All rights reserved. AbstractTricyclic antidepressant (TCA) drugs are well known medications for depression, nocturnal enuresis and chronic pain. The severe morbidity and mortality associated with these drugs is well documented due to their cardiovascular and neurological toxicity. The aim of this study is to predict the morbidity and mortality factors in patients with acute TCA toxicity in relation to outcome toxicity measures (coma grade, ECG findings and duration of hospitalization) and to detect early evidence of cardiotoxicity using quantitative analysis of Troponin I. The present study was conducted on 100 patients presented to the PCC of Ain Shams University hospitals during the period from October 2009 to March 2011 with acute TCA toxicity of both sex and different ages. Patients were divided into 3 groups according to poisoning severity score (PSS) into group I (mild toxicity), group II (moderate toxicity) and group III (severe toxicity). All subjects were examined for: I) sociodemographic data; II) medical evaluation; III) investigations including arterial blood gases, serum electrolytes (Na and K), random blood sugar, serum troponin I level and electrocardiography (ECG) monitoring; IV) outcome including coma grade, ECG findings and duration of hospitalization. Risk factors (sex, coingestion, time delay and previous attempts) had no effect on difference between groups, while age and mode of toxicity were significantly different (p-value <0.05) between groups. Type of TCA ingested had significant effect (p-value <0.05) on both coma grade and endotracheal intubation. The dose of TCA had a highly significant effect (p-value <0.0001) on severity of toxicity, coma grade and ECG findings. ADORA criteria (QRS interval >100 msec, cardiac dysrhythmias, altered mental status, seizures, respiratory depression and hypotension) had a high significant effect (p-value <0.0001) on ECG findings, coma grade and type of TCA ingested. The risk factors for intubation in the present study were evident in patients with dothiepin or amitriptyline ingestion, old age, abnormal ECG, deep coma, seizure and two or more ADORA criteria. ECG changes had no relation (P-value >0.05) with all risk factors except for the age and the mode of poisoning. Duration of hospitalization (DOH) had a highly significant (p-value < 0.001) relation with the severity of toxicity in the studied groups, ECG findings and coma grade. Grade of coma had no relation (P-value >0.05) with all risk factors except for the dose of TCA. Level of troponin I was non evident in predicting cardiotoxicity. Conclusion:Reed's coma scale is an indicator either for evaluation of poisoning severity in individual TCAs or for assessment of relative toxicity between different types of TCAs. ECG findings especially QRS duration is an easy, cheap and available diagnostic tool in Emergency Room (ER) to help not only in diagnosing TCA poisoning but also in predicting its severity and occurrence of other complications.

Introduction: Monosodium glutamate (MSG) is utilized to enhance appetite and there is rising solicitude that MSG has a role in the evolution of hepatic disturbances. Propolis has been notified to have a considerable role in the amelioration of hepatic toxicity. Aim: The aim of this study is to investigate the protective effect of propolis on hepatotoxicity induced by MSG. Materials and methods: Forty-eight male rats were divided into four equal groups (Gp). GpI was served as a control, GpII was treated orally with propolis (90mg/kg bw) and GpIII was treated with MSG (97 mg/kg bw). GpIV was treated with MSG and propolis in the same doses as GpII and GpIII. All agents were administrated orally once daily for 6 weeks. Then, rats were sacrificed and blood samples were collected for biochemical analysis. Liver tissues were harvested for histopathological and histochemical examinations with determination of oxidative markers. Results: The results showed that the levels of ALT, AST, and ALP significantly augmented in MSG-treated rats whereas serum albumin level significantly declined. Rats' exposure to MSG increased oxidative parameters; malondialdehyde (MDA) in the tissue, in parallel with decreased antioxidant enzymes levels as well as histopathological damages in the hepatic tissue. The administration of propolis highly mitigated the hepatotoxic influences of MSG based on biochemical and histological alterations. Conclusion: In summary, the study obviously indicates that MSG-induced hepatic toxicity could be protected by propolis administration and such beneficial properties could be attributed to the polyphenolic compounds present in these natural products.

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Background: Medical ethics is an arrangement of good rules that apply qualities to the act of clinical medicine. It depends on a lot of qualities that experts can allude to on account of any disarray or strife. These qualities incorporate the regard for autonomy, nonmaleficence, beneficence, and justice.Aim of the work: to assess knowledge and practice of medical ethics among physicians of all qualifications in Fayoum general hospital and Fayoum University hospitals, also make a comparison between the two hospitals.Methods: A cross sectional descriptive study was carried out at Fayoum General Hospital and Fayoum University Hospital. The survey was conducted over a period of six months between January 2017 and June 2017. This study was based on a self-administered, structured, close ended questionnaire.Results: The majority of participants could mention the correct answers with a percentage near 100% in most questions related to knowledge. participants of FUH (90%) knew more about the existence of an ethical committee and about half of them knows its role compared to participants of FGH (50% and 20% respectively). also a shortage of knowledge in both hospitals' participants as regard the Code of Ethics, 2002. There was a shortage in taking informed consent from patients before examination in participants of both hospitals. A statistical significant difference in the total knowledge score (IQR=11&7 for FUH&FGH respectively) and total practice score (IQR=14&13 for FUH&FGH respectively) between the Egypt J. Forensic Sci. Appli. Toxicol.Vol 19 (2), June 2019 two settings of the study. The total practice score was significantly different among physicians of different qualifications in participants of FGH. Knowledge score was positively correlated with practice score, while, age showed a negative correlation with practice. Conclusion:This outcome proposes that medical ethics learning in Fayoum Faculty of medicine ought to be reinforced in subjects where knowledge and practice levels were low.

Background: Aluminum phosphide (celphos) is ideal solid pesticide as it is cheap, effective and easy to use, in the form of chalky white or brown tablets. It is sold in the Egyptian market under the name of Celphos 57 % in the form of tablets. Phosphine has direct toxic effect on the myocardium via inhibition of cytochrome oxidase, which leads to intensive cellular damage and hence cell death. Aim of the work: is to assess aluminum phosphide toxicity in patients admitted in Fayoum general hospital, regarding their frequency, predictors of severity and the outcome of toxicity. Methodology: This study was carried out on 60 patients admitted at Fayoum General Hospital during the period from May 2015 to April 2017. All subjects were examined for: I) sociodemographic data II) medical evaluation III) Investigation: Including arterial blood gases, Serum electrolytes (Na and K), random blood sugar and Electrocardiography (ECG) monitoring IV) Outcome: include survived and non-survived patients. Results: 60 patients were enrolled in the study, 49 were males and 11 females. The commonest symptoms were hypotension, cardiogenic shock and palpitation which presented as 83%, 80% and 70% respectively. 10% of patients had normal ECG while 90% had abnormal ECG findings. Metabolic acidosis was detected in 72% of patients. It was found that sinus tachycardia and ventricular fibrillation was statistically significant (P-value < 0.05) with ABG analysis. Mode of poisoning was statistically significant with both hypotension &palpitation, also with the outcome of poisoning, presence of cardiogenic shock and ABG analysis. This study revealed significant difference (P-value < 0.05) between mode of poisoning, cardiogenic shock and delay time of poisoning with the outcome of toxicity. Mortality rate was 92% and ECG dysrhythmia, metabolic acidosis and cardiogenic shock were good prognostic criteria for mortality.