Characteristics of abuse in children: a prospective medico-legal study in Menoufia university hospital during the year 2009

Child abuse is a serious worldwide problem and can be difficult to detect. This work aimed at screening and evaluating the medico-legal aspects of child physical and sexual abuse cases received at Menoufia University Hospital asking for medico-legal report during one year [2009]. The present study was carried out on child abuse cases that came with one of their care taker to issue a medicolegal report in claim for others. Claims were for physical or sex abuse. Physical abuse [130 cases] was represented by 73.1% for males and 26.9% for females. Most of the cases [73.1%] wee in the age group >12-<18 years old, while 22.3% were between 6-12 years old and 4.6% were below 6 years old. Bruises represented the highest percent 26.2% while stab wound was the least [1.5%]. More statistical evaluation of the data showed that there were no significant differences between females and males regarding different age groups, type and site of injury and instrument used. Mean while females were significantly highly exposed to head and neck injuries in age group < 12 years than in females > 12 years old. At the same time females were significantly submitted to head and neck injuries than males in the age group < 12 years and to mixed sites injuries in the age group >12 years. Assailants were mainly one of the parents [70.8%] then relatives [16.9%] and stranger [12.3%]. Sexually abused children [5 cases] were mainly < 6 years [80%] and those of the age group > 6-12 were 20%. Males were 40% of the cases while females were 60%. General examination was negative in 60% of cases, while abrasions and scratches were equally represented with 20% for each. Local examination was negative in 40% of cases, while 40% showed dilatation of the anal sphincter in one male and in one female. One female case [20%] showed severe tear in the perineum and posterior commissure. Offenders of the sex abuse children were mainly relatives [80%] and only 20% a stranger [nonrelatives] that could be known to the child. The study throws light on the magnitude of the child abuse problem in the society and the importance of multi disciplinary study by different specialties. More evaluation is needed and pediatricians, orthopedists and family physicians should be oriented of the possible mimics of the child lesions that raise the suspicions for child abuse and reporting for them. Media and teaching programs should stress on the problem and its deleterious results onto the child health and futures and for the community on the instant and on the long run

Toxic coma characteristics and predictors of outcome in cases admitted to Menoufia poisoning and addiction control center [MPCC]

Although the incidence of poisoning is difficult to estimate accurately, the wide availability and accessibility of chemicals and their extensive use in a variety of applications including medicine, agriculture and industry, has increased the risk of poisoning. Severely ill patients from different toxic substances may need intensive care unit [ICU] admission for different causes including coma. Reed Coma Scale was found to be appropriate for classification and prediction of severely poisoned cases. The present work aimed at describing the demographic and clinical characteristics in toxic coma cases, and to identify and evaluate predictors of outcome. All toxic coma cases admitted to MPCC through a period from 1-1-2009 to 30-6-2009 were evaluated. The toxic coma cases were further studied by statistical tests [X2, and multivariate linear regression analysis]. Out of 769 poisoned cases, 60 cases [7.8%] were found comatose. Males surpassed females. Toxic coma cases were prevalent in the age group 18 -50 years [43.3%] followed by age group < 7 years [26.7%]. Rural cases performed 90% while urban cases were 10%. Single cases represented 66.7%. Correlating mode of poisoning to age and sex showed significant prevalence of suicidal in females and accidental mode in males. Grades of coma using Reed's classification correlated to type of poisoning showed prevalence of GIV in snake and insecticide poisoning and G I, II and III in food poisoning, drugs and insecticides respectively. Metabolic acidosis was significantly correlated to drug poisoning and agrochemicals [dormex], while hypoxia and respiratory acidosis were significantly associated with Co poisoning and snake bite. ECG changes showed tachycardia and atrial fibrillation in association to snake bites, drugs and insecticides. Meanwhile bradycardia was associated to dormex. Mortality rate was 20% of all toxic coma cases. Fifty percent of fatalities were in age group 18 - 50 years old while all toxic coma cases above 50 years had died. Studying predicting factors of outcome in toxic coma showed that age group 18 - 50 years was two times risky than 7-18 years. Snake bite, insecticides and dorm ex, grades III and IV coma were significant risk factors. Also accidental mode of exposure was found to be significant risk factor. Age group 18-50 years, snake bite, insecticides and dormex, coma grades I II and IV and accidental mode of poisoning were the most significant risk factors in the outcome of toxic coma. So study of characteristics of toxic coma cases together with identification of the most risk factors correlated to outcome, that will help in the prediction of outcome and elucidate the intensive measures that could be taken to improve the outcome as well as decrease the burden of the costs to the patient and the community

study of self- deliberate poisoned cases admitted to Menoufiya poisoning control center MPCC over one year [2004]

Suicide can be conceptualized as deviated behavior to way out of a problem that is causing suffering, associated with feelings of despair and hopelessness. Deliberate self poisoning is a frequent mean for committing suicide worldwide and in developing countries. Progress continues in research into the biological, psychological and social causes of suicide. The aim of the study was to provide socio-demographic circumstances, clinical severity characters, psychiatric assessment and outcomes of intentional self poisoned cases. The study was carried out on suicide poisoned cases [232 cases] admitted to Menoufiya poisoning control center throughout the year 2004. The study reflects the prevalence of suicide poisoned cases that represented 12.35% of all admitted cases [1852 cases] despite of the behavior, psychic built of Egyptian community and the religious factors that condemn for committing suicide. The highest rate of admission was during September. The most vulnerable age group was that of l9-<36years commonly female gender and singles. 52.6% of the represented cases were unemployed. So stress in society affecting the most vulnerable sensitive young adults, who are usually have little experience in dealing with problems e.g. as failure in love affair or forcing a female to go married to a dislike person are the factors attributable to the problem. Suicidal cases from rural and urban areas were nearly equal. 99.2% of the studied cases committed suicide in the victim's home by oral ingestion and most commonly by cholinergic insecticides. 43.9% of the cases were more significant at age group 7-<19 years while significant use of drugs to attempt suicide was at age group >50 years. The majority of cases in this study were of mild clinical severity [71.1%] and cholinergic insecticides poisoning was significantly represented with all clinical severity grades [mild, moderate and severe]. The high percentage of mild cases and the low I mortality rate [0.86%] may indicate that most of the studied cases didn't really want to kill themselves but only aimed at gaining attention. The present study revealed significant increase of emotional motives for suicide in females in age group 7-<19 years as within this age group; there are many emotional and psychological changes and troubles to females rendering them prone to suicidal tendency. Psychopathological study by psychiatrist was done on 193 cases i.e 83.2% of the total self-deliberate poisoning cases. 24.9% of psychoanalyzed cases had planned for suicide while 75.1% of the studied cases were impulsive. Most of the cases had mild attempt degree, believed that they would be saved [60.1%], [62.7%] respectively. Only 5.2% of the studied cases had previous suicide attempts. The present study revealed that about half of the psychiatric studied cases [50.3%] had depression and 37.3% suffered from agitation. This confirms the strong relationship between suicide and depression. 60.4% of the cases in the present study revealed psychiatric disorders in the form of affective disorder, personality changes and psychotic changes [26.4%], [18.8%] and [13.9%] respectively. So patients who attempt suicide may have psychiatric illness and need careful psychiatric evaluation with treatment before discharge. Regarding family history for psychiatric disorders and suicidal attempts, the present study revealed that 22.8% of the studied psychiatric cases had family history for suicidal attempt, and 18.6% of cases had members of their family received psychiatric treatment. This may reflect genetic predisposition for attempting suicide. So, it is recommended to alarm the people about the dangers of drug overdoses and the toxicity of cholinergic insecticides with restriction of the use of the dangerous toxic types for licensed especial issues. Also, self-deliberated poisoned patients are determined as medically fit for discharge by both toxicologist and psychiatrist Researches to improve management and find out ways of reducing deliberate self harm are urgently required. Keywords: self- deliberate Poisoning - suicide - demographic - cholinergic insecticides. Psychiatric

Estimation of time passed since death by ultrastructure, histopathology and DNA degradation detection by gel electrophoresis in albino rats

The estimation of postmortem interval [PMI] is of great importance in both criminal and civil cases. However this aim remains critical, difficult if not impossible but an imprecise task in forensic investigation. While the traditional thanatochronological changes upon the dead had been used for estimation of PMI inaccurately, advances in molecular biology, have propelled the analysis of DNA to criminal laboratories. Upon the death of an individual, internal nucleases contained within the cell should cause chromosomal DNA to degrade into increasingly smaller fragments over time that can be used as a predictor of PMI. Liver cells for being rich in nuclear DNA and mitochondria were proved to be the best material for the purpose. The aim of the work was to determine the time passed since death by measuring the rate of DNA degradation in samples of livers of albino rats at different post mortem intervals by using gel electrophoresis method, and to asses the changes of liver cells by histopatological examination at the same periods, with exploring the nature of the post mortem liver cell changes by using the Transmission Electron Microscope [TEM]. Passive engorgement of the sinusoids and extravasations of blood elements appeared early after death in histopathology then cell necrosis, shrunken cells, and apoptotic bodies were increasing by time. TEM examinations revealed the presence of chromatin condensations and fragmentation of the nuclear material. Finally cell lysis and apoptotic bodies appeared while cell necrosis was prominent. Electron microscope could add much to understanding postmortem cellular changes, also assessment of the relative existence of necrosis stages in histopathology might help in identifying PMI. The Gel Electrophorsis detection, measurement and analysis by computer pro analyzer revealed the presence of sequential relationship between DNA degradation level and time passed since death at the DNA visualizing positions [200 bp, 400 bp, 600 bp] up to 24 hours. Statistical evaluation showed a highly significant dependence of DNA degradation on time with P < 0.001. By using linear regression analysis an equation to define the time passed since death could be conducted where: Time after death=[DNA degradation - constant] / B. So it is recommended to apply the method of the gel electrophoresis to detect time passed since death by measuring DNA fragmentation from liver cells. These mathematical relations offer a simple and valuable means of estimating the PMI, and its validity should be tested for human being

study on cholinergic insecticide poisoned cases admitted during 2002 to Menoufiya poisoning control center [MPCC]

Organophosphates and carbamates are the most frequently used insecticides worldwide. The aim of the present work is to study the problem of cholinergic insecticides among the patients admitted to MPCC, The study included 465 cases where it is clear that the cholinergic insecticides poisoned cases represented about quarter of the total number of poisoned cases admitted to MPCC during the year of 2002. The highest rate of admission was in the summer months specially June and July due to the prevalent use of pesticides during the summer season for agricultural demand. 49.6% of cases were between the ages of >18-50 years which is the age group of field working and handling of the pesticides. As regard the sex, females showed slightly higher% age [56.99%] than males [43.01%]. Patients from rural areas showed% age [66.23%] than those from urban ones [33.76%] due to conducting the study in agricultural governorate. Single subjects were [87.1%]. 60.43% of the total cases were affected indoors which may be secondary to improper storage and illegal use of insecticides. Males were more affected than females outdoors in the age group of 18-50 years due to the fact that in this age group males are exposed in farms as most of the cases were in the rural areas. As regards to the circumstances of poisoning, it was found that accidental cases had the highest% age [72.69%] which was mainly in farmers, while suicidal cases were [26.88%] which was mainly in students and females at the age group of >18-50 years. This age in the female represents the age of changeable emotional and psychological factors together with the exposure to educational, marital andsocio-economical stresses. Oral route represented the highest% age [64.5%] of cases. Females were significantly higher than males at age group of >18-50 years in taking the pesticides orally for committing suicides. As regards frequency of clinical manifestations among studied cases, it appeared that latent cases were [35.7%] of cases, the main manifestations were muscarinic [64.3%] especially constricted pupils. Patients with predominant nicotinic manifestations represented [21.9%], and [16.3%] of cases were unconscious. The severe cases were higher in children less than 7 years. It was found that cholinesterase activity is not sensitive test to measure severity of the poisoning if it is less than 10%, but it is highly specific test [98.4%] in exclusion of poisoning, if its activity is more than 50% of normal value. Analytical toxicological screening by TLC showed [8 1.93%] of cases were +ve for organophosphates, [11.82%] of cases were +ve for carbamates while [6.25%] of cases were +ve for both of them. As regards the MPCC schedule of treatment it is clear that emesis, activated charcoal and cathartics were the most common lines used in 35.7% of cases. 28.8% of cases had gastric lavage activated charcoal, cathartics and atropine. As regarding physiological antidotes, 64.3% of cases received atropine and only [1.72%] of cases were given atropine and pralidoxime, all cases received supportive treatment. As regard period of admission, the highest% age of cases [69.89%] were discharged after one day admission, [28.81%] were discharged after 2-7 days and [1.29%] after more than one week. Prognostic data showed that [96.6%] of cases were discharged with complete cure and only very low or even negligible fatality [0.4%], this may be attributed to the well organized medical facilities and the increasing experience of the medical staff in the diagnosis andtreatment of pesticide poisoning. It is clear that early ambulance to the hospital, rapid approach to diagnoses and management, are mandatory for the best outcome of the cases. it is recommended to apply laws, which limit the use of these pesticides, and their manufacture in strict circumstances, to lessen their hazards