Evaluation of Neurotoxicity in Lithium Treated Patients Admitted to Poison Control Center-Ain Shams University Hospitals during the Years (2011-2014)
Aya
Khater
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
author
Nesrine
Sarhan
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
author
text
article
2015
eng
Lithium has been the first line drug in treating bipolar disorder. It has a low therapeutic index and toxic levels are frequently seen in clinical practice. Chronic lithium intoxication due to progressive accumulation of lithium was found to be more common. Symptoms are primarily neurologic; mental status is often altered and can progress to coma. The aim of the study is to evaluate the neurotoxicity among lithium intoxicated patients and its association with serum lithium levels through a cross sectional hospital based study over four years in the Poison Control Center, Ain Shams University Hospitals (PCC-ASUH). Factors affecting the outcome of lithium intoxicated patients were deduced. Subjects and methods: Lithium intoxicated patients presented to the PCC-ASUH during the period from January 2011 to January 2015 were prospectively evaluated. For every patient we recorded the duration of lithium intake, comorbidities and concomitant use of medications. Clinical manifestations, serum lithium level, renal function (serum urea and creatinine) and serum electrolytes (sodium and potassium) in addition to the treatment characteristics were also recorded. Patients were divided according to their outcome into two groups: (Survivors and Non survivors). Results: Twenty five lithium intoxicated patients were enrolled in our study; the mean duration of lithium therapy was similar in both groups (more than 12 years). The main clinical presenting sign of lithium intoxicated patients was coma with its different grades. Glasgow Coma Score (GCS) was significantly lower among non survivors. Relevant history of diabetes mellitus and hypertension was found in 15 patients and 13 patients respectively. Non psychotropic medications (including angiotensin converting enzyme inhibitors and diuretics) that interact with lithium clearance were more prevalent among non survivors. Neuroleptics were used by 22 patients and this was of no significant difference between survivors and non survivors. There was no significant difference between serum lithium levels in survivors and non survivors. Rehydration therapy with intravenous fluids was significantly more prevalent among the survivors. While no significant difference was found between both groups as regards the use of hemodialysis. Conclusion: The serious morbidity suffered by lithium intoxicated patients might be reduced by careful monitoring and awareness of factors that might predict their outcomes including altered conscious level or drug interactions (diuretics or angiotensin converting enzyme inhibitors). Clinicians should seriously maintain a high level of suspicion in treating patients maintained on lithium noting that serum lithium levels do not accurately predict toxicity and they should not solely rely on it.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
1
9
https://ajfm.journals.ekb.eg/article_18569_120287e509ac5f1c0eceb118a593c60e.pdf
dx.doi.org/10.21608/ajfm.2015.18569
The Possible Effect of Acute Suicidal Tramadol Overdose on CD4+ Percent
Hany
Tawfik
Fellow of clinical toxicology,Poison Control Center, Ain Shams University Hospitals, Cairo, Egypt.
author
Mahmoud
Abd El Wahab
Fellow of biochemistry, Poison Control Center, Ain Shams University Hospitals, Cairo, Egypt.
author
text
article
2015
eng
Background: Opioids can produce several well-known adverse events, and recently has been recognized to interfere with the immune response. However, from several studies it emerges that not all opioids induce the same immune-suppressive effects, some opioids have little effect on immunity, others can be immune-suppressive or immune-stimulant. Evaluating each opioids profile is important for appropriate analgesic selection. Analgesic drugs devoid of immune-suppressive effects might offer a good alternative to morphine for the treatment of postoperative pain. Aim: This study aimed to evaluate the effect of tramadol on immune system by measuring CD4+ percent in patients presented with acute suicidal tramadol overdose. Methods: This study included 40 candidates divided into 2 groups, tramadol group consisting of 30 patients with acute suicidal tramadol overdose and control group consisting of 10 healthy non-smoker persons. Lymphocytes % and Expression of CD 4+ % were assessed after admission to detect effect on immunity. Results: The results revealed that there is significant decrease in the lymphocytic percent and CD4+ expression in the tramadol group. Conclusion: We can conclude that tramadol overdose had suppressive effect on lymphocyte proliferation and CD4 expression and other studies are needed to test the effect of different doses of tramadol on immunity to document its safety as analgesic in immune-compromised patients.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
10
14
https://ajfm.journals.ekb.eg/article_18570_b725aad46528fac0d25f97be358ad155.pdf
dx.doi.org/10.21608/ajfm.2015.18570
Evaluation of Skull Base Parameters in Sex Determination Using Anthropometric Measurements among a Sample of Egyptians
Abeer
Sheta
Forensic Medicine and Clinical Toxicology Department,Faculty of Medicine, Alexandria University, Alexandria, Egypt.
author
Haidy
Megahed
Forensic Medicine and Clinical Toxicology Department,Faculty of Medicine, Alexandria University, Alexandria, Egypt.
author
Ehab
Elzaway
Anatomy Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
author
text
article
2015
eng
Determination of sex is a vital element in forensic and anthropological examination. In certain circumstances, such as in explosions, warfare and other mass disasters, sex prediction may be a difficult task as a result of loss of important body parts. The skull base bones have a high resistance to adverse environmental conditions. Accordingly, this study aimed to investigate the accuracy of different anthropometric measurements of the skull base for sex determination, to establish parameters that can reliably determine the sex of an unidentified skull. Material and methods: Eighty Egyptian adult skulls were subjected for the following anthropometric measurements; palatal measurements; incisive foramen to greater palatine foramen (right and left), right to left greater palatine foramen and incisive foramen to basion, mastoid notch measurements; incisive foramen to mastoid notch (right and left) and right to left mastoid notch and foramen magnum measurements; sagittal and transverse diameters, area and circumference. All measurements were taken using Vernier caliper and the circumference was measured by a flexible tape. Results: The results showed significant sexual difference in all the studied anthropometric measurements. The resulting formula using palatal measurement had the highest accuracy (94.1%), followed by mastoid notch that revealed 90.2% accuracy while the least accuracy was that of foramen magnum (89.2%). All measured parameters of skull base gave an accuracy of 96.1%. It was concluded that the skull base is a good basis for sex determination in adult Egyptians.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
15
23
https://ajfm.journals.ekb.eg/article_18571_da9da1d197637afa0427b31b847a015e.pdf
dx.doi.org/10.21608/ajfm.2015.18571
Estimation of Stature from Craniofacial Anthropometric Measurements in Egyptians and Bengalis Samples (A Comparative Study)
Rabab
El-Kelany
Department of Forensic Medicine and Clinical Toxicology. Faculty of Medicine, Tanta University, Tanta, Egypt
author
Ghada
El- Sarnagawy
Department of Forensic Medicine and Clinical Toxicology. Faculty of Medicine, Tanta University, Tanta, Egypt
author
Galal
Eid
Department of Forensic Medicine and Clinical Toxicology. Faculty of Medicine, Tanta University, Tanta, Egypt
author
text
article
2015
eng
Many attempts have been made to find out correlation and to derive a regression formula between crainofacial measurements and body stature, since the craniofacial remains may be the only available for postmortem examination. This study is to compare craniofacial anthropometric ratios between Egyptian and Bengali populations and to find out the correlation between craniofacial anthropometric measurements and stature with suggesting regression formulae in both populations for stature reconstruction from these dimensions. This cross-sectional analytical study included 100 subjects; 60 Egyptians and 40 Bengalis aged from 18-60 years with normal face patterns. Stature and four craniofacial parameters as maximum head length & breadth, and maximum face breadth &length were measured. The results showed that, all crainofacial parameters were significantly higher in Egyptian males than females. Maximum facial length was significantly higher in Egyptians than Bengalis of both sexes. However, maximum facial breadth and maximum head length were significantly higher in Bengalis than Egyptians of both sexes. The highest correlation coefficient with stature was exhibited by maximum facial breadth in Bengali males (r=0.60), maximum facial length in Egyptian males (r=0.42). On the other hand, in Egyptian and Bengali females, maximum head length showed highest correlation coefficient with stature (r=0.37& r=0.89 respectively). Therefore, the prediction of stature is more reliable from facial dimensions in Bengali and Egyptian males and from cephalic length in both Egyptian and Bengali females.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
24
30
https://ajfm.journals.ekb.eg/article_18572_e84b227960ad8d6a38928de3b3c1bf09.pdf
dx.doi.org/10.21608/ajfm.2015.18572
Role of Multi-detector Computed Tomography in Medicolegal Evaluation of Non-Fatal Firearm Injuries in the Head in Assiut University Hospital
Khaled
Abdel Aal
Departments of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Assiut University, Assiut, Egypt.
author
Hosam
Yossef
Departments of Radio-diagnosis, Faculty of Medicine, Assiut University, Assiut, Egypt.
author
Mohamed
Zidan
Departments of Radio-diagnosis, Faculty of Medicine, Assiut University, Assiut, Egypt.
author
text
article
2015
eng
Background: Firearm injuries may cause physical disabilities, permanent infirmities, psychological harm or death of injured individuals. Multi-detector computed tomography (MDCT) became a mainstay noninvasive diagnostic tool in investigation of firearm injuries as it gives three dimensional imaging (3-D) and colored images. Objective: This study was designed to through light on the role of MDCT in medicolagal evaluation of non-fatal firearm injuries in the head which examined in Assiut University hospital. Subjects and Methods: this study was conducted on 67 cases of non-fatal firearm injuries in the head including an age group 16-70 years which presented in the trauma unit and outpatient clinic of neurosurgery department during the period from June 2013 to June 2015. After forensic examination, the cases were examined blindly by two consultant radiologists using 16-row multi-detector CT in diagnostic radiology department of Assiut University hospital after giving an informed consent. The obtained images were post-processed using an advanced diagnostic computer workstation to obtain multi-planar reformatted and three-dimensional volume-rendered images to examine soft tissues, skull and intracranial structures. The relevant disclosing MDCT images were documented, interpreted and data were discussed between participants of the research from departments of the forensic medicine and diagnostic radiology and compared to results of forensic examination. Statistical analysis of data was done. Results: Most of injuries occurred in males which represented 89.45% of total cases and the highest percentage of victims was in the age group 21-30 years which represented 31.3%. MDCT images help in determining details of inlets and exits (in soft tissue, bone and intracranial structures), recognizing the type of used firearm weapons (weapons firing shots represented 73.1%), retained projectiles, determination of the distance of firing (79.1 % of total). In addition it demonstrated retained projectiles which represented 46.3% of total cases and their details (types, numbers, shapes, sizes, trajectory and deflection inside the skull), intracranial hemorrhage, edema, skull fractures. It can help in determination of permanent infirmity (which represented 17.9% of total cases) and in planning for surgical interference. Conclusion: This study demonstrated that MDCT is an accurate diagnostic tool in the medicolegal investigations of firearm injuries. The MDCT images are documented forensic evidence which can be stored, electronically sent for medicolegal consultation and can be shown in the court. In addition, medicolegal experts can trust on MDCT for determination of permanent infirmities which can help injured persons to obtain compensations and determine responsibility of physicians about faults in malpractice claims.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
31
47
https://ajfm.journals.ekb.eg/article_18573_c7d39259d93838e680eedb1997b37d98.pdf
dx.doi.org/10.21608/ajfm.2015.18573
Using Multi-Slice Computed Tomography In Age Estimation Based on the Fusion of the Sternal Elements among Group of Egyptian Subjects
Eman
Alaa El-Din
Departments of Forensic Medicine & Clincal Toxicolcogy and Radiodiagnosis, Faculty of Medicine, Zagazig University,AL Sharqia, Egypt.
author
Heba
Mostafa
Departments of Forensic Medicine & Clincal Toxicolcogy and Radiodiagnosis, Faculty of Medicine, Zagazig University,AL Sharqia, Egypt.
author
Sameh
Saber
Departments of Forensic Medicine & Clincal Toxicolcogy and Radiodiagnosis, Faculty of Medicine, Zagazig University,AL Sharqia, Egypt.
author
text
article
2015
eng
Objectives: Determination of age from human skeletal remains for forensic and medico-legal purpose is an important matter in civil and criminal cases. Radiological examination of sternum especially fusion of sternal segments offer considerable help. Computed tomography (CT) is rapidly becoming the gold standard for analysis of skeletal and dental development in both clinical and increasingly, in forensic practice. The purpose of the present study was to estimate age from the assessment of the degree of fusion of xiphoid process and manubrium with mesosternum using the utility of multi-slice C T. Subjects and Methods: The study includes 100 subjects consisting of 49 males and 51 females. The age groups included in the study ranged from 30 to 65 years (yrs). The fusion status of xiphoid process and manubrium with the mesosternum were evaluated for degree of fusion: complete, partial, absent by using multislice CT scan. Results: fusion of xiphoid with mesosternum In male and female groups, began after 30 yrs of age but the fusion was not complete within 30 to 40 yrs. From 45 up to 55 yrs, closure was invariable with different degrees. From the age of 55 up to 65 yrs, all subjects showed complete fusion. Complete fusion started earlier in female group (at 35 to 40 yrs) than in male group that began (at 40 to 45 yrs). While fusion of manibrium with mesosternumin male group < /em> began after 45 yrs of age. The fusion was invariable in the age from 50 up to 60 yrs old. From the age of 60 to 65 yrs all subjects showed complete fusion. In female group < /em> partial fusion began from 40 up to 45 yrs of age. In the age from above 45 to 60 yrs the fusion was invariable. From the age of 60 to 65 yrs all subjects showed complete fusion. It was also noticed that partial fusion started earlier in female group ( at 40 yrs ) than in male group that began (at 45 yrs). Conclusion: From the previous results it can be concluded that applicating multi-slice CT- based age diagnostics assessment of the degree of fusion of the xiphoid process and manubrium with mesosternum could be helpful in estimation of age. The fusion of the xiphoid process with the mesosternum began after the age of thirty. The fusion was present in uneven degrees up to the age of forty-five. In most of subjects the fusion is complete after the age of fifty. The fusion of the manubrium with the mesosternum began after the age of forty. The fusion was present in varying degrees in subjects above fifty five years. Complete fusion, when present, occurs after the age of fifty. All these data could be helpful in determination of age from sternal bone.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
48
57
https://ajfm.journals.ekb.eg/article_18574_a2bb1d00537111d10fd0ea0522fd530f.pdf
dx.doi.org/10.21608/ajfm.2015.18574
The Possible Cardio-Reno- Protective Effects of Vanillin on Isopretrenol- Induced Myocardial Infarction in Rats
Ekram
Abd Al Haleem
Department of Pharmacology and Toxicology, Faculty of Pharmacy for Girls, Al-Azhar University, Egypt.
author
Hala
Ali
Department of Pharmacology and Toxicology, Faculty of Pharmacy for Girls, Al-Azhar University, Egypt.
author
Amany
Eissa
Department of Pharmacology and Toxicology, Faculty of Pharmacy, Helwan University, Egypt.
author
text
article
2015
eng
Myocardial infarction (MI) continues to be a major public health problem in the world. Vanillin is a natural phenolic compound that possesses significant anti-oxidant and anti-inflammatory activities. The present study aimed to investigate the effects of pretreatment with vanillin (150 mg/kg, p.o.) and vanillin (300 mg/kg, p.o.) on isoprenaline-induced MI in rats. Markers chosen to assess cardiac damage included serum activity of creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH), in addition to serum level of cardiac troponin-I (cTn-I), as well as antioxidant activity of cardiac catalase (CAT) as well as cardiac contents of RGH, lipid peroxides, and nitrite. Furthermore Electrocardiograph (ECG) monitoring and histological examinations of cardiac tissues were done. In addition markers chosen to assess renal impairment included serum and urine levels of creatinin, blood urea nitrogen (BUN), also creatinine clearance (Ccr), urea clearance (Ucr) and glomerular filteration rate (GFR) were assessed. In addition, antioxidant activity of renal CAT and renal contents of RGH, lipid peroxides, and nitrite. Furthermore, histological examinations of renal tissues were done. Isoprenaline increased serum CK-MB and LDH activity and cTn-I level, cardiac and renal oxidative stress biomarkers. In addition, it produced ST-segment elevation and degenerative changes in heart and renal tissues. Pretreatment with vanillin in previous doses significantly suppressed isoprenaline-induced pathological changes, as the elevated levels of cTn-I, LDH and CK-MB in serum coupled with reduction in cardiac and renal oxidative stress markers. Moreover marked improvement in ECG and histopathologic alterations in both cardiac and renal tissues were produced. In conclusion, vanillin can be regarded as a promising cardio- and reno- protective natural agent in MI.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
58
70
https://ajfm.journals.ekb.eg/article_18575_1d960106ef652b7f76f8eb60a218206e.pdf
dx.doi.org/10.21608/ajfm.2015.18575
Protective Role of Nigella Sativa Oil on Spermatogenesis and Testicular Structure in Cadmium Intoxicated Rats
Ahmad
El-Ebiary
Departments of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt.
author
Marwa
Shahin
Departments of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt.
author
Ehab
Hantash
Departments of Anatomy, Faculty of Medicine, Tanta University, Tanta, Egypt.
author
text
article
2015
eng
Cadmium (Cd) is a common environmental pollutant associated with many industrial processes. Considering the high sensitivity of the testicular tissue to Cd insult, prevention and/or therapeutic intervention is of major concern. Previous experimental evidences indicated the involvement of oxidative stress in Cd-mediated tissue damage. The present study investigated the protective role of Nigella Sativa Oil (NSO) against the toxic effect of cadmium chloride (CdCl2) on rat testes.Forty adult male albino rats weighing 240-280 g were assigned into four groups: Group I(Control rats), Group II (NSO-treated rats), Group III (CdCl2-treated rats) and Group IV(rats treated with CdCl2 and NSO). Cadmium chloride was injected in a dose of 2mg/kg bw dissolved in isotonic saline intraperitoneal, whileNSO was administered in a dose of 1 ml/kg bwby gastric gavage.The present study found that administration of CdCl2 induced marked structural derangement in the seminiferous tubules of the rats’ testes associated with significant drop of spermatogenesis score. Concomitant administration of NSO and CdCl2 was associated with markedreduction in the adverse structural changes seen in the testes of CdCl2-intoxicated ratsbesides preservation of spermatogenesis.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
71
80
https://ajfm.journals.ekb.eg/article_18576_407b6353be7f34d81f8623f9d960def5.pdf
dx.doi.org/10.21608/ajfm.2015.18576
Comparative Study of Morbidity and Mortality between Different Types of Illicit Drug Abuse Overdose Cases Admitted to Poison Control Center Ain-Shams University Hospitals During 2014
Hend
ElHelaly
Department of Forensic Medicine and Clinical Toxicology,Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
author
Hany
Tawfik
Poison Control Center Ain-Shams University Hospitals,Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
author
Ahmed
Shaban
4th grade undergraduate student,Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
author
text
article
2015
eng
Background: There is a relatively limited new information data overall the global situation with regard to the prevalence of illicit drug abuse which in turn is considered a major medical problem. Aim of the Work:The study aimed to highlight the magnitude of illicit drug abuse in Cairo, Egypt through investigating cases of illicit drug overdose presented to Poison Control Center Ain-Shams University Hospitals (PCCASUH) during 2014. In-addition, to compare the morbidities and mortalities between different illicit drug types among such cases. Patients and Methods: A cross sectional hospital based study investigated all cases diagnosed as acute illicit drug abuse overdose presented to PCCASUH during 2014 including both addict and non-addict patients. Socio-demographic, clinical, and management data were collected analyzed and comparative study between different types of illicit drug abuse was done for all studied cases as regards morbidities and mortalities. Results: The PCCASUH received 3022 cases of acute illicit drug abuse intoxications, 2291 were addict and 523 needed in-patient and ICU admission. Tramadol and benzodiazepine cases were more prevalent among illicit drug overdose followed by those diagnosed as methyl alcohol, cannabis and opiate and other opioids with male predominance. Morbidities and severity were more noticeable among cases of acute tramadol, opiate and other opioids and methyl alcohol overdose regarding cardiovascular, neurological and metabolic morbidities. Hence those cases mandated emergency treatment and intensive care department (ICU) admission. Deaths were more seen among cases of methyl alcohol, tramadol and opiate and other opioids overdose respectively. Conclusions and Recommendations: Egyptian community suffer from a major problem of illicit drug abuse mainly among young adults males. The more prevalent drugs were tramadol followed by benzodiazepines, methyl alcohol, cannabis and opiate and other opioids. The study showed that opiate and other opioids, tramadol and methyl alcohol represented the most severe cases that developed different forms of morbidities and mandated emergency management and ICU admission. Egyptian Street need more integrated banning program between health, police and social workers against drug abuse. In-addition, awareness campaigns between adolescents and young adults in clubs, schools and universities should be done.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
81
92
https://ajfm.journals.ekb.eg/article_18577_f861812248a02f28f597b5bcec4d921c.pdf
dx.doi.org/10.21608/ajfm.2015.18577
Toxicological and Forensic Evaluation of Injury Pattern and Mortality in Marijuana Smoking Drivers and Non-Drugged Drivers: a Comparative Study
Marwa
Shahin
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
author
Arwa
Abuelfadl
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
author
text
article
2015
eng
Cannabis is the most widely consumed illicit substance worldwide. Acute cannabis intoxication can produce impairment of driving skills. Driving under the influence of cannabis is a growing global public health concern. The present study aimed to compare injury pattern and subsequent clinical outcome that occur in both marijuana smoking drivers and non-drugged drivers among motor car accident victims admitted to Tanta University Emergency Hospital. This study was carried out on 38 drivers of both sexes admitted to emergency department, Tanta University Emergency Hospital for recent road traffic injury. They were divided into two groups; 22 non-drugged drivers (group I) and 16 marijuana smoking drivers (group II).A complete clinical assessment of each patient was done. Urine sample was obtained from each patient and was subjected to rapid qualitative screening. Samples that revealed positive marijuana were subjected to Axsym® Abbott Cannabinoids assay to detect cannabinoids level. The results of the current study revealed significant statistical difference between non-drugged drivers and marijuana smoking drivers in mortality, Injury Severity Score (ISS) and Revised Trauma Score (RTS). On the other hand, injury pattern did not register any significant statistical difference between non-drugged drivers and marijuana smoking drivers. Furthermore, There was no significant correlation between urine cannabis level and both RTS and ISS. Additionally, there was no significance difference in urine cannabis level between died and alive patients. Future comparable researches on larger scale are required with detection of accurate cannabis blood level. Such data will help both prevention and better management of marijuana smoking drivers, with subsequent decrease in morbidity and mortality.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
93
103
https://ajfm.journals.ekb.eg/article_18578_d64c1ff5475ddd629e1191899f912dc7.pdf
dx.doi.org/10.21608/ajfm.2015.18578
Electrocardiographic Findings and Prognostic Value of Long QTc Interval in Acute Organophosphate Insecticide Poisoning
Ahmad
El-Ebiary
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt.
author
Mohammed
Soliman
Department of Internal Medicine, Alnahdah Hospital, Muscat, Oman
author
Essam
Hafez
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, El-Minia University, El-Minia, Egypt
author
text
article
2015
eng
Organophosphorus (OP) insecticides are one of the most important pesticides, and poisoning induced by them is a major global health problem with about 3 million intoxications and 300,000 deaths occurring worldwide every year. This study aimed to investigate the relevance of ECG findings and prognostic value of corrected QT (QTc) interval in acute OP poisoning cases. The study recruited 91 patients suffering from acute OP poisoning, who were admitted to Tanta University Poison Control Center over a period of two years (March 2013 – March 2015). ECG changes, QTc interval length, and the different outcomes of the patients were recorded including mortality, the need for endotracheal intubation and/or mechanical ventilation, the length of hospital stay, and the total amount of atropine and/or obidoxime administered. The higher need for intubation and assisted ventilation in patients with prolonged QTc compared to patients with normal QTc was statistically significant. The mortality rate in the long QTc group was not significantly different from that of the normal QTc group. Moreover, there was no statistically significant difference between the two groups regarding the length of hospital stay or the doses of obidoxime and atropine required to control the muscarinic signs and symptoms. However, the total atropine dose was significantly lower in survivors than non survivors. It could be concluded that QTc interval prolongation needs to be considered as a prognostic indicator in acute OP poisoning.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
104
109
https://ajfm.journals.ekb.eg/article_18580_1f5899dabcefbcd4d12fa94efd18632d.pdf
dx.doi.org/10.21608/ajfm.2015.18580
APACHE II, SAPS II, and SOFA Scoring Systems Used for Predicting Outcome in Acute Organophosphate Intoxicated Patients Admitted to the Intensive Care Unit-Poison Control Center Ain Shams University Hospitals (A Prospective Study)
Nesrine
Sarhan
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
author
text
article
2015
eng
Acute organophosphate (OP) poisoning accounts for a large number of intoxication cases treated in the Intensive Care Unit (ICU). The aim of this study is to evaluate the performance of APACHE II, SAPS II, and SOFA scoring systems for predicting mortality of OP poisoned patients admitted to the ICU. Subjects and methods: Seventy three OP intoxicated patients admitted to the ICU of the PCC-ASUH during the period from June 2013 to June 2015 were prospectively evaluated through a cross sectional hospital based study. Results: An APACHE II score of 10.5 or more was predictive of mortality, with 53.57 % sensitivity and 97.78% specificity. A SAPS II score of 25 or more was predictive of mortality, with 75.00 % sensitivity and 84.44% specificity. A SOFA score of 2.5 or more was predictive of mortality, with 75.00 % sensitivity and 91.11 % specificity. Conclusion:The three scoring systems, APACHE II, SAPS II, and SOFA, were more precise in differentiating the survivors from the non survivors than plasma butyrylcholinesterase.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
110
119
https://ajfm.journals.ekb.eg/article_18582_8536ccf02240f8bbb6c1d5e8ad9ac19b.pdf
dx.doi.org/10.21608/ajfm.2015.18582
Some Toxicological and Histopathological Changes Induced By Long- Term Administration of Tramadol in Male Rats
Zakaria
El-Zawakry
Department of Forensic Medicine and Toxicology, Faculty of Medicine, Zagazig University, Al sharqia, Egypt
author
Mahmoud
Ismail
Department of Forensic Medicine and Toxicology, Faculty of Medicine, Zagazig University, Al sharqia, Egypt
author
Magdy
Abou El Fotoh
Department of Forensic Medicine and Toxicology, Faculty of Veterinary medicine., Zagazig Univ. , Al sharqia Egypt
author
text
article
2015
eng
The present study investigated the effects of repeated tramadol administration on 60 male rats. The animals were randomly divided into 6 equal groups (n=10/group). The first group served as control and received saline solution only during the study. the second, third, fourth , fifth and sixth groups were given oral doses of tramadol ( tramadol HCL) suspended in saline solution equal to 40, 80, 120,160 and 200 mg/kg daily for 60 days. Liver and kidney functions, sex hormones activity, some neurochemical parameters in addition to some histopathological changes of the rat testis and brain tissues were studied. The results of the present experiment revealed a significant gradual increase in the serum ALT, AST and creatinine by increasing the dose of tramadol, the same result was obtained for PRL and E2 in male rats. Tramadol significantly reduced serum LH, FSH and testosterone levels gradually, where 200 mg/kg showed the lowest levels. Repeated administration of tramadol also increased the density of α1–adrenoceptors in the rat brain cortex, as measured by saturation analysis of [3H]prazosin binding resembling the effects induced by conventional antidepressants. The histopathological examination of testis revealed severe diffused testicular degeneration, which was aggravated till testicular tissues calcification with increasing dose of tramadol (40, 80, 120, 160 and 200 mg/ kg.b.wt.). Brain tissues in all treated groups showed slight congestion of sub-meningeal blood vessels and neural degeneration. These findings suggest increased hepatic, renal and neurological damage and sexual dysfunction evoked by repeated administration of tramadol for long periods.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
120
127
https://ajfm.journals.ekb.eg/article_18583_fe3bab8a4115161d81d23700ca684bc4.pdf
dx.doi.org/10.21608/ajfm.2015.18583
The Effect of L-Carnitine and Intralipid Emulsion in Acute Verapamil Cardiotoxicity in Albino Rats
Eglal
Elawady
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
author
Dalia
Saad
Department of Physiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
author
text
article
2015
eng
Calcium channel blockers (CCB) drugs poisoning continues to be deadly in severe cases despite recent advances and aggressive therapies. Clinically, this toxicity can manifest into severe cardiogenic shock that is often unresponsive to conventional calcium and supportive treatment. This study aimed to investigate the effectiveness of L-carnitine, as an essential compound in cellular energy production, and intralipid emulsion 20% (ILE), as an adjunctive antidote used in selected critically ill poisoned patients, for the treatment of hypotension, Electrocardiogram (ECG) changes and arterial blood gases (ABG) deficits in verapamil poisoned rats, either separately or in combination. The study was conducted on 64 albino rats divided into 8 groups (each of 8 rats). The groups are: group 1 (negative control group), group 2 (L-carnitine group), group 3 (ILE group), group4 (L-carnitine and ILE group), group 5 (verapamil group), group 6 (verapamil and L-carnitine group), group7 (verapamil and ILE group), group8 (verapamil, L-carnitine and ILE group). All animals were subjected to measurement of blood pressure, ECG recording, as well as ABG. Results: verapamil toxicity in group 5 was manifested by significant hypotension (both systolic and diastolic), ECG derangements in the form of bradycardia, prolongation of PR and QT intervals and ABG changes in the form of significant low (pH, HCO3, PaO2 and PaCO2). L-carnitine and ILE separate administration with verapamil in group 6 and group 7 respectively improved the blood pressure, heart rate, ECG and ABG parameters but they still showed statistical significant difference with both the control group and group 8, regarding )blood pressure and ECG( in group 6 and )blood pressure, ECG and ABG( in group 7. Co-administration of L-carnitine and ILE together with verapamil in group 8 showed significant improvement of all toxic parameters with insignificant difference with the control group. In conclusion, this study proved that the combined use of L-carnitine and ILE was the most effective treatment of verapamil-induced acute cardiotoxicity. Further studies are recommended on larger scale and on clinical implication to establish more the advantageous and disadvantageous of this novel therapy. It is recommended to use this novel therapy as an additive to the usual regime and when the latter fails to correct potentially fatal cases of CCB poisonings.
Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department
1687-1030
25
v.
2
no.
2015
128
137
https://ajfm.journals.ekb.eg/article_18584_43b56dd804a5ae676331aaeabed5b266.pdf
dx.doi.org/10.21608/ajfm.2015.18584