Body mass index as a predictor of the outcomes of acute clozapine toxicity: a cross-sectional study.

Acute antipsychotic overdose is frequently reported nowadays. Clozapine is one of the atypical agents that are highly lipophilic, highly protein-bound, has a large volume of distribution, and accumulates in the brain and other tissues. Obesity is an essential factor controlling patients' treatment and clinical course. The current study aimed to study the prognostic value of body mass index (BMI) in patients with acute clozapine poisoning. All patients were evaluated on admission using the Poison Severity Score (PSS) and Glasgow Coma Score (GCS). The BMI was calculated. Mortality and the need for ICU admission were defined as primary outcomes, whereas secondary outcomes included cardiovascular complications and the need for mechanical ventilation. Thirty-eight patients presented with acute clozapine poisoning. The mean age of included patients was 25.2 ± 6. Patients were categorized regarding BMI into average weight (26.3%), overweight (31.6%), and obese (42.1%). Pearson's correlation indicated a significant positive correlation between BMI and respiratory rate (r = .364, p = .025). A significant negative correlation existed between BMI and GCS (r = .674, p ≤ .001). ROC curve reveals that BMI is an excellent predictor for the requirement of mechanical ventilation area under the curve (AUC > .9), a fair predictor of ICU admission AUC (.747). BMI had a sensitivity of 100% and specificity of 51.7 for the prediction of ICU admission. In conclusion, obesity increased the severity of toxicity and the incidence of poor clinical outcomes in patients with acute clozapine poisoning.

Could the serum glucose/potassium ratio offer an early reliable predictor of life-threatening events in acute methylxanthine intoxication?

Methylxanthines are widely used to manage pulmonary disorders, particularly in developing countries. Methylxanthines are unsafe due to their narrow therapeutic index and associated morbidity and mortality. The current study aimed to investigate the role of glucose/potassium ratio as a substantially useful early predictor of life-threatening events (LTEs) in the form of cardiovascular and neurological complications among methylxanthine users. A retrospective cohort study was conducted using medical records of patients diagnosed with acute methylxanthine intoxications and presented to an Egyptian Poison Control Center for 2 years. A total of 366 patients were enrolled. Of them, 59 patients (16.1%) were complicated with LTEs. The most frequent serious arrhythmia was T wave inversion (45.6% of patients with LTEs). Laboratory investigations that could significantly predict LTEs were the random blood glucose and potassium levels, glucose/potassium ratio, pH, liver transaminases, HCO3 level, hemoglobin, and platelet count (P < 0.05). The glucose/potassium ratio was the best predictor of LTEs (odds ratio = 2.92, and 95% confidence interval = 2.02-4.23). With an excellent area under the curve (0.906) and at a cutoff of 2.44, that ratio could correctly classify the patients based on their risk of LTEs with an overall accuracy of 73% (sensitivity of 88% and specificity of 70%). The current study endorsed an important, feasible, and easily obtainable ratio that could predictor stratify the patients according to severity and risk of LTEs, which guides the decision-making and prioritizes the treatment lines in methylxanthine intoxicated patients.

Preclinical and Clinical Medical Students' Perception of the Learning Environment: A Reference to the Forensic Medicine and Clinical Toxicology Course.

Purpose: Understanding learning environments is vital for developing curricula. This study aims to evaluate medical students' achievements and perception of learning environments considering the Forensic Medicine and Clinical Toxicology course as an analog for the curricular transition process. Methods: A cross-sectional study was conducted among undergraduate medical students at the Faculty of Medicine, Tanta University, from August 2020 to October 2021. Using the Dundee Ready Education Environment Measure (DREEM) questionnaire, the perception of 621 students (of which 307 were enrolled in the integrated curriculum and 314 in the traditional curriculum) were compared. Furthermore, the appropriate tests of significance and correlations were used to compare students' perception according to their enrollment, age, gender, and previous year grade point average. Results: The mean overall DREEM score was 121.04 ± 22.35, implying a more positive than negative learning environment, that is, a more positive learning perception, with students' perceptions of teachers moving in the right direction, students' academic self-perceptions getting more on the positive side, more positive attitudes regarding student's perceptions of the learning environment, and not-too-bad student's social self-perception. Medical students enrolled in the integrated curriculum showed higher DREEM scores, with significantly better learning and academic self-perceptions (p < 0.05). Knowledgeable, qualified faculties are the most significant characteristic feature in both systems. A significant number of students achieved excellent grades in the integrated curriculum (n = 740 out of 1076, 68.8%) than in the traditional one (n = 470 out of 961, 48.9%) (p < 0.0001). Conclusion: This study revealed a smooth, successful transition from the traditional to integrated curriculum among Egyptian medical students. The main areas for improvements are focusing on factual teaching, implementing student-centered teaching activities, promoting students' memorizing, and engaging students in activities that may help them enjoy learning.

Sex estimation from maxillary arch measurements in Egyptian populations: cross-sectional study / Estimación sexual a partir de mediciones del arco maxilar en poblaciones egipcias: estudio transversal

SUMMARY: Sex estimation is an essential step in personal identification and a cornerstone for developing biological profile from skeletal remains. The present study aimed to evaluate the role of maxillary arch widths and lengths as unique parameters in the estimation of sex in Egyptian populations. Maxillary arch measurements were collected from 1410 subjects where palatal impressions were obtained from each participant. Fourteen maxillary inter-teeth widths and lengths that excluded teeth dimensions were included The current study revealed that among the studied population, Egyptian men showed significant differences (p34.57 mm, it could predict the sex with sensitivity of 69.8 %, specificity of 58.8 % and p<0.05. The first molar could be considered as one of the most valid and reliable teeth in estimating sex in Egyptian populations. These measurements may be used as a reference in different populations in cases of mass disaster or relevant events.

RESUMEN: La estimación del sexo es un aspecto esencial en la identificación personal para desarrollar el perfil biológico a partir de restos óseos. El presente estudio tuvo como objetivo evaluar el papel del ancho y longitud del arco maxilar como parámetros únicos en la estimación del sexo en poblaciones egipcias. Se obtuvieron medidas del arco maxilar de 1410 sujetos, además de las impresiones palatinas de cada participante. El estudio actual reveló que entre la población estudiada, los hombres egipcios mostraron diferencias significativas (p 34,57 mm, podría predecir el sexo con sensibilidad de 69,8 %, especificidad de 58,8 % y p <0,05. El primer molar podría considerarse como uno de los dientes más confiables para estimar el sexo en las poblaciones egipcias. Estas mediciones se pueden utilizar como referencia en diferentes poblaciones en casos de desastres masivos o eventos relevantes.

Impact of Lockdown due to COVID-19 on the Modalities of Intoxicated Patients Presenting to the Emergency Room.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic influences health care facilities world-wide. The flow rate, type, and severity of cases presented to emergency departments varied during the pandemic in comparison to the past years. However, this change has not been well-described among the cases of hospital admission due to toxic exposure. STUDY OBJECTIVE: Recognition of the pattern of toxic exposure among the cases refereed to Tanta Poison Control Center (TPCC; Tanta, Egypt) during the past five years, and furthermore, exploration of the impact of lockdown due to the COVID-19 pandemic on the pattern of presented cases. METHODS: The current study is a five-year retrospective, comparative cross-sectional study carried out among acutely intoxicated patients admitted to TPCC during the spring months (March through May) of 2016-2020. A total of 1,916 patients with complete medical records were recruited. The type and manner of toxic exposure, demographic, clinical data, and outcomes were analyzed. RESULTS: The current study noted that there were delays in time from toxic exposure to emergency services during the lockdown period. This was reflected in significant lower recovery rates (884.8/1,000 population; z = -3.0) and higher death rates (49.4/1,000 population; z = 2.1) despite the marked decrease in the total number of hospital admissions in comparison to the past four years. The lockdown period showed significantly higher phosphides (z = 3.5; χ2 = 34.295; P <.001) and antipsychotics exposure (z = 3.6; χ2 = 21.494; P <.001) than the previous years. However, predominance of female exposure and intentional self-poisoning was maintained over the past five years, including the lockdown. CONCLUSION: COVID-19-associated lockdown greatly reformed the usual intoxication pattern of the cases admitted to emergency room. Also, it played a role in delaying time of hospital arrival, which was reflected as lower recovery rates and higher death rates.