immunohistochemical studies of thyroid gland showed that carrageenan caused significant marked expression of PCNA and significant mild expression was observed in rats received combination of diacerein + carrageenan. Regarding pancreas, this study revealed no significant statistical changes in serum amylase level, MDA and GSH levels. Also, there were not any significant pathological changes of pancreatic tissues of carrageenan group. Thus, it appears that carrageenan can induce oxidative damage in the thyroid gland of rats and diacerein has an ameliorative effect against this damage.Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103030120180101Potential Protective Role of Nigella sativa Linn against Sildenafil Induced Hepatotoxicity and Nephrotoxicity in Adult Male Rabbits1011091820010.21608/ajfm.2018.18200ENMofrihHegazyForensic Medicine and Clinical Toxicology Department, Faculty of medicine, Menoufia University, EgyptIbrahimElhalfawyMolecular Diagnostics Department, Genetic Engineering and Biotechnology Research Institute, Sadat City University, EgyptMohammadShabanPathology Department, Faculty of medicine, Menoufia University, EgyptElsayedAbouelnourMedical Biochemistry Department, Faculty of medicine, Menoufia University, EgyptJournal Article20181102<strong>Introduction:</strong> <em>Nigella sativa</em> is considered to have antioxidant components though it is proposed to have hepatoprotective and nephroprotective effect.<br /> <strong>Aim of the study:</strong> This study aimed to investigate hepatotoxic and nephrotoxic effects of sildenafil and to evaluate the role of <em>Nigella sativa Linn</em> oil in improving these effects and measure testosterone levels.<br /> <strong>Materials and methods:</strong> Twenty eight male healthy domestic rabbits were randomly divided into 4 groups (7 animals for each) and gavaged by the studied substances for 28 days. Control group received 2ml/kg/day of gum acacia. <em>Nigella sativa</em> group received 2 ml/kg/day of <em>Nigella sativa</em> oil. Sildenafil group received 26 mg/kg/day of sildenafil citrate. Combined group received <em>Nigella sativa</em> oil followed immediately by sildenafil citrate daily in the previous doses.<br /> <strong>Results:</strong> Sildenafil induced hepatotoxicity and nephrotoxicity as revealed by significant increase in ALT (452.25±60.23 versus 31.67±4.51, P<0.001), AST (183.75±37.21 versus 26.00±4.00, P<0.001), urea (55.00±3.65 versus 30.00±8.72, P=0.001) and creatinine (1.34±0.22 versus 0.83±0.21, P = 0.001) in sildenafil group than controls and histopathologically by cyto-architectural distortions of the hepatocytes and centrilobular hemorrhagic necrosis and renal degenerative and atrophic changes. These toxic effects were ameliorated biochemically and histologically when sildenafil was administered with <em>Nigella sativa</em> oil in the fourth group. Moreover, the testosterone levels were improved in the combined group than in sildenafil group (19.46±0.90 versus16.71±1.16).<br /> <strong>Conclusions and recommendations:</strong> <em>Nigella sativa</em> oil has a protective effect against hepatotoxicity and nephrotoxicity of sildenafil and increases testosterone levels in combination with sildenafil.Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103030120180101Forensic Aspects of Probable Life-Threatening Complications of Closed Chest Cardiopulmonary Resuscitation in Non-Traumatic Patients1101161820110.21608/ajfm.2018.18201ENSaharMoustafaDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine- Suez Canal University, Egypt.Journal Article20181102Cardiopulmonary resuscitation (CPR)is a life-saving procedure that can also cause many life-threatening injuries to patients. The complications that can arise from the application of CPR are confronted by the existing legal system as a medical error and since forensic pathologists often encounter various types of CPR-related injuries during autopsies, they must be able to distinguish between CPR-related injuries and those caused by other factors. The aim of the present study was to analyze the findings of autopsy reports of patients who received CPR to determine the frequency of its related life-threatening injuries and to determine the possible factors that affect and increase the risk of these injuries. The study included 58 non-traumatic death cases that had undergone CPR and CPR-related injuries were determined based on X ray ̸ CT interpretation reports. The results concluded that the advanced life support was provided in the vast majority of cases (70.7%). The mean duration of CPR provided was (22.0 ± 12.35 & 21.5 ± 13.56 min.) in males and females respectively and defibrillation procedure took place in 79.3% of cases.The most common complications detected were the thoracic cage complications where the costal injuries were the most frequent complications in 48.4% of cases, mid-clavicular rib fracture was the most frequent one and 66.7% of sternal fractures were detected at the level of the third rib. Males were more susceptible to rib and sternal fractures than females. The factors of age, gender and CPR duration were found to have an effect on the increased risk of life-threatening injuries. The risk of injury increases especially when the compression depth exceeded 6 cm. and CPR duration exceeds 30 min. The present study concluded that CPR complications may decrease the patient’s chance of survival and can cause death by itself. The present study recommend detailed post-mortem studies on CPR related life-threatening injuries on a trial of their prevention.Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103030120180101Evaluation of Various Scoring Systems in Prediction of Acute Aluminum Phosphide (ALP) Poisoning Outcome1171271820210.21608/ajfm.2018.18202ENSohaAbd ElghanyForensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.MonaHeshmatForensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.MerfatOrebyForensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.GhadaElsarnagawyForensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.Journal Article20181102<strong>Introduction:</strong> Aluminum phosphide (Alp) poisoning is a major health problem developing countries because of the high rates of morbidity and mortality even in well-equipped and experienced hospitals..<br /> <strong>The aim of this study: </strong>Was to evaluate various scoring system (Acute Physiology and Chronic Health Evaluation (APACHE) score, Rapid Emergency Medicine Score (REMS), The Sequential Organ Failure Assessment (SOFA) score) at admission for outcome prediction in acute aluminum phosphide poisoned patients.<br /> <strong> Patients and methods</strong>: The present study is a cohort study that was carried out on acute Alp poisoned patients at Poison Control Unit, Tanta University Emergency Hospital. It was composed of two periods; one year retrospective (from April 2015 to March 2016) and six months prospective (from April 2016 to September 2016).All admitted patients over 16 years with acute aluminum phosphide poisoning were included in this study. Patients were grouped according to their outcome into survivors and non survivors. From the collected data, APACHE II, SOFA and REMS scores were calculated for every patient.<br /> <strong>Results:</strong> The present study was carried out on admitted fifty acute Alp poisoned patients. Out of them, survivors represented 44% and 56% were non-survivors. The majority of patients were in the age group 16-20 years, females, student, from rural areas (90%) and most of patients had ingested phosphides intentionally in a median dosage of one tablet. Hypotension, tachypnea, metabolic acidosis, hyperglycemia and higher serum creatinine levels and alanine transaminase (ALT) at admission, were risk factors of mortality from Alp. Non survivors had significantly higher APACHE II, SOFA and REMS score values than survivors. SOFA score had the best AUC (0.989) followed by APACHE II score then REMS score (0.987 and 0.970 respectively). However, no significant differences between AUC values of compared scores could be demonstrated.<br /> <strong>Conclusion:</strong> The clinical scores (APACHE II, SOFA and REMS) were similar and effective tools for determination of the severity of acute Alp poisoning. However, REMS proved to be more applicable than other scores owing to its simplicity, less time-consuming and effectiveness in emergency situations. Therefore, REMS score is suggested to be used in the emergency situations to predict outcome in Alp poisoned patients.Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103030120180101Pattern of Sexual Assault in Gharbia Governorate during the Period between 2011-2014: Retrospective and Cross Section Study1281381820310.21608/ajfm.2018.18203ENMarwaSherifDepartment of Forensic Institute of Ministry of JusticeMonaEl-GoharyDepartment of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Tanta university, Tanta, Egypt.RababEl-KelanyDepartment of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Tanta university, Tanta, Egypt.MonaAbo El-NoorDepartment of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Tanta university, Tanta, Egypt.Journal Article20181102<strong>Background: </strong>Sexual assault is a special type of violence with great effects on the victims. In Egypt, there are no accurate statistical data about sexual assault.<br /> <strong>Objective:</strong> The aim of this work was to study the pattern of sexual assault in Gharbia Governorate, Egypt.<br /> <strong>Subjects and methods:</strong> This study was conducted in Tanta Department of Forensic Institute of Ministry of Justice, Egypt. It included collection of retrospective data during the period from the start of January 2011 to the end of June 2014.Cross section study of sexual assault cases was also done from the start of July 2014 to the end of December 2014.Complete history taking as well as full general and local examination was done for the studied cases.<br /> <strong>Results and conclusion:</strong> Total number of sexual assault cases was 229 over the studied period. The median age of victims was 16 years with interquartile range of 10-21 ranging from 3 to 63 years. Most cases (63.3%) were less than 18 years, 76% of the cases were females, and came from urban areas (63.3%). Unmarried cases constituted 83%. Rape was the most frequent type of assault (41%).<br /> Most of the assailants were outside the familial relations to the victims (91.3%), and a single assailant was responsible in 78.6% of the cases. The most common type of physical injury was abrasion (46.75%), whereas the least were bites (1.29%). Most cases (68.6%) were examined within 10 days after the assault; hymnal tear was the commonest injury on vulvovaginal examination (88.4%). Anal examination revealed chronic habit of anal sex in 18.52% of cases.<br /> The present study concluded that unmarried females under the age of 18years from urban areas constituted the major victims of sexual assault in Gharbia Governorate. Rape was the commonest reported assault in this study. Logistic regression analysis revealed that age, gender and marital status were good predictors of type of sexual assault.<br /> <strong>Recommendations:</strong> Medico legal examination of sexual assaults should be done as early as possible for the value of collecting evidence. Medical education for the children and their family about methods of protection against sexual assault should be considered