Background: Acute poisoning is an important cause of unnatural death which may occur under a range of different epidemiological, social, cultural and religious implications. Aim: Study the medicolegal pattern of the reported cases of death due to poisoning in the region of Cairo and Giza governorates from 2009 to 2013. Method: Retrospective analysis of reports of all the cases of suspected fatal poisoning received by Zeinhom Morgue. Results: Toxic deaths represented 2.5% of all deaths registered in Zeinhom Morgue. Males, accidental manner, oral rout were predominant. The most common toxin was carbon monoxide. Conclusion and recommendation: The pattern of toxic deaths in Cairo and Giza governorates varies in both epidemiological and medicolegal aspects, the possibility of under-referral and reporting of these cases to Zeinhom Morgue must be taken into account. Competent system of referral of suspected toxic deaths for medicolegal investigation and autopsy must be established.
BACKGROUND
Gastrointestinal bleeding (GIB) is a major concern in patients hospitalized with acute coronary syndrome (ACS) due to the common use of both antiplatelet medications and anticoagulants. Studies evaluating the safety of gastrointestinal endoscopy (GIE) in ACS patients with GIB are limited by their relatively small size, and the focus has generally been on upper GIB and esophago-gastroduod-enoscopy (EGD) only.
AIM
To evaluate the safety profile and the hospitalization outcomes of undergoing GIE in patients with ACS and concomitant GIB using the national database for hospitalized patients in the United States.
METHODS
The Nationwide Inpatient Sample database was queried to identify patients hospitalized with ACS and GIB during the same admission between 2005 and 2014. The International Classification of Diseases Code, 9
th
Revision Clinical Modification was utilized for patient identification. Patients were further classified into two groups based on undergoing endoscopic procedures (EGD, small intestinal endoscopy, colonoscopy, or flexible sigmoidoscopy). Both groups were compared regarding demographic information, outcomes, and comorbi-dities. Multivariate analysis was conducted to identify factors associated with mortality and prolonged length of stay. Chi-square test was used to compare categorical variables, while Student’s
t
-test was used to compare continuous variables. All analyses were performed using SAS 9.4 (Cary, NC, United States).
RESULTS
A total of 35612318 patients with ACS were identified between January 2005 and December 2014. 269483 (0.75%) of the patients diagnosed with ACS developed concomitant GIB during the same admission. At least one endoscopic procedure was performed in 68% of the patients admitted with both ACS and GIB. Patients who underwent GIE during the index hospitalization with ACS and GIB had lower mortality (3.8%) compared to the group not undergoing endoscopy (8.6 %,
P
< 0.001). A shorter length of stay (LOS) was observed in patients who underwent GIE (mean 6.59 ± 7.81 d) compared to the group not undergoing endoscopy (mean 7.84 ± 9.73 d,
P
< 0.001). Multivariate analysis showed that performing GIE was associated with lower mortality (odds ratio: 0.58,
P
< 0.001) and shorter LOS (-0.36 factor,
P
< 0.001).
CONCLUSION
Performing GIE during the index hospitalization of patients with ACS and GIB was correlated with a better mortality rate and a shorter LOS. Approximately two-thirds of patients with both ACS and GIB undergo GIE during the same hospitalization.
Figure 1. A, B: Liver biopsy showing liver parenchyma with sinusoidal congestion and mild chronic inflammation within the portal tracts consisting mainly of lymphocytes and occasional plasma cells; C: Bilateral conjunctival suffusion, characteristic of leptospirosis.
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