Medicolegal aspects of maternal deaths of obstetrical origin

Understanding the extent of maternal deaths especially those due to medicolegal causes as homicide, suicide, accidents, illegal abortion and medical malpractice in women of childbearing age, may lead to improved identification of preventable problems that contribute to maternal morbidity and mortality. Maternal death due to unnatural [medicolegal] causes i.e. deaths due to violence, sudden and unexpected deaths, deaths due to medical malpractice and, in particular, those due to trauma- are increasing and forming the main causes of the maternal deaths. Maternal deaths due to natural causes i.e. direct or indirect obstetrical causes are decreasing nowadays, as a result of rapid progress in the methods of diagnosis and treatment of the various medical conditions affecting women during pregnancy, delivery and puerperium. Medical malpractice represented an important cause of the maternal deaths, especially with the development of the medical care standards. Because of this, if an accident happens the obstetrician more than any other doctor perhaps can find himself in the courts. To avoid this he has to know very well the causes of maternal mortality in order to avoid them as far as possible

possible protective role of some antioxidants on nephrotoxicity of chronic aluminium exposure in adult albino rats: histochemical and ultrastructural study

Aluminium [Al] is one of the most abundant and ubiquitous element in the nature, and its long-term administration causes accumulation of it in the tissues of vital organs including the kidneys. This study detected the effect of chronic Al administration on the kidney function and on the proximal convoluted tubules of adult albino rats, by histochemical and electron microscopical examinations. Forty rats were divided into 4 equal groups, and the period of the study was 3 months. The 1 st group was a control and the 2 nd received aqueous solution of Al chloride [AlCl 3] in a daily oral dose of 330 mg/ kg b.w., which is equal to 1/10 th of its LD50. The possible protective effect of vitamins C and E, which act as antioxidants, was examined in the 3 rd and 4 th groups, respectively. The 3 rd group of rats received the same dose of AlCl 3 as in the 2 nd group concomitant with vit C in a dose of 100 mg/ kg, while the 4 th group received the same dose of AlCl 3 + vit E in a dose of 30 mg/ 100 gm. At the end of the 3 months, the kidney function tests of A1Cl 3- treated rats were significantly elevated in comparison with the control group, as blood urea nitrogen [BUN] and serum creatinine [Cr] were 65.44 and 2.45 mg/ dl, respectively. Also, the enzymatic activities of succinic dehydrogenase [SD] and alkaline phosphatase [Alk. Ph.] were markedly decreased and acid phosphatase was markedly increased, compared to their activities in the control group. The lesions detected in the proximal convoluted tubules confirmed these results. These lesions, of A1Cl 3- treated group, were marked thickening of the cellular basement membranes with widely separated basal infoldings. The cytoplasm contained multiple lysosomes and vacuoles, whereas the mitochondria were irregular in shape and variable in the size and number. The microvilli showed focal loss and the nuclei were irregular. Co-administration of vit C with AlCl 3 showed a significant decrease in kidney function tests [BUN=30.69 and serum Cr=1.12 mg/ dl], improvement of the enzymatic activities which were more or less similar to the normal activities, and the lesions in the renal tubules were disappeared as the ultrastructural findings were similar to those in the control group. On the other hand, vit E ameliorated the Alcl3 toxicity but to a lesser extent than vit C, as the kidney function tests and activities of the enzymes were improved but not reached to the normal levels, and most of the tubular damage was disappeared, but minimal lesions could be detected. So, chronic Al exposure induced nephrotoxicity that was counteracted by vit C, and only ameliorated by vit E administration

Evaluation of the cytoprotective effect of cow's milk against ethanol-induced gastrointestinal toxicity in albino rats: immunohistochemical and histopathological studies

Ethyl alcohol [ethanol] is readily absorbed from all parts of the gastrointestinal [GI] tract due to its hydrophilic potential. Its biological effects in human refer to practically every organ and system. The exposure of gastric and small intestinal mucosae to ethanol produces pathological changes such as inflammatory process, hemorrhagic erosions, and even acute ulcers. Although several studies have shown that milk protein components have a wide range of biological activities, the potential role of these proteins in the GI mucosal defense system is less well elucidated. In this study, we detected the GI lesions induced by short-term oral administration of ethanol to adult albino rats, after 2 and 4 weeks. Furthermore, the protective ability of milk against these injuries was determined. The morphological damage in the stomach and small intestine was detected by histopathological examination while apoptosis [programmed cell death] in the GI mucosal cells induced by ethanol, could be detected by immunohistochemical [IHC] method using Bcl-2 protein expression in the cells. This study was carried out on 60 albino rats divided into 3 equal groups as follows: [1] Control group [received water and basic diet], [2] Ethanol group received a daily oral dose of 5ml/Kg b. w. of 50% ethanol [10[th] of the LD50], [3] Milk + Ethanol group [milk 500 mg/Kg was orally given one hour before the same dose of ethanol as in the 2[nd] group]. After 2 weeks of ethanol administration the gastric and intestinal mucosal injuries were detected histopathologically and apoptotic changes by Bcl-2 expression were moderate, whereas after 4 weeks these lesions induced by ethanol were increased in severity and accompanied by a strong expression of Bcl-2 protein which pointed to severe apoptosis [group 2]. These findings indicate that ethanol-induced GI apoptosis which is influenced by the duration of exposure. This study also showed that when animals were pretreated with milk before ethanol [group 3] there was a markedly reduction in the occurrence of GI lesions after 2 weeks and even after 4 weeks in which only mild apoptosis was detected by weak Bcl-2 protein expression. It can be concluded that milk has marked antiulcer activity and may serve to protect the GI mucosa against injuries induced by ethanol

Environmental pollution with cadmium is a leading cause for chronic renal failure

This study comprised 40 patients with chronic renal failure [CRF] with undefined leading cause and 40 apparently healthy subjects of comparable age and sex [control group]. Blood sample [7 ml] was taken from every one and divided into two parts: the first was heparinized for determination of cadmium, lead, and mercury in the whole blood using atomic absorption spectrophotometry and the second part was allowed to clot and centrifiged to separate serum for estimation of serum levels of urea and creatinine. There was a significant [P<0.05] increase of estimated blood levels of cadmium and lead and non-significant increase of blood level of mercury in the patients group compared to the control levels. Also, there was a positive significant [P<0.001] correlation between serum levels of urea and creatinine and blood levels of both cadmium [r=0.608 and 0.742] and lead [r=0.547, 0.688], respectively, in the control group. A similar positive significant correlation with blood cadmium [r=0.504, 0.503] and lead [r=0.473, 0.44 7], was found in patients group. The 95[th] percentile of blood levels of cadmium and lead in patients groups was 0.6875 and 16.645, respectively, there were 8 control subjects [20%] having a blood cadmium level >/=0.6875 microg/dl, while there was only one control subject [2.5%] having blood lead level >/= 16.645 microg/dl. In a trial to determine the dominant heavy metal leading to CRF, blood cadmium was found to be the variable that closely related to CRF manifested by increased serum creatinine with a significant standardized coefficient [beta=0.503, P=0.001]. We can conclude that environmental pollution with heavy metals especially cadmium, lead and mercury is responsible for the occurrence of interstitial nephritis that may progress to CRF, and that cadmium is the main causative pollution factor. We recommend considering a blood cadmium level of >/=0.6875 microg/dl as an indicator for impending renal failure, also we recommend inquiring for possible sources of drinking water pollution with cadmium

Induction of apoptosis by aflatoxicosis and its modulation by ascorbic acid and sequential biochemical and histopathological changes in albino rats

Based on the DNA fragmentation profile in gel electrophoresis and histopathological and biochemical changes induced by acute toxicity of aflatoxin B1 [AFB1], this study aimed to clarify the protective effect of ascorbic acid [A.A.] on aflatoxicosis in albino rats. Forty rats were used in this work and divided into four groups, ten in each one. The 1st group was served as reference group [R-gr] where the rats in this group feed on basal diet only, rats of the 2nd group were given daily dose of ascorbic acid [A.A.] 300 mg/kg I.P. for three weeks, rats of the 3rd group were given single dose of AFB1 [1 mg/kg] I.P. after pretreated with daily dose of A.A. 300 mg/kg I.P, while rats of the last group were given single dose of AFB1 [1 mg/kg] I.P. after pretreated with daily dose of A.A. 300 mg/kg I.P. for three weeks. The results showed that acute aflatoxicosis induced DNA fragmentation pattern [DNA ladder] i.e. induced apoptosis, while no DNA fragmentation profiles were detected in the other three groups. The results also showed that AFB1 has a hepatotoxic and nephrotoxic effects as shown from the histopathological evaluation of liver and kidney and from the biochemical results very highly significant increase in serum levels of AST, ALT and ALP and the highly significant increase in serum creatinine and BUN levels

Radiotoxicity of gamma rays and radioprotection of antioxidant vitamins against sperm head malformation in irradiated mice

In this study, 140 Swiss albino mice [Mus muscularis] aged 7 weeks and weight 15-20 gm. were used. The animals were sorted into groups, one of them was irradiated with two concentration of gamma rays 300 and 900 rad, other groups were treated with aqueous vitamin C solution; vitamin E solution dissolved in olive oil and both of them together [C and E] at two concentrations, 100 and 500 mg/kg/day for one month, then radiated in two doses 300 and 900 rad. Sperm head abnormalities in non irradiated; irradiated and pretreated with vitamins groups then irradiated were recorded. The irradiation with 300 and 900 rad caused an increase in the sperm head abnormalities compared to the control. On the other hand, animals pretreated with vitamins each alone and combination of the two together showed a decrease in the percentage of abnormalities caused by irradiation. So, vitamin C and vitamin E [antioxidant] were considered as radioprotection

Immunohistochemical detection of alveolar macrophages and pulmonary giant cells and their diagnostic value in some types of asphyxia

The occurrence of numerous alveolar macrophages and pulmonary giant cells has been reported in both fatal asphyxia and other causes of death Pulmonary giant cells as a significant diagnostic tool in cases of asphyxia is still a controversial discussion. In the present study we investigated experimentally some types of asphyxia to detect both alveolar macrophages and pulmonary giant cells by immunohistochemical method using a monoclonal antibody Ki-Mlp, and to estimate the frequency,. of these cells microscopically in each group examined to evaluate the statistical differences which may help in differentiation between the various causes of death from asphyxia. Forty two adult albino rats were divided into 7 groups each contained 6 animals. The first group were sacrificed by decapitation and act as a control group. The animals of the 2nd and 3rd. groups were killed by obstructive asphyxia as strangulation and hanging respectively, while those of the 4th group were asphyxiated by drowning. The 5th 6 th and 7th groups included deaths of asphyxia due to inhalation of irritant gases as methanol either and butagaz respectively. Serial sections were prepared from formalin-fixed paraffin-embedded tissue specimens of lungs and brains, and were used for Hx and E and immunostaining. Alveolar macrophages and pulmonary giant cells in all groups of asphyxia stained positively with a monoclonal antibody Ki-Mlp. The frequency of these reactive cells showed a variation between the different types of asphyxia which may be useful in. the differentiation between the asphyxiated cases as this immunostaining method was easily and rapidly performed. No histiocytes could be observed in the brain tissues which served as a good negative control

Effect of paracetamol on gastric erosions induced by indomethacin in rats

Gastric mucosal injury induced by application of indomethacin, as a nonsteroidal anti inflammatory drug [NSAID], is a well- documented phenomenon. This study examined the effect of acetaminophen [paracetamol] on indomethacin. - induced gastric erosions. One hundred adult albino rats of both sexes. weighing 200-250 gm were divided into two main groups. including a group of 10 rats acts as a control. The first group was to study the effect of a single oral dose of indomethacin. paracetamol and both drugs on the gastric mucosa. and the second group was to study the effect of repeated administration of each drug and both drugs together. The animals were killed and the histopathological changes of the stomach were examined microscopically. Single therapeutic dose of indomethacin was found to induce multiple gastric erosions which these were more markced after repeated administration of the drug. Single dose or prolonged administration of paracetamol were followed by very minimal changes in the gastric mucosa. Simultaneous administration of both drugs was found to reduce the pathological lesions induced by indomethacin alone, whereas the pretreatment with paraceramol one hour before a single oral dose of ndomethacin did not affect its erosive activity. Post - treatment with paracetamol reduces the erosive effect of indomethacin either in a single dose or after repeated administration. The pathogenesis of gastric erosions and ulcers was believed to he due to prostaglandin inhibition. Indomethacin was known as a potent inhibitor of prostaglandin synthesis, whereas paracetamol is a very weak inhibitor of prostaglandin production. It is also found that paracetamol had a protective action against the erosive effect of indomethacin and this appears to be mediated by mucosat regeneration, probably resulting from increased production of mucosa growth factors. So, the use of paractamal as antipyretic and analgesic drug is recommended instead of indomethacin. or they are administrated simultaneously with or after indomethacin when there is a possibility of gastric mucosal injury, especially in prolonged treatment

antifertility effect of carbamate on the gonads of rats

In Egypt, the wide indiscriminative use of pesticides and weak control measures result in the pollution of all environmental components. In the present work we use one of the carbamate group [Temik] to search for its effect on the fertility. Adult male and female rats were subjected to a daily oral administration of temik at a dose of 0.14 mg/kg which represents 1/10 of LD]50, for 10 and 20 days. The testis and ovaries were examined for the changes in collagen fibers, and the number of seminiferous tubules at the later stages of spermatogenesis was counted. Radioimmunoassay was done to measure the hormonal levels of testosterone and estrogen in the serum of rats. The number of seminiferous tubules at later stages of spermatogenesis showed marked decrease in the treated rats. There was a marked increase in stainability and irregular arrangement of collagen fibers in the interstitial areas and around the blood vessels in both testis and ovary. A decrease in serum testosterone and estrogen levels was observed in male and female rats subjected to the insecticide carbamate. All these effects became more pronounced in the rats toxicated for 20 days. These results may be due to the toxic effect of insecticide carbamate on the processes of protein synthesis and its inhibitory effect on the reproductive activity

Correlation of the serum levels of carbamazepine and the severity of the clinical manifestations of its acute toxicity

A clinical study was carried out on all cases, acutely poisoned by carbamazepine [CBMZ] [26 cases] presented to [P. C. C.] during the period from January to April 1994 and compared with equal number of non exposed subjects with similar age and sex. Cases were evaluated clinically by history and examination and by laboratory investigation in the form of ECG. serum sodium levels and CBMZ serum levels at admission and when needed thereafter. It was observed that 20 cases [13 males and 7 females] were suicidal poisoning, all of them were above age of 15 years and 6 cases [4 males and 2 females] were accidental, all of them were below age of 15 years. It was also observed that grade of coma, hypotension respiratory depression, presence of convulsions, vomiting, ECG changes and dilatation of the pupils correlated well with CBMZ serum levels. On the other hand, serum sodium and pulse changes did not correlate with it. Moreover, the line of treatment needed for each case for most cases correlated well with CBMZ serum levels