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All right received. AbstractPoisoning with Organophosphate (OP) compounds is responsible for great morbidities and mortalities all over the world especially in developing countries including Egypt. Scoring systems have been continuously developed to predict outcomes in patients with severe illness, to improve resource allocation and to assist in clinical decision-making particularly for ICU patients. The quest for biomarkers in relation to OP compound poisoning started quite a long time back but cheap and easily measurable biomarkers having prognostic value is the need of the hour. The objective of this study is to evaluate the role of acute physiology and chronic health evaluation II (APACHE II) score, the Sequential Organ Failure Assessment (SOFA) score, serum amylase and lipase in assessing severity and outcome of acute organophosphorus poisoning. A retrospective and prospective study was carried out on 200 patients of acute OP poisoning admitted to the Poison Control Center (PCC), Ain Shams University Hospitals. Information after obtaining the permission of the director of PCC and the regional ethics committee was collected from the sheets and computerized data base of the patients, an informed written consent has been obtained from each patient or from his/her caregiver for inclusion in the prospective part of the study. APACHE II and SOFA scores were calculated to each patient admitted and biochemical analysis of serum amylase and lipase were estimated in the prospective part of the study. The results were revised, coded and organized for statistical analysis. The study results revealed 180 (90%) patients discharged and 20 (10%) patients died. The study showed that there were 76% of patients had APACHE II score ≤ 9, while 12.5% of patients had APACHE II score from 10 to 14, there were 8.5% of patients had APACHE II score from 15 to 24 and APACHE II score was > 24 in 3% of patients. SOFA score in 88.5%of patients was ≤ 6, while in 4.5% of patients SOFA score was from 7 to 9 and in 7%of patients SOFA score was > 9. Hyperamylasemia observed in 83.3% of died and 33.3% of died patients had increased lipase. There was significant difference between discharged and died patients as regards APACHE II score, SOFA Score, serum amylase and lipase. It could be concluded that SOFA score, APACHEII score, serum amylase and lipase had a role in assessment of severity of acute organophosphorus poisoning but only SOFA score, APACHEII score and serum amylase could be used as predictors of outcome. SOFA score is more useful in predicting mortality, and easier and simpler than the APACHEII and serum amylase. From the previous results, our study recommends that predictors of outcome (APACHE II score, SOFA score and serum amylase) should be assessed routinely and as early as possible to evaluate the severity, improve the course of management and deciding the pathway of care.

Triage in Emergency departments requires emergency doctors to make rapid decisions based on their knowledge and experiences. Triage of patients is critical to patient safety, yet no clear information exists by the utility of initial vital signs and conscious level in identifying critically ill acutely organophosphate (OP) poisoned patients. The objective of this study is to determine the relationship between triage vital signs and conscious level in predicting outcome of acutely organophosphate poisoned patients. A retrospective and prospective study was carried out on 200 patients of acute OP poisoning admitted to the Poison Control Center (PCC), Ain Shams University Hospitals. Information including vital signs and Glasgow coma scale (GCS) on admission after obtaining the permission of the director of PCC and the regional ethics committee was collected from the sheets and computerized data base of the patients, an informed written consent has been obtained from each patient or from his/her caregiver for inclusion in the prospective part of the study. The results were revised, coded and organized for statistical analysis. The study results revealed 180 (90%) patients discharged and 20 (10%) patients died. The study also showed that 8% of patients had fever, 9.5% had tachycardia, 1.5% had bradycardia, 5% had hypotension, 2% had hypertension, 2.5% had tachypnea and 3.5% showed bradypnea. Also 89% of patients had GCS > 8, while 11% of patients had GCS ≤ 8. The study showed statistically significant difference between discharged and died patients as regards heart rate, blood pressure, respiratory rate, body temperature and GCS. It could be concluded that heart rate, respiratory rate and coma scale can serve as easily measurable tools for outcome prediction in acutely OP poisoned patients. From the previous results, our study recommends to use these parameters to help emergency physicians to quickly detect poisoned patients with poor outcomes.

A sensitive and accurate method for the extraction and quantification of tramadol (T) and its active metabolite, O-desmethyltramadol (ODT) in human plasma with high-performance liquid chromatography-diode array detection was developed and validated. The analytes were extracted from plasma samples by tert-butylmethyl ether in the presence of ammonium hydroxide as alkaline medium and back extraction with 1.0 M hydrochloric acid. Propranolol was used as internal standard. The extraction efficiencies of T and ODT were 83.51 and 78.72%, respectively. The calibration curves were linear (r(2) > 0.99) in the concentration range of 250-2000 ng/mL for T and ODT. Limits of detection and quantification were 125 and 250 ng/mL for both analytes. Intra- and interassay precision for T and ODT were ranged from 1.89 to 10.91% and 2.16 to 5.85%, respectively. Intra- and interassay accuracy for T and ODT were ranged from -13.07 to 4.99% and -2.03 to -6.98%, respectively. The method was successfully applied to quantify T and ODT from authentic plasma samples received from Hospital Sohag University. The method was completely validated and can be of interest to clinical and forensic laboratories.

Introduction: Acute cardiotoxicity patients can have adverse effects that may lead to intensive care unit (ICU) admission. Because of limited ICU beds, triage and stratification of cases into different groups according to survival is a must nowadays. Many scoring systems have been as a tool for triage and improve ICU quality management. This study aims to evaluate the role of GCS (Glasgow coma scale) and MAS (Modified Acute Physiology And Chronic Health Evaluation) as effective scoring system in predicting mortality in acute cardiotoxicity Methods: A prospective study was carried on 100 patients with acute cardiotoxicity by drugs and toxins known to cause cardiac injury admitted to Sohag Hospitals. Results 94% of patients had survived 4 of which discharged with complication. By ROC curve analysis to assess the predictor of outcome of acute cardiovascular toxicity, it was found that MAS score at cut off value > 11.5 had sensitivity 100% and specificity 74.5%, GCS at cut off < 9.5 had sensitivity 100% and specificity 72.3%.The accuracy rate of GCS was (92.4%) while that of MAS was (90.8%). Conclusion: GCS and MAS can be used as simple predictor tools of mortality in acute cardiotoxicity. Recommendation: GCS and MAS may be used as simple triage tools in acute cardiotoxicity patients in ICU to improve quality management and utilizing hospital resources.

Introduction: Cyclosporine A (CsA) is considered one of the potent drugs that are used extensively in organ transplant and oncology patients. It is also used in autoimmune diseases. Unfortunately, its use is accompanied with several hazards; one of these is testicular toxicity. Nacetylecysteine (NAC) is an antioxidant found to reduce CsA toxicity. Aim of the work: The study aims to determine the toxic effect of exposure to cyclosporine on the testis and to investigate the protective role of NAC. Methods: The study conducted on 50 adult male albino rats for 4 weeks divided into 5 groups, group A the negative control group, group B the olive oil group (0.5 ml/d orally), group C the cyclosporine group (25mg/kg/d orally), group D the NAC group (600mg/kg/d orally) and group E the cyclosporine+NAC group. At the end of the study the evaluation was achieved by biochemical analysis and histopathology. Results: Cyclosporine significantly affects the testis morphologically and functionally. The morphological changes are in the form of degenerative changes in the tubules with dislocation of germ cells into the lumen and irregular outlines, Congestion of blood capillaries in the interstitial tissue, and functionally the cyclosporine cause significant decrease in serum testosterone level. While co-administration of NAC with cyclosporine attenuate these effects. Conclusion: Cyclosporine causes testicular injury through oxidative stress and NAC as an antioxidant attenuates but not fully protect against cyclosporine induced testicular toxicity.

Introduction: Cyclosporine A (CsA) is considered powerful immunosuppressive drug which has improved the quality of life and survival rate of transplant patients and also used in autoimmune diseases. However, its use is limited by many side effects mainly nephrotoxicity. NAC is an antioxidant found to reduce CsA toxicity. Aim of the work: The study aims to determine the effect of exposure to cyclosporine on the kidney and to investigate the protective role of NAC. Methods: the study conducted on 50 adult male albino rats for 4 weeks, divided into 5 groups, group A the negative control group, group B the olive oil group (0.5 ml/d orally), group C the cyclosporine group (25mg/kg/d orally), group D the NAC group (600mg/kg/d orally) and group E the cyclosporine+NAC group. At the end of the study the evaluation was done by biochemical analysis and histopathology. Results: cyclosporine significantly affects the kidney by morphological changes in the form of dilatation of urinary space with congestion and lobulation of glomerullar capillaries in the renal corpusle. Proximal convoluted tubules showed degeneration of their cells with irregularity and destruction of brush border. Degeneration of distal convoluted tubules with exfoliation of some cells inside the lumen and the peritubular capillaries were congested and extravasated. Also cyclosporine affects the kidney by increasing serum urea and creatinine levels, while coadministration of NAC with cyclosporine attenuate its effects. Conclusion: cyclosporine causes renal injury through oxidative stress and NAC as an antioxidant attenuates but not fully protect against cyclosporine induced injuries.

Introduction: A growing concern over the use of illicit drugs in the work place has led to an interest in urine analysis as a way to detect drug abuse. Sample adulteration is a serious potential problem in forensic urine drug testing. Federal guidelines define an adulterated specimen as a urine specimen containing a substance that is not a normal constituent or containing an endogenous substance at a concentration that is not a normal physiologic concentration. Adulterants act by either interfering with immunoassay procedures or by converting the target drugs to other compounds. Once the adulterants are converted to other compounds they do not bind to the antibodies used in immunoassay. In some cases these converted compound produce false negative results in confirmatory testing. Adulterants can be classified into two categories. The first category includes in vivo adulteration comprising intentional ingestion of fluids, substances or drugs designed to dilute urine. The second category includes in vitro adulteration such as common household chemicals and nitrite containing agents. Methods of detection of urine adulterants include urine integrity tests, color tests and spectrophotometric methods.