Intensive care unit [ICU] admission and discharge criteria in acute poisoned cases admitted to Menoufiya university hospital over one year [2008] [A prospective study]

Poisoning emergency is a common occurrence which constitutes a significant source of aggregate morbidity, mortality, and health care expenditure. The aim of the present study was to clinically evaluate the ICU admitted poisoned cases as regard criteria of ICU admission, approach to treatment and discharge criteria during the period from 1-1-2008 to 31-12-2008. Data were collected from self designed admission clinical sheet which included all needed data. The present study revealed that the total poisoned cases that were admitted to Menoufiya poison control center [MPCC] were, 423 cases from 35550 total menoufiya hospitals admission during the year of the study i.e [1.18%] of which 86 cases have been admitted to ICU i.e. [20.33%] and they represented about [2.79%] of total hospital ICU admission [3073 cases]. Most of admitted poisoned cases throughout the year of the study were due to anticholinesterase poisoning 126 cases [29.78%] from those 34 cases were admitted to ICU i.e. [26.98%] from total ICU admitted poisoned cases. Regarding the admission criteria the present work represents that the patients who were admitted due to both hemodynamic instability and altered mental status were the commonest ones [61.63%], followed by altered mental status [16.3%], hemodynamic instability [13.9%] while those presenting with the three admission criteria were [8.1%]. There is a statistically significant relationship between type of poison and admission criteria where all digitalis poisoned cases were admitted with hemodynamic instability [100%] while a high proportion of anticholinesterase poisoned cases were admitted for both hemodynamic instability and altered mental status were [67.6%]. As regards the poisoning characteristics, the present work shows that suicidal cases who were admitted due to hemodynamic instability were [66.7%], ingestion of solution form of poison, represented in both homodynamic instability and altered mental status were [62.3%] and high percentage of patients that were transported by ambulance were admitted due to both haemodynamic instability and altered mental status [85.7%]. Regarding the discharge criteria from ICU, the present study revealed that the patients who were discharged due to death represented [19.76%] of cases. Discharge of patients as hemodynamic instable [in the form of no need for mechanical ventilation, normal ABG] were [26%], controlled arrhythmia [7.2%], shocked patients discharged with no need for inotropic drugs [5.8%]. The patient who were admitted to ICU due to altered mental status and didn't receive mechanical ventilation were discharge as fully conscious [alert and aware] and represented [76.8%] of ICU discharged cases. This study revealed that an ideal ICU must be available in each PCC [poison control center] and ICU admission and discharge criteria are an important part of clinical evaluation for acutely poisoned patients in emergency room

Genetic and anthropometric studies of Prader-Willi syndrome

This study included 26 Prader-Willi syndrome [PWS] cases. Full clinical examination, pedigree analysis and intelligent quotient [IQ]were carried out. Fifteen anthropometric parameters, including longitudinal and transverse body and head measurements as well as two derived indices, were taken. Cytogenetic studies using G-banding and high resolution techniques were performed. According to chromosomal profile, the cases were divided into three groups: Cases with 15q deletions, cases with normal chromosomes and cases with chromosome 15 rearrangements. The study showed that the most characteristic anthropometric finding of PWS was truncal obesity and the variability in chromosomal pattern had no marked influence on the anthropometric findings. The cytogenetic results suggested that PWS is due to chromosome 15 imbalance

medico legal study on cases of blunt chest injuries referred to menoufiya University Hospital in one year [2000-2001]

Chest trauma is one of the most common injuries either as isolated injuries or in polytraumatic patients. The study was carried out on all patients received or referred to Menoufiya University Hospitals [MUH] with blunt chest injuries during the period of the study in order to study the magnitude of the problem from it's different medico-legal aspects. A clinical sheet was filled for each injured case including all personal data, the clinical examination, radiological investigations and the follow up of the cases till their discharge. 200 injured patients with different chest trauma were examined by Forensic Med. and Clinical Toxicology Department from the first of June 2000 to the end of May 2001 [study period], and 163 cases of them were blunt chest trauma. They were 104 males and 59 females with a sex ratio [1.8:1]. 1] The maximum number of the injured male patients was encountered in the age group 15->25 years old and in females it was in age group 35<45 years old. The least number of the cases was in the age group <5 years among both sexes. As regard the marital status singles [56.4%] outnumbered married ones. The study revealed that nearly half of the cases [49.1%] were illiterate and mostly manual workers. More than half of the cases [58%] were transported by ambulance and the arrival of the cases to the hospital was mainly in the morning shift. Chest injuries were more common in rural areas [62.6%], than in urban areas and 75% of injuries were due to assaults and the rest of the cases were accidental injuries, most of them were due to motor vehicle accidents. As regard the site of injuries, the commonest site was the front of the chest [59%] and [41%] of injuries were present in the back. Contusions were the most common type of lesions [60%] followed by abrasions [33%] and lastly contused wound [7%]. Associated chest and other regional body injuries were more common than isolated chest injuries [74% - 26%] respectively. The most common combinations were blunt injuries in different regions of the body [the upper limbs 35%, head injuries 22% followed by abdominal injuries 10% and lastly with lower limbs 7%]. X-ray was done in about 29% of the cases and it was free in more than half of them. Isolated rib fracture [14%], rib fractures with pleural injuries [3.5%], pleural injuries without rib fractures in the form of haemothorax, pneumothorax, and haemo-pneumothorax [21%], and isolated clavicle fractures [8.5%] were the main radiological findings. The study revealed that 69% of the injured patients were managed in the emergency room as outpatient and discharged immediately. The remaining cases [31%] were admitted and discharged later on. The mortality rate was 6% most of them were in a very bad condition at the time of arrival. Recommendations: to minimize the complications and mortalities of chest injuries the following is advised: Well equipped ambulances for rapid and save transportation with well trained ambulance and emergency personnel should always be available. Also more strict law enforcement with severe penalty is suggested for disobeying speed limits and traffic safety rules. The risky injured cases should be referred to the highly equipped hospitals,. Also more educational programs indicating the correct dealing with the cases of chest trauma should be done

medico-legal study at abdominal injury cases referred to Menoufiya University Hospital over one year [incidence type site, cause, associated injuries, management and outcome]

Abdominal injuries have a specific character as a very minimal or non-apparent external injuries may be associated with severe internal damage to solid or hollow abdominal organs. So trauma to the abdomen is dangerous and often life threatening. The present study aimed to throw light upon the incidence, the type, the site, causative instruments, associated injuries, management and outcome of abdominal injuries over one year from first of April 2000 to the end of March 2001. A clinical examination sheet was filled for each case including all personal data, clinical examination, investigations and follow up of the patients till their discharge. Two hundred and sixty cases of different abdominal injuries were referred to Forensic Medicine andClinical toxicology Department in Menoufiya University Hospital during the period of the study. They were 193 males and 67 females with a sex ratio 2.88:1.The highest number of injuries was in the age group 15-<25 years [32.3%] followed by the age group 25-<35 years old [21.9%] and the least number was in the age group less than 5 years old [2.3%]. The study revealed that the less the level of education the more the incidence of injuries due to assault as the highest number of cases were illiterates [40.4%] and only the least [10.8%] were university educated. Most injuries were encountered among un-employed patients [50.4%] and the least was met with in the professionals [11.2%]. As regards the residence or district, the large number of patients came from rural areas [68.5%] while only 31.5% came from urban areas. Regarding the circumstances of injuries the study showed that abdominal injuries due to assault were more than the accidental cases [68.8%, 31.2% respectively]. A significant relation between the circumstances of injuries and the age and sex of patients was present where accidental causes of injuries were more than assault in the age groups less than 15 years old and the reverse was in the age groups > 15 years old. As regards the sex, assault cases outnumbered accidental cases in both sexes. The commonest causative instruments were blunt objects [55.4%] followed by mobile vehicles [27.3%] followed by sharp cutting instruments [14.2%] the falling from height 1.9% and lastly firearm injuries were only 1.2%. Regarding the type of the lesion, contusions were present in about 35.4% of the cases followed by abrasions [26.9%], then contused, incised and stab wounds were 10%, 5.7%, 3.5% respectively, while firearm lesions were 1.2% only. The commonest site exposed to trauma in the abdomen was in the front [45%] while the injuries in the back were present in 33.9% of cases. Injuries in both front and back of abdomen were present in 9.6% and no apparent injuries were seen in 11.5% of the cases. The study showed that cases of abdominal injuries per-se were 46.6%, while abdominal injuries were associated with limb injuries in 20%, with head injuries in 13.9%, and with chest injuries in 8% of cases. Majority of cases were treated as outpatients [64.2%] most of them were due to assault, while 32.37% of cases were admitted in the hospital most of them were accidental injuries.50.6% of all inpatient cases were discharged without any surgical interference within 24 hours or more as their abdominal ultrasounds were free while 49.4% of inpatient cases were explored and all of them showed internal injuries. Solid organ injuries were in 42.86% of all admitted cases while gastrointestinal injuries were found in 30.95% of cases. 4.76% of cases showed diaphragmatic injuries. Abdominal wall and vascular injuries were 2.38%, and 4.76% respectively. Multiple internal injuries were present in 14.29%. Mortality rate was 8.85%. Most of these cases sustained fatal abdominal injuries were polytraumatic. Conclusions and Reconimendations: - Age, gender, education, occupation, type. and cause of mortality associated with abdominal injuries. So interventions to minimize the complications and mortalities of abdominal injuries should focus on: More efforts should be done to decrease the incidence of illiteracy and get rid of unemployment, more strict law enforcement with severe penalty is suggested for carrying sharp or firearm weapons illegally, and also for disobeying speed limits and traffic safety rules. Also dangerous injured cases should be referred as early as possible to the highly equipped hospitals

Premarital genetic investigations: effect of genetic counselling

Over a period of 2 years, 86 couples [172 cases] were referred to the genetics clinic of the National Research Centre for premarital genetic counselling. About 73.25% had a family history of different genetic disorders. Consanguinity was found in 86.04%. Genetic investigations revealed chromosomal abnormalities in 26 cases [15.11%]; 23 cases [13.37%] had other abnormal results. After genetic counselling, postconceptional follow-up was carried out for 30 couples; 10 of them required amniocentesis that showed abnormal fetuses in 2 mothers. Other couples had normal offspring. We conclude that premarital genetic counselling is of great use in the detection of genetic disorders and is an essential step in changing attitudes towards premarital testing and reducing consanguineous marriage