Ain Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103038120220101Study of Road Traffic Accidents Cases admitted to Ain Shams University Hospitals during Years 2017 and 201811021025710.21608/ajfm.2022.210257ENRadwaHassanDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.AssemAbdel-RahimDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.RaniaHadhoudDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.00 00000280332720Journal Article20211223<strong>Background:</strong> Egypt loses about 12,000 persons every year because of road traffic accidents with mortality rate of 42 deaths per 100 000 populations. Little less than half (48%) of them are four-wheelers passengers and the fifth (20%) are pedestrians. The world health organization estimated that 50 million people are injured, and the worldwide annual road traffic deaths was 1.2 million and continues to rise steadily, reaching 1.35 million in 2016. <strong>Aim:</strong> This study aimed at determination of pattern and status of Road traffic accidents (RTA) injuries and deaths on an Egyptian sample. <strong>Methods:</strong> This is a retrospective study on cases of RTA admitted to the Emergency Department of Ain Shams University Hospitals during a two-year period starting from the first of January 2017 till the end of December 2018. <strong>Results:</strong> In the years 2017 and 2018, 1282 RTA patients were admitted to Ain Shams University Hospitals. The highest proportion of cases was from 20 - Conclusion: RTAs are a considerable problem threatening population safety. Most of Victims were males, in the productive age and pedestrians. Head injury is the most frequent cause of death. <strong>Recommendation:</strong> Nationally accepted, well-coordinated safety education programs are one of the fundamental steps leading to limiting the problem that costs huge mortalities, morbidities, and property damage.https://ajfm.journals.ekb.eg/article_210257_b8af798a6a370839f093e0e830863bc1.pdfAin Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103038120220101Study of the Correlation between clozapine levels and clinical findings in acutely intoxicated patients admitted to Poison Control Center-Ain Shams University Hospitals: 6 months (A prospective Study)111821134110.21608/ajfm.2022.211341ENNadaIbrahimDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.MohyEL-MasryDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.AymanAbd El-FatahDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.Journal Article20211229<strong>Background:</strong> Clozapine (CLZ) superior efficacy compared to other antipsychotics is well established. Unlike other antipsychotic medications, a safe therapeutic blood level range for clozapine has not been clearly established.<strong> Objective:</strong> This study was undertaken as a trial to evaluate the potential correlation between clinical findings and CLZ blood levels in patients with acute CLZ toxicity. <strong>Methodology:</strong> A prospective study was conducted on all patients of both sexes with history of acute clozapine overdose, admitted to Poison Control Center of Ain Shams University Hospitals (PCC-ASUH) from the first of March 2019 to the end of August 2019. The total number of acutely intoxicated clozapine cases in this study was 25 patients, number admitted in 6 months period. The data collected for each patient included socio-demographic data, clinical data (intoxication data and clinical examination), laboratory investigation (including blood clozapine level), ECG, treatment, and outcome. <strong>Results:</strong> The results showed that there was no statistically significant correlation between the blood level of clozapine and any of the studied parameters, except with the level of consciousness, where there was statistically significant increase in the level of clozapine in comatose patients compared to conscious ones. <strong>Conclusion:</strong> It was concluded that the study suggests that there could be a potential benefit of blood clozapine level as a predictor and prognostic marker of coma in acute clozapine overdose.<br /> Received in original form: 30 Augest 2021 Accepted in a final form: 30 October 2021https://ajfm.journals.ekb.eg/article_211341_8ea846e385b7065b26049473fbad6638.pdfAin Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103038120220101Intravenous Lipid Emulsion as an Adjuvant Therapy of Acute Antipsychotic Poisoning: A randomized Controlled Trial193221237210.21608/ajfm.2022.212372ENSaraBasiounyDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine – Tanta University, Tanta, Egypt.MonaElgoharyDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine – Tanta University, Tanta, Egypt.FatmaElgazzarDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine – Tanta University, Tanta, Egypt.HebaLashinDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine – Tanta University, Tanta, Egypt.Journal Article20220103<strong>Background:</strong> Antipsychotics toxicity is one of the top five substances most frequently included in human poisoning. Various case reports documented successful use of intravenous lipid emulsion (ILE) in the management of acute antipsychotics poisoning. <strong>Aim:</strong> The aim of this study was to assess the efficacy and safety of ILE as adjuvant therapy for acute antipsychotic poisoning. <strong>Patients and methods:</strong> Forty patients presented with moderate to severe acute antipsychotic poisoning were randomly allocated into two equal groups. The control group was given the standard treatment only while the intervention group was given the standard treatment plus ILE infusion. For all patients, history, clinical examination, ECG, and laboratory investigations were done. The safety and efficacy outcomes were evaluated. <strong>Results:</strong> results revealed that the median Glasgow Coma Scale assessed at 6 and 12 hours after admission was significantly higher in the intervention group compared to the control group. Both corrected QT intervals measured 12 hours after admission and period of hospital stay were significantly shorter in the intervention group compared to the control group. During follow-up of the intervention group, there were no significant differences between serum triglycerides levels, liver enzymes and, platelet count measured at admission and 12 hours later. <strong>Conclusion:</strong> It was concluded that ILE was a safe and effective therapy for acute antipsychotic poisoning.<br /> Received in original form: 4 June 2021 Accepted in a final form: 3 October 2021https://ajfm.journals.ekb.eg/article_212372_0dd50ad55dafcdb4ffa86dadde5f4820.pdfAin Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103038120220101The role of cortisol and thyroid stimulating hormone in prognosis of acute anticholinesterase pesticides poisoned patients admitted to Tanta Poison Control Center334521237710.21608/ajfm.2022.212377ENWafaaMasoudDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine Tanta University, Tanta, Egypt.MonaHeshmatDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine Tanta University, Tanta, Egypt.NemaSolimanDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine Tanta University, Tanta, Egypt.HebaKhalifaDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine Tanta University, Tanta, Egypt.Journal Article20220103<strong>Introduction:</strong> Anticholinesterase poisoning is a major global health problem with thousands of deaths each year. Determination of prognosis is a major concern for clinical toxicologists. Previous studies reported that cortisol and thyroid stimulating hormone (TSH) may have prognostic role in patients poisoned by organophosphates.<strong> Aim of the work:</strong> Evaluation of prognostic role of cortisol and TSH in acute anticholinesterase pesticides poisoned patients admitted to Tanta Poison Control Center.<strong> Methodology:</strong> This prospective study included 29 patients of moderate to severe acute anticholinesterase poisoning according to poisoning severity score (PSS) between August 2019 and July 2020. TSH and serial cortisol were assessed by ELISA techniques. <strong>Results:</strong> TSH has no prognostic role, but cortisol has predictive role in mortality, need for ICU admission and intubation. <strong>Conclusion:</strong> Measuring cortisol at admission, after six and twelve hours from admission could predict need for ICU admission, intubation and mechanical ventilator, while measuring it at admission can be predictor for mortality.<br /> Received in original form: 27 June 2021 Accepted in a final form: 5 October 2021https://ajfm.journals.ekb.eg/article_212377_4aba2dcf072fdfbe070433bb8b4d500f.pdfAin Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103038120220101The Possible Ameliorative Effect of Hesperidin Administration in Aluminum Phosphide Induced Acute Nephrotoxicity in Adult Albino Rats465621237910.21608/ajfm.2022.212379ENSaharMoustafaDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine- Suez Canal University, Suez EgyptRaniaHashishDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine- Suez Canal University, Suez EgyptRehabAbdel-KarimDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine- Suez Canal University, Suez Egypt.Journal Article20220103<strong>Background:</strong> Aluminum phosphide (ALP) is considered as an inorganic phosphide used in controlling insects and rodents. Aluminum phosphide is highly toxic to human and animal and it can be lethal even in little amount, as it liberates a poisonous gas, phosphine under the moist conditions. Hesperidin (HSD) is a flavanone glycoside and is considered as an anti-inflammatory and antioxidant agent. <strong>Aim of the work:</strong> The present study aimed to explore the probable ameliorative effect of antioxidant hesperidin on aluminum phosphide-induced nephrotoxic changes in adult albino rats after acute exposure. <strong>Materials and methods:</strong> A thirty-six adult albino rats were divided into four groups as follows: Control group I, HSD-treated group (II): The rats received HSD (200 mg/kg b.w.). ALP-treated group (III): The rats received ALP (12 mg/kg b.w.). HSD-therapeutic group (IV): The rats received HSD (200 mg/kg b.w.) after ALP administration. Serum protein, urea, creatinine, antioxidant enzymes (GST and SOD), renal GST, MDA, SOD and lipid peroxidation markers (TBARS), were analyzed. The histological changes in kidney were assessed by using both light and electron microscopes.<strong> Results:</strong> The results revealed that HSD therapy provided marked improvement against ALP-induced acute renal toxicity which appeared in biochemical, histological and proximal convoluted tubules changes which were assessed by light and electron microscopes. <strong>Conclusion:</strong> The study concluded that HSD has an ameliorative effect in ALP induced-nephrotoxicity in adult albino rats. It increases the hope of using HSD as a new effective antidote in ALP-induced toxicity and gives an opportunity for experimental and clinical trials to evaluate its role in ALP toxicity management.<br /> Received in original form: 30 July 2021 Accepted in a final form: 7 Augest 2021https://ajfm.journals.ekb.eg/article_212379_084e4bfeba98625c1f7b4d278a32a58c.pdfAin Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103038120220101A Triage for Disposition of Poisoned Patients with Cardiovascular Therapeutic Agents Presented to Poison Control Center of Ain Shams University Hospitals576721238110.21608/ajfm.2022.212381ENAhmedOmarDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.SehamAbdel-aalDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.HananSalemDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.Journal Article20220103<strong>Background:</strong> According to the 2016 annual report of the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH), toxicity of cardiovascular drugs represented 7.8% of all intoxicated cases. There is a great variability in the disposition of the poisoned patients with cardiovascular therapeutic agents between poison control centers depending on triage guidelines, compliance to these guidelines and the current practice. <strong>Objective:</strong> To compare the triage for disposition of intoxicated patients with cardiovascular therapeutic agents in PCC-ASUH with the American Association of Poison Control Centers (AAPCC). <strong>Methods:</strong> This study was a comparative cross-sectional study. Patients were divided into; retrospective group in which disposition was based on PSS and local PCC protocols, and a prospective observational group using the AAPCC guidelines. <strong>Results:</strong> Eight hundreds and six patients were included. Retrospectively, (37.2%) of the studied patients were observed in ER then discharged, (36.7%) were admitted to ICU, (8.37%) were admitted to inpatient unit, and (17.73%) were referred to another toxicology center. Prospectively, most of poisoned cases (57.39%) observed in ER then discharged, (11.78%) of patients were admitted to ICU, (27.82%) were admitted to inpatient unit, and (3.01%) were referred to another toxicology center, with no apparent adverse effects during follow up. <strong>Conclusion:</strong> Application of the AAPCC triage method can reduce the unnecessary admissions of poisoned patients with cardiovascular therapeutic agents through increasing the percent of observed patients in ER and reducing ICU admissions and the need for referral to other health care facility.<br /> Received in original form: 25 September 2021 Accepted in a final form: 30 November 2021https://ajfm.journals.ekb.eg/article_212381_58bdcb282f26527b8256def184b40e03.pdfAin Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103038120220101Patterns and Severity of Motorcycle Accidents Injuries at Tanta University Emergency Hospital687821330510.21608/ajfm.2022.213305ENNadiaHelalDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt.MohamedShamahDepartment of Emergency Medicine and Traumatology, Faculty of Medicine, Tanta University, Tanta, Egypt.SamahElbastawesyDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt.0000-0001-5626-3203Journal Article20220109<strong>Background:</strong> In last few years especially during the era of COVID 19 pandemic, motorcycle use has been widely increased either as a mode of transport or for deliveries. However, this increase leads to proportionate increase in number of traffic accidents. <strong>Aim of the study:</strong> to analyze patterns and severity of injuries in patients of motorcycle accidents and evaluate possible associated factors. <strong>Methods:</strong> This prospective study was performed at Tanta University Emergency Hospital including all victims of motorcycle accidents during the period from the 15th February 2021 to the 15th of August 2021.Patients were classified according to their position during the accidents into 3 major groups motorcyclist (motorcycle driver), passenger (motorcycle backseat rider) or pedestrian. Data of demographic, injury circumstances, pattern and severity of injuries in addition to outcome in these patients were reported. <strong>Results:</strong> The majority of motorcycle accidents occurred in young middle aged males. Frontal collision hitting of a vehicle or pedestrians in agriculture road and over speed were the main injury circumstances. Head injuries were the most commonly reported injuries resulting in higher mortality rate. Severity of injuries was higher in motorcyclists and was strongly associated with over speed together with absence of helmets or personal protective measures. <strong>Conclusions:</strong> Our study shows that; head injuries were the most commonly reported injuries in motorcycle accidents patients. Over speed and negligence of helmets wear were associated with more severe injuries.<br /> Received in original form: 17 August 2021 Accepted in a final form: 9 November 2021https://ajfm.journals.ekb.eg/article_213305_299233558cf8f64fd2cdb045f07eb590.pdfAin Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103038120220101Evaluation of Various Scoring Systems in Prediction of Acute Carbon Monoxide Poisoning Outcome798621330610.21608/ajfm.2022.213306ENElhawaryAEDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt.SagahGADepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt.Journal Article20220109<strong>Background:</strong> Carbon monoxide (CO) poisoning is one of the most common fatal poisoning worldwide. Laboratory parameters and imaging studies have been used to predict late cardiac and neurological complications in CO poisoned patients. However, very few studies have applied scoring systems as predictors of CO poisoning outcome. <strong>Objectives:</strong> To evaluate various scoring systems used in emergency settings [Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS) and Simple Clinical Score (SCS)] for outcome prediction in acute CO poisoned patients. <strong>Methodology:</strong> It was a cross-sectional study that was conducted on forty five acute CO poisoned patients. It was composed of two parts; retrospective (From 1 st of January 2020 to 28th of February 2021) and prospective part (From 1st of March 2021 to 30th of June 2021). Patients with major medical conditions, pregnant females, smokers and those exposed to associated trauma and other substances in addition to CO were excluded. Using patients’ data on admission, REMS, MEWS and SCS were calculated and compared for prediction of outcome. <strong>Results:</strong> On admission REMS, MEWS and SCS showed significant elevation in both mechanically ventilated and non-survivors when compared to nonmechanically ventilated patients and survivors. MEWS was excellent predictor for requirement of mechanical ventilation (AUC > 0.9). For mortality prediction; REMS, MEWS and SCS were all excellent (AUC = 1). <strong>Conclusion:</strong> REMS, MEWS and SCS are simple, rapid, reliable and applicable scoring system in predicting mechanical ventilation requirement and in-hospital mortality in acute CO poisoning.<br /> Received in original form: 31 August 2021 Accepted in a final form: 13 october 2021https://ajfm.journals.ekb.eg/article_213306_7ace0ad9ffcfac064d8ae9792f872839.pdfAin Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103038120220101Validity of computed tomography maxillary sinuses dimensions measuring in sex determination in Egyptian sample879121390110.21608/ajfm.2022.213901ENHadhoudRMDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.AbdelhakimEDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.Journal Article20220113<strong>Background:</strong> Gender determination is an essential issue in forensic medicine. It is one of the deceased person identification data that could not be easily elucidated in several conditions as road traffics and mass disasters. Maxillary sinus is characterized by being intact even with skull disfigurement. <strong>Aim of the study:</strong> assessment of the maxillary sinus dimensions as measured from CT scan and evaluation of its potential efficacy in sex determination. <strong>Patients and methods:</strong> 64 patients attended the radiology department Al-Demerdash hospital, Ain Shams University for paranasal sinuses computerized tomography (PNS CT scan) were the subjects of the study. CT scan was performed and maxillary sinus dimensions were obtained. <strong>Results:</strong> no statistically significant difference was found between both genders regarding the maxillary sinus dimensions. <strong>Conclusion:</strong> The current study did not validate the use of maxillary sinus dimensions in sex determination among Egyptian individuals.<br /> Received in original form: 25 September 2021 Accepted in a final form: 25 December 2021https://ajfm.journals.ekb.eg/article_213901_78eeec8ba065343afde81451f073cd06.pdfAin Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103038120220101Study of Hematological Parameters in Patients with Scorpion Envenomation Presented to the Poison Control Center of Ain Shams University Hospitals9210221390410.21608/ajfm.2022.213904ENAsmaaNour EldinDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.MahmoudSakrDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.AyaKhaterDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.Journal Article20220113<strong>Background:</strong> Scorpion envenomation constitutes a genuine problem of public health all over the world, especially in North-Saharan Africa. <strong>Aim:</strong> To evaluate alterations in hematological parameters correlated to the severity of scorpion envenomation and to assess the relation between these alterations and antivenin therapy. <strong>Methods:</strong> A prospective study included 36 patients presented to the Poison Control Center of Ain Shams University Hospitals (PCCASUH) with history of scorpion envenomation, from the first of May 2018 to the end of May 2019. Patients were classified into two groups according to the severity of envenomation: Group I (mild envenomation) and Group II (moderate and severe envenomation). <strong>Results:</strong> Patients presented with moderate and severe envenomation showed increase in hemoglobin level, hematocrit value (Hct) and total leukocytic count (TLC) when compared to those with mild envenomation. Increase of the platelet distribution width (PDW), mean platelet volume (MPV), and platelet large cell ratio (P-LCR) was observed among the patients with moderate and severe envenomation when compared to those with mild envenomation. Decrease of the platelet count and plateletcrit (PCT) was observed among patients with moderate and severe envenomation when compared to those with mild envenomation. Hematocrit value, TLC, platelet count, PCT and activated partial thromboplastin time (APTT) were lower in patients with moderate and severe envenomation after antivenom therapy. <strong>Conclusion:</strong> Our findings showed that TLC, PLCR and APTT seem to be useful tools in predicting the severity of scorpion envenomation. Hematocrit value, TLC, platelet count, PCT and APTT were useful tools to follow up the patient’s condition.<br /> Received in original form: 11 October 2021 Accepted in a final form: 9 November 2021https://ajfm.journals.ekb.eg/article_213904_97f06083659338fd20aaaaf8a41375a4.pdfAin Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103038120220101Comparative study between acute toxicity of natural cannabis and synthetic cannabinoids10310921656510.21608/ajfm.2022.216565ENHendElhelalyDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.HodaSalah EldinDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine-Ain Shams University, Cairo Egypt.0000-0001-8368-3019Journal Article20220131<strong>Introduction:</strong> Synthetic cannabinoids (SCs) are psychoactive substances that are gaining popularity for being available and indetectable by standardized drug tests. Synthetic cannabinoids products have similar effects to cannabis, yet are more potent, and have been associated with dangerous adverse effects. <strong>Aim of the study:</strong> evaluation of the dangerous effects of SCs in comparison to cannabis. <strong>Methods:</strong> This study was an observational retrospective cohort study including patients admitted to Poisoning Control Centre Ain Shams University Hospitals with acute toxicity of cannabis or synthetic cannabinoids over 5 years period from January 2015 to December 2019. <strong>Results:</strong> The study included 834 patients. SCs group included 113 patients mostly males (96%) between 13-40 years of age and due to recreational use by smoking (95%). Compared to the cannabis group, the SCs group showed a significant increase in mortality, occurrence of seizures, and need for mechanical ventilation. <strong>Conclusion and recommendations:</strong> SCs drugs show greater toxicity than cannabis. Further investigations of acute and long-lasting adverse effects are required.<br /> Received in original form: 20 November 2021 Accepted in a final form: 30 December 2021https://ajfm.journals.ekb.eg/article_216565_fb38148b9a7d762fb95b158960fcfac3.pdfAin Shams University, Faculty of Medicine, Forensic Medicine & Clinical Toxicology DepartmentAin Shams Journal of Forensic Medicine and Clinical Toxicology1687-103038120220101Is Multi-detector Computed Tomography an Early Predictor for Esophageal Injury Following Acute Caustic Ingestion?11011821656710.21608/ajfm.2022.216567ENAmiraADepartment of Forensic Medicine and Clinical Toxicology, Poison Control Center, Faculty of Medicine, Ain Shams
University Hospitals, Cairo, Egypt.ManalADepartment of Forensic Medicine and Clinical Toxicology, Poison Control Center, Faculty of Medicine, Ain Shams
University Hospitals, Cairo, Egypt.KhaledADepartment of Radiology, faculty of medicine, Ain Shams University, Cairo, Egypt.HendEDepartment of Forensic Medicine and Clinical Toxicology, Poison Control Center, Faculty of Medicine, Ain Shams
University Hospitals, Cairo, Egypt.Journal Article20220131<strong>Background:</strong> Caustic ingestion is considered severe condition with poor outcome that mandate early diagnosis to improve the management. Although endoscopy is considered the gold standard of diagnosis worldwide, some authors urge caution in developing treatment plans for patients with caustic ingestion based only on endoscopic findings. Besides, it is not considered as routine management at Ain Shams University hospitals. Recent studies suggests that computed tomography (CT) scan can accurately predict risk of stricture formation and also guide towards more judicious use of surgical management. <strong>Aim of the Work:</strong> Evaluating the role of Multi-detector Computed Tomography (MDCT) as an early predictor for esophageal injury following acute caustic ingestion and comparing MDCT grading system and DROOL score, for patients with acute caustic ingestion. <strong>Subjects and Methods:</strong> A prospective cohort study carried out on 50 pediatric patients admitted to Poison Control Center-Ain Shams University Hospitals (PCCASUHs) with history of corrosive ingestion within 24 hours post ingestion. <strong>Results:</strong> In the current study, (25.6%) of the patients included in the current study had esophageal injury while (74.4%) of them had no esophageal injury. DROOL score (≤ 4) could predict the development of esophageal injury with sensitivity of (90.9%), specificity of (81.2%) and accuracy of (83.7%),(62.5%) positive and (96.3%) negative predictive values. Also CT grades III and IV could predict the development of esophageal injury with sensitivity of (90.9%), specificity of (87.5%) and accuracy of (88.4%), (71.4%) positive and (96.6`%) negative predictive values. AUC for CT grading system (AUC = 0.88) was larger than that for the DROOL scoring system (AUC =0.83). CT grading system had higher specificity and accuracy than DROOL score. <strong>Conclusion and Recommendations:</strong> The current study concluded that CT grading system can be used as an early predictor for esophageal injury following acute caustic ingestion. It is recommended to evaluate the esophageal injury by doing MDCT for all cases admitted with caustic ingestion even those with mild signs and symptoms.<br /> Received in original form: 8 December 2021 Accepted in a final form: 30 December 2021https://ajfm.journals.ekb.eg/article_216567_28bef0ebda4a2ca93fbf4fd09f7e3a26.pdf