ORIGINAL_ARTICLE
Electrocardiographic Findings and Prognostic Value of Long QTc Interval in Acute Organophosphate Insecticide Poisoning
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.
https://ajfm.journals.ekb.eg/article_18528_36d30adeecdc94b134c68bfb0e1176f2.pdf
2016-01-01
1
6
10.21608/ajfm.2016.18528
Organophosphorus poisoning
electrocardiography
prognosis
QTc interval
Ahmad
El-Ebiary
1
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
AUTHOR
Mohammed
Soliman
2
Department of Internal Medicine, Alnahdah Hospital, Muscat, Oman.
AUTHOR
Essam
Hafez
3
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, El-Minia University, El-Minia, Egypt.
AUTHOR
ORIGINAL_ARTICLE
The Potential Role of S-100β Protein in Evaluation of CNS Affection and Prediction of Mortality in Acute Phosphides Intoxication
Phosphides poisoning is a commonly encountered poisoning in most developing countries and is emerging as a common self-poisoning agent. Over the past 20 years, biochemical markers of brain damage have been increasingly studied as potential tools for prognostic evaluation. S-100β protein is the β-subunit of a calcium binding protein present mainly in glial and Schwann cells. The current study was conducted to evaluate central nervous system affection and the prognostic value of S-100β protein for prediction of mortality after acute phosphides intoxication. Twenty nine patients admitted to Poison Control Unit (Emergency Hospital, Tanta University) suffering from acute phosphide poisoning in nine months period were included in this study. For all patients sociodemographic, clinical and toxicological data were explored. One milliliter venous blood was withdrawn for analysis of S-100β protein level. Primary outcome included mortality. Meanwhile, secondary outcomes included GCS, hypotension and length of hospital stay. There was statistical significant difference between survivor patients and non-survivor patients regarding blood pressure. Meanwhile, no statistical significant difference was noticed between survivors and non-survivors in either GCS, pulse or duration of hospital stay. Toxicological data of the participant patients revealed that (96.6%) of patients were in suicidal attempts by oral route. Zink phosphide was identified in (75.9%) of patients, while, aluminum phosphide was recognized in (24.1%) patients. Serum level of S-100β concentrations was significantly increased in phosphide intoxicated patients compared to the reference value for detection of injury to neural tissue (0.1 µg/L). There was significant negative statistical correlation between serum S-100β concentrations and GCS. Analysis of (ROC) curve of serum S-100β level as a predictor of mortality showed (AUC) = 0.956, P <0.0001* at a cut off value > 1.762 ug/l, serum S100β had a sensitivity of 100% and a specificity 95%. (PPV) was 95%, while (NPV) was 100%.
https://ajfm.journals.ekb.eg/article_18529_c4016bb12ad38ee08f405f15f3858ab1.pdf
2016-01-01
7
15
10.21608/ajfm.2016.18529
phosphides
toxicity
CNS
S100β
mortality
prediction
Marwa
Shahin
1
Departments of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
AUTHOR
Arwa
Abuelfadl
2
Departments of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
AUTHOR
Ahmed
Zaki
3
Departments of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
AUTHOR
ORIGINAL_ARTICLE
Possible Protective Role of Propolis and Nigella Sativa Oil against the Toxic Effects of Chlorpyrifos on the Liver and Testes of Adult Albino Rats
Objective: Pesticides are major contaminants of our environment. Chlorpyrifos (CPF), a broad spectrum organophosphate insecticide, is one of the most used organophosphate pesticides in domestic and industrial applications all over the world. This work was undertaken to evaluate the protective effect of propolisand nigella sativa oil against the toxic effects of Chlorpyrifos on the liver and testes of adult male albino rats. Material and methods: Eighty adult male albino rats were used in this study. They were divided into 8 equal groups: Group I (negative control group); Group II (positive control group); Group III gavaged with propolis (400mg/Kg b. w.); GroupIVgavaged with nigellasativa oil (100 mg/Kg b.w.); Group V with CPF 6.75 mg/ Kg b. w. / (1/20 of the oral LD50); while group VI gavaged with propolis and CPF, group VII gavaged with nigella sativa oil and CPF, and groupVIII gavaged with both propolis and nigella sativa oil and CPF in the same previous doses. All treatments were given by oral gavage once daily for 12 weeks. Blood samples were obtained for assessment of total antioxidant capacity (TAC). Liver and testicular specimens were obtained for assessment of malondialdehyde (MDA) and histopathological examination by light and electron microscopes. Results: CPF induced chronic toxic effects in the liver and testes which were evidenced by significant increases in hepatic and testicular MDA and significant decrease in TAC serum levels. These results were confirmed by structural and ultra-structural alterations in liver and testes of CPF treated rats. Administration of propolis or nigella sativa alone or in combination ameliorated CPF induced toxic effects, but the most remarkable effects were observed in rats treated with combination of Propolis and nigella sativa. Conclusion: Combination of propolis and nigella sativa had marked protective effects against CPF-induced toxicity in liver and testes of adult albino rats.
https://ajfm.journals.ekb.eg/article_18533_1a15d3e136d64a4ea527057b732eb33f.pdf
2016-01-01
16
34
10.21608/ajfm.2016.18533
chlorpyrifos
Liver
testis
Propolis
Nigella Sativa
Oxidative Stress
Dalia
Mesallam
1
Department Forensic Medicine and Clinical Toxicology,Faculty of Medicine, Zagazig University, Al Sharqia, Egypt.
AUTHOR
Ahmed
Omar
2
Department Forensic Medicine and Clinical Toxicology,Faculty of Medicine, Zagazig University, Al Sharqia, Egypt.
AUTHOR
Marwa
Abass
3
Department Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Zagazig University, Al Sharqia, Egypt.
AUTHOR
Magdy
Gawish
4
Department Histology & Cell Biology ,Faculty of Medicine, Zagazig University, Al Sharqia, Egypt.
AUTHOR
ORIGINAL_ARTICLE
Pattern of Acute Poisoning Cases Admitted to Menoufia Poisoning and Addiction Control Center: A Prospective Study
Introduction: Poisoning is a growing public concern and real potential threat to the Egyptian community. Acute poisoning is a common medical emergency encountered in practice. The knowledge profile of poisoning cases encountered in a particular area is useful to prepare health care professionals to handle these emergencies efficiently Aim of the study is to highlight the pattern of acute poisoning cases in poisoning and control center of Menofia University hospital in order to take appropriate management of these cases. Subjects and methods: a hospital based prospective study carried out on 653 acute poisoning cases admitted to Poisoning and Addiction Control Center at Menoufia University Hospital during the period from the 1st of March to the end of June 2015. Information was obtained from direct interview with patients, their relatives and the attending medical staff at the center after management of the patient as well as from the health records. Personal data, circumstances, type of poisonous substance and outcome were collected. Results: Overall, 653 poison exposure cases were recorded. Children under 7 years old were involved in 40.1% of cases. In 84.4%% of cases, the poisoning was accidental. Attempted suicide was definitely more common in females (83.3%) and the more prevalent age group was from 15-25 years (59.8%). Substances most frequently involved were insecticides (30.4%), drugs (25.4%) especially tramadol and corrosives (11.2%). Most cases (83.0% ) improved. Twenty fatalities were mainly from zinc and aluminum phosphide poisoning . Conclusions and recommendations: Poisoning is more prevalent in children and young adolescents by volatiles, insecticides and drugs this necessitates keeping of poisonous substances out reach of children, restriction in free sale of the poisonous substances. Also, promotion of Poison Information Centers along with public awareness could be suggested to decrease the incidence and mortality of poisoning cases
https://ajfm.journals.ekb.eg/article_18536_a5e618ec1586658280ca2bf4a0fe4239.pdf
2016-01-01
35
43
10.21608/ajfm.2016.18536
Mofrih
Hegazy
1
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
AUTHOR
Ahmed
Elfiky
2
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
AUTHOR
ORIGINAL_ARTICLE
Asphyxial Deaths in Riyadh, Saudi Arabia: A Two Years Retrospective Study
A retrospective study was carried out on 172 cases of asphyxial death autopsied at the Forensic Medicine Centre in Riyadh, Kingdom of Saudi Arabia during the period from January 2012 to December 2013. Of the 172 cases, 111 (64.5%) were male and 61 (35.5%) were female, with approximately 51% of the cases being male manual workers and 28.5% female housemaids; the most common age group was 21-30 years (52.3%). Saudi nationals comprised only a small proportion of cases (11.6%), the majority of deaths were amongst foreign workers. Suicide was the most common manner of death (87.8%) followed by accident (10.5%), and few homicides (1.7%). As expected, the most common cause of death was hanging (87.8%) followed by drowning (6.4%), ligature strangulation (3.5%) and chemical asphyxia, i.e., carbon monoxide poisoning (2.3%). Alcohol, amphetamine and cannabinoids were found in 7.6%, 2.3% and 1.7% of cases and carboxyhaemoglobin was found in 2.3%.
https://ajfm.journals.ekb.eg/article_18538_5af0e25a29b9cef34dbcfb4894c7d25c.pdf
2016-01-01
44
52
10.21608/ajfm.2016.18538
Asphyxial deaths
hanging
suicide
Saudi Arabia
Mofrih
Hegazy
1
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
AUTHOR
Ahmed
Alyahya
2
Forensic Science Department, King Fahad Security College, Riyadh, Saudi Arabia.
AUTHOR
Abdullah
Aldossary
3
Forensic Medicine Center, Riyadh, Saudi Arabia.
AUTHOR
Hussain
Bahshwan
4
Forensic Medicine Center, Riyadh, Saudi Arabia.
AUTHOR
ORIGINAL_ARTICLE
Pattern of Suicidal Poisoning Cases Admitted to Menoufia Poison Control Center (MPCC) over Two Years (2013-2014)
Suicide is one of the most important public health problems worldwide especially among teenagers and adults under 35 years old. Poisoning is a common method of suicide, especially in the developing countries. The aim of this work is to evaluate the suicidal poisoning problem among patients attending at the Menoufia Poison Control Center (MPCC) at Menoufia University Hospital over two years (from the first of January 2013 to the end of December 2014), The study showed that The total number of suicidal poisoning cases arrived at Menoufia Poison Control Center at Menoufia University Hospital over the two years of study (2013 and 2014) was 1240 patients which represented 28.46% of the total number of poisoning cases arrived at the same period (4357cases). Suicidal poisoning was more common among females, (73.55%). Patients from urban areas represented 56.85%. 64.92% of patients were single, the most vulnerable age group was 18-30 years old, Pesticides were the most commonly used substance (45.32%). Family conflict represented (45.56%) of causes, followed by educational problems (15.00%), financial (14.52%), romantic causes (11.29%), unknown cause (8.95%) and lastly psychiatric disease (4.60%). 57.5% of cases of suicidal poisoning were classified as mild according to poisoning severity score.
https://ajfm.journals.ekb.eg/article_18542_ece452d23ea3582bc0bec61c24e09e1a.pdf
2016-01-01
53
60
10.21608/ajfm.2016.18542
suicide
demographic
severity score
Poisoning
Ola
Sweilum
1
Department of Forensic Medicine And Clinical Toxicology, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
AUTHOR
Fatma
Kandeel
2
Department of Forensic Medicine And Clinical Toxicology, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
AUTHOR
ORIGINAL_ARTICLE
Estimation of Postmortem Interval from Cartilage Changes of Rabbit Auricle
In forensic practice, estimating the time of death is one of the most important procedures but is often extremely difficult. There are many methods for estimating the time of death, which can be divided into two categories (rate methods and concurrence methods). Postmortem decompositional changes to auricular cartilage were analyzed to help establish a new methodology in determining the postmortem interval. Methods: The ears were collected from rabbits buried in simulated shallow graves for different time periods (0, 5, 10, 15, 20, 25, 30 days). The auricles were examined both macroscopically and microscopically to detect changes occurring over a specified time. Results: Numerous macroscopic changes including color and texture changes and gradual degradation of cartilage were observed. LM showed gradual structural changes in the tissue over time including: cartilage matrix density and nuclear material. Conclusion: Postmortem degradation of ear cartilage may be useful for estimating a presumptive postmortem interval.
https://ajfm.journals.ekb.eg/article_18545_6d750e53ba97cc0739b04ea6ab1bbb7e.pdf
2016-01-01
61
69
10.21608/ajfm.2016.18545
Time since death
ear cartilage
LM
Melad
Paulis
1
Departement of Forensic Medicine and Clinical Toxicology,Faculty of Medicine, Minia University, Minia, Egypt
AUTHOR
, Eman
Hassan
2
Departement of Forensic Medicine and Clinical Toxicology,Faculty of Medicine, Minia University, Minia, Egypt
AUTHOR
Nisreen
Abd-Elgaber
3
Departement of Pathology, Faculty of Medicine, Minia University, Minia, Egypt
AUTHOR
ORIGINAL_ARTICLE
Medico-legal Implications of Changes in Handwriting of Some Hemodialysis Egyptian Patients (A Prospective Study)
Little attention has been paid to the possibility of cognitive deficits in patients with major organs failure such as the liver, kidney, or heart. Hemodialysis patients are at high risk for cognitive dysfunction, psychometric deficits and metabolic alternations than chronic kidney disease alone that can affect the quality of hand writing and impair its proper recognition. Aim of the study it aims to : Structurally analyze changes in handwriting characteristics among some hemodialysis Egyptian patients and to assess their medico-legal implications of the handwriting . Thirty seven stable hemodialysis patients were included in this study. All the patients were asked to write a sample. Typing tool, writing surface, writing mode and time for filling the form were standardized for all the patients. Qualitative data were presented as frequencies and percentages. Results: Handwriting analysis showed, There was a statistically significant difference (P< 0.001) regarding Writing speed (slow speed (81.1%), medium (13.5%), and very slow speed (5.4%), Pen pressure grades (light pressure (62.2%),heavy pressure (24.3%) and medium pressure (13.5%», word size (large word size (46%), medium word size (40.5%) and small word size (13.5%), Interrupted stroke (97.3%), Curved (zigzag) stroke (100%), Extra stroke (100%) and Stiff stroke(100%), dirtiness(78.4%), spacing represented (97.3%)over-Writing (73%) defined as number of over-writings done by each subject / total number of words written by each subject x 100. Conclusion: hemodialysis patients had a characteristic impairment in handwriting skills which may indicate cognitive deficit that cannot be elicited by clinical examination and investigations. These changes may carry great medico legal implications, and should be considered when analyzing their hand writings.
https://ajfm.journals.ekb.eg/article_18546_2e294fdefcef8e9467529339d343f108.pdf
2016-01-01
70
84
10.21608/ajfm.2016.18546
Uremic encephalopathy
End stage chronic renal failure, Hemodialysis, Handwriting
Hala
Mohamed
1
Forensic Department ministry of Justice, Egypt
AUTHOR
Magdy
EISharkawy
2
Nephrology Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
AUTHOR
Fatma
Agha
3
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine for Girls, AI-Azhar University, Cairo, Egypt
AUTHOR
ORIGINAL_ARTICLE
Evaluation of the Possible Role of Interlukin-1beta (IL-1β) in Diclofenac-Induced Hepatoxicity and the Exacerbative Effect of Progesterone Hormone in Mice
Diclofenac (DCLF) is one of the most widely prescribed non-steroidal anti-inflammatory drugs (NSAIDs). DCLF is associated with rare but serious idiosyncratic drug-induced liver injury (IDILI) in humans. It ranges from asymptomatic increase of plasma transaminases to life-threatening fulminant hepatitis with the need for liver transplantation. Mechanisms of DCLF-induced IDILI are not yet clarified, but immune responses are suspected to underlie them. In general, it is believed that women exhibit worse outcomes from DILI than men. The aim of this study is to investigate the involvement of immune reaction in mediating DCLF- hepatotoxicity and to evaluate the exacerbative effect of progesterone on DCLF-IDILI. The study was conducted on 100 albino mice divided into 5 main groups; each group was subdivided into a (female subgroup) and b (male subgroup) each of 10 mice; group I (negative control group), group II (normal saline group), group III (progesterone group), group IV (DCLF group), group V (progesterone and DCLF group). Results: DCLF administration, either alone or following progesterone, induced liver toxicity as manifested by abnormalities of hepatic profile (AST, ALT, T.Bil and GGT) together with increased plasma level of immune cytokine interlukin-1beta (IL-1β), with significant higher results encountered in females compared to males. Progesterone pre-treatment led to augmentation of the afro-mentioned indices in female mice only. These changes were substantiated with histopathological observations. From the previous results it can be concluded that an immune factor such as IL-1β is implicated in acute DCLF-induced hepatotoxicity and progesterone inflicts an exacerbative effect on this toxicity.
https://ajfm.journals.ekb.eg/article_18547_b0a31c2e74b0f037419e4be0eee09139.pdf
2016-01-01
85
94
10.21608/ajfm.2016.18547
Eglal
Elawady
1
Departments of Forensic Medicine &Clinical Toxicology,Faculty of Medicine- Ain Shams University, Cairo, Egypt.
AUTHOR
Gihan
Azab
2
Departments of Forensic Medicine &Clinical Toxicology,Faculty of Medicine- Ain Shams University, Cairo, Egypt.
AUTHOR
Eman
Ibrahim
3
Departments of Pathology , Faculty of Medicine- Ain Shams University, Cairo, Egypt.
AUTHOR
ORIGINAL_ARTICLE
Some Biochemical Parameters as a Simple Tool for the Prediction of Severity of Scorpion Envenomation among Some Egyptian Children
BACKGROUND: Scorpion sting envenomation is a common public health problem in Egypt and life-threatening emergency, particularly in children. They are at greater risk of developing severe cardiac, respiratory, and neurological complications. Early evaluation of the severity of the envenomation is essential to institute adequate treatments and prevent mortality. AIM: The aim of this study was to assess the value of some routine biochemical parameters in the prediction of severity of scorpion envenomation among some Egyptian children. METHODS: A prospective observational study was conducted on all scorpion envenomated children, admitted to the poison control centre , Ain shams university hospitals from January to December 2015. On admission, all the children with envenomation were subjected to complete medical history, physical examination and routine biochemical laboratory tests. The patients were classified in to three main groups, according to the degree of severity; Group II (mild grade); Group III (moderate grade) and Group IV (severe grade). In addition, ten apparently healthy children were included as a control group (Group I). RESULTS: there were 25 patients (41.6%) in group II, 20 patients (33.4%) in group III and 15 patients (25%) in group IV. The mean age and body weight were significantly decreased in groups III and IV, being lower in group IV. The mean delay time between sting and hospital admission was significantly longer for group IV compared with group III followed by group II. The frequency of stings in lower limb (68%) was significantly higher than those on the upper limb (32%) in group II. It was significantly higher in upper limb than lower limb in groups III and IV. Clinically,the most common finding was severe pain at sting site in all studied groups. Furthermore, the results of patients in group IV were significantly higher when compared with group III as regards: the general manifestations (sweating, fever and cold extremities); respiratory manifestations (tachypnea, cyanosis and pulmonary edema); cardiac manifestations (hypertension, tachycardia and heart failure); neurological manifestations (agitation and coma) and gastrointestinal manifestations (vomiting and abdominal pain). The mean values of random glucose level, total WBC and platelet counts were significantly higher in groups III and IV when compared with control group, being higher in group IV when compared with group III. The mean values of CK-MB level were significantly higher in group IV when compared with control group. In severe cases (group IV), Platelet counts showed a significant positive correlation with WBC count, and CK-MB level values, In addition WBC count showed a significant positive correlation with CK-MB level. While glucose level showed insignificant correlation with CK-MB level, WBC and platelet counts. The mean duration of hospital stay was significantly longer in group IV compared with groups II and III. All the patients discharged with complete recovery with no morbidity or mortality. CONCLUSION: Increased levels of on admission glucose, CK-MB, total WBC and platelets count were more obvious in severely envenomated cases. Increased platelet, total WBC count and CK-MB level were found to be predictors of severe envenomation.
https://ajfm.journals.ekb.eg/article_18548_aab7478757601af72386c1ebabc2594b.pdf
2016-01-01
95
104
10.21608/ajfm.2016.18548
Gihan
Azab
1
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
AUTHOR
Eglal
ELawady
2
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
AUTHOR
ORIGINAL_ARTICLE
The Use of Auricular Biometrics to Identify Age and Sex in Egyptian Population Sample
Determination of age and sex represents a challenging task to the forensic anthropologist and this explored the field of biometrics. Recognition using ear biometrics is promising and has received broad attention. In spite of this, no previous studies addressed this topic to identify Egyptian population traits. Hence, the aim of this study was to investigate the possible role of some auricular dimensions in identifying age and sex of Egyptian population sample. This study was undertaken on 426 selected healthy male and female Egyptians, aged 4–82 years. For each subject, both right and left auricular length, width, and position were measured by electronic digital caliper. The enrolled subjects were divided into six non-overlapping age groups. Statistical significant differences were found in the mean length, width, and position of both right and left auricles among the different studied age groups and between both sexes. Additionally, regression analysis revealed the following equation (for age estimation; Age (years) = - 91.884 + (19.921 x right auricular length).Moreover,all the studied measurements were significantly valid (area under the ROC curve greater than 0.6) in discriminating males from females but, the Lt auricular width showed the best accuracy (72.4 %). Finally, it could be concluded that auricular length, width, and position could be useful tools for age and sex estimation of Egyptian population.
https://ajfm.journals.ekb.eg/article_18549_82c290d17332e1bf05eb6d1c7a996e6d.pdf
2016-01-01
105
114
10.21608/ajfm.2016.18549
Auricle
Biometrics
Age estimation
sex determination
Egyptian population
Hanan
EL-Faresy
1
Medicolegal Institute, El Mansoura Department, Ministry of Justice, Egypt
AUTHOR
Fatma
Elgazzar
2
Department of Forensic Medicine and Clinical Toxicology, Tanta University, Tanta, Egypt
AUTHOR
Mona
Elgohary
3
Department of Forensic Medicine and Clinical Toxicology, Tanta University, Tanta, Egypt
AUTHOR
Mona
Heshmat
4
Department of Forensic Medicine and Clinical Toxicology, Tanta University, Tanta, Egypt
AUTHOR
ORIGINAL_ARTICLE
The immunotoxic effects of short term chronic exposure to Titanium Dioxide Nanoparticles on spleen of adult albino rats and the role of after toxic effect follow up
Objective: The usage of Titanium Dioxide NanoParticles (TiO2NPs) on a large scale of applications was a reason of a variety of many health problems. The aim of the current study was to evaluate the immune toxic effects of short term administration of TiO2NPs on spleen. Material and Methods: Forty Adult male Rats were equally divided into four groups as follows: Group I: negative control, Group II: positive control, Group III: received TiO2NPs (1200 mg/kg) orally daily for 12 weeks. Group IV: follow up group received TiO2NPs by the same dose, route and for the same duration as TiO2NPs group and then they were left untreated for another 8 weeks. Total leukocytes, differential leukocytic counts, Interleukins IL-2 and IL-10 levels were measured, the spleen sections were examined immunohistochemically for the detection of CD4+ and iNOS expressing cells. Histopathological alterations in the spleen were also evaluated. Moreover, DNA damage was evaluated by comet assay. The results: TiO2NPs exposure for 12 weeks resulted in significant decreased in the total and deferential leukocytic counts, serum interleukins IL-2 as well as IL-10. It caused marked decrease in CD4+T-lymphocytes and increase in iNOS expressing cells indicating oxidative stress in spleen tissues. It also caused histopathological disruption of spleen architecture and produced DNA damage in splenocytes. Discontinuation of TiO2NPs administration for 8 weeks resulted in significant improvement of leukocytes, interleukins, increase in CD4+ T-lymphocytes and decrease in iNOS expressing cells in spleen tissues. Moreover, there was moderate improvement in histopathological alterations and DNA damage.
Conclusion:TiO2NPs consumption have immunotoxic effects which may resulted from genetic damage and oxidative stress in the spleen of adult male albino rats which could be improved by its discontinuation for a period of time and it was recommended to increase the period of discontinuation as complete improvement may occur
https://ajfm.journals.ekb.eg/article_18550_20262f7a84548ecfc668cade6f7e6db7.pdf
2016-01-01
115
128
10.21608/ajfm.2016.18550
TiO2NPs
spleen
immune toxic
interleukin
iNOS
CD4+
DNA
Rats
Arwa
El-Sheikh
1
Departments of Forensic Medicine and Clinical Toxicology,Faculty of Medicine, Zagazig University, Alsharqia, Egypt.
AUTHOR
Shimaa
Ameen
2
Departments of Forensic Medicine and Clinical Toxicology,Faculty of Medicine, Zagazig University, Alsharqia, Egypt.
AUTHOR
Hanaa
Ibrahim
3
Departments of Pathology,Faculty of Medicine, Zagazig University, Alsharqia, Egypt.
AUTHOR
Samaa
AbdEl-Fatah
4
Departments of Anatomy, Faculty of Medicine, Zagazig University, Alsharqia, Egypt.
AUTHOR
ORIGINAL_ARTICLE
Methemoglobinemia and Intravascular Hemolysis; Unusual Presentations of Metal Phosphides Poisoning
Introduction: Metal phosphides are highly effective insecticides and rodenticide. They are used as a cheap and effective rodenticide in developing countries. Hemolysis and methemoglobinemia are rare but reported complications of phosphide poisoning Aim of the work: The aim of this study was to detect the incidence of methemoglobinemia and intravascular hemolysis in some cases of acute phosphide poisoning. Patients and methods: A cross sectional study was conducted on 50 cases suffering from acute metal phosphide poisoning admitted to Tanta toxicology unit, from the start of October 2014 till the end of March 2015. For each case, the following were done: history taking, physical examination and laboratory investigations (including measurement of methemoglobin (Met-Hb) level, arterial blood gas analysis, routine investigations, lactate dehydrogenase enzyme and complete blood picture with reticulocytic count). Results: Eight cases (16%) had combined methemoglobinemia and hemolysis. Aluminum phosphide was the toxic agent in seven of them and zinc phosphide in only one. Three cases (6%) had methemoglobinemia alone; one of them was poisoned by aluminum phosphide and the other two by zinc phospide. Another three cases had hemolysis alone; one of them was due to aluminum phosphide toxicity and the other two were due to zinc phospidetoxicity. So the present study included a total of eleven cases (22%) of methemoglobinemia. Their median age was 27 years old, while it was 24 years for patients with normal Met-Hb level. The median delay time was 4 hours for them and 2 hours for cases with normal Met-Hb level with significant statistical differences between both. The mean Met-Hb level was 14.45 ± 9.32% and1.63 ± 0.45% in cases with high and normal Met-Hb level respectively, with a significant statistical difference between both. Furthermore, the mean oxygen saturation showed a significant statistical difference between both. In addition, the present study included a total of eleven cases (22%) of hemolysis. Their median age was 27 years old, while it was 24 years for patients with no hemolysis. The median delay time was 3 hours in them and 2 hours in cases with no hemolysis. Conclusion: It was concluded that methemoglobinemia and hemolysis can complicate the course of acute phosphide poisoning. Recommendations: Further studies on a large scale of cases of acute phosphide poisoning with assessment of the outcome of cases presented with methemoglobinemia and hemolysis and the efficacy of the available treatment for such cases are recommended. Furthermore, it is important that health care professionals be aware of these rare presentations of phosphide poisoning.
https://ajfm.journals.ekb.eg/article_18551_e44542e688ec45bfa0318d0197092b8c.pdf
2016-01-01
129
139
10.21608/ajfm.2016.18551
Aluminum phosphide
Zinc Phosphide
Poisoning
methemoglobinemia
Hemolysis
Amira
Wahdan
1
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt.
AUTHOR
Enas
Elmadah
2
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt.
AUTHOR
ORIGINAL_ARTICLE
Prediction of Outcome of Acutely Intoxicated Patients Admitted To Intensive Care Unit in Mansoura-Dakhlia Governorate-Egypt
Acute poisoning is a frequent cause of admission to emergency departments and intensive care units, as it is considered as an important medical emergency requiring early diagnosis and rapid initiation of therapy. The aim of the present study was to assess characteristics, and outcomes of acutely intoxicated patients who were admitted to ICU. Also, design a scoring system regarding priority for ICU admission. The present study was carried out on 40 patients who were admitted to intensive care unit of El Mansoura General Hospitals- Egypt during a period of 6 months. Personal, toxicological, and medical histories, clinical examination and routine investigations were recorded for each patient. At discharge; all patients were reassessed for determination of patients' outcome. The patients were mostly females, single; student aged less than 30 years and from rural areas. The majority of the patients (72.5%) were recovered, 22.5% were died and 5% were referred to hyperbaric oxygen therapy units after carbon monoxide intoxication. Many patients were presented by constricted pupil (45%), respiratory depression (42.5%), altered mental status (42.5%), tachycardia (47.5%), and nausea & vomiting (75%). The highest numbers of cases were poisoned by medicinal drugs (40%) followed by agricultural chemicals (35%). Statistically significant difference between occupation, toxicological amount & frequency, pulse rate, Glasgow coma score, PH & PCO2 and type of poison (zinc phosphide) and patient outcomes was observed. Although many of the patients' characteristics were significantly associated with patient outcome yet none of them was considered significant predictors for death. So, the suggested scoring system depended mainly on clinical data and simple rapid investigation that may be helpful for rapid assessment of the patients after further validation. We recommend the presence of a channel of communication between the general care centers and the poison control centers for consultation about the protocol of treatment of poisoned patients. Nationwide, a mechanism of communication between the poison centers must be done to benefit from the different expertise and to make a uniform protocol for treatment of poisoned cases to decrease the mortality rate and the burden on hospitals resources.
https://ajfm.journals.ekb.eg/article_18552_c25efded4335803df056103588e6a55c.pdf
2016-01-01
140
150
10.21608/ajfm.2016.18552
Intensive Care Unit
poison
Outcome
Score
characteristics
Merfat
Oreby
1
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Egypt
AUTHOR
Aisha
Maklad
2
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Egypt
AUTHOR
Nihal
Shihab
3
Public and Community Medicine Department, Faculty of Medicine, Tanta University, Egypt
AUTHOR
Hoda
Kassem
4
Emergency Medicine and Traumatology Department, Faculty of Medicine, Tanta University, Egypt
AUTHOR
ORIGINAL_ARTICLE
The Protective Role of Curcumin and Melatonin in Amelioration of Cadmium- Induced Cardiac Toxicity in Adult Albino Rats
Cadmium (Cd), a common toxic environmental and occupational pollutant which cause many organ toxicities probably due to its ability to induce oxidative stress. Curcumin and melatonin have many beneficial effects.
THE AIM of this study is to investigate the possible role of curcumin and melatonin in amelioration of cadmium-induced cardiac toxicity in rats.
METHODS: This study was conducted on 140 adult male albino rats divided into 7 equal groups. Group I served as negative control. Group II received curcumin in an oral dose of 200mg/kg/day. Group III received melatonin in an oral dose of 10mg/kg/day .Group IV received cadmium chloride an oral dose of 5.2mg/kg/day for 15 days. By using the same doses and period Group V received cadmium chloride and curcumin, Group VI received cadmium chloride and melatonin, Group VII received cadmium chloride, curcumin and melatonin. At the end of the experiment, rats were sacrificed and samples were collected. Serum markers of myocardial damage were measured includingcreatine kinase –MB isoform (CK-MB) , lactate dehydrogenase (LDH) ,cardiac Troponin I (cTn-I). Oxidative status was evaluated by estimation of superoxide dismutase (SOD), catalase (CAT) and glutathione -S transferase (GST) activity Total antioxidant capacity (TAC) in serum in addition to tissue malondialdehyde (MDA) in heart.
RESULTS: Compared to negative control group, there was insignificant difference in the mean values of all the tested parameters in groups II and III, while significant difference was found in group IV. Group V showed significant difference from cadmium chloride group regarding all studied parameters but in comparison with control group, there was insignificant difference regarding cardiac parameters only. On the other hand, Group VI showed significant difference from Cd chloride group regarding all studied parameters and in comparison with control group, there was insignificant difference regarding cardiac parameters and SOD. As for Group VII, it showed significant difference from Cd chloride group, and insignificant difference from control group regarding all studied parameters.
CONCLUSION: Cadmium chloride caused significant oxidative cardiac toxicity. Co- administration of melatonin could improve such toxicity more significantly than curcumin did, while co-administration of both melatonin and curcumin provided superior protection against Cd chloride toxicities compared to either of them alone.
RECOMMENDATIONS: Further research is needed to investigate the beneficial effects of curcumin and melatonin and its applicability in humans vulnerable to Cd toxicity.
https://ajfm.journals.ekb.eg/article_18553_d41d8cd98f00b204e9800998ecf8427e.pdf
2016-01-01
161
170
10.21608/ajfm.2016.18553
toxicity
Cadmium chloride
Melatonin
Curcumin
Hoda
Salah Eldin
hodasalah1974@gmail.com
1
Department of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
AUTHOR
Rabab
Hafez
2
Department of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
AUTHOR