Assessment of cases of acute tramadol toxicity as regards clinical, laboratory and management procedures in some university hospitals in Cairo

Tramadol, a widely used opioid in recent years, is a centrally acting analgesic drug that has been used clinically for the last two decades to treat pain in humans. Tramadol also has antitussive activity. Tramadol is a centrally acting analgesic which is extensively used in the management of moderate to severe pain. It slightly affects opioid receptors and inhibits the reuptake of norepinephrine and serotonin in the CNS. The aim of this study was to evaluate the clinical manifestations, the laboratory findings, the different lines of treatment and the outcome of cases presented with acute toxicity by tramadol overdoses. This study was carried out at Al-Azhar University Emergency Hospitals in Cairo [El-Hussein and Bab El-Shaaria University Hospitals] and Ain Shams University Hospitals on one hundred subjects in the period from July 2016 to February 2018. Toxicological screening was done for every patient by rapid lateral flow chromatographic immunoassay for detection of tramadol and its principal metabolites in human urine by special kits at a cut off level of 1000 ng/ml. In this study, 95% of studied cases fully recovered and 5% died

value of routine appendectomy during cholecystectomy operation

The value of incidental appendicectomy during cholecystectomy has been studied prospectively in 128 patients over a 4 years period. Incidental appendicectomy was performed for 80 patients together with the main cholecystectomy operation, whereas cholecystectomy alone was performed for the rest 48 patients. Appendicectomy technique was standardized and prophylactic antibiotics were administered together with drains for high risk patients and randomly for other patients. No mortality nor intraabdominal sepsis were reported. Postoperatively, wound sepsis was more observed in patients who had undergone appendicectomy whether antibiotics were dispensed or not and that was attributed mostly to risk factors e.g. old age, diabetes, acute cholecystitis, drains or positive bile culture rather than the appendicectomy procedure itself. Patients without risk factors did not show specific difference regarding the sepsis rate and mean post-operative stay. Histopathologically, macroscopically normal appendices showed a surprising incidence of abnormal findings [41.3%]. Thus, we recommend routine incidental appendicectomy at the time of cholecystectomy whenever the appendix is readily accessible and patients with risk factors should be protected by antibiotics

Fine needle aspiration biopsy in diagnosis of tuberculosis

Fine needle aspiration biopsy [FNA] is alternative to excision biopsy in the diagnosis of tuberculosis. Biopsy materials from 45 cases were studied by both Z-N stain and cultures. Z-N stain was positive in 27 cases out of 45 [60%], cultures were positive in 35 cases out of 45[78%]