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Maximal coronary conductance with adenosine in anaemic fetal sheep is twice that of non-anaemic fetuses. To investigate whether this increase in conductance persists into adulthood we studied twin sheep as fetuses and again as adults. Nine anaemic fetuses (118 days gestation) underwent isovolaemic haemorrhage for 18.0 +/- 4.6 days (means +/- S.D.) during which time the haematocrit was reduced from 39.9 +/- 5.2 % to 16.3 +/- 3.4 % and oxygen content from 8.6 +/- 1.3 to 2.3 +/- 0.2 ml dl-1. At 138 days the anaemic fetuses were transfused; at delivery the haematocrit was 29.3 +/- 6.8 % compared to nine control fetuses in which the haematocrit was 38.5 +/- 4.3 %. The weight at delivery was 3.5 +/- 0.36 kg in the anaemic fetuses vs. 4.2 +/- 0.83 kg in controls. Twenty-eight weeks later, we placed an occluder on the descending thoracic aorta and inferior vena cava, a flow probe around the proximal left circumflex coronary artery, and catheters in the left atrial appendage, jugular and carotid vessels. Maximal coronary conductance was determined in the adults by recording coronary blood flow as driving pressure was altered by inflating the occluders while adenosine was infused into the left atrium. Right atrial, left atrial, systolic and mean arterial pressures, systemic vascular resistance and haematocrit were not different between 'in utero anaemic' and control adults. The adults that were anaemic in utero weighed less than the controls 39.4 +/- 4.6 kg vs. 45.0 +/- 5.6 kg. Maximal conductance was greater in the adults that were anaemic in utero: 11.2 +/- 4.0 ml min(-1) (100 g)(-1) mmHg-1 as compared to 6.1 +/- 1.8 ml min(-1) (100 g)(-1) mmHg(-1) in the controls. Vascular reactivity of the mesenteric arteries was not different. These data suggest that coronary conductance can be modified in utero by anaemia (high flow and hypoxaemia) and that the remodelled coronary tree persists to adulthood.

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.

An easy axial approach using 15 cm long spinal needles, 21-gauge to the cranial aspect of the sacral tuber and obliquely at 30 degrees to the vertical was very satisfactory for achieving successful analgesia and therapy of sacroiliac pain in show jumping horses.

Introduction:In the last years poisoning by aluminium phosphide (AlP) became a common method of suicide with high mortality rates. Aim of the work: The study aimed to evaluate the characters and outcome of acute aluminum phosphide intoxicated cases at Sohag University Hospitals. Patients and methods: It is a cross sectional study conducted on acutely AlP intoxicated patients attended Sohag University Hospitals including a retrospective part from January 2020 to December 2021(23 case) and a prospective part from January 2022 to June 2022 (41 case). Demographic data, mode of poisoning, route of administration, amount taken, delay time, vital signs, degree of coma, ejection fraction, troponin I and creatinine levels and first aid measures were recorded then related them to the patient outcome. Results: the incidence of ALP toxicity increased every year, in 2020 was 10.9%, in 2021 (25%), while, in the first half of 2022 it was 64.1%. The mean age was 21.7± 10.65 with male predominance by 53.1%. There was a significant increase in percentage of survived patients decontaminated by paraffin oil (84.6%) compared to other methods (15.4%). Receiver operating characteristic curve (ROC) was used to assess predictors of mortality in acute ALP-poisoned patients. The accuracy rate of ejection fraction, poisoning severity score (PSS), dose, serum troponin I, systolic blood pressure, delay time, and HCO3 were 100%, 97.7%, 94.4%, 93.7%, 89.5%, 81.9%, and 80.1% respectively with excellent discrimination. Diastolic blood pressure (77.9%) and PH (75.2%) with acceptable discrimination. While, creatinine and GCS gave non-acceptable discrimination. Conclusion: the frequency of suicidal ingestion of ALP is increasing every year. Decontamination by paraffin oil and early presentation had a better prognosis. At admission assessment of ejection fraction, PSS, serum troponin and creatinine, blood pressure, ABG have a beneficial role as predictors of mortality and emergency intervention to cases with probable bad prognosis.

Background: Methotrexate (MTX) is used as an anti-cancer drug in higher doses. However, lower doses of methotrexate have been used in the treatment of rheumatic diseases due to its immunosuppressant effects such as rheumatoid arthritis, psoriatic arthritis, inflammatory myopathies, asthma, and other inflammatory conditions. Objective: The current study aimed to estimate the prevalence and severity of methotrexate toxicity among patients receiving low-dose methotrexate and followed up in the Rheumatology Department, at Sohag University. Patients and Methods: A retrospective, record-based study. All cases with rheumatoid arthritis were treated with lowdose methotrexate for at least 3 months and were recorded in the files of the Rheumatology Department, Sohag University Hospitals, in the period from 1 Jan 2012 to 31 December 2021. The files of the selected cases were revised carefully regarding details of the demographic data, clinical history, comorbidities, and side effects and toxicities supposed to be due to methotrexate. Results:The study included the files of 1077 rheumatoid arthritis cases. 849 cases (78.8%) were chronic MTX users, and 228 cases (21.2%) were non-chronic MTX users, taken as the control group. The comparison between MTX users and non-users as regards the clinical data revealed that MTX users had less disease duration, more morning stiffness, and less hypertension. MTX use was significantly associated with a higher incidence of gastritis, blurred vision, anemia, pneumonitis, and hepatotoxicity. Conclusion: Although generally tolerable in low doses, MTX is sometimes associated with some toxicities including gastritis, blurred vision, anemia, pneumonitis, and hepatotoxicity.

Background: In spite speedy development of clinical toxicology researches and protocols cardiovascular failure in severe acute intoxication remains a leading cause of death. Early cardiovascular risk assessment in acutely intoxicated patients is a must nowadays. This study aims to evaluate the role of ECG, serum cardiac troponin I (cTnI) and creatine kinase myocardial band (CK-MB) for early detection of cardio-toxicity in acutely poisoned patients. Methods: Prospective study was carried on100 patients with acute cardiotoxicity by drugs and toxins known to cause cardiac injury admitted to Sohag University hospitals, informed written consent has been obtained from each patient; ECG and biochemical analysis of serum cTnI and CK-MB were estimated in all studied patients. Results: (90%) of studied patients had complete free recovery, (4%) discharged with complications and (6%) of patients died. ECG test can be used as a predictor of mortality and had sensitivity 100%, specificity 46.8% and negative predictive value (NPV) 100%. Serum cTnI was highly significantly increased with death hence could be used as predictors of outcome. While serum CK-MB couldn't be used as an outcome predictor. ROC curve analysis to assess serum cTnI as a predictor of mortality of acute cardiovascular toxicity with cut off > 1.0 ng/ml had sensitivity 100%, specificity 89.4% and NPV 100% with excellent diagnostic characteristic (accuracy rate 96.4%). There is no significant difference of serum CK-MB and serum cTnI among cardiac drugs toxicity patients and non-cardiac toxins patients. Conclusion: the study concluded that ECG and serum cTnI can be used as a predictor of mortality. Also, the protocol of management will be same in acute cardiotoxicity by cardiac drugs and non-cardiac drugs and toxins. Recommendation: the study recommends combining of ECG changes and serum cTnI as they can early detect acute cardiovascular effects in acutely poisoned patients.