Background: Maxillofacial fractures are of great medico-legal implications because they are of common occurrence with other injuries, predominantly head injuries that might involve serious esthetic and functional problems, and so clinically described as consequential injuries. The aims were to assess the medico-legal aspects of maxillofacial fractured cases concomitant with closed head injury over a 6-year period (2011-2016) in the Trauma Unit of Assiut University Hospitals, Egypt, and to evaluate the demographic feature and the trend of different patterns of such fractures. Patient and methods: A descriptive hospital-based study included all cases of maxillofacial fractures combined with closed head injury attending the Trauma Unit of Assiut University Hospitals in the period of January 2011 to December 2016. Results: The study included 1221 cases, the percent of maxillofacial fractures with a closed head injury was 4%, the age group 18-40 years was having the highest incidence, and mean age was 25.9 ± 15.3 years with male to female ratio of 7:1. Road traffic accidents were the main etiology of injury (69.7%), followed by falls (15.1%) and violent assaults (10.2%) while firearm injuries were the last (5%). Unintentional injuries were the commonest in 83.1% followed by homicidal (16.3%); only 7 cases were due to suicidal attacks. The mandibular fracture was the commonest (49.7%) followed by fracture maxilla (19.2%), fracture zygoma (16.8%), and lastly frontal bone and nasal fracture. The trend of maxillofacial fractures over the 6-year period tended to be increased with the highest number in 2011 (21.5%) and the lowest in 2014 (13.3%). Conclusion: Maxillofacial fracture with a closed head injury in Upper Egypt is common in the middle age with male predominance. Road traffic accident is the main etiologic factor, and accidental trauma is the commonest manner. Mandibular fractures are the commonest pattern followed by fracture maxilla. Traumatic head injuries in cases of maxillofacial fractures were mild in about half of the cases. The trend of maxillofacial fractures over the 6year period of the study (2011-2016) tended to be increased with the highest number in 2011 and the lowest in 2014.

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Pesticides are a large and heterogeneous group of chemicals which have long been used to control and repel pests in different fields.The organophosphates are the most widely used pesticides in industry, agriculture and houses. This study intends to evaluate the effectiveness of obidoxime therapy for reactivation of cholinesterase enzyme and its correlation with severity of poisoning among organophosphorus poisoning cases presented to Mansoura poisoning control unit (received oxime as aline of therapy) and Damietta general hospital, (did not received oxime as aline of therapy) during the period from 1 st March 2015 to the end of February 2017. A total number of 303 patients presented with acute anticholiesterase poisoning (150 in Damietta and 153 in Mansoura Emergency Hospital). A total of 250 cases were diagnosed to be organophosphorus by TLC {112 in Damietta and 138 in Mansoura emergency hospital} and only 200 of them were included in this study according to exclusion criteria. Data on evaluation of obidoximes in treatment of organophosphorus (OP) poisoning incorporating the maximal clinical parameters and comparing the two groups in an unbiased manner, revealed that the use of obidoximes decreased the required dose of atropine and duration of hospital stay when compared with atropine alone. It is clear that there may be potential benefit from oximes as acetyl cholinesterase (AChE) activity is clearly increased by treatment.

Early assessment of patients presented with acute organophosphorus toxicity in the Emergency Department is an essential step to detect their pathway in the hospital. The present study aimed to assess the overall accuracy of Acute Physiology and Chronic Health Evaluation (APACHE II), Modifies Early Warning Score (MEWS), and Worthing Physiological Score (WPS) in predicting mechanical ventilation in acute organophosphorus toxicity patients. A cross-sectional cohort study was conducted on 132 patients presented with acute organophosphorus patients. From each patient, the following was collected: clinical data, routine laboratory investigations results, and blood samples for estimation of cholinesterase levels. The clinical and laboratory data were used to calculate APACHE II, MEWS, and WPS scores within six hours from admission. Statistical analysis revealed that the median values of APACHE II, MEWS, and WPS differed significantly between mechanically ventilated and non-mechanically ventilated patients. A strong significant negative correlation was detected between clinical severity and cholinesterase levels. WPS score showed the highest discriminatory power for predicting mechanical ventilation (area under the curve [AUC] 0.977). However, APACHE II and MEWS scores were nearly equal in their discriminatory power (AUC 0.924 and 0.927 respectively). Cholinesterase levels can be used as a useful diagnostic tool but are very poor in predicting patient outcomes (AUC 0.209 and 0.129 for acetylcholinesterase and butyrylcholinesterase respectively). In conclusion, using the WPS score for clinical evaluation of acute organophosphorus toxicity patients has valuable prognostic abilities for predicting patients' outcomes.