Exertional heat stroke is a true medical emergency resulting from thermoregulatory failure. The risk of death is related directly to the peak temperature, duration of exposure and acclimatisation period. This case report illustrates the management of multiple casualties of heat stroke in the emergency department and their outcomes. Clinical feature: Nine policemen arrived in the emergency department in semiconscious state after being retrieved from a group of policemen who were loaded into a bus without proper ventilation during a selection program. All of them presented with hyperpyrexia, hypotension, tachycardia and altered sensorium. Treatment: Immediate evaporative cooling with support of organ-system dysfunction was commenced. Six patients were intubated and admitted to the intensive care unit. One patient was monitored in high dependency ward while the other two were admitted to the general medical ward. Outcome: All patients were extubated within 48 hours. None of them had residual neurological dysfunction. One patient developed coagulopathy which required blood product transfusion. Three patients were discharged in less than one week and the rest were observed in the general ward in stable condition for liver profile monitoring.

Background: Organophosphorus compounds (OPC) poisoning leads to several neurotoxic disorders in humans. Glial Fibrillary Acidic Protein (GFAP) released in response to neuronal cell injury and has been used as a sensitive and specific indicator of several neurotoxic conditions, there is no human studies focused on the diagnostic and prognostic value of GFAP in OPC toxicity. Thus, there is a need for studying its role in OPC poisoning. Objectives: This study aimed to assess the usefulness of GFAP as early predictor of OPC related neurotoxic disorders both in acute poisoning and chronic exposure and to correlate levels of GFAP with severity of acute OPC poisoning. Methods: This is a prospective clinical study that was conducted in Poison Control Center, Ain Shams University Hospitals. The study included 4 groups, control group (23 healthy volunteers), group II acute moderate OPC patients (19 patients), group III acute severe OPC patients (25 patients), and group IV chronic group (41 farmers). All participants were subjected to measurement of GFAP, serum acetylcholine (ACh), serum pseudo cholinesterase (PChE), serum glucose, potassium, serum lactate ,lactate dehydrogenase (LDH), and serum creatine phosphokinase (CPK). Results: Serum GFAP and ACh were significantly high in all patient groups compared to the control group, but no significant difference was found between acute moderate and acute severe groups. Also serum PChE had no significant difference between patients of acute moderate and severe groups. Serum glucose, lactate, LDH and CPK were highly significant in acute severe group when compared to acute moderate group. Conclusion: Glial Fibrillary Acidic Protein, a biomarker of neurotoxicity, can be used in patients with acute and chronic OPC poisoning as early predictor of OP induced brain cell injury. Serum glucose, lactate, LDH and CPK could be used as simple tools in prediction of severity in acute OP poisoning.

Introduction Pulmonary thromboembolism (PTE) still remains a diagnostic challenge to junior doctors working in emergency departments. Being aware of the condition and its associated risk factors can improve the diagnostic accuracy. Association between passenger travelling long-haul flight and PTE has been well documented; however its association with short-haul flight is very rare and controversial. This case report illustrates the possible linkages between short-haul air travel with the development of classic non-fatal PTE. Clinical feature A young Indian gentleman after travelling four hours on a flight complained of progressive worsening of breathlessness when he arrived at Kuala Lumpur. Clinically he was tachypnoeic and tachycardiac. The electrocardiogram showed T inversion in leads III and aVF, and S wave in lead I. Oligaemia was shown on the chest X-ray and hypoperfused areas were seen on the spiral computed tomographic angiogram. Treatment He was started on unfractionated heparin, switched to low molecular weight heparin, and then warfarin and subsequently admitted to the coronary care unit. Outcome He was discharged well on day 7 after admission with warfarin and medical advice before returning to India. Conclusion Non-fatal PTE is at times difficult to diagnose and requires a high index of suspicion. Its association with healthy passengers of short-haul flight is not well established and this case report illustrates the possibility of linkages.

Background: Opioids can produce several well-known adverse events, and recently has been recognized to interfere with the immune response. However, from several studies it emerges that not all opioids induce the same immune-suppressive effects, some opioids have little effect on immunity, others can be immune-suppressive or immune-stimulant. Evaluating each opioids profile is important for appropriate analgesic selection. Analgesic drugs devoid of immune-suppressive effects might offer a good alternative to morphine for the treatment of postoperative pain. Aim: This study aimed to evaluate the effect of tramadol on immune system by measuring CD4+ percent in patients presented with acute suicidal tramadol overdose. Methods: This study included 40 candidates divided into 2 groups, tramadol group consisting of 30 patients with acute suicidal tramadol overdose and control group consisting of 10 healthy non-smoker persons. Lymphocytes % and Expression of CD 4+ % were assessed after admission to detect effect on immunity. Results: The results revealed that there is significant decrease in the lymphocytic percent and CD4+ expression in the tramadol group. Conclusion: We can conclude that tramadol overdose had suppressive effect on lymphocyte proliferation and CD4 expression and other studies are needed to test the effect of different doses of tramadol on immunity to document its safety as analgesic in immune-compromised patients.

Patients with acute carbon monoxide (CO) poisoning have been found to have a correlation between initial clinical severity on admission and blood lactate levels. Recently, it is suggested that the lactate level may be a useful prognostic factor in cases study. The purpose of this study was to assess whether plasma lactate levels can be used as a biomarker for the assessment of severity and outcome of acute carbon monoxide poisoning. Selected Forty patients whom presented to the Poison Control Centre (PCCA) of Ain Shams University Hospitals after acute CO poisoning, over 1 year, were included in this study. Based on clinical criteria, patients were classified into 3 groups (mild, moderate and severe). Blood pH, Carboxyhemoglobin (COHb), blood sugar (B.S), and lactate level were estimated in the blood of all patients. Our results revealed that the blood lactate level was significantly increased in all poisoned patients and the dead patients showed significant increase of blood lactate at time of admission when compared with the survived patients. The correlation study revealed positive correlation between plasma lactate level with B.S levels, COHb levels and the delay time and negative correlation with blood pH. It is concluded that the initial blood lactate may correlate with the patient outcomes and prove to be a useful prognostic factor in acute CO poisoning. Thus lactate level is recommended to be considered in cases of acute CO poisoning.