Tramadol, one of the most commonly abused drugs in Middle East, impacts spermatogenesis and disturbs reproductive hormones in animal studies. We aimed to investigate tramadol impact on sperm quality and on levels of testosterone, prolactin and gonadotropins, in tramadol abusers (n = 30) to age-matched control (n = 30). Abusers had significantly low percentages of sperm motility, normal forms and vitality compared with control (95% CI -40.7 to -19.3, -13.5 to -9.3 and -31.9 to -9.7 respectively). Hypoandrogenism (95% CI -4.5 to -2.8), hyperprolactinaemia (CI (95%) 4.9 to 9.4) and hypergonadotropinaemia (95% CI 2.9 to 7.2 for FSH and 2.0 to 7.8 for LH) were observed in tramadol abusers vs controls. Smokers (26 of 30), concurrently abusing other drugs (11 of 30) and asymptomatic leucocytospermic (15 of 30) patients subgroups significantly abused tramadol beyond 3 years (p = .02, <.001, = .03 respectively) and in excess >450 mg/day (p = .02, = .01, = .005 respectively). Progressive motility (a + b%) was significantly low in young men <25 years old (p = .03) subgroup. Tramadol abuse is associated with poor sperm quality, hyperprolactinaemia and hypergonadotropic hypogonadism. We recommend semen analysis for tramadol long-intakes, question sperm donors and follow-up studies to prevent and reverse tramadol-induced testicular damage.

Suicide attempts by self-poisoning have become a critical health problem. This study aimed to investigate the trend, incidence, and the associated risk factors of suicide attempts by self-poisoning. A total of 7398 Egyptian patients were analyzed. The trend of suicide attempts by self-poisoning was analyzed using 6745 patients over four registry years from January 1, 2016, to January 1, 2020. Then, the associated risk factors behind attempted suicide by self-poisoning from January 1, 2019, to January 1, 2020, were assessed using 2523 suicide attempters by self-poisoning, 201 fatalities by self-poisoning, and another 653 survivors of accidental poisoning. Results showed a rising trend of suicide attempts by self-poisoning over the studied years. The incidence of suicide attempts through deliberate self-poisoning represented 26.63/1,000 (CI95%: 25.63–27.86) to the admitted patients and 26.10/100,000 (CI95%: 25.10–27.14) to the regional population. The death rate due to suicide attempts by self-poisoning was 2.08/100,000 (1.90–2.49). The case fatality rate and the proportionate mortality rate for suicide by self-poisoning were 7.38% (CI95%: 6.45–8.42) and 14.11% (CI95%: 12.4–16.0) respectively. Multivariate analysis revealed that attempted suicide by self-poisoning was predicted among patients aged <25 or 25–40 years old (OR = 27.49, CI95%: 15.28–49.64 and OR = 59.42, CI95%: 32.76–107.77 respectively), those of low or moderate socioeconomic status (OR = 35.03, CI95%: 21.32–57.56 and OR = 14.11, CI95%: 10.86–18.43 respectively), students (OR = 2.91, CI95%: 1.57–5.43) and those living in rural residency (OR = 4.12, CI95%: 3.27–5.19). Suicide attempts by self-poisoning exhibited an incremental rise across time which raises a serious concern. Efforts should be directed to overcome the mentioned risk factors triggering suicide attempts by self-poisoning.

Introduction: Nowadays tramadol is the most common drug of abuse. Egyptian surveys found a gradual increase in the use of tramadol among Egyptians. It has been associated with a wide range of drug abuse such as benzodiazepines. Aim of the work: This study aimed to evaluate the effects of dependence of tramadol, diazepam, and their combination on biochemical, histopathological and immunohistochemical changes of brain of adult albino rats.Material and Methods: Forty adult male albino rats were divided into four equal groups as follows: Group I (control) received1ml normal saline (0.9%NaCl) once orally for one month. Group II (tramadol dependent) received increasing therapeutic doses of tramadol orally for one month, Group III (diazepam dependent) received increasing therapeutic doses of diazepam orally for one month, Group IV (tramadol and diazepam dependent) received increasing therapeutic doses of tramadol and diazepam orally for one month. Blood samples were collected from all groups for evaluation of serum cortisol level. Brain was excised for biochemical, histopathological and immunohistolochemical studies. Results: Compared to the control group, serum cortisol level was significantly decreased in tramadol dependent and combined tramadol and diazepam dependent groups. In all experimental dependent groups, brain cholinesterase level was not changed and the brain showed histopathological and immunohistochemical changes Conclusion and recommendation: Tramadol or diazepam dependence for long time affects the brain cells and the combination of both of them leads to more neurotoxic effect. Therefore it is recommended that tramadol or diazepam should be taken only with the prescription of doctor and self medication of these drugs may be hazardous.

Objectives: Suicide by self-poisoning is a serious public health problem that accounts for global morbidities and mortalities. This work aims to study the incidence, trend, and determinants of suicide by self-poisoning in two Egyptian provinces. Methods: The current study is a bi-designed two-phases observational study carried out in two Egyptian poison control centers including Menoufia Poison Control Center (MPCC) and Tanta Poison Control Center (TPCC). A total of 7,802 patients were enrolled. The first phase of the current study was conducted retrospectively to show the trend of suicide attempts over 2016, 2017, and 2018 when the cases diagnosed as suicide by self-poisoning were extracted from medical record. The second part was conducted prospectively (January 2019-Januaray 2020) among cases of suicide by self-poisoning and accidental poisoning. Results: The current study revealed that incidence of poisoning exposure no matter what its type represented 34.99/100,000 (CI95%: 33.84–36.20) distributed as 28.18/100,000 (CI95%: 27.14–29.26) for suicide by self-poisoning and 6.82/100,000 (6.32–7.36) for accidental poisoning. The suicide by self-poisoning death rate represented 2.08/100,000 (1.90–2.49). The suicide by self-poisoning was significantly associated with young age <25years, low socioeconomic status, being a student or not working. Conclusion: Suicide by self-poisoning shows a continuous increase across time raising a serious concern. Collaborative Efforts are required by to conduct health education and enforce legislation to overcome this serious condition. Keywords: Aluminum phosphide; Egypt; pesticides; self-poisoning; suicide

Antipsychotics rank in the top five substance classes involved in human exposures. Overdose of antipsychotic medications is common. Aim of the work: to study antipsychotic drug poisoning cases that were admitted to MPCC during one year as regarding: socio demographic pattern, their clinical manifestation, investigation and outcome according to poisoning severity score (PSS). Patients and Method: Patients complaining of antipsychotic drug overdose admitted to MPCC from 1 st October 2012 to 30 th September 2013 were included. The socio-demographic and clinical data were collected from each patient in a designed clinical toxicological sheet. The studied cases were classified according to poisoning severity score. Results: The total patient's number was 60 patients. Females outnumbered males. Cases 33.3% below 10 years old were males, while females above 40 years old constituted 50.2%. Accidental poisoning was in males below age of 10 years from rural side, on the other hand 75% of females exposed to suicidal mode mainly from urban area. Regarding (PSS); most of cases were of moderate degree and the least were of severe and fatal degrees. Palpitation and abnormal movements were the commonest symptoms. Sinus tachycardia was the most prominent ECG changes seen in 20% of cases. ICU admission was indicated for 16.7% of cases. Improvement has occurred in 40% of cases, while only one case died. Conclusion and Recommendation: Significant relation was found between PSS and poison history as regard Co-ingestion and patients on antipsychotic therapy. Cases with moderate severity toxicity had palpation and abnormal movements. Acute antipsychotic overdose seldom results in death. Therefore it is recommended to improve awareness of physician about appropriate pharmacologic treatment of psychiatric problems.

No abstract

No abstract

All rights reserved. AbstractThere are numerous toxins and drugs that can cause, in overdose, ECG changes, even in patients without history of cardiac pathology. Theophylline intoxication results in substantial morbidity and mortality, particularly in those with chronic overmedication. The aim of this work was to study ECG changes in cases of poisoning by theophylline overdose that were admitted to MPCC over 2011 and the relation between ECG changes, theophylline blood level and poison severity score. In this study, theophylline overdose patients admitted to MPCC in the period from 1 st of January 2011 to 31 st of December 2011 were included. The total patients' number was 44 patients. Most cases of the study were females (77.2%) in the age group of (20-<40) years (40.9%), mainly from rural side (65.9%). Regarding relation between theophylline serum level and clinical manifestations, a significant relation was found between serum level and each of vomiting and dizziness, where both were noticed with majority of cases of minimal and moderate toxicity serum level. Regarding poison severity score, exactly one half of moderate and severe cases had minimal toxicity serum level, and the other half had moderate toxicity level. A significant negative correlation between theophylline serum level and PCO 2 was found. There was a non significant negative correlation between theophylline serum level and each of Na and K blood level. Concerning ECG changes, a significant relation was found between theophylline serum level and each of sinus tachycardia and second degree heart block.