Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by increasing airflow limitation and respiratory symptoms, often associated with chronic co morbidities, leading to a significant burden for the patient. Aim of the work: to assess plasma NT-proBNP level in patients with acute exacerbation of COPD (AECOPD) and to evaluate the prognostic value of elevated NT-proBNP levels to predict in-hospital outcome of those patients. Material and Methods: From 1 November 2010 to 30 April 2011, 45 adult patients ≥ 40 years of age with acute exacerbation of COPD (AECOPD) admitted to department of pulmonary medicine &or Respiratory ICU ;Assiut University Hospital; Egypt were enrolled in this study. Plasma NT-proBNP levels were measured and systolic pulmonary arterial pressure (SPAP) was estimated by echocardiography. Arterial blood gas analysis, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were also measured. Results: NT-proBNP levels were significantly elevated during the acute exacerbation compared to recovery (254 pg/mL [interquartile range IQR, 103 to 972 pg/mL] vs 89 pg/mL [IQR, 45 to 269 pg/mL]; p = 0.000). Also in those patients requiring ICU admission [416 pg/mL (IQR, 214 to 972)] vs [200.5 pg/mL (IQR,103 to 516)]p=0.000.To predict ICU admission in patients with AECOPD, a receiver operating Characteristic (ROC) analysis was performed with NT-proBNP level > 300 has the best sensitivity and specificity (Sensitivity = 89.5%, Specificity = 92.3%) with area under the ROC curve (AUC) = 0.933. NT-proBNP levels at exacerbation were significantly elevated in patients with cor pulmonale compared to those without cor pulmonale [329 pg/mL (IQR, 167 to 972)] vs [197pg/mL (IQR,103 to 324)]p=0.000. With cut-off level of NT-proBNP > 214 pg/ml, which gives the best sensitivity and specificity (Sensitivity = 95.7%, Specificity = 72.7%) with area under the ROC curve (AUC) = 0.895. There was significant correlation between NT-proBNP levels at exacerbation and partial pressure of carbon dioxide (PaCO2),(PH),systolic pulmonary artery pressure(SPAP),duration in ICU and length of hospital stay (r =-0.422, p =0.004) , (r =-0.426, p =0.004) , (r = 0.811, p =0.000) , (r = 0.765, p =0.000) and (r = 0.805, p =0.000) respectively. Conclusions: This study revealed that, plasma NT-proBNP levels are elevated in AECOPD patients and can predict the need for ICU admission. Also can predict the occurrence of cor pulmonale in those patients.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by increasing airflow limitation and respiratory symptoms, often associated with chronic co morbidities, leading to a significant burden for the patient. Aim of the work: to assess plasma NT-proBNP level in patients with acute exacerbation of COPD (AECOPD) and to evaluate the prognostic value of elevated NT-proBNP levels to predict in-hospital outcome of those patients. Material and Methods: From 1 November 2010 to 30 April 2011, 45 adult patients ≥ 40 years of age with acute exacerbation of COPD (AECOPD) admitted to department of pulmonary medicine &or Respiratory ICU ;Assiut University Hospital; Egypt were enrolled in this study. Plasma NT-proBNP levels were measured and systolic pulmonary arterial pressure (SPAP) was estimated by echocardiography. Arterial blood gas analysis, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were also measured. Results: NT-proBNP levels were significantly elevated during the acute exacerbation compared to recovery (254 pg/mL [interquartile range IQR, 103 to 972 pg/mL] vs 89 pg/mL [IQR, 45 to 269 pg/mL]; p = 0.000). Also in those patients requiring ICU admission [416 pg/mL (IQR, 214 to 972)] vs [200.5 pg/mL (IQR,103 to 516)]p=0.000.To predict ICU admission in patients with AECOPD, a receiver operating Characteristic (ROC) analysis was performed with NT-proBNP level > 300 has the best sensitivity and specificity (Sensitivity = 89.5%, Specificity = 92.3%) with area under the ROC curve (AUC) = 0.933. NT-proBNP levels at exacerbation were significantly elevated in patients with cor pulmonale compared to those without cor pulmonale [329 pg/mL (IQR, 167 to 972)] vs [197pg/mL (IQR,103 to 324)]p=0.000. With cut-off level of NT-proBNP > 214 pg/ml, which gives the best sensitivity and specificity (Sensitivity = 95.7%, Specificity = 72.7%) with area under the ROC curve (AUC) = 0.895. There was significant correlation between NT-proBNP levels at exacerbation and partial pressure of carbon dioxide (PaCO2),(PH),systolic pulmonary artery pressure(SPAP),duration in ICU and length of hospital stay (r =-0.422, p =0.004) , (r =-0.426, p =0.004) , (r = 0.811, p =0.000) , (r = 0.765, p =0.000) and (r = 0.805, p =0.000) respectively. Conclusions: This study revealed that, plasma NT-proBNP levels are elevated in AECOPD patients and can predict the need for ICU admission. Also can predict the occurrence of cor pulmonale in those patients.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by increasing airflow limitation and respiratory symptoms, often associated with chronic co morbidities, leading to a significant burden for the patient. Aim of the work: to assess plasma NT-proBNP level in patients with acute exacerbation of COPD (AECOPD) and to evaluate the prognostic value of elevated NT-proBNP levels to predict in-hospital outcome of those patients. Material and Methods: From 1 November 2010 to 30 April 2011, 45 adult patients ≥ 40 years of age with acute exacerbation of COPD (AECOPD) admitted to department of pulmonary medicine &or Respiratory ICU ;Assiut University Hospital; Egypt were enrolled in this study. Plasma NT-proBNP levels were measured and systolic pulmonary arterial pressure (SPAP) was estimated by echocardiography. Arterial blood gas analysis, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were also measured. Results: NT-proBNP levels were significantly elevated during the acute exacerbation compared to recovery (254 pg/mL [interquartile range IQR, 103 to 972 pg/mL] vs 89 pg/mL [IQR, 45 to 269 pg/mL]; p = 0.000). Also in those patients requiring ICU admission [416 pg/mL (IQR, 214 to 972)] vs [200.5 pg/mL (IQR,103 to 516)]p=0.000.To predict ICU admission in patients with AECOPD, a receiver operating Characteristic (ROC) analysis was performed with NT-proBNP level > 300 has the best sensitivity and specificity (Sensitivity = 89.5%, Specificity = 92.3%) with area under the ROC curve (AUC) = 0.933. NT-proBNP levels at exacerbation were significantly elevated in patients with cor pulmonale compared to those without cor pulmonale [329 pg/mL (IQR, 167 to 972)] vs [197pg/mL (IQR,103 to 324)]p=0.000. With cut-off level of NT-proBNP > 214 pg/ml, which gives the best sensitivity and specificity (Sensitivity = 95.7%, Specificity = 72.7%) with area under the ROC curve (AUC) = 0.895. There was significant correlation between NT-proBNP levels at exacerbation and partial pressure of carbon dioxide (PaCO2),(PH),systolic pulmonary artery pressure(SPAP),duration in ICU and length of hospital stay (r =-0.422, p =0.004) , (r =-0.426, p =0.004) , (r = 0.811, p =0.000) , (r = 0.765, p =0.000) and (r = 0.805, p =0.000) respectively. Conclusions: This study revealed that, plasma NT-proBNP levels are elevated in AECOPD patients and can predict the need for ICU admission. Also can predict the occurrence of cor pulmonale in those patients.

In mechanical ventilation for status asthmaticus, a lung protective strategy directed at reducing dynamic hyperinflation must be used, with low tidal volumes and long expiratory times. Pressure regulated volume control is a dual mode with tidal volume is feedback control for continuously adjusting pressure control. On the other hand pressure control is a fixed pressure in each breath with no target tidal volume. Objective: To compare between the two modes (PC and VC+) regarding clinical, gasometric and ventilatory response in patients with status asthmaticus. Patients& methods: Fourty intubated patients (21males and 19 females) with status asthmaticus were studied. The patients had been mechanically ventilated with puritan Bennett, 840 ventilator. They are divided into two groups: G1: Submitted to PC, and G2: Submitted to VC+. Results: Both groups were comparable regarding demographic, clinical, gasometric, and laboratory data. The successful outcome was recorded in 75% of patients in G1, versus 80 % in G2. There was a significant (P0.05) improvement in RR, pH, PaCO2, PaO2after 1hour of mechanical ventilation in both groups, with significantly better improvement for pH & PaCO2 in G2.In successful outcome there was a significant (P0.05) lower end inspiratory pressure inG2 (21.6 ±2.1 vs 27 ± 0.9 in G1), lower auto PEEP in G2 (3.3 ±0.7 vs 5.2 ± 1.0 in G1), and decrease of missing efforts in G2 (0.9 ±0.6 vs 1.7 ± 0.5 in G1) after 6hours ventilation. Also Tidal volume revealed a significant (P.001) higher values in G2 (394 ±33 vs 330 ± 28 in G1) after 1 hour ventilation. In both groups, auto PEEP showed significant positive correlation(r=0.916; P0.001in G1 and r=0.872; P0.001 ) with number of missing efforts. Conclusion: VC+ offers better minute ventilation, lower inspiratory pressure, less homodynamic compromise and is more comfortable than pressure control for intubated patients with status asthmaticus.

Between February 2000 and April 2009, twenty-three patients with floating shoulders( double disruption of the superior shoulder suspensory complex) underwent internal fixation of both the clavicular and scapular fractures The mean age of the patients was 40 (18—57) years. All patients had associated injuries. We evaluated the clinical results using the Rowe Score[1] in 20 available patients after a minimum follow-up of 20 months. All fractures united and the average time to union was 12 weeks for clavicular and 10 for scapular fractures. A mean functional result obtained according to Rowe Score was 86 . Surgical treatment for double disruption of the SSSC which inherently unstable rare injury is a good option, allowing early rehabilitation and improve the functional outcome

Age estimation in children is an important question in forensic medicine as well as clinical dentistry. Developing teeth are thought to be useful means to assess maturation and hence biological age estimation in children. Several methods have been adopted to examine developing teeth especially those dedicated to measure stages of teeth formation rather than its eruption. The purpose of the present work was to evaluate the suitability of using Willems and Cameriere methods for dental age estimation among children from the Middle East region. METHODS: Retrospective study of orthopantomographs of 345 healthy children representing a sample from Arab countries of the Middle East that were collected during the period from 2008-2010 were examined. Willems and Cameriere methods were implemented for dental age estimation from left mandibular teeth. RESULTS: Preliminary results for boys from Egypt and Qatar state (60 and 50 respectively) using Willems method indicated significant correlation with chronological age with average overestimation of age by 0.44+/-0.05 years for Egyptian children and for Qatari boys by 0.64+/-0.08. CONCLUSIONS: Initial conclusion showed that Willems method can be a suitable method for both forensic and dental application for Egyptian and Qatari boys.

Clothes examination may provide important clues in crime investigation. In addition to its role in identification of the victim and sometimes the assailant. It may carry some physical evidence which have the potential to play a critical role in the overall investigation and resolution of a suspected criminal act. Clothes may be disordered indicating a struggle, or may be soiled or stained with blood or other biological stains including semen, hair, saliva or non biological evidence as fibers, paint, glass, debris and dirt as a result of contact with assailant or the scene. The interposition of clothing may prevent the features of secondary projectile deposition and/ or searing from occurring, and the examination of clothing by forensic scientists may provide essential evidence in cases involving firearms. These evidences shouldn't be missed or overlooked. So clothes should be photographed, examined thoroughly and described carefully before beginning the examination of the body. Clothes shouldn't be removed except by the medical man after recording the condition of rigor. Cuts or injuries sustained by the clothing should be carefully compared with the underlying surface of the body. It should be dried preserved carefully in special bag or envelope and seal with sealing- wax impressed with the private seal of the examiner. Chemical and or serological examination may be required. This paper aimed for recognition of the significance of clothing as a potential source of evidence for forensic scientist, physicians as well as emergency room and intensive care personnel, to adopt and follow the procedure designed to preserve such important evidence.

Tramadol is one of a typical centrally acting opioids.It is indicated for management of moderate to sever pain. Now it is considered to be the most widely sold analgesic in the world and is registered and marketed in more than 100 countries. Objectives: A study was conducted to investigate the histopathological changes in rat brain and spinal cord with particular reference to formation of red neurons in response to long term administration of Tramadol in progressively increased doses. Material& Methods: Sixty adult male albino rats (160-180 g) were included and divided into three groups. Control group: (a) given normal saline (n=10) for three months ( b) given normal saline (n=10) for one month orally. Group I (n=20) received Tramadol orally at doses 1/10 LD50 , 1/5 LD50 and lastly four times the initial dose for the first second and third months respectively. Group II 1/10 LD50 (22.8mg/kg/day)for one month. All rats were scarified after 24 hours of the last dose at the end of each experimental period under ether anesthesia. Craniotomy and laminectomy was performed and intact brains and spinal cords were dissected and removed for histopathological studies. The presence of number of red neurons which are histological marker of apoptosis were investigated in frontal, parietal, temporal, Entorhial, pyriform occipital , hippocampal and spinal cord tissues. Results: There was significant decrease in weight of experimental animals in both groups in comparison to the control one. The number of small sized neurons were greater in group II than in group I. There was statistical difference regarding neuopil density and color staining among three groups. Neuopil was lighter in staining and less dense in groups I and II comparing to control(p≤0.002 and p≤0.001) using ANOVA test. Red neurons were found in group I and II higher than control. There were statistical difference between density of red neurons in group I and II and control (p 0.001). The highest number of red neurons was found in hippocampal region followed by occipital and frontal. The abnormalities occurred in the spinal cord tissue is less than those in the brain tissue. The only changes were found in the neuropil (fainter and less dense in group Iand II compared with control. Conclusions:

the application of hair analysis for the detection of drugs in the human body has become an important method, because it can provide evidence of drug use over a much longer period than the conventional testing in blood and urine. Aim:The present work was designed to detect amitriptyline HCl and clozapine in hair of albino rats. Hair samples were examined during drug administration and after stopping. Method: Fifty adult albino rats of both sex were divided into three groups. Each of the first two groups included fifteen rats which were given the therapeutic doses of amitriptyline HCl at a concentration of 3.4 mg/day and clozapine at a concentration of 4.2 mg/day .The third group included twenty rats, which was subdivided into two subgroups, each included ten rats, subgroup (A) which was given distilled water (positive control), and subgroup (B) which was the blank group that lived in the same environmental conditions without being treated with any medications. The drugs were given orally by gavage for three consecutive months. Hair samples were taken on the second day of drug administration then on the fifth day and then weekly till the end of the three months to detect the onset of appearance and the rate of increase of these drugs, and after stopping the drugs, we continued to take hair samples every week to detect the time of drug disappearance. Combination of thin-layer chromatography and color reactions have been used. Samples were confirmed by using high performance liquid chromatography. Results: The results revealed that, amitriptyline HCl and clozapine were detected in the hair in the second day after drug administration. After stopping drug administration ,hair samples taken revealed that, clozapine, can be detected in the hair up to 28 days. Amitriptyline HCl disappeared after clozapine, as it can be detected in the hair up to 35 days after stopping drug administration. Conclusion: This study can concluded that psychotropic drugs can be detected in hair. Also hair analysis can be used to differentiate between drug consumers, chronic poisoning and drug abusing.