Cairo University, Faculty of Medicine, Forensic Medicine and Clinical Toxicology DepartmentThe Egyptian Journal of Forensic Sciences and Applied Toxicology1687-087522220220601Toxicity and suicidal tendency linked to the antiepileptic medications11523158710.21608/ejfsat.2021.79847.1203ENHoda Ahmed MohamedBasyoniForensic medicine and Clinical toxicology, Faculty of medicine, Cairo University, Egypt.Yasmin KamalAbdrabouforensic medicine and clinical toxicology kasr alainy cairo universityUsama MohamedEl-Barranyfaculty of medicine ,cairo universityEmanAbdelrasheedpharmacology department kasr alainy cairo universityHeba AbdoAbdel Razikforensic medicine and clinical toxicology kasr alainy cairo universityHeba MohamedAboubakrforensic medicine and clinical toxicology kasr alainy cairo universityJournal Article20210616Antiepileptic drugs (AEDs) are increasingly used, usually as an unlicensed usage, in patients with psychiatric disorders who are at increased risk of self-harm. This is expected to raise the likelihood that these drugs are used as means of overdose. Objectives: The current study was conducted to assess the AEDs–acutely intoxicated cases and to assess, in particular, the relation between the administration of antiepileptic drugs and committing suicide. Methods: The study included 127 cases who were intoxicated with antiepileptic drugs presented at national environmental and clinical toxicology research center (NECTR)for six months period from May to october2018. Data were analyzed with respect to socio-demographic data, primary data for patients' assessment, data concerning physical examination on admission, manner of overdose intake, status of admission, period of hospitalization and outcome. Results: The most common age group was those between 20-40 years with female dominance (75.6%). Carbamazepine was the most common ingested AED (73.2%). The most common manner of overdose intoxication was suicidal (73.2%) and most of cases were cured. Conclusion: Suicidal mode of AEDs-intoxication comprised a significant higher frequency among females & among the adult age group. So, psychiatric evaluation & monitoring of these vulnerable patients are recommended.https://ejfsat.journals.ekb.eg/article_231587_9f50a6b60389f6fa32018c0d4b2a38ee.pdfCairo University, Faculty of Medicine, Forensic Medicine and Clinical Toxicology DepartmentThe Egyptian Journal of Forensic Sciences and Applied Toxicology1687-087522220220601The child sexual abuse diagnosis from the medico-legal point of view and contributing role of clinical parasitology173323158810.21608/ejfsat.2022.112087.1232ENFatmaNada Khalifaforensic medicine and clinical toxicology kasr al einy cairo university. cairo ,egyptEnasA. El Saftawyparasitology, cairo university kasr alainyAhmedA. A. Al. Abdul Latifparasitology, 6october universityRihamF Husseinforensic medicine and clinical toxicology, kasr alainy cairo universityHebaAbdo Abdel Razikforensic medicine and clinical toxicology kasr alainy cairo universityJournal Article20220102Child sexual abuse (CSA) is defined as forcing, coercing or persuading a child to engage in any type of sexual act and it is very important issue to be discussed. It has a profound impact on physical and mental health. As well as causing physical injury, it is associated with an increased risk of a range of sexual and reproductive health problems, with both immediate and long-term consequences. Some children may display signs, symptoms or clues raising the suspicious that sexual abuse has occurred. In the field of applied parasitology, there are many procedures related to the same anatomical site as where CSA occurs. Additionally, parasitic infections may be associated with CSA and their routine investigation may help to discover such abuse there is thus a need for protective service and child abuse law enforcement investigators to work together with the medical parasitologists to establish a safe panel of routine investigations to cases of child abuse.https://ejfsat.journals.ekb.eg/article_231588_e3246135d03ac0342461920262ae9faf.pdfCairo University, Faculty of Medicine, Forensic Medicine and Clinical Toxicology DepartmentThe Egyptian Journal of Forensic Sciences and Applied Toxicology1687-087522220220601MID-REGIONAL PRO ATRIAL NATRIURETIC PEPTIDE (MR-PROANP) AS A NOVEL BIOMARKER FOR EARLY PREDICTION OF CARDIAC INJURY FOLLOWING SCORPION STING AMONG CHILDREN.354624159010.21608/ejfsat.2021.67326.1193ENMohammed BakerSarhanegypt,minia0000-0001-8941-1479ZakiZakiminia , EgyptEmanMahmouddepartment of forensic medicine and clinical, faculty of medicine, minia university, Minia city, EgyptJournal Article20210315Background: Scorpion envenomation represents a vital health problem, especially in children. Scorpion venom causes diverse harmful side effects on different body systems; however, the most serious one is considered the cardiotoxic effect. Aim of the work: this study aims to predict heart failure in children following scorpion sting using MR-proANP (cardiac biomarker), owing to reduced sensitivity and specificity of currently used biomarkers. Subjects & methods: the study was carried out on 87 children patients presented to Minia University Poisoned Control Center (MUPCC) with a history of a scorpion sting (within the first hour of sting) during the period from 1st of June, 2018 to the 31st of May, 2020. Venous blood samples were drawn from patients for biochemical analysis (MR-proANP and troponin I). Result: MR-proANP predicted clinical heart failure (HF) in the first hour of sting (sensitivity was73.91% and the specificity was 100%) and predicted sub-clinical heart failure after 6 hours of sting (sensitivity was 89.66% and the specificity was 91.67%); however, troponin I predicted HF only after 12 hours of the sting. Conclusion: MR-proANP was superior to troponin I in predicting HF due to scorpion envenomation.https://ejfsat.journals.ekb.eg/article_241590_ea8f87f4add9c0a7f71d21c55fe4dae9.pdfCairo University, Faculty of Medicine, Forensic Medicine and Clinical Toxicology DepartmentThe Egyptian Journal of Forensic Sciences and Applied Toxicology1687-087522220220601Assessment of cyber abuse during the years 2020 and 2021 among a sample of Egyptian females475624159310.21608/ejfsat.2022.126994.1253ENRababEltokhyDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University0000-0002-0666-5949AmalMahmoudDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo UniversityShimaa AhmedAlsaeedDepartment of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo UniversityJournal Article20220317Violence against women is a global issue, but it is particularly prevalent in the Middle East. According to WHO estimates, approximately 35% of women around the world have been exposed to physical and/or sexually intimate relationship violence or non-partner sexual violence at some point in their lives. Because nearly one in every two people uses the internet and one billion homes have an internet connection, cyber violence is a growing global epidemic with serious public health implications, it is linked not only to negative psychological, social, and reproductive health outcomes for victims but also to offline physical and sexual assault. Cyber harassment, cyberstalking, defamation, non-consensual pornography, e-mail spoofing, cyber hacking, and virtual rape are all examples of cyber violence against women. Data on the scope of cyber violence and its prevalence across various people and cultures is limited, but studies suggest that women, girls, and sexual minorities are more likely to be victims of cyber abuse. Objectives: Our research aimed to assess the problem of cyber violence against women in Egypt, including its prevalence, different forms, and impact on victims' lives to identify and develop preventive strategies. Methodology: The research was conducted utilizing an online poll that was distributed over two of Egypt's most popular social media platforms, Facebook and WhatsApp, to assess if the participants were subjected to cyber abuse during two years, 2020 and 2021. To get a high response rate, the researchers chose groups with a large number of female members. The researchers collected responses, by a survey published at link to the study page for three months, in the period from November 1, 2021, till January 31, 2022. Results: Our study included 324 adult female participants, about 52 % of them were between 31 and 40 years old. About 85 percent of our participants said they had been subjected to cyber violence, 64 percent said they had been subjected to cyber harassment three times or more and 52.7 percent said they were harassed via social media. Conclusions, the Egyptian population has seen a high rate of cyber violence against women in the past two years.https://ejfsat.journals.ekb.eg/article_241593_c8aab17c0d897849d2c9f455bb1957fc.pdfCairo University, Faculty of Medicine, Forensic Medicine and Clinical Toxicology DepartmentThe Egyptian Journal of Forensic Sciences and Applied Toxicology1687-087522220220601PREDICTORS OF POOR OUTCOMES IN ACUTE METHANOL POISONING576824159510.21608/ejfsat.2021.76747.1198ENSamah MaherElbastawesyForensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.0000-0001-5626-3203Mohamed AShamaEmergency Medicine and Traumatology department, Faculty of Medicine, Tanta University, Tanta, Egypt0000-0002-4083-4742AhmedElsharkawyEmergency Medicine and Traumatology department, Faculty of Medicine, Tanta University, Tanta, EgyptNadia EzzatHelalForensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.0000-0002-4998-7331Journal Article20210531BACKGROUND: Methanol is an extremely toxic compound. Severe metabolic acidosis, intense neurological and visual affection are the hallmark of toxicity. Despite maximal supportive care, mortality rate is yet high. OBJECTIVES: This study aimed to determine the predictors of poor outcome in acute methanol poisoning. METHODS: In this retrospective study, forty acute methanol poisoned patients were recruited. Data of four years (2017 to 2020) was obtained from Tanta university Poison Control Center (TUPCC) archive. Data of patients’ outcomes were recorded in addition to demographic data, clinical examination and laboratory investigations results. RESULTS: Out of the 40 enrolled patients, 17 patients had poor outcome either death or visual affection and the remaining 23 patients had completely recovered. A significantly prolonged time elapsed between methanol ingestion and admission in poor outcome group compared to good outcome one. Likely, the mean GCS, arterial pH andHCO3 levels were significantly lower in poor outcome group. Additionally, significant increase in total leucocytic count, RBS, ALT, AST, serum creatinine, blood urea, PT and anion gap was noticed in poor outcome group. CONCLUSIONS: Our study shows that, delayed hospital admission and on admission GCS were identified as potential predictive factors of poor outcome in acute methanol poisoning.https://ejfsat.journals.ekb.eg/article_241595_cf2717eca4f20bfba6cf8c9533a06f44.pdfCairo University, Faculty of Medicine, Forensic Medicine and Clinical Toxicology DepartmentThe Egyptian Journal of Forensic Sciences and Applied Toxicology1687-087522220220601Evaluation of the stability of DNA methylation markers in biological stains and its impact on forensic investigations698124320710.21608/ejfsat.2021.77683.1201ENLamisNaderDepartment of Forensic Medicine and Clinical Toxicology, College of Medicine, Cairo UniversityRaniaGomaaDepartment of Forensic Medicine and Clinical Toxicology, College of Medicine, Alexandria UniversityKhawlaAl TeneijiCollege of Biotechnology, UMS,Dubai, UAEJournal Article20210605Background: Study of epigenetic modifications such as DNA methylation has become an important tool in forensic investigations due to its reliability and specificity. DNA methylation is highly dynamic and sensitive to several environmental and lifestyle factors. DNA samples collected from crime scenes can be tested according to their methylation patterns to help in the identification of different types of biological pieces of evidence including hair, blood, semen, and saliva found at the crime scene. Furthermore, it could help in the identification of sex, age and shed light on the overall identity of the suspect or victim. <br /> Objectives: This study aimed to validate the use of DNA methylation-specific markers in the identification of peripheral blood, menstrual blood, and saliva, and to investigate the stability of these markers. Additionally, this research assessed the effect of exposure of blood and saliva to different environmental conditions on the detection of DNA methylation-specific markers.<br /> Methodology: The samples used in this study are peripheral blood, saliva, and menstrual blood. DNA was extracted from all samples and its quality was detected on gel electrophoresis. Then bisulfite conversion and real-time PCR had been applied using BLM1 primer to detect peripheral blood samples, MENS1 primer to detect menstrual blood samples, and SPEI1 to detect saliva samples. Dried Stains from the saliva, menstrual blood, and peripheral blood samples were collected and exposed to different environmental conditions.<br /> Results: The results of real-time PCR and statistical analysis of BLM1 and MENS1 primers showed better results than SPEI1 primers in identifying fresh body fluids as well as those exposed to different environmental conditions of degradation. <br /> Conclusion: DNA methylation is highly specific to the tissue type, age, and sex of the person. This unique characteristic of DNA methylation is exploited in the identification of victims or culprits during a forensic investigation. Amount, as well as the integrity of DNA used for analysis, is often the determining factor in the success of methylation studies. Various factors such as exposure to UV radiation, high temperature, pH, and salt concentration can affect DNA stability.https://ejfsat.journals.ekb.eg/article_243207_25513af9dca2247d2383714ca6fb8cb9.pdfCairo University, Faculty of Medicine, Forensic Medicine and Clinical Toxicology DepartmentThe Egyptian Journal of Forensic Sciences and Applied Toxicology1687-087522220220601RISK FACTORS FOR THE NEED OF INTENSIVE CARE UNIT ADMISSION AMONG ACUTE CLOZAPINE POISONED PATIENTS: A RETROSPECTIVE COHORT STUDY8310224321210.21608/ejfsat.2020.43176.1168ENAmiraWahdanForensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.SaraEl SharkawyCardiology Department, Faculty of Medicine, Tanta University, Tanta, EgyptMohamedAfandyAnesthesia, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.HebaLashinForensic medicine and Clinical toxicology department, Faculty of medicine, Tanta University, Egypt0000-0001-9223-9008Journal Article20200916Introduction: Clozapine is the most effective antipsychotic drug for the treatment of refractory schizophrenia. It is also seen as the most toxic in its class. Drug poisoning has been detected as one of the major causes of intensive care unit (ICU) admission. The study aimed to develop a decision tool using readily available parameters in the emergency room for patients with acute clozapine poisoning to identify patients who need ICU admission. Patients and Methods: This retrospective cohort study was carried out on 121 patients with acute clozapine poisoning admitted to the Tanta University Poison Control Center. For each patient, demographic, toxicological, clinical data, laboratory findings, and electrocardiography records were analyzed against ICU admission. Results: The results revealed that 29 patients needed ICU admission, and they were significantly older than patients who did not. A significant association was found between the history of addiction and/or psychiatric illness, mode of poisoning, amount and dose of clozapine, and the need for ICU admission. Patients admitted to ICU had a significantly higher percentage of tachycardia, tachypnea, and hyperthermia, while they had a lower Glasgow Coma Scale (GCS) and oxygen saturation. Besides, they had a significantly higher percentage of hyperglycemia, respiratory alkalosis, and prolonged QTc interval. There was a significant association between the need for ICU admission and both electrocardiogram (ECG) severity grading and acute clozapine poisoning severity score. The logistic regression model showed that large doses of clozapine, tachypnea, increased the severity of ECG grading, and decreased level of O2 saturation on admission significantly increased the probability of requiring ICU admission. Based on receiver operating characteristic curve analysis, take a dose of clozapine at a cut-off value above 250 mg is a good predictor of the need for ICU admission. Conclusion: It could be concluded that higher taken doses of clozapine, tachypnea, low O2 saturation, and increased severity of ECG grading are considered independent predictors of the need for ICU admission in acute clozapine poisoned patients.https://ejfsat.journals.ekb.eg/article_243212_3ce9e3533957bd4002084102b4c2735d.pdfCairo University, Faculty of Medicine, Forensic Medicine and Clinical Toxicology DepartmentThe Egyptian Journal of Forensic Sciences and Applied Toxicology1687-087522220220601OXIDATIVE STRESS AND GENOTOXICITY USING ALKALINE COMET ASSAY AMONG ANESTHIOLOGISTS10311224321510.21608/ejfsat.2021.77507.1200ENEman S.ShaltoutDepartment of Forensic Medicine and clinical toxicology Faulty of Medicine, Assiut University,Egypt0000-0001-8963-0356DohaYahiaDepartment, Faculty of Veterinary Medicine, Assiut University, Egypt.0000-0001-6758-8265NohaEbrahemForensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Assiut University, Egypt0000-0002-1073-3959Journal Article20210529Introduction: Long-term inhalation anesthetics exposure may provide health risks that cannot be completely ruled out. Aim of the study: The target of this research was to see how waste anesthetic gases influenced DNA damage and oxidative damage. Subjects and Methods: Two groups of healthcare workers from the department of anesthesiology joined in the study: Group I comprised of 15 staff who had operated for at least ten years, while Group II consisted of 15 healthcare members who had worked in operating rooms for more than ten years. In addition to control group consisted of 15 employees who had never been exposed to anesthetic agents. The comet assay was used to detect the damage of DNA in whole blood samples. Serum malondialdehyde (MDA) values were used to assess oxidant stress, and superoxide dismutase (SOD) and glutathione peroxidase (GPX) activities were used to assess antioxidant response (SOD). Results: The result indicates that the mean comet variables have increased (tail DNA percentage, olive tail moment, and tail moment). In Group I, the most DNA damage was observed. There were important positive associations between years of anesthetic gas exposure and damage to DNA. In addition, in comparison to the control group, there was a significant decrease in serum GPX activity and rises in serum levels of both MDA and SOD activity in Groups I and II. Conclusions: According to the results, years of working as an anesthetic can damage DNA and lipid peroxidation. As a result, safe waste anesthetic gas concentration limits in operating rooms, as well as precautions for professionals who might be exposed, are important.https://ejfsat.journals.ekb.eg/article_243215_c025a8d2f15f3f55ed588e4bce25d003.pdfCairo University, Faculty of Medicine, Forensic Medicine and Clinical Toxicology DepartmentThe Egyptian Journal of Forensic Sciences and Applied Toxicology1687-087522220220601Prognostic Significance of Acid Base Disturbances among Patients with Acute Aluminum Phosphide Poisoning11312524321710.21608/ejfsat.2021.80524.1204ENGhada AttiaSagahForensic Medicine and Clinical Toxicology Department,Faculty of Medicine, Tanta University,Tanta,EgyptAmira ElsayedElhawaryForensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, EgyptJournal Article20210617Background: Aluminum phosphide (ALP) is used as a pesticide for protection of stored grains from rodents & pests. ALP poisoning is considered one of the major public health problems which could occur accidental, suicidal or even occupational. The main presentations of acute ALP poisoning are gastrointestinal symptoms, profound circulatory collapse, arrhythmia and electrolyte & acid base disturbances.<br /> Objectives: The current study aimed to evaluate acid base disturbances on admission as a simple outcome predictor in acute ALP poisoned patients.<br /> Patients & methods: 100 adult patients with acute ALP poisoning were included in this study. Patients with cardiovascular, chronic renal and liver diseases were excluded. Additionally, patients admitted with mixed intoxication or associated trauma and those who received any medications before admission were excluded from this study. Arterial blood gases (ABG) was done and analyzed to all included patients on admission before receiving any medications. <br /> Results: There was a significant positive correlation between pH value and pre-hospitalization period, systolic blood pressure (SBP), diastolic blood pressure (DBP) and period of hospital stay. A significant negative correlation existed between pH and dose of ALP, respiratory rate and dose of required vasopressor. Bicarbonate level (HCO3) registered significant positive correlation with SBP and DBP. Meanwhile, significant negative correlation existed between HCO3 and both respiratory rate and dose of required vasopressor. There was a significant difference between survivors and non survivors regarding pH, HCO3, PaCO2 and PaO2. Furthermore, there was a significant difference between patients who required and who did not require intubation and mechanical ventilation considering pH, HCO3 and PaO2.<br /> Conclusion: It could be concluded that determining acid base disturbance on admission in acute ALP poisoned patients is a simple, cheap, and reliable marker that may help to predict mortality and mechanical ventilation requirement.https://ejfsat.journals.ekb.eg/article_243217_2ef3820dae1737e05c16e862bc6df716.pdfCairo University, Faculty of Medicine, Forensic Medicine and Clinical Toxicology DepartmentThe Egyptian Journal of Forensic Sciences and Applied Toxicology1687-087522220220702Possible Multi-Organ Toxicity in Rats after Chronic Oral Administration of Titanium Dioxide: Biochemical and Histopathological Study.12713724734610.21608/ejfsat.2021.78014.1202ENEmanShaltoutDepartment of Forensic Medicine and clinical toxicology Faulty of Medicine, Assiut University,Egypt0000-0001-8963-0356RaniaMakboulPathology Department, Faculty of Medicine, Assiut University, Egypt0000-0001-6605-622NoraAbdellahDepartment of Forensic Medicine and clinical toxicology Faulty of Medicine, Assiut University, Egypt0000-0003-1463-1009NohaEbrahemLecturer of Forensic Medicine and Clinical Toxicology, Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Assiut University, Egypt0000-0002-1073-3959Journal Article20210617Titanium dioxide (TiO2) is used abundantly as a white pigment with many applications; food coloring agents, additives, tooth whitening paste, pharmaceutical preparations, painting materials, and sunscreen creams. Objectives: The present study aimed to explore the possible toxicological effects of orally administered TiO2. Methodology: Twenty male albino rats were given food-grade TiO2 in a dose of 20 mg/kg BW via oral gavage at 1 mL daily volume for 120 consecutive days. 20 male rats were used as a control group. Liver enzymes (AST, ALT, and ALP), renal function (urea and creatinine), creatine kinase activity (CK-MB isoenzyme), and serum levels of troponin were measured at the end of the study for each rat. Histopathological analysis of cardiac, hepatic, renal, and gastrointestinal tissue sections was also performed for both groups. Results: Increased CK-MB, cardiac Troponin, ALT, ALP, and urea serum levels in TiO2 treated groups were recorded. Histopathological examination showed focal fibrosis of cardiac tissue. Hepatic sections showed inflammation and fat deposits. Gastrointestinal wall inflammations with blunting of the villi all over the small intestine, active inflammation of the colon and kidney tissues in the renal pelvis were found. Conclusion: Prolonged daily oral administration of food-grade TiO2 can induce cardiovascular, hepatic, intestinal, and renal adverse effects.https://ejfsat.journals.ekb.eg/article_247346_cdcd1d43afe6805d38f9a79e5b44e273.pdfCairo University, Faculty of Medicine, Forensic Medicine and Clinical Toxicology DepartmentThe Egyptian Journal of Forensic Sciences and Applied Toxicology1687-087522220220601KNOWLEDGE AND EXPERIENCES OF PHYSICIANS ABOUT MEDICAL MALPRACTICE13914928332810.21608/ejfsat.2022.113752.1236ENNoha MaherElrewienyforensic and toxicology department faculty of medicine cairo universityAmr Mohamed TawfikKhattabForensic and Toxicology department, Faculty of Medicine, Cairo UniversityHowaidaMohammedforensic and toxicology department faculty of medicine Cairo universityJournal Article20220103BACKGROUND: In Egypt, medical malpractice problems have been magnified during the last few years. AIM OF THE WORK: to evaluate and address the knowledge and previous experiences of the physicians regarding malpractice in Egypt and to increase the physician’s awareness to avoid medical litigation through good malpractice and ensure a good doctor patient relationship. PARTICIPANTS AND METHODS: a cross-sectional study was done through spreading of a simple formatted questionnaire among 181 randomly selected physicians in Kasr alainy teaching hospital from 2019 to 2020. RESULTS: (72.37%) of the physicians thought that sometimes malpractice affects doctor's thinking and actions. About (34.25 %) of the physicians thought that failure of diagnosis is the most common cause of malpractice. The majority of the physicians agreed that the patient, stress and overwork have a role in the adverse events, and malpractice. More than half of the physicians (58.56 %) handled malpractice cases. The majority (83.43 %) of the physicians thought that the patient should be told if any mistake happened & (86.25 %) of the physicians agreed that patients should be compensated. Most physicians (72.92 %) agreed that malpractice could be avoided, and (45.30 %) thought that staying up to date is the best way to avoid malpractice. More than half of the physicians (54.14 %) disagreed that informed consent is enough to protect the doctors from malpractice. CONCLUSION: More education and training systems are recommended for doctors to increase doctors’ competence and awareness about medical responsibility, performing regular assessment and evaluation, creation of a conducive working environment, encouraging communication between all departments, encouraging reporting and discussing possible errors. The insecure sensation of the physicians should be put in mind and more efforts should be exerted to improve doctor patient relationship.https://ejfsat.journals.ekb.eg/article_283328_b24113a6a9f957627ddef8b4b3c7ed2c.pdf