الفهرس 
INTRODUCTION AND AIM OF THE WORK
Aim of the workOnly 14 pages are availabe for public view
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Abstract
This study was carried in order to identify the poisoning pattern of patients presented in emergency units of Assiut city hospitals in years 2011 and 2012. These hospitals are Assiut University hospital, Pediatric University hospital, El Eman General Hospital, Assiut General Hospital and El Mabra hospital of health insurance in Assiut by revising the reception archives of these hospitals after obtaining official approvals.
The results of this study have shown the following:-
Statistically significant increase in the total number of poisoning cases in year 2012 than year 2011, where the total number of cases in year 2012 was 3033 cases (1493 males – 1540 females) while the total number of poisoning cases in year 2011 were 2401 cases (1225 males – 1176 females).
It has been found statistically significant increase in the percentage of poisoning cases in Pediatric University hospital and El Eman General hospital than Assiut University hospital, Assiut General hospital and El Mabra hospital of health insurance during years 2011 and 2012, where the total number of poisoning cases in year 2011 was 738 cases (424 males – 314 females) and in year 2012 the total number of poisoning cases were 843 cases (456 males – 387 females).
The total number of poisoning cases in El Eman General hospital in year 2011 was 685 cases (322 males – 363 females) and in year 2012 were 670 cases (307 males – 363 females). The total number of poisoning cases in Assiut General hospital in year 2011 was 558 cases (280 males – 278 females) and in year 2012 were 855 cases (433 males – 422 females).
The number of poisoning cases in Assiut University hospital was 417 cases (196 males – 221 females) in year 2011, while the number of cases in year 2012 were 665 cases (297 males – 368 females). The number of cases in El Mabra hospital of health insurance in year 2011 was 3 cases (all are males) but there is no cases were reported in year 2012.
It was found a statistically significant increase in the percentage of the number of poisoning cases in children less than ten years, which represent the majority of poisoning cases, the percentage was 38% in year 2011 and 36.3% in year 2012.
It has been found increase in the percentage of cases of poisoning among males than females in year 2011, where the percentage in the male 51%, while the percentage in the female 49%, while in year 2012 there was an increase in the percentage of poisoning among females than males, where the percentage was in females 50.8%, while the percentage was 49.2% in males.
It has been found a statistically significant increase in the percentage of poisoning cases in summer season than the rest of seasons of the year, where the percentage was 41.6% in year 2011, and 49.9% in year 2012, and this may be due to the increase in the number of poisoning cases by scorpion sting, pesticides and food poisoning in Assiut Governorate.
It has been found a statistically significant increase in the percentage of poisoning cases which coming from rural areas than urban areas where the percentage was 78.3% in year 2011 and 80.4% in year 2012, and this may be due to the low level education, living standards and health awareness in rural areas.
When we follow the pattern in the occupations of poisoning cases has been observed an increase in the percentage of poisoning cases among students, pre-education and housewives than the rest of jobs in years 2011 and 2012, where the percentage of students was 29.7% in year 2011 and 30.9% in year 2012 and the percentage of pre-school children was 26.4% in year 2011 and 23.8% in year 2012 and the percentage of housewives was 16.7% in year 2011 and 19.8% in year 2012, this may be due to the increase number of cases poisoned by scorpion sting and snake bite and drugs in the pre- education enrollment and also through the various stages of education, as well as the increase number of poisoning cases by all types of poisons between housewives, especially the illiterate of them.
It has been found a statistically significant increase in poisoning by scorpion sting and snake bite than the rest of poisoning cases where the percentage was 47.6% in year 2011 and 54.5% in year 2012 from the total number of cases, followed by food poisoning, where the percentage was 20% in year 2011 and 14.4% in year 2012, followed by poisoning by drugs, where the percentage was 14.7% in year 2011 and 13.6% in year 2012 then poisoning by chemicals, where the percentage was 11.9% in year 2011 and 13.1% in year 2012 then poisoning by unknown substances where the percentage was 5.1% in year 2011 and 4.2% in year 2012 and finally poisoning by inhalation of the gases, where the percentage was 0.6% in year 2011 and 0.3% in year 2012.
It has been found a statistically significant increase in the number of cases resulting from the sting or bite route than other sources of entering the poison to the body, such as oral and inhalation routes, where the percentage was 47.6% in year 2011 and 54.5% in year 2012 and this is due to the increase in the percentage of scorpion sting and snake bite cases than the rest of poisoning cases.
It has been found a statistically significant increase in the percentage of the number of poisoning cases by accidental manner, where the percentage was 85.8% in year 2011 and 85.5% in year 2012 than poisoning by intentional intent to commit suicide, where the percentage was 14.2% in year 2011 and 14.5% in year. There are no recorded cases of criminal poisoning during years 2011 and 2012.
As regard the fate of the poisoning cases which received by emergency units in mentioned hospitals have found a statistically significant increase in the proportion of cases that have been completely cured, where the percentage was 47.5% in year 2011 and 48.3% in year 2012 of the total number of cases. The percentage of cases of escape from hospitals was 30.5% in year 2011 and 36.8% in year 2012 and this is due to the fear of poisoning patients from legal responsibility. The percentage of poisoning cases which discharged on patients request before the completion of treatment was 11.9% in year 2011 and 9.6% in year 2012 from the total number of cases.
The percentage of poisoning cases which admited in internal departments of mentioned hospitals was 8% in year 2011 and 3.5% in year 2012. The mortality rate was 1.6% in year 2011 and 1.3% in year 2012. The percentage of poisoning cases referal to other hospital was 0.5% of the total number of poisoning cases in years 2011 and 2012, and these cases have been transferred from the Ministry of Health hospitals to University hospitals.
It has been found a statistically significant increase in the percentage of deaths in the age group of 11-20 years, where the percentage was 36.8% in year 2011 and 35% in year 2012 then age group of 21-30 years, where the percentage was 31.6% in year 2011 and 20% in year 2012, then age group less than 10 years, where the percentage was 18.4% in year 2011 and 25% in year 2012.
There was a statistically significant increase in the proportion of deaths from chemicals, where the percentage was 57.9% in year 2011 and 40% in year 2012, followed by deaths from scorpion sting and snake bite, where the percentage was 21.1% in year 2011 and 32.5% in year 2012 then deaths from drugs, where the percentage was 7.9 % in year 2011 and 15% in year 2012 then deaths from unknown substances by 10.5% in year 2011 and 7.5% in year 2012 and finally deaths from food poisoning where the percentage was 2.6% in year 2011 and 5% in year 2012.
There is a statistically significant increase in the percentage of drugs of abuse, where the percentage was 16.9% in year 2011 and 17.5% in year 2012 and the most of them was hypnotics where the percentage was 33.3% in year 2011 and 31.9% in year 2012 followed by tramadol by 16.7% in year 2011 and 12.5% in year 2012, then alcohol by 15% in year 2011 and 11.1% in year 2012, then antideprassantes by 10% in year 2011 and 9.7% in year 2012 from the total number of drugs of abuse.
There is a statistically significant increase in the percentage of therapuetic known drugs, where the percentage was 21.5% in year 2011 and 20.4% in year 2012 and the most of them was antiepeleptic drugs by 18.4% in year 2011 and 16.7% in year 2012, followed by antipyretics by 13.2% in year 2011 and 17.9% in year 2012, then hormons by 15.8% in year 2011 and 31.1% in year 2012, then antihypertensives & antibiotics by 11.8% in year 2011 and 8.3% in year 2012 for each of them, then bronchodilators by 6.6% in year 2011 and 13.1% in year 2012 from the total number of therapuetic known drugs.
It has been found a statistically significant increase in the percentage of pesticide poisoning, where the percentage was 64.7% in year 2011 and 74.6% in year 2012, then poisoning by corrosives by 16.1% in year 2011 and 11.6% in year 2012, then poisoning by petroleum distillates where the percentage was 11.9% in year 2011 and 5.3% in year 2012, then poisoning by household poisons where the percentage was 7.3% in year 2011 and 8.6% in year 2012.
The results of this study concluded that: -
(1) There is defect in complete informations about the type of poison or management or investigations or fate of poisoning in most medical reports
(2) There is a continuous increase in the number of poisoning cases, especially among children as a result of the increase in population and the increase in the use of chemicals and drugs, as well as the presence of a high percentage of poisoning cases poisoned by scorpion sting and snake bite as a result of the nature of the geographic area that helped the spread of scorpions and snakes, especially in Assiut Governorate.
(3) Lack of specific prevention program about poisoning in the community.
(4) Lack of specified physcians in clinical toxicology to treat cases of poisoning effectively.
(5) Lack of presence of poison control center in Assiut governorate.
The followng recommendations must be implemented:-
1 – Pay attention about recording and documentation of poisoning cases in the hospitals’s archives which help the researchers to perform statistical studies about the pattern of poisoning in the various governorates of Egypt which help the health authorities to develop a suitable health strategy for the diagnosis and treatment of poisoning.
2 - The importance of supporting the clinial toxicology and forensic chemistry laboratory in Faculty of Medicine, Assiut University for poisons analysis, as well as establishing a center for the treatment of poisoning cases at Assiut University to help poisoned patient of Assiut Governorate and Upper Egypt. There is a need for presence of poisoning management clinic in each hospital in the governorate.
3- The importance of development of community poisoning prevention program during putting the health strategies.
4 – Child-resistant containers for drugs and other household products are one of the most important measures to reduce childhood poisoning; also children must be taught the elements of safety. Physician should limit the prescription of dangerous drugs and advise against self-medication.
5 - The importance of presence of antidote and the availability of materials of gastric lavage, induction of emesis and activated charcoal in all hospitals to speed treatment of poisoning cases rather than the loss of more time in transferring of them to other places, this can lead to decrease of both morbidity and mortality levels.
6 - Need to establish obligatory training programs and workshops, especially the diagnosis and treatment of poisoning cases for all physcians under the supervision of staff members specialized in clinical toxicology.
7 - The need to establish awareness and guide programs about poisoning in the mass media, especially for housewives on the causes and how to deal with cases of poisoning, as well as teach them ways to first aid measures in Occurrence of poisoning cases.
8 - Need to work warning labels on all hazardous products inside the labs, buildings, houses and factories, and put those products in special places far from the reach of children.
9- Techniques for safety storage of poisons should be educated to all population in the community.House hold agents and drugs should be kept in a closed cupboardaway from curious children.
10- Arise the problem of acute accidental poisoning as a part of educational program during pregnancy in the primary health centers. More emphasis is needed on those families with repeated accidental poisoning for possible presence of child or family problems.
11- Magnitude of the problem of poisoning among children should be studied on a national basis concerning the incidence and types of poisons involved. Also poisoning prevention programs must be held on the mass media in order to explain the problem and the safety measures to prevent it especially to the illiterate mothers.
12- School curriculum program, poster contents, films and seminars about poisoning should be used to increase the community awareness about poisoning prevention and tachniques for safe storage of poisons. Poisons must not be stored in cups or bottles previously contained soft drinks. Household products and medicines should be stored in closed cupboard away from the curious children.
13- As the major problem in this locality is the prevalence of scorpion sting and snake bite, therefore the following measures should be done
* Efforts must be attempted to make the first aid measures and the specific antiserum available in primary care centers and all hospitals.
* Scientific seminars and workshops about update management of scorpion and snake envenomation are essential for all emergency physicians.
* Space under houses and boardwalks should be tightly enclosed and sprayed regularly with insecticides.
* Rubbish should not be left scattered where children play.
14- Restriction of pesticides usage and workers should wear safety measures (as gloves, masks and googles and inspirtators) during dealing with these chemicals.
15- Law enforcement to control illicit drugs especially among school and university students and prevent sale of annonymus chemicals, dyes, herbs and unknown drugs.
16- There is a need to study the cases of chronic toxicity and its prevalence in the community.