Introduction: Carbon monoxide (CO) poisoning is the leading cause of death from intoxication. The heart is extremely susceptible to CO-induced hypoxia due to its high oxygen demand. Cardiovascular involvement in CO poisoning could be clinically occult and undiagnosed due to lack of overt symptoms or specific electrocardiogram (ECG) changes. There is an emerging need for early and specific markers for myocardial hypoxia. One potential candidate is the glycogen phosphorylase BB isoenzyme (GPBB). Aim of the study: The study was planned to assess the role of glycogen phosphorylase in early prediction of myocardial toxicity due to CO poisoning. Methods: This prospective study included 2 groups; Control group and Patient group. Control group included 15 non-smokers healthy adults aged between 20 and 35 years old selected from patients' companions presented to Zagazig University Hospitals. Patient group included 30 adults aged 20-35 years old with history of CO exposure within 6 hrs. They were subdivided into mild & moderate CO poisoning groups according to COHB% & clinical manifestations. The study was performed during the period between January 2015 to April 2016. All the subjects enrolled in the study were subjected to clinical examination, ECG, echocardiogram (Echo), cardiac troponin 1 (cTn-1) and GPBB assessment. Results: There was a significant increase in heart rate between patient and control groups. Also, a significant increase in GPBB was found between patient and control groups and this was associated with a significant decrease of ejection fraction evaluated by Echo in moderate CO poisoning group when compared with control group. No significant difference was found as regard ECG findings between patient and control groups. Conclusion: GPBB can be used as an early predictor of CO-induced myocardial ischemia which in turn may modify management plan to avoid later sequelae affecting ventricular function.

Introduction: Ivermectin (IVM) and paracetamol (APAP) are among drugs used for treatment of mild and moderate cases of covid-19 infection. Aim: this study aimed to evaluate the potential hepatotoxic effects on combination of both Paracetamol and Ivermectin in adult male albino rats. Methodology: fifty adult male albino rats were divided into control groups (negative and Positive) and IVM and APAP treated group which included thirty rats and subdivided equally into 3 subgroups (III A, B, C). Each rat received orally 3.7mg/kg/day of Ivermectin concomitantly with 370 mg/kg /day of paracetamol (groups III A, B, C were sacrificed after 7 days, 14 days and 28 days respectively). Serum levels of aminotransferases ALT, AST, glutamate dehydrogenase (GLDH) and Hyaluronan (HA), Histopathological examination of liver and immunohistochemical staining for inducible nitric oxide synthase (iNOS) were performed. Results: HA was elevated after 7 days followed by GLDH which increased after 14 days while aminotransferases levels increase only after 28 days of combined IVM and APAP treatment. After 7 days, the histopathological changes in IVM andAPAP treated group was restricted to congestion of central vein with some vaculation in the hepatocytic cytoplasm then aggravated with increased duration of treatment to periportal fibrosis, inflammatory infiltration areas and necrotic foci. Conclusion: Combination of IVM and APAP induced liver injury, detected 7 days after treatment by HA level and accompanied by histopathological changes which became more severe with increasing duration of treatment. IVM and APAP should be used cautiously to avoid possibility of aggravation of liver injury which is believed to be one of covid-19 complications.

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Background: Strox is the street name of the novel synthetic cannabinoids widely abused in the last few years in Egypt causing many toxic effects including seizures. The aim of the work: The study evaluated the potential seizurogenic effect of strox toxicity and the possible use of microRNA (miR) expressions as predictive biomarkers for diagnosis and follow up. Methodology: A cross-sectional prospective observational study was carried out on 60 patients presented to ER of Zagazig University Hospitals following strox intake during the period from March 2018 to May 2020. Epidemiological data, route of consumption & frequency of drug abuse during the last 12 months were recorded. All patients were subjected to clinical examination, Electroencephalogram (EEG), measurement of serum miR-9-3p, miR-106b-5p and miR-15a-5P, and miR 30a-5P expressions using real time-polymerase chain reaction (qRT-PCR) at time of presentation, after 72hrs and 28 days of presentation. Results: The median age of patients included were 19-35, most of them were male (96.6%). Of the included cases, 46.6% presented with seizures which was mainly in the form of generalized tonic clonic convulsions (43%). EEG revealed abnormal changes in only 35% of patient who developed seizures at time of presentation and in 9% of those who developed seizures after 72 hours with no EEG changes were recorded after 28 days of follow up. Assessment of genes expressions revealed upregulation of miR-9-3P, miR-106b-5p and miR-30 a-5P and downregulation of miR-15 a-5P at time of presentation in patients with seizures with both miR9-3P, and miR 30 a-5P persisted upregulated during follow up periods, while miR106b-5p and miR 15 a-5P returned to normal. Conclusion: miR9-3p and miR 30 a-5p can be used as predictive biomarkers in diagnosis and follow up of strox induced seizures.

Introduction: During apheresis, anticoagulation is accomplished by use of acid citrate dextrose (ACD). Acid citrate dextrose returns to the donor with the remainder of blood after separation of the targeted blood component. Objectives: This study was conducted to assess the potential toxic effects of ACD in first-time blood donors through clinical and biochemical assessment. Methodology: Seventy -five healthy plateletpheresis donors were recruited in the study where they were subjected to clinical and laboratory assessment just before the procedure (baseline), at 30 min. & at 60 min. during the procedure and 30 min. post procedure. Clinical evaluation included vital signs evaluation and reporting of any clinical manifestation developed. Biochemical assessment included ABG, serum ionized Ca (iCa), ionized Mg (iMg) and parathyroid hormone (PTH) levels. Also activity of erythrocyte phosphofructokinase (PFK) and hematological parameters including RBCs (million/ul), hemoglobin level (Hb g/dl) and hematocrite (Hct %) were evaluated. Results: Apheresis using citrate anticoagulant resulted in changes in mineral homeostasis in the form of hypocalcemia and hypomagnesemia with subsequent tremors (9.3%) and tetany (5.3%). Also, some of the donors exhibited tachycardia and hypotension. Parathyroid hormone (PTH) level increased during apheresis which nearly returned to normal level 30 min. after the procedure while, no significant changes in ABG were detected at different time intervals of the procedure. When RBCs PFK activity was measured, a significant decrease was found during the procedure with significant decrease in RBCs at 60 min. and post 30 min. But no significant changes were detected as regard Hb level and Hct % in comparison to baseline ones. Conclusion: Citrate toxicity may occur even with first time exposure in platelet apheresis donors in form of possible developing tremors, tetany, tachycardia and hypotension with decreased calcium & magnesium levels, increased PTH, decreased erythrocyte PFK activity with subsequent decreased RBCs integrity and possible hemolysis.