Clinical application of mangled extremity severity score [MESS] among injured patiens attending emergency department at the main Alexandria University Hospital

Management of mangled lower extremity is one of the most challenging problems for a trauma surgeon. The decision of whether to amputate or not and when to amputate is a critical decision. It has surgical, medicolegal, social and psychological importance. Many scoring systems have been devised to facilitate the decision of amputation of an injured extremity. Mangled Extremity Severity Score [MESS] is one of the used scores and it is needed to be evaluated in our country. Of this study was to evaluate the validity of clinical application of MESS for mangled lower limbs and its predictive value in the decision making for injured cases. Fifty patients admitted to the emergency department of the Main Alexandria University Hospital were studied. They were assessed by MESS to have a provisional decision for amputation or conservative treatment. The final decision of conservative treatment or amputation was decided after complete investigations and proper evaluation. In five patients, trials of conservative treatment were done first. The utility of MESS for decision of amputation was assessed. The studied patients were 38 males and 12 females. Their ages ranged between 2.5 and 42 years with a median of 23. 7 +/- 18.]. MESS had a score 7or more than 7for 3lpatients with probability of amputation; and score less than 7 for 19 patients with probability of saving the limb. After complete investigations, trials of revascularization and proper evaluation; amputation was performed for 18 patients. Secondary amputation was done for five of them. The sensitivity of MESS on decision making for amputation was 58% and specificity of the scoring was 63%. Positive predictive value of MESS for amputation was 72% and negative predictive value was 68%. This study showed that MESS has limits for its usefulness and cannot be used as the sole criterion by which amputation decision can be made. With a cooperative multidisciplinary effort with close communication between the trauma, orthopaedic and plastic surgeons, the outcome of mangled lower extremity injuries can be optimized. More limbs could be salvaged by complete evaluation after necessary investigations, continuous surveillance and even operative exploration

Electrophysiological evaluation of nerve affection after trauma to the extremities

Evidence of peripheral nerve injury should be sought in all wounds of extremities. Nerve conduction studies [NCSs] and electromyography [EMG] are used to evaluate the nature of pathophysiology, and quantification of severity of involvement, detection of the level of neurological deficit and determining prognosis. The study was conducted to correlate between clinical examination and electrophysiological studies in diagnosis and prognosis of nerve affection. The study was conducted on 36 cases with trauma to the extremities referred to the Department of Physical Medicine. They were clinically examined and electrophysiological study was performed to every case including motor conduction of the relevant and contralateral nerves in addition to EMG of the relevant muscle. The mean age of patients was 30.11 +/- 13.23 years. 44.44% of cases were manual workers. 58.33% of the injuries were accidental, of these 33.33% were occupational accidents. The number of nerves affected in all cases was 49 nerves. The clinical evaluation revealed that 33.33% of cases had partial injury, while 55.56% had complete injury A percent of 11.11% of cases were considered to be clinically free, however the nerves were proved to be affected by electrophysiologic study. Electrophysiologically 80% of cases showed same nerve affection as showed clinically. 10% of cases showed multiple nerve affection electrophysiologically, while clinically they were diagnosed as single nerve affection. Ulnar nerve was the most frequent nerve affected in the studied sample. Evidence of reinnervation was detected in 35% of cases by electrophysiological studies, while clinically they were considered completely paralyzed. It was concluded that in every case of extremity injury requiring medicolegal evaluation, electrophysiological studies should be done beside the clinical examination to discover mild, subclinical or even unnoticed deficits of nerve affection to determine the prognosis

Evaluation of the severity of organophosphous insecticide intoxication using poisoning severity scoring, laboratory and therapeutic parameters

Organophosphorus [OP] compounds are the most widely used insecticides that cause poisoning after accidental, occupational or suicidal exposure. Poisoning is particularly common in the developing countries where more potent agents are widely available for agricultural and household purposes. The aim of the study was to evaluate the role of poisoning severity score [PSS], different laboratory and therapeutic measures in assessment of severity of OP poisoning, and to determine the need for intensive care management in cases of OP intoxication. One hundred patients suffering from acute OP poisoning were interviewed and categorized clinically according to PSS into three grades. Routine laboratory tests were done including arterial blood gases, random blood sugar and serum potassium on admission. Specific tests were estimation of pseudo choline sterase activity on admission and serum amylase on admission and after six hours. The studied patients received different lines of treatment in the form of general measures plus atropine or atropine and pralidoxime with or without assisted mechanical ventilation.55% of patients had the mildest degree of OP intoxication [PSS1], 31% had PSS2 and 14% were graded as PSS3. Significant correlation was detected between the degree of poisoning assessed by PSS and different laboratory investigations as well as the lines of treatment used. Cases having the highest score of severity [PSS3] had the lowest psudocholinesterase activity with more pronounced hyperglycemia, hypoxia, metabolic acidosis and hypokalemia. Acute pancreatitis occurred specifically in them. They needed atropine and pralidoxime in addition to assisted mechanical ventilation with longer stay in hospital than other cases. Accordingly, all these parameters including clinical scoring[PSS], laboratory findings and lines of treatment needed can be used for determination of the severity of OP poisoning. They are recommended to be applied in all OP-intoxicated patients

Intelligence quotient IQ in congenital heart disease in Alexandria

The study comprised 2 groups of patients with congenital heart diseases [CHD]; the first included 12 patients with cyanotic CHD and the second included 32 patients with acyanotic CHD. Their ages ranged between 2 and 27 years. Intelligence quotient [IQ] was measured for all patients as regards verbal, performance and full scales. In the cyanotic group, the mean IQ for verbal, performance and full scales were lower than those in acyanotic group, but without significant statistical differences. The IQ in the lower age groups were much lower in the cyanotic group. The greater number of patients in both groups were on the borderline. Patients with Fallot's tetralogy showed lower IQ scales than the other types of cyanotic CHD. Patients with pulmonary stenosis had higher IQ scales than the other types of acyanotic CHD

Evaluation of the sensitivity of different methods for detection of seminal stains

identification of seminal stain by finding spermatozoa has long been regarded as the best and most certain means of detection. When the demonstration of complete spermatozoa was impossible, especially in persons having azoospermia as a result of disease or vasectomy, several methods have been sought for seminal fluid identification. The study showed that Florence test remained positive till five or six fold dilutions. On the other hand, Barberios and dithizone tests retained their positivity till 10-fold dilutions. As regards thin layer chromatography, the Rf value of fresh seminal stains was significantly higher than that of old seminal stains in undiluted specimen, but both could be identified till 1:64 dilution. A high creatine phosphokinase activity was reported with both fresh and old seminal stains, but it was significantly higher with fresh than with old stains till 1:16 dilutions. The activity of CK in fresh seminal stains remained high for less than a week [6 days]. This indicated that the presence of high CK activity might provide additional evidence for seminal fluid identification