Introduction: Aluminum phosphide (Alp) poisoning is a major health problem developing countries because of the high rates of morbidity and mortality even in well-equipped and experienced hospitals.. The aim of this study: Was to evaluate various scoring system (Acute Physiology and Chronic Health Evaluation (APACHE) score, Rapid Emergency Medicine Score (REMS), The Sequential Organ Failure Assessment (SOFA) score) at admission for outcome prediction in acute aluminum phosphide poisoned patients. Patients and methods: The present study is a cohort study that was carried out on acute Alp poisoned patients at Poison Control Unit, Tanta University Emergency Hospital. It was composed of two periods; one year retrospective (from April 2015 to March 2016) and six months prospective (from April 2016 to September 2016).All admitted patients over 16 years with acute aluminum phosphide poisoning were included in this study. Patients were grouped according to their outcome into survivors and non survivors. From the collected data, APACHE II, SOFA and REMS scores were calculated for every patient. Results: The present study was carried out on admitted fifty acute Alp poisoned patients. Out of them, survivors represented 44% and 56% were non-survivors. The majority of patients were in the age group 16-20 years, females, student, from rural areas (90%) and most of patients had ingested phosphides intentionally in a median dosage of one tablet. Hypotension, tachypnea, metabolic acidosis, hyperglycemia and higher serum creatinine levels and alanine transaminase (ALT) at admission, were risk factors of mortality from Alp. Non survivors had significantly higher APACHE II, SOFA and REMS score values than survivors. SOFA score had the best AUC (0.989) followed by APACHE II score then REMS score (0.987 and 0.970 respectively). However, no significant differences between AUC values of compared scores could be demonstrated. Conclusion: The clinical scores (APACHE II, SOFA and REMS) were similar and effective tools for determination of the severity of acute Alp poisoning. However, REMS proved to be more applicable than other scores owing to its simplicity, less time-consuming and effectiveness in emergency situations. Therefore, REMS score is suggested to be used in the emergency situations to predict outcome in Alp poisoned patients.

The decision of intubation and mechanical ventilation in poisoned patients with impaired consciousness can be a difficult task. The present study aimed to evaluate the power of Glasgow Coma Scale (GCS), acute physiology and chronic health evaluation (APACHE II), rapid acute physiology score (RAPS) and rapid emergency medicine score (REMS) at admission in predicting the need of intubation and mechanical ventilation in drug overdose patients with disturbed consciousness level (DCL). This prospective observational study was conducted on 104 poisoned patients who were admitted to Tanta Toxicological Unit with a DCL. Four scoring systems (GCS, APACHE II, RAPS and REMS) were recorded for all patients on admission. Discrimination was evaluated using receiver operating characteristics curve and calculating the area under the curve (AUC). Twenty-four cases required mechanical ventilation. The mechanically ventilated patients had significantly lower value of GCS and higher values of APACHE II, REMS and RAPS than other group ( p < 0.001). Although the APACHE II score has the best AUC value (0.796) in predicting mechanical ventilation, there was no statistically significant difference between the four scores. GCS > 8 had 100% negative predictive value, while REMS > 8 had 100% positive predictive value.

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.

Introduction: Aluminum phosphide (ALP) is a widely used rodenticide for grain preservation. Acute aluminum phosphide poisoning became one of the serious public health problems especially in developing countries due to its high mortality rates. Aim of the work: The aim of the present study was to evaluate the predictive factors of mortality from acute ALP poisoned cases admitted to Tanta Poison Control Unit in a 5 years interval from the start of January 2012 to the end of December 2016. Patients and methods: This retrospective study was performed on medical records of acute ALP poisoned patients admitted to Tanta Poison Control Unit during the 5 years period. Patients were divided according to their outcome into survivors and non-survivors. For all patients; sociodemographic data, toxicological data, physical examination, laboratory investigation and therapeutic intervention were recorded to evaluate their associations with the patients' outcome. Results: During the five years period, 105 acute ALP poisoned patients were admitted with 44.7% deaths. There was significant association between each of young age group, rural residence, suicidal ingestion, increase toxic dose and prehospitalization period with the risk of mortality. Other prognostic factors included altered consciousness, agitations, hypokalemia, hypernatremia, hyperglycemia, elevated (liver enzymes, blood urea& serum creatinine), need of mechanical ventilation, increased vasoactive drug administration and low magnesium sulphate administration were also associated with poor outcome. Moreover, presence of abnormal ECG, metabolic acidosis and low systolic blood pressure at admission were associated with high risk of mortality (odd ratios were 48.488, 10.251 and 0.964 respectively). Conclusion: Early recognition of the alarming risk factors with proper medical intervention may improve patients' outcome and decrease the mortality rate of acute aluminum phosphide poisoning. Recommendations: Owing to the increase mortality rates of ALP poisoning, it is recommended to make restrictions of its open sales and perform a safe manufacture forms in a not ingestible containers.

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: In late 2019, SARS-COV-2 disease is firstly discovered in Wuhan, China and it reached millions of people worldwide. Later, the World Health Organization (WHO) described COVID-19 as the first pandemic invading the world in 21st century. The WHO has declared that the emerging infection will last long enough to force adjustments not only in people's lifestyles but also in health care system. This amendment is expected to spread through many medical practices and specialties. A lot of diagnostic and therapeutic modalities have been proposed for COVID-19 management. The best strategy for management of patients requires a multi-disciplinary team approach with correct decision regarding the right timing of each modality of treatment. The participating multidisciplinary team for COVID-19 management includes six infectious diseases experts in Tanta University; one critical care management expert; an emergency medicine expert and two pharmacists in Tanta University. In this review, we reported our multi-disciplinary team experience with up to date literature guidance to propose a valid protocol for management of COVID-19 patients in limited resources setting.

Sex determination is a crucial issue and is usually the first step in the process of identification in forensic investigations. However, it remains a very challenging task. The aim of this study was to determine the validity of radiographic measurements, from the superior and inferior borders of the mental foramen to the lower border of the mandible (S-L and I-L), and from the medial margin of the mental foramen to the mandibular symphisis (MF -MS) on both right and left sides of the mandible, in sex determination in a sample of Egyptian population. The studied measurements were obtained digitally from high quality panoramic radiographs using imaging software. The recruited sample consisted of four hundred and thirty panoramic radiographs of patients aged 20 to 68 years with equal sex distribution. They were divided into two age groups; group 1 (from 20-50 years) and group 2 (more than 50 years). No significant difference was found in the studied measurements between the right and left sides of the mandible in both sexes. The mean Rt S-L, Rt I-L, and Rt MF-MS were significantly higher in males than females in both age groups. The receiver operating characteristic curve analysis identified the Rt I-L as the best valid and accurate one (area under the curve was 0.950 and accuracy was 87.2%) for sex determination. A combination of Rt S-L, Rt I-L, and Rt MF-MS for sex prediction identified males correctly in 95.3% and females in 94.4% of the studied cases with overall predictive accuracy of 94.9%. It could be concluded that a combination of S-L, I-L, and MF-MS has shown promising applications in sex determination among Egyptians. For more population specific standards and accurate sex identification, further research on a greater number of cases including more age groups is recommended.