Poisoning or intoxication is the occurrence of harmful effects resulting from exposure to a foreign substance. According to the Center for Disease Control, approximately 1 million of the 110 million annual emergency department (ED) visits are related to poisoning and other toxic effects. Electrocardiogram (ECG) is a noninvasive, relatively inexpensive diagnostic test that provides important information regarding not only the heart, but also non-cardiac events impacting the cardiac system. The aim of this study was to evaluate the electrocardiographic changes conducted on 282 cases of acute poisoning admitted to Tanta Poison Center, Faculty of Medicine, Tanta Emergency University Hospital during the period from the start of July-2009 to the end of June-2010. In order to fulfill this aim, each patient was subjected to history taking, complete physical examination, laboratory investigations and ECG analysis. This study found that poisons associated with ECG changes account for 58.5 % of patients included in this study. Furthermore, 36.17% of patients are mainly in the middle age group between 20 and 30 years. Organophosphorus compounds (34.4%) were responsible for most cases of intoxication of ECG changes. Sinus tachycardia (73.94%) was the commonest ECG change among them. Followed by prolonged QT corrected for heart rate (QTc) interval (21.82 %) and sinus bradycardia (11.51 %).

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.

All rights reserved. Introduction rganophosphates are the most widely used pesticides for killing agricultural pests all over the world as a result of its availability, low coast, and rapid degradation. Despite all efforts to improve management of them, accidental and suicidal ingestion is still a major public health problem. They are life-threatening condition associated with high morbidity and mortality especially in developing countries (Coskun et al., 2015). Organophosphates compounds deposit a phosphoryl group at acetylcholinesterase enzyme resulting in its inhibition at the muscarinic and nicotinic synapses. The net effect is accumulation of acetylcholine and uncontrolled activation of cholinergic synapses (Costa, 2006; Jokanović, 2009). Furthermore, glia and neurons apoptotic death may be another mechanism of OP poisoning (Bozkurt et al., 2010). Glia are the most common cells in the brain, providing critical nutritional, structural, and homeostatic support that is essential to the architectural modeling of the brain and to the establishment and maintenance of synaptic function (Garcia et al., 2001). Astroglial cells are known to be as sensitive as neurons to hypoxic stress. Therefore, a marker for astroglial cell damage may indirectly reflect neuronal damage (Bottiger et al., 2001). The protein S100 is a calcium-binding protein that has various effects on glia and neurons. There are 19 S-100 proteins, 4 subtypes present in human tissue: S-100A1 (striated muscles, heart, and kidneys), S-100A1B (astroglial cells), S-100B (astroglial and

Introduction: Falling from height is considered a major public health problem being the second leading cause of unintentional injury death, after road traffic injuries. Falling represents a specific type of blunt force trauma, which is produced by rapid vertical deceleration and impact. There is no adequate literature available with reference to the type and pattern of injuries sustained in cases of falling from heights. Aim of the work: The aim of the present study was to analyze the different patterns of injuries sustained in victims of falling from different heights looking for recording possible uncommon patterns of injuries and to detect the incidence of substance abuse among them. Patients and methods: This study is a cross sectional statistical study of 200 cases of falling from different heights presented to Alkasr Alainy Emergency department during a period of six months from July to December 2013. Data collected included age, gender, occupation, circumstances of fall, height of falling, nature of landing surface, site and type of injuries sustained due to falling, besides calculation of injury severity score (ISS) for each case. In addition; urine dipstick test for detection of drugs of abuse was done for each case using the commercial kit (Abon Biopharm, Hangzhou, China). Results: Half of the cases fell from heights of one meter or less. Except for the three suicidal cases, the rest of the cases fell from height accidentally. The distribution of injuries took one of two forms; injuries in combined multiple sites of the body or injuries in isolated body region (uncommon pattern of injuries in cases of falling from height). At a height of one meter or less (low level), more than half of the cases had their injuries in the extremities while in higher heights, injuries were in combined multiple sites of the body. Blunt force wounds of the skin & subcutaneous tissue were the most common types of injuries in all cases. Urine dipstick test was positive in 21.5 % of cases. Only tramadol and cannabis were detected. Conclusion: It was concluded that falling from low heights is a very common phenomenon with its resultant injuries especially in the extremities. Injuries in isolated body region are not uncommon in cases of falling from height and represent one of the medicolegal challenges. External blunt force wounds were the most common type of injuries due to falling. In addition substance abuse is among the factors leading to falling from height.

Background: Carbon monoxide (CO) poisoning is a common accidental cause of toxicological morbidity and mortality worldwide. Aim of this study: the aim of this study was to evaluate the cardiovascular manifestations of acute CO poisoning and the value of ECG changes, cardiac biomarkers (troponin I and CK-MB) determination and echocardiography in diagnosing cardiac damage in acute carbon monoxide poisoning cases. Additionally, evaluate the impact of delayed time of hospital presentation and duration of exposure on these parameters. Subjects & Methods: This is a cross-sectional study that was conducted on admitted patients with acute carbon monoxide poisoning to Toxicology Unit, Emergency Hospital, Tanta University in the period from the first of March 2014 to the end of September 2015. All patients were subjected to history taking and clinical examination. Additionally, ECG, echocardiogram, cardiac biomarkers (creatinephosphokinase CK-MB, and troponin I), and carboxyhemoglobin (COHb) levels were performed for all patients. Result: the age of the studied patients ranged from 15-55 years, the delay time from 1.5-10 hours and the duration of exposure to CO ranged from 0.5 to 5 hours. The most common cardiovascular manifestations were tachycardia; occurred in 50.9% of the patients then dyspnea (24.6%), chest pain (12.3%) and lastly hypotension (10.5%). The ECG findings showed that 48.2% of the studied patients had sinus tachycardia, 5.4% had T-wave inversion or ST depression and combination of T-wave inversion and ST depression occurred in 3.6% of the patients. All patients who had ECG suggestive of cardiac ischemia had abnormal CPK-MB, troponin I and cardiac wall motion abnormalities in echocardiography. Furthermore, significant negative correlation between delay time and duration of exposure with Glasgow coma scale was evident as well as significant positive correlation between both ECG & echocardiographic changes and delayed presentation. Conclusion: the present study revealed that sinus tachycardia was the most common cardiac manifestation of acute CO poisoning. ECG finding that suggested myocardial ischemia occurred in only 14.4% of the patients. Therefore, a baseline ECG should be routinely performed but, it is not necessary to routinely measure troponin I and do echocardiography. But, it can be restricted to only cases with abnormal ECG findings.

No abstract

No abstract

No abstract