Increased rate of seizures and respiratory complications due to tramadol poisoning have been observed, even with first time of tramadol intake. So, the present work was used to investigate the clinical manifestations and laboratory investigations of acute tramadol toxicity and the correlation between toxic tramadol manifestations and blood tramadol level and laboratory parameters. A study was performed on 100 patients (80 males and 20 females) acutely intoxicated with tramadol, admitted to toxicology unit of Al-Azhar University Hospital (New Damietta) in the period from January to December 2017. Informed consent, urine sample was collected and 10 mL of blood was separated and used for extraction of tramadol residues by using a high-performance liquid chromatography (HPLC) and other blood samples were stored at-8°C for routine investigations. Then a detailed clinical examination was done to all patients. Generally, the frequency of seizures was (46 %) with acute tramadol poisoning. There was no correlation between blood tramadol level and toxic manifestations of tramadol poisoning. So, the frequency of seizures and toxic manifestations are not dosed dependent. Cannabis was the most common co-ingested drugs and adult males were more commonly affected by tramadol poisoning. It is recommended that the drug abuse problem must be treated at the level of community problems in order to minimize medical emergencies related to acute tramadol overdose occurring mostly by addiction and further studies should be proposed to extend our knowledge about relationships between sex and seizures among tramadol intoxicated patients _________________________________________
Background: During cancer chemotherapy, drug-induced oxidative stress can limit therapeutic efficiency and cause a number of side effects. Objectives: Our study aimed to characterize the side effects of an alkylating agent chemotherapy ifosfamide to the retina and if the supplementation of lecithin and or quercetin can diminish its oxidative stress by means of comet assay and FTIR.Methods: Seventy female albino rats divided as control, rats given orally quercetin or lecithin, rats injected with ifosfamide, rats given quercetin or lecithin and in combination of them with ifosfamide injection.Results: Lecithin and quercetin groups indicate a normal comet parameters and distribution of protein secondary structure components content of β-turn, α-helix and β-sheet. After Ifosfamide injection, all comet parameters and β-Turns content were significant increase (p˂0.05) with the same context significant decrease (p˂0.05) of α-helix was observed. Lecithin or quercetin reduces the effect of ifosfamide injection in tail length and percentage tailed DNA. Combined treatment gives more protection against DNA damage. Lecithin role is cleared in returning the normal distribution of β-turn, α-helix, β-sheet and lack of protective effect of quercetin regarding the protein secondary structure of retina was observed.Conclusion: We suggest using lecithin and quercetin in combined treatment to reduce the oxidative stress due to ifosfamide.
Introduction: Every year hundreds of thousands of people die from injuries caused by firearms. T herefore, the present work aimed to determine and analyze the pattern of firearm injuries among deaths on which medicolegal autopsies were conducted at Cairo Department of Forensic Medicine (Zeinhom mortuary), Ministry of Justice, Egypt, during 2014 .Material and Methods: Data were obtained from available medicolegal reports and were statistically analyzed.Results: There were 468 firearm deaths representing 26.3% of the total deaths received during the study period. Conclusion:Most of cases were males in the age group (20-30) years. In most of the cases (93.4%) there is no relation between assailant and victim. T here was a high prevalence (68.6%) of rifled weapons and chest was the most common injured anatomical region (38.2%), followed by head (36.9%). Homicidal manner was the most common (91.7%) and the majority (88.5%) of cases died suddenly without any medical intervention. T he major mechanism of death was hemorrhagic shock (60.5%).
Early assessment of patients presented with acute organophosphorus toxicity in the Emergency Department is an essential step to detect their pathway in the hospital. The present study aimed to assess the overall accuracy of Acute Physiology and Chronic Health Evaluation (APACHE II), Modifies Early Warning Score (MEWS), and Worthing Physiological Score (WPS) in predicting mechanical ventilation in acute organophosphorus toxicity patients. A cross-sectional cohort study was conducted on 132 patients presented with acute organophosphorus patients. From each patient, the following was collected: clinical data, routine laboratory investigations results, and blood samples for estimation of cholinesterase levels. The clinical and laboratory data were used to calculate APACHE II, MEWS, and WPS scores within six hours from admission. Statistical analysis revealed that the median values of APACHE II, MEWS, and WPS differed significantly between mechanically ventilated and non-mechanically ventilated patients. A strong significant negative correlation was detected between clinical severity and cholinesterase levels. WPS score showed the highest discriminatory power for predicting mechanical ventilation (area under the curve [AUC] 0.977). However, APACHE II and MEWS scores were nearly equal in their discriminatory power (AUC 0.924 and 0.927 respectively). Cholinesterase levels can be used as a useful diagnostic tool but are very poor in predicting patient outcomes (AUC 0.209 and 0.129 for acetylcholinesterase and butyrylcholinesterase respectively). In conclusion, using the WPS score for clinical evaluation of acute organophosphorus toxicity patients has valuable prognostic abilities for predicting patients' outcomes.
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