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.

Objective: To evaluate potential oxidative stress in patients with acute phosphide poisoning and the effect of vitamin C. Methods:Participants were females and divided into three groups; group I: healthy volunteers group II: healthy volunteers received vitamin C, group III: patients with acute phosphide poisoning received the supportive and symptomatic treatment and group IV: patients with acute phosphide poisoning received the supportive and symptomatic treatment in addition to vitamin C. All the participants were subjected to thorough history, clinical examination, ECG and laboratory investigations were carried on collected blood and gastric lavage samples on admission. Blood samples were divided into two parts, one for measurement of routine investigations and the second part was used for evaluation of malondialdehyde and total thiol levels before and after receiving the treatment regimen.Results: Most of the cases in this study were among the age group of 15-25 years, females, single, secondary school education, from rural areas and suicidal. All vital signs were within normal range and the most common complaint was vomiting and abdominal pain. All cases in this study showed normal routine investigations. The mean MDA levels after receiving treatment decreased significantly in groups II and IV. The mean total thiol levels increased significantly after receiving treatment in groups II and IV. Conclusion:It can be concluded that vitamin C has a potential benefit due to its antioxidant property on zinc phosphide induced-oxidative stress in acute zinc phosphide poisoned patients.

Tramadol dependence became an increasing and alarming problem in the Egyptian community. Wide availability of tramadol as a pain killer and its role in the treatment of premature ejaculation may be the most apparent causes of increased magnitude of the problem among youth who believe that tramadol has a positive impact on their sexual functions. This study aimed to explore the real impact of chronic tramadol administration on sexual functions in males dependent on tramadol. The study was carried on 80 subjects (50 subjects were tramadol dependent group and 30 subjects represented the control group). Personal, family and past histories were obtained from all the participants in addition to the toxicological history from tramadol dependent group. Urine screening for tramadol was done for all cases of history of tramadol dependence then confirmation by HPLC technique to measure tramadol blood level was done. Both groups were investigated for serum testosterone and prolactin level. Curiosity (22%) and treatment of premature ejaculation (20%) were the main motives for dependence. Erectile dysfunction and decreased libido occurred in 44% and 48% of tramadol dependent group respectively. Significant increase in erectile dysfunction and decreased libido was noted as the duration of dependence increased. Additionally, significant decrease in serum testosterone level and increase in serum prolactin level as tramadol daily dose and duration increased was found. In conclusion, men who take tramadol for premature ejaculation or any other purpose must know that they are very susceptible to many sexual dysfunctions.

In Egypt, workers have potentially high exposure levels to chromium (VI) in the cement production and construction industry and to chromium (III) in the leather tanning industry. This study aimed to evaluate the effect of chromium exposure on lipoperoxidation, thiol antioxidants and DNA in cement and tannery workers. This study was conducted on 65 adult male volunteers. These subjects were divided into three groups: Group I (control group); 23 normal healthy volunteers, Group II; 22 cement workers and Group III; 20 tannery workers. All participants were subjected to thorough history, clinical examination and laboratory determination of total blood and urinary chromium, plasma malondialdehyde and total thiol in plasma and assessment of oxidative DNA damage through p53 overexpression. About one third of cement and tannery workers had severe skin and chest manifestations and severe nasal manifestations were observed in 22.7% and 20% of cement and tannery workers, respectively. The blood and urinary Cr and plasma malondialdehyde levels of cement and tannery were significantly higher than control group. Additionally, there was a significant increase of total thiol in control group compared to exposed groups. About half of cement and one third of tannery groups expressed high grade of p53 expression. The blood chromium revealed significant negative correlation with thiol, but, positive correlation with malondialdehyde and p53 expression. Cement and tannery workers should be subjected to frequent clinical examination and blood or urine chromium analysis level to keep guard against its toxic consequences.

Acute poisoning is a frequent cause of admission to emergency departments and intensive care units, as it is considered as an important medical emergency requiring early diagnosis and rapid initiation of therapy. The aim of the present study was to assess characteristics, and outcomes of acutely intoxicated patients who were admitted to ICU. Also, design a scoring system regarding priority for ICU admission. The present study was carried out on 40 patients who were admitted to intensive care unit of El Mansoura General Hospitals-Egypt during a period of 6 months. Personal, toxicological, and medical histories, clinical examination and routine investigations were recorded for each patient. At discharge; all patients were reassessed for determination of patients' outcome. The patients were mostly females, single; student aged less than 30 years and from rural areas. The majority of the patients (72.5%) were recovered, 22.5% were died and 5% were referred to hyperbaric oxygen therapy units after carbon monoxide intoxication. Many patients were presented by constricted pupil (45%), respiratory depression (42.5%), altered mental status (42.5%), tachycardia (47.5%), and nausea & vomiting (75%). The highest numbers of cases were poisoned by medicinal drugs (40%) followed by agricultural chemicals (35%). Statistically significant difference between occupation, toxicological amount & frequency, pulse rate, Glasgow coma score, PH & PCO2 and type of poison (zinc phosphide) and patient outcomes was observed. Although many of the patients' characteristics were significantly associated with patient outcome yet none of them was considered significant predictors for death. So, the suggested scoring system depended mainly on clinical data and simple rapid investigation that may be helpful for rapid assessment of the patients after further validation. We recommend the presence of a channel of communication between the general care centers and the poison control centers for consultation about the protocol of treatment of poisoned patients. Nationwide, a mechanism of communication between the poison centers must be done to benefit from the different expertise and to make a uniform protocol for treatment of poisoned cases to decrease the mortality rate and the burden on hospitals resources.