Introduction: Clozapine is a frequently prescribed atypical antipsychotic drug. Various case reports documented the successful recovery of acute antipsychotics toxicity in association with the administration of intralipid emulsion (ILE). Aim: This study aimed to assess the adjuvant therapeutic role of SMOF Lipid administration on the outcomes of acute clozapine poisoning. Methods: Forty patients with acute clozapine poisoning were randomly allocated into two equal groups. The control group received the standard supportive treatment only, whereas the intervention group received the standard supportive treatment plus SMOF Lipid 20% infusion. All patients were subjected to history taking, full clinical examination, and laboratory investigations. The study outcomes were evaluated. Results: The mean Glasgow Coma Scale (GCS) at 6 hours (13.1 ± 2.3 vs 9.2 ± 2, p < 0.001) and 12 hours (14.3 ± 1.5 vs 9.6 ± 2, p < 0.001) after admission was significantly higher in the intervention group compared to the control group. The intervention group showed a significantly lower frequency of prolonged QTc interval 12 hours after admission (p = 0.003), as well as a significantly shorter hospital stay (p < 0.001). Conclusions: SMOF Lipid infusion seemed to have improved GCS, the prolonged QTc interval, and shortened the length of hospital stay. Furthermore, there were no adverse effects related to its administration.

Background Globally, the need for an accurate and valid method for age estimation in adults still exists. The aging process is associated with secondary dentine deposition that reduces the volume of teeth pulp. Therefore, dental age could be recognized from the volume of pulp cavity. The aim of this study was to assess the accuracy and validity of pulp chamber/crown volume ratio of maxillary and mandibular canines in estimating age using cone beam computed tomography (CBCT) images in a sample of the Egyptian population. Results There were significant strong negative correlations between age and each of the maxillary pulp chamber volume (PCV), mandibular PCV, maxillary pulp chamber/crown volume (PCV/CV) ratio, and mandibular PCV/CV ratio (p < 0.001). Furthermore, no significant differences were detected between both sexes regarding the mean maxillary and mandibular PCV and PCV/CV ratios (p > 0.05). The best fit regression model for age prediction was as follows: age (years) = 70.21 − 784.0x maxillary PCV/CV ratio − 1.66x maxillary PCV. The proposed model showed good power of prediction (R2 adjusted = 0.951). Additionally, the model was validated on an independent sample of 100 CBCT images with a root mean squared error (RMSE) of 2.86 years. Conclusion The obtained valid regression formula in this study can serve as a reliable tool for age estimation in Egyptians. This formula should be further validated on a larger sample size of the Egyptian population that considers more steady age distribution.

Early risk stratification of acutely poisoned patients is essential to identify patients at high risk of intensive care unit (ICU) admission. We aimed to develop a prognostic model and risk‐stratification nomogram based on the readily accessible clinical and laboratory predictors on admission for the probability of ICU admission in acutely poisoned patients. This retrospective cohort study included adult patients with acute toxic exposure to a drug or a chemical substance. Patients' demographic, toxicologic, clinical and laboratory data were collected. Among the 1260 eligible patients, 180 (14.3%) were admitted to the ICU. We developed a generalized prognostic model for predicting ICU admission in patients with acute poisoning. The predictors included the Glasgow coma scale, oxygen saturation, diastolic blood pressure, respiratory rate and blood bicarbonate concentration. The model displayed excellent discrimination and calibration (optimistic‐adjusted area under the curve = 0.924 and optimistic‐adjusted Hosmer and Lemeshow test = 0.922, respectively) when internally validated. Additionally, we developed prognostic models that determine ICU admission in patients with specific poisonings. Furthermore, we constructed risk‐stratification nomograms that rank the probability of ICU admission in these patients. The developed risk‐stratification nomograms help decision‐making regarding ICU admission in acute poisonings. Future external validation in independent cohorts is necessary before clinical application.

Background: Aluminum phosphide (ALP) is efficient rodenticide and insecticide. The increased incidence of acute ALP poisoning and its high mortality is a challenge for health professionals, there is no specific antidote and the treatment is mainly supportive. Aim of the work: The aim of this study was to evaluate the efficacy and safety of intravenous lipid emulsion as an adjuvant therapy for acute ALP poisoning. Patients and methods: The present study was carried out on fifty patients with acute ALP poisoning admitted at Poison Control Unit, Tanta University Emergency Hospital, throughout a period from the start of December 2016 till November 2017. The study participants were randomly allocated into 2 equal groups (25 patients each): The experimental group (received ILE 20% at a rate of 10ml/h IV infusion plus the conventional treatment of ALP poisoning), and the control group (received the conventional treatment only). Results: The number of deaths in the experimental group was lower than the control group, but it did not reach a significant level. The need for intubation and mechanical ventilation was significantly lower in the experimental group compared to the control group. Conclusion: The administration of ILE 20% in acute ALP poisoning at a rate of 10ml/h IV infusion is a safe therapy. Moreover, the adjuvant ILE use along with the conventional supportive treatment could have a therapeutic effect in ALP poisoned patients.

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Background: 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. Aim: The aim of this study was to assess the efficacy and safety of ILE as adjuvant therapy for acute antipsychotic poisoning. Patients and methods: 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. Results: 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. Conclusion: It was concluded that ILE was a safe and effective therapy for acute antipsychotic poisoning.