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Background: Organophosphorus (OP) compounds have been widely available for decades in agriculture for crop protection and as cheap pest controllers, which increases the rate of exposure and poisoning cases. Using serum cholinesterase as prognostic markers for the acute OP toxicity is controversial; therefore, we aim to find out prognostic biomarkers that best correlate with mortality and outcomes of patients with acute OP toxicity. Levels of serum oxidative stress biomarkers (malondialdehyde (MDA) and total antioxidant capacity (TAC)) and activity of the apoptotic biomarkers (caspase 3 and caspase 9) and pseudo-cholinesterase (p.ChE) were performed. Also, we evaluated the apoptotic capacity through determining the genotoxic effects and chromosomal abnormalities among OP intoxicated patients. Results: We found the activity of caspases and serum MDA and TAC were significantly increased after OP poisoning and decreased after the appropriate atropine and oxime treatment course. The ROC curve suggested caspases as mortality and outcome predictive markers for acute OP poisoning patients. However, OP poisoning cases before treatment showed significant DNA damage, and they did not show any chromosomal aberration. Conclusion: The mentioned results strongly suggest apoptotic-related markers (caspase 3, caspase 9) as prognostic markers for evaluation of the treatment, outcomes, and mortality rate in the acute OP toxicity patients.

Tramadol is a widely used, synthetic centrally acting opioid analgesic commonly used for the treatment of moderate to severe pain. Very few reports about its excretion into breast milk were published and most of them suggested that short-term maternal use of tramadol is compatible with breastfeeding. No available data about its chronic daily use in addict lactating mothers. To date, there are no published reports of tramadol poisoning through breastfeeding. We report a case of tramadol intoxication in 8-month-old infant through breastfeeding as her mother was an addict on tramadol. The infant presented to the Emergency Department (ER) of the Poison Control Center (PCC) of Ain Shams University Hospital twice with 36 h apart. The first time, the infant was discharged from the hospital with no sequelae after receiving the appropriate management. The second time, the infant deceased due to cardiac arrest three days after tramadol poisoning. This case report highlights the dangers of excretion of tramadol in milk and the severity of complications that can even be near fatal to infant.

Background Voodoo is a heterogeneous mixture of psychoactive substances that has recently grown in popularity among youth in Egypt. Patients can present with a variety of manifestations that may lead to death in some cases. This study assessed the acute toxic effects of voodoo among patients presented to the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH) during a one year period. Methods This is a retrospective study of all patients presented with voodoo intoxication at the PCC-ASUH from 1 January 2017 to 31 December 2017. Clinical data, routine laboratory findings, and ECG results as well as duration of hospitalization and outcome were compiled from hospital records. Results Seventy-one voodoo intoxication cases meeting the inclusion criteria were analyzed (mean age: 25.19 ± 9.54 years, range: 15–50 years, 97.2 % male). Pulse, blood pressure, and respiratory rate were normal in more than half of all patients. Neurological abnormalities including agitation, hallucinations, disturbance of consciousness were the most frequent manifestations. Respiratory acidosis was the most common laboratory finding (54.9 %), followed by increased serum urea (43.6 %), hypokalemia (33.8 %), hyperglycemia (28.1 %), and leukocytosis (26.7 %). The most common ECG finding was sinus tachycardia (31 %), followed by QT prolongation (15.4 %). More than half of the studied patients (53.5 %) co-administered other illicit substances, most frequently cannabis and tramadol. Most patients recovered fully and were discharged, but death occurred in two cases. Conclusions Voodoo toxicity can manifest with many presentations, hampering timely diagnosis. Clinicians should consider possible voodoo poisoning in patients presenting with a history of drug use with neurological symptoms, and they should conduct follow-up arterial blood gases, electrolytes and ECG as voodoo may contain potentially fatal psychoactive substances.

Background: Metal phosphides are type of rodenticides that are extremely lethal with low safety and high mortality rates. They are commonly used as a powerful suicidal tool in Egypt and developing countries due to its low price and easy availability. Heart is a significant target organ of acute metal phosphides toxicity, causing myocardial damage and myocarditis. Aim: The study aimed to evaluate usefulness of total antioxidant capacity (TAC) and troponin I as predictive biomarkers for phosphides induced oxidative stress and cardiotoxicity among patients admitted to the Poison Control Center Ain Shams University Hospitals (PCC-ASUH). Methods and results: A prospective study included patients of both sexes presented to the PCC-ASUH with acute metal phosphides poisoning during six months period from July to December 2017. The demographic, intoxication and clinical data were collected for every patient. On admission investigations included electrocardiogram (ECG) in addition to TAC and troponin I levels. Outcome was also recorded. This study was conducted on 188 patients of both sexes with acute metal phosphides poisoning. The patients were classified according to the Poisoning Severity Score (PSS) into three groups; mild, moderate and severe. TAC value was significantly decreased in patients who developed cardiovascular manifestations and ECG abnormalities. Serum troponin I value was significantly higher in patients who developed cardiovascular manifestations and ECG abnormalities. Conclusion: The current study concluded that TAC and troponin I levels could be useful in predicting development of oxidative damage, cardiotoxicity and mortality after acute metal phosphides poisoning. Recommendations: The present study recommended the use of TAC and troponin I as useful markers for prediction of cardiotoxicity and mortality in patients with acute metal phosphides poisoning.