@article { author = {Moussa, Mona and Tolba, Nahla and Ashry, Soha and Ali, Asmaa and Atallah, Suzi}, title = {Impact of Chronic Tramadol Intake on Reproductive Hormones and Related Histopathological Changes in Adult Albino Rats}, journal = {Ain Shams Journal of Forensic Medicine and Clinical Toxicology}, volume = {35}, number = {2}, pages = {1-13}, year = {2020}, publisher = {Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department}, issn = {1687-1030}, eissn = {2636-3356}, doi = {10.21608/ajfm.2020.102261}, abstract = {Background: Tramadol is a synthetic opioid analgesic, widely used in the treatment of osteoarthritis, back pain, sports injuries, and other musculo-skeletal conditions, rheumatological conditions, and headaches. Tramadol is a common prescription pain reliever as it is considered to possess a much better safety profile than other opioid analgesics. Aim of the Work: To examine the influence of chronic use of tramadol on reproductive hormones, and to outline the histopathological changes in ovaries, testes and pituitary glands of adult albino rats.Materials and Methods: A number of 90 male and female adult albino rats were used for this study. They were divided into three groups each comprising 30 rats (15 males and 15 females). Group one was the control group which received normal saline, group two was treated with low dose of tramadol (40 mg/kg) daily, while group three was treated with high dose of tramadol (80 mg/kg) daily for one month. Results: The present study revealed that there was a statistical significant decrease in serum LH, FSH, Estradiol among tramadol treated male and female groups when compared with control group. In addition, there was a significant decrease in serum testosterone level among tramadol treated male groups when compared to the control group. Furthermore, serum progesterone level showed a statistically significant decrease among the high dose tramadol treated female group when compared to both the low dose tramadol treated group and the control group but there was a statistically significant increase when comparing the low dose to the control group and the high dose group. While monitoring the effect of tramadol on serum prolactin level there was significant increase among tramadol treated male groups, while there was non significant change among tramadol treated female groups. By histopathological examination of ovaries and testes under light microscopy and pituitary glands by electron microscopy there were changes related to the hormonal changes. Conclusion: Chronic use of tramadol in rats even with its therapeutic doses has a passive effect on gonadal function affecting both males and females. }, keywords = {tramadol,Hormones,Histopathological Changes}, url = {https://ajfm.journals.ekb.eg/article_102261.html}, eprint = {https://ajfm.journals.ekb.eg/article_102261_b5bf6a11b730bd9b7a9934b804d34a5e.pdf} } @article { author = {Elgazzar, Fatma and Abdelaziz, Mohamed and Khalifa, Heba}, title = {Prevalence and Factors Related to Delayed Disclosure of Child Sexual Abuse in Benha region, Egypt during the Period 2016-2018}, journal = {Ain Shams Journal of Forensic Medicine and Clinical Toxicology}, volume = {35}, number = {2}, pages = {14-22}, year = {2020}, publisher = {Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department}, issn = {1687-1030}, eissn = {2636-3356}, doi = {10.21608/ajfm.2020.102264}, abstract = {Introduction: Child sexual abuse (CSA) is a serious breach of a child’s basic human rights. A variety of distressing short-term and long-term consequences might occur. Lack of reporting by the victims makes determination of actual prevalence rates for CSA difficult. Aim: This study aimed to assess the prevalence of child sexual assault and to identify factors related to its delay reporting by the victims.  Methods: This retrospective study was conducted in Benha Medico-legal Department, Ministry of Justice, from the start of 2016 to the end of 2018. Detailed medicolegal report of every case was obtained to fulfill personal data, assault data and data of general and local examination of the victims. Results: The total number of cases in the study was 155. Most of them were females aged between 12-18 years. Anal sex was more frequent among males (91.2%) while, rape, attempted rape, and mixed assault occurred only in females with statistically significant association between gender of victim and the type of sexual assault. It was found that gender of victim was significantly related to delayed disclosure. Additionally, there was a statistically significant association between both the victim’s and the assailant’s ages and delayed disclosure (p < 0.00). Conclusion: Sexual child abuse is a problem in our society and its reporting by the victims was often delayed. Recommendations: Female children should be encouraged by their families to report any attempt of sexual abuse early for proper documentation and protection of their rights. Furthermore, consistent methods and checklist for defining and reporting cases of CSA are required both in general hospitals and medicolegal institutions. There by proper preservation and collection of medical evidence could be achieved; to avoid the problem of lost data and the victim’s rights. }, keywords = {Child sexual abuse,anal sex,rape,prevalence,delayed disclosure}, url = {https://ajfm.journals.ekb.eg/article_102264.html}, eprint = {https://ajfm.journals.ekb.eg/article_102264_284521642212dadca86dcb8fe04f3f8d.pdf} } @article { author = {Hwait, Mohamed and Ramadan, Magda and Abd Elfatah, Ayman}, title = {Permanent Disability between Current Medicolegal System and Reality (A Retrospective Study in Menoufya Medicolegal Authority, Egypt)}, journal = {Ain Shams Journal of Forensic Medicine and Clinical Toxicology}, volume = {35}, number = {2}, pages = {23-33}, year = {2020}, publisher = {Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department}, issn = {1687-1030}, eissn = {2636-3356}, doi = {10.21608/ajfm.2020.102268}, abstract = {Introduction: Disability is simply the inability to engage in any substantial gainful activity as a result of any physical or mental impairment. Disability, impairment and infirmity are interchangeable terms. It is always difficult and confusing to distinguish between these terms. Disabilities and permanent infirmity have a great impact on most of the societies. They represent a challenging health, social and medicolegal wide world problem. Around 15% of the world's population, or estimated 1 billion people, live with disabilities. According to 2006 Egyptian census, it was estimated that 1.8% of the Egyptian population is living with disabilities and the number increase as 10.7% of the Egyptian population is living with disabilities according to 2017 Egyptian census. Aim of the Work: To assess the validity and effectiveness of laws and tables determining disability percentage and compare between Egyptian permanent infirmity tables and other methods like ICF  Methods: A retrospective study of all cases with permanent infirmity prescribed to Menoufya Medicolegal Authority for 6 months period starting from 1st of July 2015 till the 31th of December.  Results: The total cases of injuries with permanent infirmity were 295 of which 205 were excluded as some of these cases were not considered as disabilities according to the Egyptian permanent infirmity tables e.g. skin distortion, so only 90 cases (30.5%) were enrolled in the study. The highest percent was in age group between 30-45 years old (42.2%) and the least in age group between 15- 30 years old (4.4%). Male cases were the predominant represented (74 cases, 82.2%) blunt instruments were accountable for (55 cases, 61.1%) followed by sharp instruments (18 cases, 20%). Skeletal disabilities were the predominant (48 cases, 53.4%) followed by peripheral nerve affection (13 cases, 14.4%). The cause of disability was mostly due to non-occupational injuries (84 cases, 93.3%), which occurred as a sequence of homicidal manner (68 cases, 81%) while there were no suicidal cases that ended in permanent infirmities. Conclusion: The Egyptian permanent infirmity tables are in need for reupdating and fulfillment of the missing infirmities.  Recommendations: Applying ICF as a tool for disability assessment guarantees amore fair compensation method. A large study on disability assessment in Egypt should be carried out to cover all governorates and include ,not only entities of the Medicolegal Authority but also those of the Health Insurance Organization ,being the other party involved in this critical risk with applying ICF as a tool for infirmity assessment }, keywords = {ICF: International Classification of Function, Disability and Health,EPI: Egyptian permanent infirmity tables}, url = {https://ajfm.journals.ekb.eg/article_102268.html}, eprint = {https://ajfm.journals.ekb.eg/article_102268_77586cffc5ff45780749c4cf16d06787.pdf} } @article { author = {Abdelati, Mohammed and Hilal, Maha and Mohamed, Khaled and Elsayed, Reda}, title = {Review on The Effects of Adulterants on Drugabuse Testing in Urine Samples}, journal = {Ain Shams Journal of Forensic Medicine and Clinical Toxicology}, volume = {35}, number = {2}, pages = {34-38}, year = {2020}, publisher = {Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department}, issn = {1687-1030}, eissn = {2636-3356}, doi = {10.21608/ajfm.2020.102277}, abstract = {Introduction: A growing concern over the use of illicit drugs in the work place has led to an interest in urine analysis as a way to detect drug abuse. Sample adulteration is a serious potential problem in forensic urine drug testing. Federal guidelines define an adulterated specimen as a urine specimen containing a substance that is not a normal constituent or containing an endogenous substance at a concentration that is not a normal physiologic concentration. Adulterants act by either interfering with immunoassay procedures or by converting the target drugs to other compounds. Once the adulterants are converted to other compounds they do not bind to the antibodies used in immunoassay. In some cases these converted compound produce false negative results in confirmatory testing. Adulterants can be classified into two categories. The first category includes in vivo adulteration comprising intentional ingestion of fluids, substances or drugs designed to dilute urine. The second category includes in vitro adulteration such as common household chemicals and nitrite containing agents. Methods of detection of urine adulterants include urine integrity tests, color tests and spectrophotometric methods. }, keywords = {Drug of abuse,Urine analysis,Adulteration}, url = {https://ajfm.journals.ekb.eg/article_102277.html}, eprint = {https://ajfm.journals.ekb.eg/article_102277_e659f0ecd7c1f0aaf9e50b5f7f70f8aa.pdf} } @article { author = {Shokry, Meray and Hilal, Maha and Abdalla, Sharaf and Said, Ahmed}, title = {Predicting outcome in acute cardiotoxicity based on Glasgow coma scale (GCS) and modified APACHE II score (MAS)}, journal = {Ain Shams Journal of Forensic Medicine and Clinical Toxicology}, volume = {35}, number = {2}, pages = {39-48}, year = {2020}, publisher = {Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department}, issn = {1687-1030}, eissn = {2636-3356}, doi = {10.21608/ajfm.2020.104107}, abstract = {Introduction:  Acute cardiotoxicity patients can have adverse effects that may lead to intensive care unit (ICU) admission. Because of limited ICU beds, triage and stratification of cases into different groups according to survival is a must nowadays. Many scoring systems have been  as a tool for triage and improve ICU quality management. This study aims to evaluate the role of GCS (Glasgow coma scale) and MAS (Modified Acute Physiology And Chronic Health Evaluation ) as effective scoring system in predicting mortality in acute cardiotoxicity Methods: A prospective study was carried on 100 patients with acute cardiotoxicity by drugs and toxins known to cause cardiac injury admitted to Sohag Hospitals. Results 94% of patients had survived 4 of which discharged with complication . By ROC curve analysis to assess the predictor of outcome of acute cardiovascular toxicity, it was found that MAS score at cut off value > 11.5 had sensitivity 100% and specificity 74.5%, GCS at cut off < 9.5 had sensitivity 100% and specificity 72.3%.The accuracy rate of GCS was (92.4%) while that of MAS was (90.8%). Conclusion: GCS and MAS can be used as simple predictor tools of mortality in acute cardiotoxicity. Recommendation: GCS and MAS may be used as simple triage tools in acute cardiotoxicity patients in ICU to improve quality management and utilizing hospital resources. }, keywords = {cardiotoxicity,MAS,GCS,APACHE II}, url = {https://ajfm.journals.ekb.eg/article_104107.html}, eprint = {https://ajfm.journals.ekb.eg/article_104107_0516c8bf94db6be1cf9f3ad7a7f32ebb.pdf} } @article { author = {Abdel Ati, Mohammed and Hilal, Maha and Mohamed, Khaled and Elsayed, Reda}, title = {Influence of Five Adulterants on Detection and Quantification of Tramadol in Urine Samples}, journal = {Ain Shams Journal of Forensic Medicine and Clinical Toxicology}, volume = {35}, number = {2}, pages = {49-60}, year = {2020}, publisher = {Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department}, issn = {1687-1030}, eissn = {2636-3356}, doi = {10.21608/ajfm.2020.104108}, abstract = {Background: There is a growing evidence of abuse of tramadol in some African and West Asian countries considering large seizures of such preparations in North and West Africa especially in Egypt. Urine testing for drugs of abuse has become an integral weapon in the nation’s war against drugs. A limitation inherent in all urine drug testing is the possibility of sample adulteration or substitution. Aim of study:  To detect qualitative and quantitative effects of five adulterants on positive urine samples for tramadol. Subject and Method(s): This study was conducted in Clinical Toxicology Laboratory in Sohag University Hospitals. The samples were tested for its integrity by checking PH, specific gravity and creatinine. The samples were tested by RIA then confirmed and quantified by HPLC. Results: Urine samples adulterated with vinegar, drano and liquid hand soap generated false negative results by immunoassay testing. HPLC confirmation showed decrease tramadol conc. below limit of quantification in urine samples adulterated with 40%vinegar and 40% drano. Conclusion: Some adulterants make it easy to produce false negative results and the specimen integrity testing is inadequate in detection of these adulterants.}, keywords = {}, url = {https://ajfm.journals.ekb.eg/article_104108.html}, eprint = {https://ajfm.journals.ekb.eg/article_104108_566dd0b8e06a5ac310c0d566de533cc0.pdf} } @article { author = {Shahin, Marwa and Allam, Alzahraa and Elkholy, Rasha and Lashin, Heba}, title = {Hematological parameters as early predictors of delayed neurological sequelae in acute carbon monoxide poisoning.}, journal = {Ain Shams Journal of Forensic Medicine and Clinical Toxicology}, volume = {35}, number = {2}, pages = {61-72}, year = {2020}, publisher = {Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department}, issn = {1687-1030}, eissn = {2636-3356}, doi = {10.21608/ajfm.2020.104446}, abstract = {Introduction: Delayed neurological sequelae (DNS) are the most frequent morbidity after acute carbon monoxide (CO) poisoning. Therefore, their prevention and early prediction are the main goal of treatment. Aim of the work: This study aimed to investigate parameters based on peripheral complete blood cell count (CBC) as predictors of DNS in acute CO poisoning. Methodology: It included 67 acutely CO poisoned patients and 38 healthy volunteers. On admission, history, clinical examination and routine laboratory investigations were done. Ratios based on CBC counts were measured. Patients were followed up along 6 months for DNS signs. Results: The results revealed that total white blood cells (WBC) count, absolute neutrophil count & percentage and median values of neutrophil-lymphocyte ratio (NLR) & systemic immune inflammation index (SII) were significantly higher while lymphocytes percentage, absolute monocytic count and percentage were significantly lower in CO poisoned patients compared to control group. DNS-complicated patients had significantly lower total WBC count, absolute neutrophil count & percentage and significantly higher median values of NLR and SII than non-complicated. Based on receiver operating characteristic analysis (ROC), NLR and SII were significant predictors of DNS. Conclusion: It was concluded that, NLR and SII ratios may be helpful predictors of DNS after acute CO poisoning. }, keywords = {Carbon monoxide poisoning,Neutrophils,systemic immune inflammation index,delayed neurological sequelae,prognosis}, url = {https://ajfm.journals.ekb.eg/article_104446.html}, eprint = {https://ajfm.journals.ekb.eg/article_104446_d68e1d1f2d7a46af33b5771105865ea6.pdf} } @article { author = {Abdel Rahman, Asmaa and Khater, Sarah and Attia, Eman}, title = {Rapid Stain Identification (RSID-TMSemen): A rapid tool for seminal fluid detection}, journal = {Ain Shams Journal of Forensic Medicine and Clinical Toxicology}, volume = {35}, number = {2}, pages = {73-80}, year = {2020}, publisher = {Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology Department}, issn = {1687-1030}, eissn = {2636-3356}, doi = {10.21608/ajfm.2020.111862}, abstract = {Introduction: The identification of semen stain is one of the most common human stains that can provide crucial information for crime scene reconstruction and forensic investigation. In sexual assault cases semen identification helps to support or refute victim’s allegations, it also provides a material for DNA analysis. The rapid Stain Identification of Human Semen (RSIDTM -Semen) bioassay is designed to detect specifically the presence of human semenogelin. It does not cross‐ react with other human or nonhuman tissues. Aim: To assess the efficacy of RSIDTM – Semen strip test for the detection of human semen under some different variables (different fabrics, different time intervals and mixed with vaginal secretions). Methodology: Semen samples were collected from four male participants; each sample was divided into two portions; one used for semen only test group and the other mixed with vaginal secretions for the mixed test group. Vaginal swabs were carried out from the four female participants using cotton, linen or nylon-tipped plastic rods (2 swabs from each female). One of the fabrics tipped vaginal swab was mixed with semen for the mixed test group and the other used as a positive control group to test the sensitivity and specificity of the RSIDTM – Semen strip. The semen samples were deposited over different fabrics at the same time. All the samples were left to dry for 15 minutes at room temperature (summer) then extracted and analyzed. Each of the previous groups, was categorized into 5 subgroups (a, b, c, d and e) according to the time interval of semen extraction (zero (on the spot), 2, 4, 6 and 10 days respectively). Results: Semen could be identified in 100% of tested samples of the semen only group as well as of the combined semen and vaginal secretions group over cotton and linen fabrics at all the different tested time intervals. However, semen extracted from nylon fabric was identified in tested samples of the semen only group and of the combined semen and vaginal secretions group only at zero time only and couldn’t be identified at the rest of tested time intervals. Conclusion: The current study evidenced that the new RSIDTM -semen kit is a reliable method for semen identification over different types of fabrics even in the presence of vaginal secretions. It also persists up to 10 days except on nylon fabric.}, keywords = {Rapid stain identification test of semen,semenogelin,semen identification}, url = {https://ajfm.journals.ekb.eg/article_111862.html}, eprint = {https://ajfm.journals.ekb.eg/article_111862_6d94d50f09a313217f1b3c17c31cfa31.pdf} }