Toxicology in Emergency Medicine

Poisoning is a serious worldwide public health problem. Based on WHO data in 2012, almost 190,000 people died worldwide and the number of deaths due to poisoning in 2008 exceeded the number of deaths due to motor vehicular crashes; also, poisoning death rate nearly tripled worldwide. Number of patients presenting to the emergency departments with overdose, had been increased both intentionally and accidentally. All the previous facts make Toxicology an important field in emergency medicine. Management of intoxicated patients has a unique approach because of the challenge in diagnosis and treatment of overdose cases. This chapter is focusing on general approaches for intoxicated patients and initial management and on how the history and physical examinations could help physicians to have what drug have been abused as well as review the mechanism of action, physical finding and treatment of the most common drugs-causing toxicity in addition to the drugs with high mortality morbidity rates

Evaluation of selective peripheral neurotomies in the treatment of refractory lower limb spasticity in adults

Background: ‘‘Selective peripheral neurotomies” (SPNs) are indicated for the treatment of refractory focal and multifocal spasticity of lower limbs in adults.Objective: To evaluate the surgical results of selective peripheral neurotomies in 20 adult patients who had refractory focal & multifocal spasticity of the lower limbs, follow up period of one year.Patients and Methods: Prospective study included 20 adult patients who had refractory spasticity of the lower limbs. Preoperative evaluation for muscle tone using Modified Ashworth Score (MAS), muscle power using Medical Research Council Scale (MRCS), functional assessment using Oswestry Functional Scale (OFS) and Range Of Motion (ROM) using manual goniometry were done for all patients. All cases underwent surgery in the form of SPN of tibial, obturator, sciatic and/or femoral nerves. Follow up of the patients was done at 10th day, 3, 6 months and one year postoperatively.Results: The mean age of patients was 31.35 ± 12.42 years. There were statistically significant improvement of muscle tone, muscle power, functional assessment and range of motion between preoperative and one year postoperative values. Improvement of the muscle tone was from a preoperative Mean ± SD of 3.60 ± 0.68 on MAS to a postoperative 2.30 ± 0.86 at one year, improvement of muscle power on MRCS was from preoperative Mean ± SD 3.75 ± 1.08 to postoperative 4.08 ± 0.69 at one year, There was a functional improvement from a preoperative Mean ± SD of 3.0 ± 0.73 on OFS to 3.60 ± 0.60 at one year postoperatively. Also, there was a significant improvement between preoperative ROM Mean ± SD 61.25 ± 15.29 and one year postoperatively 72.25 ± 12.19.Conclusions: Selective peripheral neurotomies could effectively improve muscle tone, muscle power, functional performance & range of motion in patients with refractory focal and multifocal spasticity in the lower limbs.Keywords: Selective peripheral neurotomies, Spasticity, Neuroablative surgeries, Functional neurosurger

Assessment of genotype by year interaction for yield components and physiological traits in cotton under drought stress using multivariate analysis and genetic parameters

The objective of this study was to identify genotype high yielding and drought-tolerant, by understanding the interaction GY pattern for yield, yield components and physiological traits in 24 cotton genotypes over five years under drought stress conditions using AMMI analysis, genetic parameters and multivariate analysis. All assessed traits were significantly impacted by genotypes and GY interaction using the AMMI model, with the exception of chlorophyll b by GY interaction. Meanwhile, seed cotton yield/plant, number of open bolls/plant, lint percentage, lint cotton yield/plant, and number of fruiting branches/plant were significantly affected by the year's factor. High BSH coupled with high GAM% was observed for all studied traits, indicating the heritability due to additive type of gene action and, the importance of these genotypes and the possibility of effective selection for drought-tolerant genotype development. A statistically significant correlation was discovered between cotton yield and most investigated traits under drought stress conditions. Direct selection can be done through these traits based on genetic parameters and Pearson's correlations analyses, which will be effective for drought tolerance and enhancing cotton yield. The results of our study's Pearson's correlation analysis, PCA and cluster analysis could be relevant and appropriate for studying drought tolerance mechanisms and cotton yield improvement. According to PCA and cluster analysis, the genotypes G20 and G19 followed by G5, G4 and G21 genotypes showed the best performance in response to drought stress regarding the yield, yield components and physiological-related traits. The previous genotypes could be used in future cotton breeding efforts in Egypt to promote drought tolerance, improve cotton productivity, and sustainable production during drought stress conditions

Subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumoperitoneum after upper gastrointestinal endoscopy

Upper gastrointestinal (GI) endoscopies are performed for several reasons. The overuse of endoscopy has negative effects on the quality of healthcare and pressurises endoscopy services. It also results in the complications. These complications include pneumoperitoneum, pneumomediastinum and subcutaneous pneumomediastinum. However, it is worth noting that these complications rarely occur during endoscopy of the upper GI tract. These complications, when they occur, indicate perforation of the retroperitoneal space or peritoneal cavity. In this article, we discuss a case of pneumoperitoneum, pneumomediastinum and subcutaneous emphysema after upper GI endoscopy.Scopu

Evaluation of Some Proposed Methods for Protecting Bridge Substructure Using Physical Models

Bridges constructed across streams with erodable beds are normally subjected to serious scouring during the flood at piers and abutment sites. As a result, scour holes will be formed at the bridge substructure. The scour hole can be described by its maximum vertical scour depth which is called local scour depth and by the size of its projected scour area. Experience has shown that progressive depth of scour holes at the site of bridge substructures could undermine the foundation and result in bridge failure. Protection against scouring for constructed bridges is necessary to minimize the risk of failure. The formation of the scour hole at the bridge substructure is considered as very complex and this phenomenon is so involved that only very limited success has been made to predict the size of the scour hole computationally. Physical model remains the principal tool employed for estimating the size of scour hole at the site of bridge substructure. In this study, the efficiency of five different proposed methods of protecting the bridge substructure were tested using a physical model. These methods are piers with collar, pier with multiple collars, pier with slot, piles in front of piers, and using riprap. The physical model comprises a tilted flume (5 m long, 76 mm wide and 250 mm high) with sand on its bed (nominal size =0.35 mm) and a single circular cylindrical pier model which was made of hard teak wood (diameter =16 mm). A collar form steel with a diameter of 40 mm was attached to the pier model. A slot of a dimension 7 mm x 20 mm (width x depth) was opened in the upper side of the pier. Steel nails 3 mm in diameter each were used to simulate the piles. Coarse graded gravel was used as a riprap. Data collected from the physical model showed that using multiple collars around the pier can give 88% reduction in the scour area while the reduction in the maximum scour depth ranges from 73% to 64%, depending on the flow rate in the flume. It was observed that the riprap protection at the bridge substructure is also effective in reducing the maximum scour depth and reduction ranges from 100% to 68%. However, the reduction in the scour area ranges from 100% to 83%. The reduction was also dependent on the flow rate

Acute Management of Heat Stroke: Facts and Figures

Heat-related illnesses range from heat exhaustion to heat stroke. Heat stroke is a life-threatening medical emergency causing multiple organ dysfunction that if not treated, can be fatal. It is a severe heat illness with a body temperature of more than 400c and organ dysfunction. Epidemiology of heat stroke varies depending on geographic location, and reported incidences range from 1.98 to 2.89/100000 per year. Heat stroke is classified as exertional or non-exertional. Pathophysiology is exposure to higher temperatures with impaired thermoregulation. Patients will present with high core body temperature; tachypnea, tachycardia, and hypotension may be present. The manifestations of organ dysfunction range from coagulopathy to altered levels of consciousness, and pulmonary edema. Accurate core body temperature measurement with clinical manifestations will diagnose the heat stroke. Early diagnosis, earlier temperature management, and organ supportive care are essential

Self Esteem level of Students enrolled in Football Context according to Teaching Methods Applied A Comparative Study

The study aims to investigate the effect of applying the command and practice teaching method in comparison to the cooperative teaching method in football classes on students’ self-esteem level at the school of Sport Sciences. The sample of the study consisted of (33) male and female students enrolled in “Football - Advanced Level” class. The sample was divided into two groups; (1) the control consisted of (14) students taught by the command and practice teaching method, (2) the experimental group consisted of (19) students taught by the cooperative teaching method. The Arabic version of the Rosenberg Self- Esteem Scale was used to collect the data required. The results of the study revealed a significant effect of both teaching methods in both groups on students’ self-esteem levels. Nevertheless, no significant differences have revealed in students’ post self-esteem levels between both the control and experimental groups. We conclude that both teaching methods are effective in boosting students’ self-esteem levels. We recommend both methods to improve learners and players self-esteem