Background: Snake bite is neglected tropical disease. Snake bite accident is common in farmers, hunters, labors and migrating population. Patient has to travel 15-20 miles to obtain medical aids, moreover doctors are not train regarding management of snake bite. High morbidity and mortality due to venomous envenoming attributed to delay in diagnosis and management. We report rapid diagnosis and early intervention result in reduction in fatality and morbidity.
Methods: This is retrospective study. Victims of snake bite on arrival to out patient department are examined in details by expert or trained physician. Species of snake bitten is confirmed by detail examination of killed specimen if it produced or by clinical syndromes. This is case series and not the trial.
Results: January 2002 to 31st august 2015, 1625 (87.45%) were bitten by venomous species of snake of these 388 (23.87%), 343 (21.10%), 507(32.20%), 257 (15.81%) 33 (2.03%) and 97 (5.96%) were bitten by cobra, krait, Russell's viper, echis carinatus, pit viper and haematotoxic without identified the species respectively. Of these 67(4.12%) (Cobra 8, krait 41 Russell's viper 17 and echis carinatus 1) died.
Conclusion: Rapid transport of snake bite victim to health center. Early diagnosis by trained physician and rapid interventions reduced the mortality and morbidity due to venomous snake bite poisoning.

It is often difficult to predict the likelihood of immunostimulation by monoclonal antibodies and identify who is at risk based on preclinical results. We explored the feasibility of an ex vivo cytokine release assay to detect trastuzumab -induced immunostimulation by correlating in vivo and ex vivo results. Also the effect of trastuzumab on human umbilical vein endothelial cells (HUVECs) was studied.
Healthy male volunteers were selected from a previous clinical trial where they had been exposed to trastuzumab. Five donors had experienced fever (responders) and six had not (non-responders). Additionally, ten male donors were selected from a healthy, trastuzumab-naïve population. Heparinised whole blood samples were collected and incubated for 24 h with 0.2 mg/mL trastuzumab. HUVECs were grown under a constant laminar flow for 7 days, followed by incubation with 2 mg/mL trastuzumab alone or in combination with TNF-a.
Trastuzumab induced a very mild IL-6 response in the supernatant of the cell cultures, which was more pronounced in the responders. A correlation was detected between the in vivo maximum body temperature (T max) and the IL-6 response with Pearson's r = 0.83 (95% confidence-interval: 0.45 - 0.95), p = 0.0017. Virtually no TNF-a response was observed, although a linear relationship to T max was suggested in responders: r = 1.00 (0.93 - 1.00), p = 0.0004. No increased conversion of C5 to C5a was observed. The trastuzumab-naïve population did not show any cytokine or complement response. Trastuzumab did not increase E-selectin expression in HUVECs.
Individuals who demonstrate clinical signs of trastuzumab-associated immunostimulation show an elevated ex vivo IL-6 response to trastuzumab. Both IL-6 and TNF-a responses are correlated with T max, yet do not explain the full clinical picture.

Aluminum phosphide (Alp) poisoning is one of commonest causes of hepatotoxicity in Minia Governorate. Glutamate dehydrogenase (GDH) and high-mobility group box-1 (HMGB1) are liver biomarkers that reflect structural liver damage.
Subjects and methods: The current study was conducted at Minia Poisoning Control Centre during the period from January, 1st, 2015 till December, 31st, 2015, where 28 patients presented with acute oral AlP poisoning. All subjects were investigated at 12, 24, 36 & 48 hours post ingestion for serum GDH and liver function tests (ALT, AST and ALP).
Results: The results revealed that serum GDH significantly increased in the first 12 hours samples, while the other liver function tests and HMGB1 were not significantly affected. In addition, it was reported that serum GDH, HMGB1 and liver function tests (ALT, AST, and ALP) were significantly increased after 24 and 36 hours post-ingestion. All measured parameters started to decline in the 48 samples, but still significantly increased.
Conclusion: Basing on the result of this study it could be concluded that GDH is a novel hepatic biomarker that could be used as an early predictor of AlP hepatotoxicity rather than the other investigated parameter. It is suggested to conduct a bigger study that involves multi-centers to assure this specificity and accuracy.

Antivenom treatment of domestic animals is becoming more common following introduction of more veterinary products. The aim of this study was to investigate the ability of a new polyvalent equine origin antivenina to neutralize the effects of two North American rattlesnake venoms. LD50s were established for two rattlesnake venoms [Western Diamondback rattlesnake (Crotalusatrox) and Mojave rattlesnake (Crotalusscutulatus)] using a murine model and standard methods. An ED50 was established for the product for both venoms using these LD50s. Venom (5x the LD50) and antivenom (5 varying doses) were combined and incubated for 30 minutes and administered intraperitoneally. Sickness scores and time to death were recorded during the study period and compared amongst groups in the ED50 studies. The LD50 for the Western Diamondback rattlesnake was 5.567ug/g and Mojave rattlesnake was 0.122ug/g. The ED50 for the Western Diamondback rattlesnake was 16.4mls/kg and the Mojave rattlesnake was 17.3mls/kg. Envenomated mice treated with higher doses of antivenom had significantly lower sickness scores (p < 0.05) and lived longer (p < 0.05). The equine origin antivenom product tested in this study was successful at neutralizing lethality up to 48 hours and reducing morbidity when tested against 5 times the LD50 of both venoms in this mouse model.

Diabetes Mellitus is a chronic multi-system metabolic disease associated with significant morbidity, mortality and cost to the society. The aim of this study is to evaluate the demographics, prescribing patterns, drug cost and analyze effectiveness of different antidiabetic therapies.
A prospective cross sectional study of 210 patients was conducted, out of whom 115 were used for cost study, by reviewing their case-notes and prescription pattern. A standardize data collection form was designed and used to collect data generated from prescriptions and case notes. The cost effectiveness therapy was evaluated.
Majority of the patients were aged 63.08 +/- years. 13.91% of the patients were diagnosed with type 1 diabetes and 86.09% with type 2 diabetes. Patients on sulphonylureas and its combination therapy showed a better glycemic control. Good glycemic control of 72.17% was observed. The biguanides, 56.45% was more prescribed than the other antidiabetics. Cost effectiveness analysis compared the value of the most prescribed drug metformin with its combination of metformin plus sulphonylureas and it shows that new anti-diabetics like the glibenclamide, glimepiride, and gliclazide. Metformin was prescribed with pioglitazones. The combination therapy with new antidiabetic drugs were cost – effective compared to older generations.
The good glycemic control suggests good adherence to antidiabetic therapy in a large number of patients under this study.