Tramadol-induced seizures (TIS) are reported to occur in 15%-35% of tramadol poisoned cases. The ... more Tramadol-induced seizures (TIS) are reported to occur in 15%-35% of tramadol poisoned cases. The present study aimed to evaluate the risk factors of TIS and to find out if there is a correlation between TIS and the ingested dose and the blood level of tramadol. This study included cases of both genders with acute tramadol poisoning admitted to Tanta University Poison Control Center from January 2019 to December 2019. Each case was subjected to history taking, clinical and laboratory evaluation including tramadol urine screen, and tramadol blood level estimation at admission. Sixty-two cases were enrolled in the study. Their mean age was 28.3 9.6 years, 85.5% of them were males; addiction was the most common mood of poisoning. The seizure was recorded in 40.4% of the cases. There was a significant statistical difference between non-seizing and seizing groups regarding ingested tramadol dose and tramadol blood level. Furthermore, there was a strong significant positive correlation between ingested tramadol dose, tramadol blood level and occurrence of seizures. Receiver operating curve analysis revealed that ingested tramadol dose and tramadol blood level had an excellent discriminatory power in predicting seizure occurrence, but tramadol blood level had a better area under the curve. It was concluded that acute tramadol poisoning is associated with an increased risk of developing seizures. The ingested tramadol dose and the tramadol blood level could be used as excellent predictors of seizures in cases of tramadol overdoses.
Introduction: Ricin is one of the most potent and deadly plant toxins known. It induces oxidative... more Introduction: Ricin is one of the most potent and deadly plant toxins known. It induces oxidative stress and was exploited as a poison for bioterrorism due to its characters. Developing an effective antidote for ricin toxicity becomes a reliable way against its potential biothreat. Alpha lipoic acid (ALA) being an ideal antioxidant, was chosen as protection against ricin toxicity. Aim of the work: The current study was carried out to confirm the hepatotoxic effect of ricin using the electron microscope (EM) and to assess the potential protective effect of ALA against ricin hepatotoxicity and lethality. Material and methods: The current study was conducted on 60 adult male albino rats. Rats were divided into four groups. The first group (10 rats) was used as control group. Group II (10 rats) was injected with ALA (100mg/kg intraperitoneal). Group III (20 rats) was injected once with ricin (25ug/kg subcutaneous). Group IV was injected with ALA (100 mg/kg) 15 minute prior to and immedi...
The Egyptian Journal of Forensic Sciences and Applied Toxicology
Introduction: Road traffic accidents (RTAs) represent a leading contributor to global disease bur... more Introduction: Road traffic accidents (RTAs) represent a leading contributor to global disease burden. Drivers involved in some RTAs were found to be under the influence of different drugs. Marijuana effects on driving risks are not thoroughly understood. The study aimed to compare the pattern, severity and clinical outcome of injuries between marijuanasmoking drivers and non-drugged drivers in RTAs. Patients and Methods: This prospective, comparative study was carried out on 78 drivers admitted to emergency department, Tanta University Emergency Hospital during the period from the start of January to the end of December 2018. All drivers were subjected to history taking, clinical examination, assessment of injury severity score (ISS) and revised trauma score (RTS) and detection of tetrahydrocannabinol (THC) in urine. Results: Thirty-six drivers tested positive for THC with a median level of 314.6 ng/ml. There was lack of significant association between marijuana smoking and the site of injuries. The marijuana-positive group had a significantly higher frequency of skull fractures, ruptured spleen, intraperitoneal hemorrhage, and abrasions on body surface when compared to the marijuana-negative group. The median ISS was nonsignificantly higher, and the mortality was significantly higher in the marijuana-positive group. The THC level correlated significantly and strongly with both ISS and RTS. A significantly higher median THC level was detected in non-survivors compared to survivors. Conclusion: It could be concluded that Marijuana smoking is associated with increased mortality rate in victims of RTAs. There are strong correlations between THC level and both ISS and RTS, suggesting a dose-dependent effect of marijuana smoking.
Mansoura Journal of Forensic Medicine and Clinical Toxicology, Feb 20, 2020
Aluminum phosphide (AlP) is a fumigant widely used in Egypt. Limited data is available about mort... more Aluminum phosphide (AlP) is a fumigant widely used in Egypt. Limited data is available about mortality prediction in AlP poisoned patients. This work was designed to evaluate role of clinical data, laboratory investigations and ECG findings in predicting mortality in these cases. A cohort retrospective study was conducted on 113 cases of AlP poisoning admitted to Tanta University Poison Control Center. History, clinical data and results of laboratory investigations were recruited. The mortality rate was 68.1%. There was a significant difference between survivors and non-survivors as regards mode of poisoning, GCS, vital signs (except heart rate), ECG abnormalities, pH, HCo3, K, creatine level and white blood cell count. The multivariate analysis logistic regression revealed that ECG changes and pH level were the only independent variables that can predict mortality. Analysis of receiver operating curve of blood pH level revealed a good area under the curve (AUC) of 0.881. At a cut off value of ≤7.28 the blood pH level had a sensitivity of 71.43. It was concluded that AlP poisoning causes high mortality rate. Mortality could be predicted by ECG changes and blood pH level. At a cut off value of ≤7.28 the blood pH level was able to predict mortality. ECG assessment and blood pH monitoring are highly recommended in cases of AlP poisoning for early prediction of mortality.
Introduction: Falling from height is considered a major public health problem being the second le... more Introduction: Falling from height is considered a major public health problem being the second leading cause of unintentional injury death, after road traffic injuries. Falling represents a specific type of blunt force trauma, which is produced by rapid vertical deceleration and impact. There is no adequate literature available with reference to the type and pattern of injuries sustained in cases of falling from heights. Aim of the work: The aim of the present study was to analyze the different patterns of injuries sustained in victims of falling from different heights looking for recording possible uncommon patterns of injuries and to detect the incidence of substance abuse among them. Patients and methods: This study is a cross sectional statistical study of 200 cases of falling from different heights presented to Alkasr Alainy Emergency department during a period of six months from July to December 2013. Data collected included age, gender, occupation, circumstances of fall, height of falling, nature of landing surface, site and type of injuries sustained due to falling, besides calculation of injury severity score (ISS) for each case. In addition; urine dipstick test for detection of drugs of abuse was done for each case using the commercial kit (Abon Biopharm, Hangzhou, China). Results: Half of the cases fell from heights of one meter or less. Except for the three suicidal cases, the rest of the cases fell from height accidentally. The distribution of injuries took one of two forms; injuries in combined multiple sites of the body or injuries in isolated body region (uncommon pattern of injuries in cases of falling from height). At a height of one meter or less (low level), more than half of the cases had their injuries in the extremities while in higher heights, injuries were in combined multiple sites of the body. Blunt force wounds of the skin & subcutaneous tissue were the most common types of injuries in all cases. Urine dipstick test was positive in 21.5 % of cases. Only tramadol and cannabis were detected. Conclusion: It was concluded that falling from low heights is a very common phenomenon with its resultant injuries especially in the extremities. Injuries in isolated body region are not uncommon in cases of falling from height and represent one of the medicolegal challenges. External blunt force wounds were the most common type of injuries due to falling. In addition substance abuse is among the factors leading to falling from height.
The Egyptian Journal of Forensic Sciences and Applied Toxicology
Introduction: Ricin is one of the most potent and deadly plant toxins known. It induces oxidative... more Introduction: Ricin is one of the most potent and deadly plant toxins known. It induces oxidative stress and was exploited as a poison for bioterrorism due to its characters. Developing an effective antidote for ricin toxicity becomes a reliable way against its potential biothreat. Alpha lipoic acid (ALA) being an ideal antioxidant, was chosen as protection against ricin toxicity. Aim of the work: The current study was carried out to confirm the hepatotoxic effect of ricin using the electron microscope (EM) and to assess the potential protective effect of ALA against ricin hepatotoxicity and lethality. Material and methods: The current study was conducted on 60 adult male albino rats. Rats were divided into four groups. The first group (10 rats) was used as control group. Group II (10 rats) was injected with ALA (100mg/kg intraperitoneal). Group III (20 rats) was injected once with ricin (25ug/kg subcutaneous). Group IV was injected with ALA (100 mg/kg) 15 minute prior to and immediately after ricin injection. Survival time was recorded and liver samples were taken for examination under EM. Results: Injection of ALA together with ricin significantly prolonged the survival time of the rats in group IV more than those in group III. Electron microscopic examination of liver specimens obtained from group III revealed hepatocytes with either euchromatic nuclei, shrunken hyperchromatic nuclei or nuclei with marginated chromatin. Hugely dilated degranulated rough endoplasmic reticulum (RER), many lipid droplets and electron dense mitochondria were detected. Treatment of animals with ALA resulted in less ultra structure damage. The hepatocytes showed either euchromatic nuclei or nuclei with marginated chromatin. Their cytoplasm exhibited slightly dilated RER, electron dense mitochondria and some vacuoles. Conclusion: It was concluded that ricin is a hepatotoxic substance causing ultra structure damage. Furthermore, ALA proved to be beneficial in prolonging the survival time and decreasing the toxic effect of ricin on the liver. Recommendations: Further studies are recommended to detect the underlying mechanism of ricin hepatotoxicity and to find more protective substances against ricin toxicity
Journal of biochemical and molecular toxicology, 2014
Atrazine is currently the most widely used herbicide in agriculture with lots of adverse effects ... more Atrazine is currently the most widely used herbicide in agriculture with lots of adverse effects on human health. Curcumin is a polyphe-nol known for its antioxidant, anti-inflammatory, and anticancer properties. In the present study, the protective effect of curcumin on atrazin-intoxicated rats is evaluated. Toxicity was induced by oral administration of atrazine (400 mg/kg/day) for 3 weeks. Curcumin at a dose of 400 mg/kg/day was given simultaneously by oral route. Redox status, mitochon-drial function, 8-hydroxydeoxyguanosine (8-OHdG) level by immunoassay, and caspace-3 expression by immunohistochemistry were evaluated. Curcumin showed significant cardiac protection with improvement of redox status, mitochondrial function, 8-OHdG level, caspase-3 immunoreactivity, and cardiac muscle degeneration. From this current study, it can be concluded that administration of curcumin improved atrazine-induced cardiotoxicity through its modulatory effect on redox status, mitochondrial function, and caspase-3 expression. C
Ain Shams Journal of Forensic Medicine & Clinical Toxicology, 2016
Introduction: Metal phosphides are highly effective insecticides and rodenticide. They are used a... more Introduction: Metal phosphides are highly effective insecticides and rodenticide. They are used as a cheap and effective rodenticide in developing countries. Hemolysis and methemoglobinemia are rare but reported complications of phosphide poisoning Aim of the work: The aim of this study was to detect the incidence of methemoglobinemia and intravascular hemolysis in some cases of acute phosphide poisoning. Patients and methods: A cross sectional study was conducted on 50 cases suffering from acute metal phosphide poisoning admitted to Tanta toxicology unit, from the start of October 2014 till the end of March 2015. For each case, the following were done: history taking, physical examination and laboratory investigations (including measurement of methemoglobin (Met-Hb) level, arterial blood gas analysis, routine investigations, lactate dehydrogenase enzyme and complete blood picture with reticulocytic count). Results: Eight cases (16%) had combined methemoglobinemia and hemolysis. Aluminum phosphide was the toxic agent in seven of them and zinc phosphide in only one. Three cases (6%) had methemoglobinemia alone; one of them was poisoned by aluminum phosphide and the other two by zinc phospide. Another three cases had hemolysis alone; one of them was due to aluminum phosphide toxicity and the other two were due to zinc phospidetoxicity. So the present study included a total of eleven cases (22%) of methemoglobinemia. Their median age was 27 years old, while it was 24 years for patients with normal Met-Hb level. The median delay time was 4 hours for them and 2 hours for cases with normal Met-Hb level with significant statistical differences between both. The mean Met-Hb level was 14.45 ± 9.32% and1.63 ± 0.45% in cases with high and normal Met-Hb level respectively, with a significant statistical difference between both. Furthermore, the mean oxygen saturation showed a significant statistical difference between both. In addition, the present study included a total of eleven cases (22%) of hemolysis. Their median age was 27 years old, while it was 24 years for patients with no hemolysis. The median delay time was 3 hours in them and 2 hours in cases with no hemolysis. Conclusion: It was concluded that methemoglobinemia and hemolysis can complicate the course of acute phosphide poisoning. Recommendations: Further studies on a large scale of cases of acute phosphide poisoning with assessment of the outcome of cases presented with methemoglobinemia and hemolysis and the efficacy of the available treatment for such cases are recommended. Furthermore, it is important that health care professionals be aware of these rare presentations of phosphide poisoning.
Tramadol-induced seizures (TIS) are reported to occur in 15%-35% of tramadol poisoned cases. The ... more Tramadol-induced seizures (TIS) are reported to occur in 15%-35% of tramadol poisoned cases. The present study aimed to evaluate the risk factors of TIS and to find out if there is a correlation between TIS and the ingested dose and the blood level of tramadol. This study included cases of both genders with acute tramadol poisoning admitted to Tanta University Poison Control Center from January 2019 to December 2019. Each case was subjected to history taking, clinical and laboratory evaluation including tramadol urine screen, and tramadol blood level estimation at admission. Sixty-two cases were enrolled in the study. Their mean age was 28.3 9.6 years, 85.5% of them were males; addiction was the most common mood of poisoning. The seizure was recorded in 40.4% of the cases. There was a significant statistical difference between non-seizing and seizing groups regarding ingested tramadol dose and tramadol blood level. Furthermore, there was a strong significant positive correlation between ingested tramadol dose, tramadol blood level and occurrence of seizures. Receiver operating curve analysis revealed that ingested tramadol dose and tramadol blood level had an excellent discriminatory power in predicting seizure occurrence, but tramadol blood level had a better area under the curve. It was concluded that acute tramadol poisoning is associated with an increased risk of developing seizures. The ingested tramadol dose and the tramadol blood level could be used as excellent predictors of seizures in cases of tramadol overdoses.
Introduction: Ricin is one of the most potent and deadly plant toxins known. It induces oxidative... more Introduction: Ricin is one of the most potent and deadly plant toxins known. It induces oxidative stress and was exploited as a poison for bioterrorism due to its characters. Developing an effective antidote for ricin toxicity becomes a reliable way against its potential biothreat. Alpha lipoic acid (ALA) being an ideal antioxidant, was chosen as protection against ricin toxicity. Aim of the work: The current study was carried out to confirm the hepatotoxic effect of ricin using the electron microscope (EM) and to assess the potential protective effect of ALA against ricin hepatotoxicity and lethality. Material and methods: The current study was conducted on 60 adult male albino rats. Rats were divided into four groups. The first group (10 rats) was used as control group. Group II (10 rats) was injected with ALA (100mg/kg intraperitoneal). Group III (20 rats) was injected once with ricin (25ug/kg subcutaneous). Group IV was injected with ALA (100 mg/kg) 15 minute prior to and immedi...
The Egyptian Journal of Forensic Sciences and Applied Toxicology
Introduction: Road traffic accidents (RTAs) represent a leading contributor to global disease bur... more Introduction: Road traffic accidents (RTAs) represent a leading contributor to global disease burden. Drivers involved in some RTAs were found to be under the influence of different drugs. Marijuana effects on driving risks are not thoroughly understood. The study aimed to compare the pattern, severity and clinical outcome of injuries between marijuanasmoking drivers and non-drugged drivers in RTAs. Patients and Methods: This prospective, comparative study was carried out on 78 drivers admitted to emergency department, Tanta University Emergency Hospital during the period from the start of January to the end of December 2018. All drivers were subjected to history taking, clinical examination, assessment of injury severity score (ISS) and revised trauma score (RTS) and detection of tetrahydrocannabinol (THC) in urine. Results: Thirty-six drivers tested positive for THC with a median level of 314.6 ng/ml. There was lack of significant association between marijuana smoking and the site of injuries. The marijuana-positive group had a significantly higher frequency of skull fractures, ruptured spleen, intraperitoneal hemorrhage, and abrasions on body surface when compared to the marijuana-negative group. The median ISS was nonsignificantly higher, and the mortality was significantly higher in the marijuana-positive group. The THC level correlated significantly and strongly with both ISS and RTS. A significantly higher median THC level was detected in non-survivors compared to survivors. Conclusion: It could be concluded that Marijuana smoking is associated with increased mortality rate in victims of RTAs. There are strong correlations between THC level and both ISS and RTS, suggesting a dose-dependent effect of marijuana smoking.
Mansoura Journal of Forensic Medicine and Clinical Toxicology, Feb 20, 2020
Aluminum phosphide (AlP) is a fumigant widely used in Egypt. Limited data is available about mort... more Aluminum phosphide (AlP) is a fumigant widely used in Egypt. Limited data is available about mortality prediction in AlP poisoned patients. This work was designed to evaluate role of clinical data, laboratory investigations and ECG findings in predicting mortality in these cases. A cohort retrospective study was conducted on 113 cases of AlP poisoning admitted to Tanta University Poison Control Center. History, clinical data and results of laboratory investigations were recruited. The mortality rate was 68.1%. There was a significant difference between survivors and non-survivors as regards mode of poisoning, GCS, vital signs (except heart rate), ECG abnormalities, pH, HCo3, K, creatine level and white blood cell count. The multivariate analysis logistic regression revealed that ECG changes and pH level were the only independent variables that can predict mortality. Analysis of receiver operating curve of blood pH level revealed a good area under the curve (AUC) of 0.881. At a cut off value of ≤7.28 the blood pH level had a sensitivity of 71.43. It was concluded that AlP poisoning causes high mortality rate. Mortality could be predicted by ECG changes and blood pH level. At a cut off value of ≤7.28 the blood pH level was able to predict mortality. ECG assessment and blood pH monitoring are highly recommended in cases of AlP poisoning for early prediction of mortality.
Introduction: Falling from height is considered a major public health problem being the second le... more Introduction: Falling from height is considered a major public health problem being the second leading cause of unintentional injury death, after road traffic injuries. Falling represents a specific type of blunt force trauma, which is produced by rapid vertical deceleration and impact. There is no adequate literature available with reference to the type and pattern of injuries sustained in cases of falling from heights. Aim of the work: The aim of the present study was to analyze the different patterns of injuries sustained in victims of falling from different heights looking for recording possible uncommon patterns of injuries and to detect the incidence of substance abuse among them. Patients and methods: This study is a cross sectional statistical study of 200 cases of falling from different heights presented to Alkasr Alainy Emergency department during a period of six months from July to December 2013. Data collected included age, gender, occupation, circumstances of fall, height of falling, nature of landing surface, site and type of injuries sustained due to falling, besides calculation of injury severity score (ISS) for each case. In addition; urine dipstick test for detection of drugs of abuse was done for each case using the commercial kit (Abon Biopharm, Hangzhou, China). Results: Half of the cases fell from heights of one meter or less. Except for the three suicidal cases, the rest of the cases fell from height accidentally. The distribution of injuries took one of two forms; injuries in combined multiple sites of the body or injuries in isolated body region (uncommon pattern of injuries in cases of falling from height). At a height of one meter or less (low level), more than half of the cases had their injuries in the extremities while in higher heights, injuries were in combined multiple sites of the body. Blunt force wounds of the skin & subcutaneous tissue were the most common types of injuries in all cases. Urine dipstick test was positive in 21.5 % of cases. Only tramadol and cannabis were detected. Conclusion: It was concluded that falling from low heights is a very common phenomenon with its resultant injuries especially in the extremities. Injuries in isolated body region are not uncommon in cases of falling from height and represent one of the medicolegal challenges. External blunt force wounds were the most common type of injuries due to falling. In addition substance abuse is among the factors leading to falling from height.
The Egyptian Journal of Forensic Sciences and Applied Toxicology
Introduction: Ricin is one of the most potent and deadly plant toxins known. It induces oxidative... more Introduction: Ricin is one of the most potent and deadly plant toxins known. It induces oxidative stress and was exploited as a poison for bioterrorism due to its characters. Developing an effective antidote for ricin toxicity becomes a reliable way against its potential biothreat. Alpha lipoic acid (ALA) being an ideal antioxidant, was chosen as protection against ricin toxicity. Aim of the work: The current study was carried out to confirm the hepatotoxic effect of ricin using the electron microscope (EM) and to assess the potential protective effect of ALA against ricin hepatotoxicity and lethality. Material and methods: The current study was conducted on 60 adult male albino rats. Rats were divided into four groups. The first group (10 rats) was used as control group. Group II (10 rats) was injected with ALA (100mg/kg intraperitoneal). Group III (20 rats) was injected once with ricin (25ug/kg subcutaneous). Group IV was injected with ALA (100 mg/kg) 15 minute prior to and immediately after ricin injection. Survival time was recorded and liver samples were taken for examination under EM. Results: Injection of ALA together with ricin significantly prolonged the survival time of the rats in group IV more than those in group III. Electron microscopic examination of liver specimens obtained from group III revealed hepatocytes with either euchromatic nuclei, shrunken hyperchromatic nuclei or nuclei with marginated chromatin. Hugely dilated degranulated rough endoplasmic reticulum (RER), many lipid droplets and electron dense mitochondria were detected. Treatment of animals with ALA resulted in less ultra structure damage. The hepatocytes showed either euchromatic nuclei or nuclei with marginated chromatin. Their cytoplasm exhibited slightly dilated RER, electron dense mitochondria and some vacuoles. Conclusion: It was concluded that ricin is a hepatotoxic substance causing ultra structure damage. Furthermore, ALA proved to be beneficial in prolonging the survival time and decreasing the toxic effect of ricin on the liver. Recommendations: Further studies are recommended to detect the underlying mechanism of ricin hepatotoxicity and to find more protective substances against ricin toxicity
Journal of biochemical and molecular toxicology, 2014
Atrazine is currently the most widely used herbicide in agriculture with lots of adverse effects ... more Atrazine is currently the most widely used herbicide in agriculture with lots of adverse effects on human health. Curcumin is a polyphe-nol known for its antioxidant, anti-inflammatory, and anticancer properties. In the present study, the protective effect of curcumin on atrazin-intoxicated rats is evaluated. Toxicity was induced by oral administration of atrazine (400 mg/kg/day) for 3 weeks. Curcumin at a dose of 400 mg/kg/day was given simultaneously by oral route. Redox status, mitochon-drial function, 8-hydroxydeoxyguanosine (8-OHdG) level by immunoassay, and caspace-3 expression by immunohistochemistry were evaluated. Curcumin showed significant cardiac protection with improvement of redox status, mitochondrial function, 8-OHdG level, caspase-3 immunoreactivity, and cardiac muscle degeneration. From this current study, it can be concluded that administration of curcumin improved atrazine-induced cardiotoxicity through its modulatory effect on redox status, mitochondrial function, and caspase-3 expression. C
Ain Shams Journal of Forensic Medicine & Clinical Toxicology, 2016
Introduction: Metal phosphides are highly effective insecticides and rodenticide. They are used a... more Introduction: Metal phosphides are highly effective insecticides and rodenticide. They are used as a cheap and effective rodenticide in developing countries. Hemolysis and methemoglobinemia are rare but reported complications of phosphide poisoning Aim of the work: The aim of this study was to detect the incidence of methemoglobinemia and intravascular hemolysis in some cases of acute phosphide poisoning. Patients and methods: A cross sectional study was conducted on 50 cases suffering from acute metal phosphide poisoning admitted to Tanta toxicology unit, from the start of October 2014 till the end of March 2015. For each case, the following were done: history taking, physical examination and laboratory investigations (including measurement of methemoglobin (Met-Hb) level, arterial blood gas analysis, routine investigations, lactate dehydrogenase enzyme and complete blood picture with reticulocytic count). Results: Eight cases (16%) had combined methemoglobinemia and hemolysis. Aluminum phosphide was the toxic agent in seven of them and zinc phosphide in only one. Three cases (6%) had methemoglobinemia alone; one of them was poisoned by aluminum phosphide and the other two by zinc phospide. Another three cases had hemolysis alone; one of them was due to aluminum phosphide toxicity and the other two were due to zinc phospidetoxicity. So the present study included a total of eleven cases (22%) of methemoglobinemia. Their median age was 27 years old, while it was 24 years for patients with normal Met-Hb level. The median delay time was 4 hours for them and 2 hours for cases with normal Met-Hb level with significant statistical differences between both. The mean Met-Hb level was 14.45 ± 9.32% and1.63 ± 0.45% in cases with high and normal Met-Hb level respectively, with a significant statistical difference between both. Furthermore, the mean oxygen saturation showed a significant statistical difference between both. In addition, the present study included a total of eleven cases (22%) of hemolysis. Their median age was 27 years old, while it was 24 years for patients with no hemolysis. The median delay time was 3 hours in them and 2 hours in cases with no hemolysis. Conclusion: It was concluded that methemoglobinemia and hemolysis can complicate the course of acute phosphide poisoning. Recommendations: Further studies on a large scale of cases of acute phosphide poisoning with assessment of the outcome of cases presented with methemoglobinemia and hemolysis and the efficacy of the available treatment for such cases are recommended. Furthermore, it is important that health care professionals be aware of these rare presentations of phosphide poisoning.
Uploads
Papers by Amira Wahdan