Retrospective analysis of an outbreak of scarlet fever in United Arab Emirates.

Background: Scarlet fever is an infectious disease caused by Streptococcus pyogenes. However, there is limited data regarding the disease in the Arab World, including the United Arab Emirates. Objective: To analyse a scarlet fever outbreak in United Arab Emirates. Methods: This retrospective cross-sectional study included scarlet fever cases diagnosed at the Kanad Hospital, Al Ain, United Arab Emirates in 2022 and 2023. Data were retrieved from the hospital records and analysed using SPSS version 23.0. Chi-Square, Mann-Whitney, and Monte Carlo tests were applied. Results: Two hundred and twenty-two cases (13.5% in 2022 and 86.5% in 2023) were confirmed (P<0.001). Majority (67.1%) of the patients were aged 3-6 years, with a mean age of 4.56 ± 1.99 years. Rash, fever and sore throat were observed in 100%, 99.1%, and 82.0% of cases, respectively. The majority (85.1%) were managed as outpatients and 77.0% responded to oral penicillin. Patients' age was not significantly associated with nonresponse to penicillin and in-hospital admission. The outbreak had winter and summer peaks, with the highest incidence occurring during January and February 2023. Conclusion: This study serves as a valuable reference for other studies, which should include antimicrobial susceptibility testing and the prevailing genetic variance of Streptococcus pyogenes.

Medicolegal analysis of physical violence toward physicians in Egypt.

This study analyzed physical violence against physicians in Egypt from a medicolegal perspective. 88%, 42%, and 13.2% of participants were exposed to verbal, physical, and sexual violence. Concerning the tools of violence, 75.2% of attackers used their bodies. Blunt objects (29.5%), sharp instruments (7.6%), and firearm weapons (1.9%) were used. The commonest manners of attacks were pushing/pulling (44.8%), throwing objects (38.1%), and fists (30.5%). Stabbing (4.8%) and slashing (2.9%) with sharp instruments were also reported. Traumas were mainly directed towards upper limbs (43.8%), trunks (40%), and heads (28.6%). Considering immediate effects, simple injuries were reported that included contusions (22.9%), abrasions (16.2%), and cut wounds (1.9%). Serious injuries included firearm injuries (4.8%), internal organs injuries (3.8%), fractures (2.9%), and burns (1.9%). Most (90.5%) of injuries healed completely, whereas 7.6% and 1.9% left scars and residual infirmities, respectively. Only 14.3% of physicians proceeded to legal action. The current study reflects high aggression, which is disproportionate to legal actions taken by physicians. This medicolegal analysis could guide protective measures for healthcare providers in Egypt. In addition, a narrative review of studies from 15 countries pointed to violence against physicians as a worldwide problem that deserves future medicolegal analyses.

Gastrointestinal decontamination using oil-based solutions in patients with acute aluminum phosphide poisoning: a systematic review and meta-analysis.

Some studies suggested that gastrointestinal (GIT) decontamination with oil may improve the prognosis of patients who ingested aluminum phosphide (AlP). The aim of this study is to compare the efficacy and safety of gastric lavage with oil-based solutions to any method of gastric decontamination not using oils in patients presenting with acute AlP poisoning. The literature was searched for English-published randomized controlled trials (RCTs) from inception to 16 September 2023. The searched electronic databases included MEDLINE/PubMed, Cochrane Library, Web of Science, Egyptian Knowledge Bank, Scopus, and Google Scholar. Data were extracted and pooled by calculating the risk ratio (RR) for categorical outcomes and standardized mean difference (SMD) for numerical outcomes, with 95% confidence intervals (CI). Seven RCTs were included. Paraffin oil was significantly associated with a lower risk of mortality (RR = 0.59 [95% CI: 0.45, 0.76], p < .001), intubation (RR = 0.59 [95% CI: 0.46, 0.76], p < .001) and vasopressor need (RR = 0.71 [95% CI: 0.56, 0.91], p = .006). Survival time was significantly prolonged with paraffin oil (SMD = 0.72 [95% CI: 0.32, 1.13], p < .001). Coconut oil was significantly associated with prolonged survival time (SMD = 0.83 [95% CI: 0.06, 1.59], p = .03) as well as decreased risk of requiring intubation (RR = 0.78 [95% CI: 0.62, 0.99], p = .04). Oil-based GIT decontamination using paraffin oil showed benefits over conventional lavage regarding the incidence of in-hospital mortality and endotracheal intubation, and survival time. Coconut oil showed some benefits in terms of the intubation incidence and survival time. Decontamination using paraffin oil is recommended. Future clinical trials are warranted with larger sample sizes and focusing on cost-benefit and safety.

Pathological causes of sudden death in autopsied children with reference to peculiar findings: An Egyptian perspective.

Childhood is a long period extending up to the age of 18 years. Childhood encompasses different developmental stages; each stage has specific characteristics. This 5-year study included 244 autopsied children who died unexpectedly due to natural causes. This study was conducted in the forensic pathology unit of the Egyptian Forensic Medicine Authority (EFMA). Pathological causes of death were diagnosed in 181 cases, representing nearly three-quarters (74.2 %) of cases. Males represented 60.8 % of these cases. More than half (51.4 %) of deaths due to natural disease occurred within the first month of life. The diagnosis was established for the first-time during autopsy in 58 % of cases. Prematurity complications and infections were the cause of death in 35.9 % and 30.4 % of deaths attributed to natural pathologies, respectively. Prematurity complications are the most common cause of death in perinatal (63.6) and neonatal (71.4 %) periods. Whereas infection is the most common cause of death during infancy (55 %), childhood (52.8 %), and adolescence (43.8 %). Pneumonia was the most common infection (61.8 %). This study highlighted cases with peculiar pathologies that include cardiomyopathies (idiopathic dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), and Arrhythmogenic right ventricular cardiomyopathy (ARVD)), Waterhouse-Friderichsen syndrome (WFS), ruptured cerebral cavernous hemangioma, and cerebellar medulloblastoma.

Evaluation of Global Dystonia Rating Scale as a predictor of unfavorable outcomes among acute antipsychotics poisoned patients.

Worldwide, acute antipsychotic poisoning results in high morbidities and mortalities. Though extrapyramidal syndromes are commonly associated, the extent of extrapyramidal syndromes in relation to the severity of antipsychotic poisoning has not been addressed yet. Thus, this study aimed to assess the Global Dystonia Rating Scale (GDRS) as an unfavorable outcomes predictive tool in acute antipsychotic poisoning. A cross-sectional study included 506 antipsychotic-poisoned patients admitted to Tanta University Poison Control Center, Egypt, over three years was conducted. The mean GDRS was 9.1 ± 16.7 in typical antipsychotic poisoning, which was significantly higher than that of atypical antipsychotics (4.2 ± 11.5) (p = 0.003). Patients with GDRS> 20 showed significantly higher liability for all adverse outcomes (p < 0.05). However, poisoning with typical antipsychotics was associated with significantly more cardiotoxicity (p = 0.042), particularly prolonged QRS (p = 0.005), and intensive care unit (ICU) admission (p = 0.000). In contrary to the PSS, which failed to predict the studied adverse outcomes, GDRS significantly predicted all adverse outcomes (p < 0.000) for all antipsychotic generations. In atypical antipsychotics, GDRS above three accurately predicted cardiotoxicities, prolonged QTc interval, and respiratory failure with Area under curves (AUC) of 0.937, 0.963, and 0.941, respectively. In typical antipsychotic poisoning, at higher cutoffs (7.5, 27.5, 18, and 7.5), cardiotoxicities, prolonged QTc interval, and respiratory failure were accurately predicted (AUC were 0.974, 0.961, and 0.960, respectively). GDRS is an objective, substantially useful tool that quantifies dystonia and can be used as an early reliable predictor of potential toxicity in acute antipsychotic poisoning.

Physicians' perspectives on different therapeutic approaches for aluminum phosphide poisoning and their relevant outcomes.

Background: Aluminum phosphide is a highly toxic pesticide that results in high mortality. To date, there is neither a definitive antidote nor a unified protocol for managing acute aluminum phosphide poisoning. Objectives: This cross-sectional questionnaire-based study aims to explore different management approaches and rely on the expertise of Egyptian medical professionals to enhance the prognosis for acute aluminum phosphide poisoning. Subjects and methods: A self-administered questionnaire was formulated and electronically distributed according to published literature and experience of senior physicians. Results and conclusions: Responses were received from 151 physicians from 10 governorates. Management modalities were variable among respondents. Noradrenaline was used by 90.7% of respondents with no fixed-dose regimen. In all, 84.1% of participants utilized oil in gastrointestinal decontamination; paraffin oil was the most used solution. Overall, 92.1, 61.6, 46.4, and 34.4% of participants used sodium bicarbonate, proton pump inhibitors, IV magnesium sulfate, and antioxidants, respectively. Regarding the frequency of acute aluminum phosphide poisoning, 47% of participants managed these cases daily or a few times a week. Participants' responses denoted a poor prognosis of acute aluminum phosphide poisoning, and high percentages attributed the prognosis to exposure factors rather than treatment modalities. Statistical analysis revealed that using oil in gastrointestinal decontamination improved the outcome by 4.62-fold. Clinical toxicologists were more likely to rescue ≥ 30% of the cases about 3-fold (2.97) than other specialties. Clinical toxicologists used oil in gastrointestinal decontamination, magnesium sulfate, and antioxidant therapy and calculated base deficit before administration of sodium bicarbonate by 7.70-, 5.30-, 3.26-, and 2.08-fold than other specialties.

The therapeutic benefit of antioxidants on the outcome of acute aluminum phosphide poisoning: a systemic review and meta-analysis.

This systematic review and meta-analysis pool evidence available from clinical trials to verify the effect of antioxidants on the outcome of acute aluminum phosphide (AlP) poisoning. A systematic review complied with "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) Protocols. Meta-analysis was conducted on 10 studies that fulfill eligibility criteria. Four antioxidants were implemented: N-Acetyl cysteine (NAC), L-Carnitine, Vitamin E, and Co-enzyme Q10 (Co Q10). Risk of bias, publication bias, and heterogeneity were assessed to ensure the results' reliability. Antioxidants significantly decrease mortality of acute AlP poisoning around three folds (OR = 2.684, 95% CI: 1.764-4.083; P < .001) and decrease the need for intubation and mechanical ventilation by two folds (OR = 2.391, 95% CI 1.480-3.863; P < .001) compared with control. Subgroup analysis revealed that NAC significantly decreases mortality by nearly three folds (OR = 2.752, 95% CI: 1.580-4.792; P < .001), and vitamin E significantly decreases mortality by nearly six folds (OR = 5.667, 95% CI: 1.178-27.254; P = .03) compared with control. L-Carnitine showed a borderline significance (P = .050). Co Q10 decreased the mortality compared with the control; however, the difference was not statistically significant (P = .263). This meta-analysis provides solid evidence regarding the efficacy of antioxidants in improving the outcome of acute AlP poisoning with reference to NAC. Wide confidence interval and small relative weight affect reliability regarding vitamin E efficacy. Future clinical trials and meta-analyses are recommended. To our knowledge, no previous meta-analysis was conducted to investigate the efficacy of treatment modalities for acute AlP poisoning.

Exploring research gaps and trends in the management of acute phosphide poisoning: a systematic review.

Metal phosphides are highly toxic pesticides that result in high morbidities and mortalities worldwide. This systematic review included 350 studies that fulfilled the eligibility criteria. There were significant rising trends of studies on acute aluminum phosphide (AlP) and zinc phosphide (Zn3P2) poisoning (p-values = <.001), pointing to an increased number of phosphide-intoxicated patients. Acute AlP poisoning studies represented 81%, 89.3%, and 97.7% of all descriptive, analytical, and experimental interventional studies included in this review, respectively. High AlP poisoning mortality explains great research interest in AlP poisoning. Thus, after 2016, nearly half (49.7%) of studies on acute AlP poisoning were issued. Also, 78.82% of experimental interventional studies on AlP poisoning were published after 2016. The trends of in-vitro, animal, and clinical studies on AlP poisoning significantly increased with p-values equal to .021, <.001, and <.001, respectively. Seventy-nine treatment modalities for acute AlP poisoning were pooled from 124 studies; 39 management-related case reports, 12 in-vitro studies, 39 animal studies, and 34 clinical studies. All therapeutic modalities were summarized to formulate an integrated and comprehensive overview. For clinicians, therapeutic modalities significantly decreased mortality of acute AlP poisoning in clinical trials included extracorporeal membrane oxygenation (ECMO), N-acetyl cysteine (NAC), vitamin E, glucose-insulin-potassium (GIK) infusion, fresh packed RBCs infusion, and GIT decontamination using oils. However, meta-analyses are needed to provide solid evidence regarding their efficacies. To date, there is no effective antidote nor evidence-based standardized protocol for managing acute AlP poisoning. This article outlined the potential research gaps in phosphide poisoning that might promote and direct future medical research in this context.

Experience of obstetricians and gynecologists in the management of medicolegal cases in Egypt.

BACKGROUND: Obstetrics and gynecology (OB/GYN) is concerned with both fetal and maternal wellbeing with doubled professional responsibilities. Also, OB/GYN specialists are engaged in management of medicolegal cases (MLC). This study had an in-depth look at handling of MLC by obstetricians and gynecologists in Egypt. Also, influence of religious and cultural norms on OB/GYN practice was investigated. METHODS: A questionnaire was formulated in compliance with literature and modulated according to religious and cultural background. RESULTS: Responses were received from practitioners in 19 governorates. 28% of respondents were accused of malpractice. 87.3% of participants denoted increasing rate of litigations over last years. The commonest mentioned error is intra-operative problems (60%), whereas the commonest harm is neonatal deaths (46.7%). The mean participants' awareness score regarding elements of malpractice was 1.49 ± 0.76 (maximum possible score is 4). 18.7% of respondents managed cases of sexual assaults and premarital sexual relations. Hymen repair is not justified by 53.3% of participants. Termination of pregnancy before 16 weeks without medical indication is unaccepted by 96.7% of participants. The mean participants' awareness score regarding precautions of therapeutic abortion was 3.34 ± 1.63 (maximum possible score is 5). CONCLUSIONS: OB/GYN specialists are at high risk of accusation with inadequate measures to guard against malpractice claims in Egypt. High controversy among respondents regarding management of cases with premarital sexual acts and termination of pregnancy was elucidated.

The possible thyroid disruptive effect of di-(2-ethyl hexyl) phthalate and the potential protective role of selenium and curcumin nanoparticles: a toxicological and histological study.

Di-(2-ethylhexyl) phthalate (DEHP) is one of the ubiquitous pollutants worldwide. This study aimed to clarify the potential thyroid disrupting effect of DEHP and explore the probable ameliorative effects of selenium nanoparticles (Se-NPs) and curcumin nanoparticles (CUR-NPs). Forty-two male albino rats were divided into seven groups (n = 6): Group I (negative control); group (II) orally received DEHP (500 mg/kg BW, dissolved in corn oil); Group (III) orally received Se-NPs (.2 mg/kg BW) in combination with DEHP; Group (IV) orally received CUR-NPs (15 mg/kg BW) alongside with DEHP; Group V (corn oil); Group VI (Se-NPs) and Group VII (CUR-NPs). The duration of the experiment was 30 days. DEHP administration significantly decreased serum free T4 and significantly increased serum free T3 as compared to control group, whereas thyroid-stimulating hormone showed no significant change. DEHP disrupted redox status leading to accumulation of malondialdehyde and depletion of reduced glutathione. Histologically, the effect of DEHP on thyroid follicles was confirmed by light and electron microscopic examination and morphometric analysis. Se-NPs slightly improved thyroid parameters as well as redox status. CUR-NPS reinstated the values of all studied thyroid parameters to nearly control levels. This research provides Se-NPs and CUR-NPs as novel protective agents against DEHP-thyroid disrupting effects.

Sengers syndrome: a rare case of cardiomyopathy combined with congenital cataracts in an infant: post-mortem case report.

Sengers syndrome is a rare autosomal recessive disorder caused by a mutation in the Acylglycerol Kinase (AGK) gene with subsequent mitochondrial dysfunction. It is a combination of cardiomyopathy, skeletal myopathy, congenital bilateral cataracts, and lactic acidosis following exertion. The current study describes an extremely rare case of Sengers syndrome that is diagnosed during post-mortem examination. A four-month-old female child underwent sudden cardiac arrest immediately following the induction of general anesthesia for lens extraction surgery. This infant was the first child born to healthy, non-consanguineous, Egyptian parents. There were unremarkable medical problems either during pregnancy or during delivery. This infant was born at term with a normal APGAR score and weight. She had congenital bilateral cataracts since birth, easily-fatigued, and delayed milestones for her age. A post-mortem examination revealed a hypertrophied heart that weighed 96.6 grams with left ventricular hypertrophy. The left ventricle free wall thickness was 1cm, and an interventricular septum thickness of 1.3 cm. Histopathologically, the myocardium showed myocytes disarray. Also, the myocytes were hypertrophied, and vacuolated. The Gömöri trichrome stain revealed vacuolated cardiomyocytes surrounded by collagenous connective tissue, and the Periodic Acid Schiff (PAS) stain excluded that these vacuolations were related to glycogen storage disease. Focal lymphocytic infiltrations were observed within the myocardium. Thus, Sengers syndrome should be taken into consideration as a possible diagnosis whenever a congenital cataract is present for clinical and medicolegal cases.

Bile pulmonary embolism-related sudden death following an abdominal firearm injury: An autopsy case report and review of literature.

Bile pulmonary embolism (BPE) is a rare type of non-thrombotic pulmonary embolism (NTPE). For bile emboli to pass through the bloodstream to the lungs, there must be a connection created between the biliary and the venous vessels. This article reports a fatal BPE in a 12-year-old child who died 14 days following an abdominal firearm injury. The right lobe of the liver had a yellowish-green stained lacerated track along with bile collection. Both lungs were congested with peripheral dark areas in all lobes. Microscopically, many interstitial pulmonary arterioles were occluded by bile emboli along with the presence of hemorrhagic infarcts. Other than the present case, only 21 cases of BPE were published in the literature until the present day. The history of hepatic trauma and/or hepatobiliary disease in association with pulmonary manifestations points to BPE as a possible diagnosis. However, visualization of bile emboli within the pulmonary vessels is pathognomonic for BPE.

Knowledge, attitude, and practice of forensic practitioners during COVID-19 pandemic in Arab countries.

COVID-19 pandemic burdens forensic practice worldwide. The experience of crisis management is a lesson learned that guides future preparedness for similar casualties. Thus, the present study takes an in-depth look at the knowledge, attitude, and practice of forensic practitioners during the COVID-19 pandemic in the Arab world. A comprehensive questionnaire was adopted in compliance with optimum international standards for the management of deaths during the pandemic. The survey was electronically distributed in 13 Arab countries. The responses were received from 29 forensic practitioners from 11 countries. Total median knowledge, attitude, and practice scores of respondents constituted 37.9%, 74%, and 36.8% of optimum scores respectively. Regarding knowledge, better scores are related to risk assessment and routes of exposure to Coronavirus, whereas, least scores were related to ventilation and negative pressure system. Most of the participants had a positive attitude, 85.2% were concerned about proper management of COVID-19 deaths, and 77.8% trusted the decisions of their teams. Considering practice, better scores are related to forensic staff competence, whereas, least scores were related to the implementation of ideal safety measures. Participants described the management process as useful (52%), reliable (35%), high quality (21%), and cost-effective (17%), however, they expressed challenges as staff infection, limited resources, and infrastructure issues. This survey guides readjusting of procedures and future preparedness for similar disasters in the Arab world. This research adopted a questionnaire that could be used in initial and periodic assessments in any medicolegal institute worldwide. Also, it could support infrastructure projects and disaster management plans.

Coronal and sagittal suture lengths as novel measurements for sex identification in a sample from the Egyptian population.

Sex estimation from isolated or fragmented bones is a cornerstone in medicolegal identification. The current study aimed to estimate sex from the lengths of the coronal and sagittal sutures in a sample of Egyptians. The study was performed on a total of 80 adult cadavers (48 males and 32 females) during a routine autopsy. After exposure of the skull vault, the lengths of the coronal and sagittal sutures were measured using a thread and a graduated scale. The mean length of the coronal suture was significantly higher in males (24.8 ± 1.4 cm) than in females (22.7 ± 1.4 cm). The mean length of the sagittal suture was significantly higher in males (11.9±1.6 cm) than in females (10.8±1.6 cm). This study used the lengths of the coronal and sagittal sutures as measurements for sex estimation for the first time. Receiver operator characteristic (ROC) curve analysis revealed that the combined coronal and sagittal sutures lengths were the best sex discriminator (AUC= 0.859), followed by the coronal suture length (AUC= 0.855), and sagittal suture length (AUC= 0.697). Moreover, regression analysis was performed for sex determination; the highest accuracy was obtained by an equation that included the lengths of the coronal and sagittal sutures together (76%); followed by the coronal suture length (75%); then the sagittal suture length (71%). These measurements are easily obtained during a conventional autopsy and this method of sex estimation is cost effective when compared to radiological and DNA analysis. Moreover, the measurements can be carried out on dry skulls as long as the vault has identifiable landmarks.

A Computed Tomographic Analysis of Spheno-Occipital Synchondrosis Ossification for Age Estimation in a Sample of Egyptians.

ABSTRACT: The aim of the present work was to create statistically quantified age estimation standards based on spheno-occipital synchondrosis (SOS) fusion state as visualized in computed tomography in Egyptians. The study included 208 Egyptians between the ages of 5 and 30 years (117 male and 90 female participants). Spheno-occipital synchondrosis was visualized in a midsagittal view in a neutral head position. Degree of ossification of SOS was assessed using a 4-stage system. Interobserver agreement and intraobserver agreement were almost perfect with Cohen κ values of 0.863 and 0.983, respectively. The mean ages of complete fusion (stage 3) were 20.36 ± 3.11 and 20.94 ± 4.06 years in male and female participants, respectively. Nonfusion (stage 0) was observed up to 15 and 13 years in male and female participants, respectively. Complete fusion occurred as early as 15 and 13 years in male and female participants, respectively. All subjects with nonfused SOS were minors (<18 years). A total of 87.9% of male participants and 85.3% of female participants with completely fused SOS were legally adults (≥18 years). Significant regression models were formulated to predict age from SOS fusion stage (adjusted R2 = 0.779 for male participants and 0.780 for female participants). Regression models predicted that male and female participants 18 years or older with 96.30% and 95.59% accuracy, respectively.

Prediction of zinc phosphide-induced hepatotoxicity and cardiotoxicity from clinical, laboratory, and radiological indicators.

Zinc phosphide (Zn3P2) is a phosphine-generating pesticide. Serious hepatotoxicity or cardiotoxicity might develop late in initially stable patients. The current prospective study aimed to predict Zn3P2-induced hepatotoxicity and cardiotoxicity. This prospective cross-sectional study included 150 patients admitted to the Alexandria Poison Center (APC) for over 6 months (from August 2018 to January 2019). The recorded patients' data included personal data, poisoning, medical history, clinical assessment using the poisoning severity score (PSS), investigations, and the outcome. The mean age of the patients was 23.36 ± 13.53 years. Females constituted 68.7%, and 76% of the patients ingested Zn3P2 deliberately. Only two cases that ingested the highest amount of Zn3P2 had radio-opaque shadows in the abdominal plain X-ray. The peak of clinical manifestations was in 12 h, whereas the peak liver transaminases (alanine aminotransferase (ALT), aspartate aminotransferase (AST)) and cardiac enzymes (creatine phosphokinase (CPK), creatine kinase-muscle/brain (CK-MB), troponin) were in 24 h. No fatalities were reported, 56.7% are completely cured, 37.3% are discharged on consent, and 6% are discharged with elevated liver and/or cardiac enzymes. The receiver operating characteristic (ROC) curve was applied. Persistent elevation of liver enzymes after 72 h could be predicted if the ingested amount > 3.5 (accuracy 86.2%), time till hospitalization > 5 h (accuracy 85.9%), PSS > 1 with (accuracy 58.9%), AST > 50 U/L (accuracy 86.2%), or ALT > 82 U/L (accuracy 86.3%). Elevation of cardiac enzymes could be predicted if the ingested amount > 2.5 sachets (accuracy 99.5%), time till hospitalization > 5 h (accuracy 99.7%), PSS > 1 with (accuracy 61.2%), CPK > 260 U/L (accuracy 99.9%), CK-MB > 6 ng/mL (accuracy 99.7%), or troponin > 0.9 ng/mL (accuracy 99.8%).

The efficacy of Coenzyme Q10 and liquid paraffin oil in the management of acute aluminum phosphide poisoning.

Aluminum phosphide (AlP) poisoning had high morbidities and mortalities with absence of a standardized approach for the treatment. The present study investigated the efficiency of GIT decontamination methods and Coenzyme Q10(Co Q10) (Ubiquinone) in improving the outcome of acute AlP poisoning. A total of 90 patients were included and all patients received immediately supportive measures, then they distributed into three equal groups: In group I, gastric lavage was done using KMNO4 solution (1:10 000); group II received 250-500 ml liquid paraffin oil orally; group III received 300 mg of Co Q10 dissolved in liquid paraffin. Co Q10 was continued in a dose of 200 mg/day every 12 h. Follow-up blood pressure, arterial blood gases, serum troponin level and need for intubation revealed that the best improvement was in group III followed by group II. The percentage of survivors was 76.67% in group III and 70% of the patients had no residual effects. In group II, the survivors were 63.33%, and 36.67% of the cases discharged without sequelae. The survivors in group I constituted 26.67% and only 16.67% of the patients had no residual effects. GIT decontamination with aqueous solutions in acute AlP poisoning should be avoided. Rapid oral intake of any available oil as a prehospital treatment or immediately on hospital admission could critically improve the outcome of acute AlP poisoning. Besides, the addition of Co Q10 to the oil further improve patients' prognosis. HighlightsAcute aluminum phosphide (AlP) poisoning is associated with high mortalities.The appropriate method of GIT decontamination in acute AlP poisoning is controversy.Conventional gastric lavage was associated with poor prognosis in acute AlP poisoning.GIT decontamination using liquid paraffin oil improved outcome of acute AlP poisoning.Coenzyme Q10 ameliorated AlP toxicity with improvement of cardiac functions.

Sex determination from chest measurements in a sample of Egyptian adults using Multislice Computed Tomography.

BACKGROUND: In forensic sciences to determine one's sex is quite important during the identity defining stage. The reliability of sex determination depends on the completeness of the remains and the degree of sexual dimorphism inherent in the population. Computed Tomography is the imaging modality of choice for two- and three-dimensional documentation and analysis of many autopsy findings. OBJECTIVE: The aim of the present work was to assess the reliability of Three-dimensional Multislice Computed Tomography (3D MSCT) to determine sexual dimorphism from certain chest measurements; sternum and fourth rib using the 3D MSCT and to develop equations for sex determination from these bones among adult Egyptians sample. SUBJECTS AND METHODS: The present study was performed on 60 adult Egyptians. Their age ranged from 21 up to 74 years and they were equally divided between both sexes. Sixty virtual chests (reconstructed Multislice Computed Tomography 3D images) were examined for detection of Sternal measurements; Manubrium length (ML), Sternal body length (BL), Manubrium width (MW), Sternal body widths(BWa&BWb), Sternal area (SA) [(ML + BL) × (MW + BWa + BWb)/3]and Fourth rib width (FRW). RESULTS: All the studied measurements were significantly higher in males than in females. Multiple regression analysis was used to and three significant regression equations were developed for predicting sex using the different studied chest measurements; the sternal measurements, the sternal area and the widths of the right and left fourth ribs with their accuracies 96.67%.95.0%.72.68% respectively. CONCLUSION: Sterunm and fourth rib width revealed significant metric sex differences with the use of Multislice Computed Tomography 3D images thus provide a great advantage in the analysis of skeletal remains and badly decomposed bodies.

The potential DNA toxic changes among workers exposed to antimony trioxide.

Occupational exposure to antimony has gained much interest when specific toxic effects were noticed among workers processing antimony. Thus, the aim of the present work was to investigate the potential DNA oxidative damage occurring among Egyptian workers occupationally exposed to antimony trioxide. The study was conducted on 25 subjects exposed to antimony trioxide while working in the polymerization process of polyester in Misrayon and Polyester Fiber Company, KafrEldawwar, Beheira, Egypt. Urinary antimony levels were assessed using inductive coupled plasma-optical emission spectrometry (ICP-OES) and considered as a biological exposure index. DNA damage and total oxidant capacity (TOC) were assessed using ELISA. DNA damage was detected in the form of increased apurinic/apyrimidinic (AP) sites among antimony trioxide-exposed workers compared to control subjects, but it could not be explained by oxidative mechanisms due to lack of significant correlation between DNA damage and measured TOC. Antimony trioxide might have a genotoxic impact on occupationally exposed workers which could not be attributed to oxidative stress in the studied cases.