Retrospective and statistical study of pattern of acute poisoning among cases presented to emergency department of kafr el - sheikh governorate hospitals

Background: Acute poisoning is a common situation in emergency departments all over the world. It may cause severe complications and death. Treatment of these cases requires great medical care and significant costs. There are many differences with respect to the pattern and cause of acute poisoning between geographical regions, even within the same country

Objective: This study was carried out to assess the pattern of acute poisoning with drugs, chemicals and natural toxins in both adults and children in Kafr El - Sheikh Governorate hospitals

Methods: The study was conducted onacutely intoxicated cases admitted to some of Kafr El - Sheikh Governorate hospitals. The medical records of cases who were admitted due to acute poisoning from January 2015 to January 2017 were reviewed retrospectively

Results: This study included 1046 acute poisoned cases presented to ED. There were 85% less than 6 years old and 15 % more than 12 years old. .Number of males with toxic exposure was 421 while that of females was 625. Pharmacological agents, constituted the highest percentage of the poisoning [28.92%], followed by Insecticides [24.4 %], household products [20.45 %], food poisoning [12.5 %] and animal poisoning [8.03%].The majority of cases of acute poisoning were accidental [78.01%], followed by attempted suicide [21.98%].The majority of cases stayed at the hospital [51.9 %], while [40.8 %] Discharged from ED and about [7.2%] referred to nearest poison centers. 1027 patients [98.18%] recovered, only 1.3% developed complications

Conclusion: Accidental poisoning is still a significant cause of morbidity. Regarding the high prevalenceofpharmaceuticaldrugandhouseholdproductspoisoninginchildren, implementation of legislations to ban over the counter selling of medications and to sell potentially dangerous chemicals in childproof containers is recommended. Improving proper and complete medical record-keeping is also suggested for a better information access

Duodenal tube test in the diagnosis of biliary atresia

Biliary atresia [BA] is a main cause of severe liver damage in infants. Successful surgical treatment is related directly to the early and rapid diagnosis. The aim of this study was to determine specificity, sensitivity and predictive value of duodenal tube test [DTT] in diagnosis of biliary atresia in a series of 20 infants with cholestatic jaundice. The inclusion criteria include a clay coloured stool and a direct bilirubin level > 2mg/dL. The study protocol include thorough history and clinical examination liver function tests complete blood count, abdominal ultrasound. TORCH screen, HIDA scan and percutaneous liver biopsy. A nasoduodenal tube was placed at the distal duodenum and the fluid was collected by gravity every 2 hours for 24 hours. DTT was considered bile positive when yellow biliary fluid was observed. The patients with bile +ve DTT were not explored surgically and cholestatic workup was completed. Laparotomy and ultra-operative cholangiography was indicated for bile -ve DTT patients and porto-enterostomy was done when biliary atresia was identified. The result of the study show that 13 cases were Bile -ve DTT and 7 cases were Bile +ve DTT. Sensitivity, specificity, positive and negative predictive values of DTT vsHIDA scan were 85%, 71%, 80% and 85% respectively. Sensitivity, specificity, positive and negative predictive values of DTT vs percutaneous liver biopsy were 87%, 100%, 100% and 71% respectively. Lastly all of these 4 parameters were 100% on comparing DTT with intra-operative cholangiography

Role of helicobacter pylori infection and autoimmunity in chronic idiopathic urticaria

Urticaria is a vascular reaction characterized by transient erythematous or pale swellings of skin and/or mucous membrane representing localized edema caused by dilatation and increased permeability of capillaries and venules result in leakage of plasma into the surrounding connective tissue, marked by development of wheals. If edematous process extends through the dermis into subcutaneous or sub mucous tissue it results in angioedema. Wheats and angioedema often coexist in the same patient but may occur separately. During the last few years some authors reported their experience about cases of CIU related to presence of Helicobacter pylori [Hp] infection. Hp is a micro aerophilic gram positive bacterium, periodic infection with which is associated with reduced gastric acidity secretion where as chronic infection with Hp is associated with increased secretion of acid and pepsin. However recent study found that no relation between Hp infection autoantibody productions in CIU could be proved using direct measures of serum antibodies. Was to evaluate the role of autoimmunity and Helicobacter pylori infection in cases of chronic idiopathic urticaria. Forty patients with chronic urticaria [recurrent hives lasting 4 to 36 hours occurring at least four times/ week for six weeks] were enrolled for this study. All patients were subjected to the following: history taking included, general examination, skin examination, routine laboratory tests and specific tests included: Autologous Serum Skin Test [ASST], Antithvroicl peroxidase autoantibody test [TPO] and Helicobacter pylori IgG antibody test. Forty patients with age ranged between 17 and 58 years, the highest frequency was encountered in age group of 21- 30 years. The control subjects were age matched ranged between 18 and 50 years. Routine laboratory investigations showed no significant findings in CBC, SGPT, serum creatinine, urinalysis and stool analysis. Only ESR was significantly higher in cases of CIU than in control subjects in both first and second hour. Moreover, ESR was significantly higher in patients with positive ASST than those with negative ASST in both hours. The ASST was positive in 4 patients [10%] all of them were females, and negative in 36 patients [90%]. Serum level of TPO was significantly higher in patients with positive ASST than those with negative ASST. Hp IgG level in the sera of patients with CIU did not reveal a significant difference with that of the control subjects. The gastroscopic examination revealed that 55% of patients with CIU had Hp gastritis [only 25 out of 40 patients underwent gastroscopy]. In most patients with chronic idiopathic urticaria, no underlying disorders or cause can be discerned. Diagnostic studies should be directed by the findings elicited by the history and physical examination. There is no recommended standard diagnostic laboratory evaluation for CIU, and routine laboratory tests seems to be of limited value

Study of apoptosis inducing Fas receptors on T and B lymphocytes, soluble Fas and caspase 3 in type 1 diabetes mellitus

Aim: The aim of this work was designed to assess the expression of Fas receptors on T and B lymphocytes from patients with type 1 diabetes mellitus at different stages of the disease and to analyse the role of the soluble isoform of Fas and caspase-3 in Fas mediated apoptosis of T and B lymphocytes. Subjects and this study was carried on 21 type 1 diabetic patients divided into two groups: newly diagnosed [ND] and longstanding [LS], and 10 normal subjects as control group. All patients were subjected to thorough history taking, clinical examination, and laboratory investigations [fasting blood glucose and glycated haemoglobin], Immunofluorescence staining and flow cytometry analysis for Fas receptors on T and B -lymphocytes was done. Soluble isoform of Fas [S-Fas] was measured in the plasma by Elisa, and caspase-3 activity was assessed by colorimetric chemical method. Fas receptors: expression on T lymphocytes was significantly decreased among ND diabatic patients than LS and normal controls [P<0.001 and P < 0.049] and the percentage of T cells expressing Fas receptors was significantly increased in ND diabetics versus LS and controls [P = 0.000 and P= 0.000]. The soluble isoform of Fas was significantly increased in ND diabetic patients as compared to LS and control groups [P =0.000 and P< 0.015]. There was a positive correlation [r=0.750, P= 0.000] between Fas receptor expression as mean fluorescence intensity ratio of T cells and that of B cells and a negative correlation with s-Fas [r= 0.750, P= 0.000 and r= -0.540, P=0.004 and r= -0.573, P=0.002, respectively] in diabetic patients. Conclusions: Defective apoptosis of peripheral lymphocytes is well documented and clearly expressed both at the cell membrane Fas receptors and plasma s-Fas levels in ND type 1 diabetic patients. So, it is likely that defective Fas-mediated apoptosis of peripheral lymphocytes may contribute partly to loss of tolerance seen in type 1 diabetes mellitus

Granulocyte macrophage colony stimulating factor as a marker for neonatal sepsis

To evaluate Granulocyte Macrophage Colony Stimulating Factor [GM-CSF] as an early marker of neonatal sepsis.: forty-five newborn infants of varying gestational age were included in the study. Thirty-five neonates with suspected sepsis [group I] were classified according to the results of blood culture into: subgroup Ia: 17 infants with positive blood culture and subgroup Ib: 18 infants with negative culture. Ten healthy neonates served as control group [group II]. The GM-CSF level was measured in all the studied subjects. Comparison of mean GM-CSF levels by group was accomplished by an analysis of variance.: the mean GM-CSF levels in subgroup Ia was significantly higher than that of subgroup Ib and II. The mean GM-CSF level in subgroup Ib was significantly higher than that in group II. The mean GM-CSF level was 45.76 pg/ml in subgroup Ia, 22.81 pg/ml in subgroup Ib and 6.40 pg/ml in group II [P<0.0001]. The GM-CSF level was positively correlated with the immature or band cell/total neutrophil ratio in subgroup Ia.: GM-CSF level represents a reliable early marker for neonatal infection