Ahmed Refat - Academia.edu (original) (raw)

Papers by Ahmed Refat

Journal of Environmental & Analytical Toxicology, 2014

In addition to a wide range of adverse effects on human health, toxic metals such as cadmium, ars... more In addition to a wide range of adverse effects on human health, toxic metals such as cadmium, arsenic and nickel can also promote carcinogenesis. The toxicological properties of these metals are partly related to generation of reactive oxygen species (ROS) that can induce DNA damage and trigger redox-dependent transcription factors. The precise mechanisms that induce oxidative stress are not fully understood. Further, it is not yet known whether chronic exposures to low doses of arsenic, cadmium or other metals are sufficient to induce mutations in vivo, leading to DNA repair responses and/or tumorigenesis. Oxidative stress can also be induced by environmental xenobiotics, when certain metabolites are generated that lead to the continuous release of superoxide, as long as the capacity to reduce the resulting dions (quinones) into hydroquinones is maintained. However, the specific significance of superoxide-dependent pathways to carcinogenesis is often difficult to address, because formation of DNA adducts by mutagenic metabolites can occur in parallel. Here, we will review both mechanisms and toxicological consequences of oxidative stress triggered by metals and dietary or environmental pollutants in general. Besides causing DNA damage, ROS may further induce multiple intracellular signaling pathways, notably NF-B, JNK/SAPK/p38, as well as Erk/MAPK. These signaling routes can lead to transcriptional induction of target genes that could promote proliferation or confer apoptosis resistance to exposed cells. The significance of these additional modes depends on tissue, cell-type and is often masked by alternate oncogenic mechanisms being activated in parallel.

Journal of Alcoholism & Drug Dependence, 2013

Adults across the globe in majority of the nations consume alcohol in different ratios. Usage of ... more Adults across the globe in majority of the nations consume alcohol in different ratios. Usage of alcohol is linked with many adverse medical and psychological results for both the drinker and the community in general apart from resulting in considerable issues for majority of the drinkers. The focus of the current study is to assess the clinical influence of a set of majority of identified dangerous compound substances including acetone, methanol and isopropanol, in habitual alcoholics symbolized by severe ethanol alcoholism at the emergency divisions. The extant research employed an associate reviewing investigation of electronic medical record (EMR) evaluative assessment of patients currently suffering from severe ethanol harmfulness leading the habitual alcoholic ranking. When the patient was admitted to the ER division, the average intensity of ethanol, acetone, isoprpanolol and methanol in assumed ethanol harmfulness with other dangerous compounds were (131.06 mg/dl, 60.5 mg/dl, 9.2 mg/L and 26.6 mg/L). The intense intensities of blood acetone, isopropanol and methanol surpassing their endogenous proportions were linked uncharacteristically to be "ache in the stomach-62%, anxiety-68% and acetone breath smell-31.25%" and an overstated severe ethanol harmfulness appearance as "puking-56% and Haematemsis 25%". Considering the above, it can be inferred that the intensities of blood acetone, isopropanol and methanol surpassing their endogenous propositions can be employed as clinical signs of uncharacteristic and/or overstated severe ethanol poisonous appearance.

Journal of Alcoholism & Drug Dependence, 2015

The word "endogenous" means produced or originating from within the body, so endogenous ethanol t... more The word "endogenous" means produced or originating from within the body, so endogenous ethanol therefore implies a spontaneous auto regulation of ethanol through various human metabolic processes. In the current research, endogenous ethanol concentrations in blood were determined by sensitive headspace gas chromatography/mass Spectrophotometry in 1400 residents of Saudi Arabia. The subjects were from 14 nationalities, of both sexes and of different age groups. There was no significance difference in blood ethanol concentration between nationalities or between sexes within and between nationalities. The data was extracted and the overall mean ± SD, minimum, maximum, 5% percentile and 95% percentile were 0.14, ± 0.35, 0.00, 1.53 , 0.00, 1.20 mg/dl respectively. The values of blood ethanol concentration as reported in this study indicate they are far too low to have any forensic significance.

Journal of Clinical Toxicology, 2013

Background: Cyclosporine is the backbone of immunosuppression in kidney transplantation. However,... more Background: Cyclosporine is the backbone of immunosuppression in kidney transplantation. However, it leads to multiple toxic effects, most of which are dose-dependent. In this respect, the quality of renal functions is undoubtedly linked to cyclosporine drug levels. Objective: To evaluate the association among cyclosporine trough-peak levels, dosage and its toxic effects. Methods and materials: In 102 kidney transplant recipients, serum cyclosporine trough-peak levels, serum creatinine, blood urea, blood urea and nitrogen, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase were measured periodically from the beginning of May, 2011 until the end of July, 2012. The relationships among previous laboratory parameters were detected in relation to the prevalence of toxic cyclosporine effects. Results: Consequently, the patients are with renal transplantations; concentrations of cyclosporine trough that can get lowered safely towards the range of 150-200 ng/ml, added by minimal toxic cyclosporine effects without increased risk for graft rejection. Conclusion: The findings of this study showed the detrimental toxic effects of high cyclosporine concentrations and the efficiency of low cyclosporine trough/peak levels in maintaining of an efficient immunosuppressive effect plus a minimal toxic cyclosporine effects and positive therapeutic outcomes in the renal transplant patients.

Journal of Clinical Toxicology, 2012

Digitalis toxicity is a complication of the digitalis therapy. It could occur also due to the pat... more Digitalis toxicity is a complication of the digitalis therapy. It could occur also due to the patient taking in a much larger dose of the drug than prescribed. The general symptoms of Digitalis toxicity are typically gastro-intestinal, neurologic and non-specific cardiac type manifestations that are strikingly similar to the clinical picture of primary Congestive Heart Failure (CHF) making a diagnosis of chronic digitalis toxicity in particular relatively difficult. Serum digoxin measurement is today becoming a crucial subject of concern because of the narrow therapeutic window of digoxin besides increasing mortality and morbidity due to its intoxication. The present work is focused on evaluating the clinical value of Serum Digoxin Concentrations (SDCs) in relation to appropriate assessment of chronic digitalis toxicity in cardiac patients. The current study was conducted in the form of a cross-sectional Electronic Medical Record (EMR) review study of patients presently on continuous prescriptions for digoxin with there being zero gaps in therapy for at least 10 days prior to SDC result entered into the Online Analytical Toxicology Request Result (OTARR). There was also a complete clinical examination report as well as a review of the results of serum potassium concentration, liver and kidney functions. Patients with digoxin toxicity (11.9%) had a significantly higher mean SDC (2.75 ± 1.2) than those with subtherapeutic (0.67 ± 0.17 ng/mL) or eutherapeutic SDC (1.19 ± 0.26 ng/mL) (p value ≤ 0.05). About 12% of the total cases showed an abnormal serum potassium concentration of electrolyte fluctuations. From this, one can conclude that a regular monitoring of serum digoxin level would be seen as mandatory for the verifica tion of digoxin's therapeutic effects and then the subsequent prevention and early diagnosis of chronic toxicity.

Infectious Diseases and Therapy, 2013

Introduction: To investigate the pattern of vancomycin-associated nephrotoxicity in children and ... more Introduction: To investigate the pattern of vancomycin-associated nephrotoxicity in children and to examine potential predisposing factors for nephrotoxicity, including average serum trough concentrations C10 lg/mL. Methods: Patients C1 week old to B15 years with normal baseline serum creatinine values who received vancomycin for C48 h between October 2010 and September 2012 were retrospectively evaluated. Nephrotoxicity was defined as a serum creatinine increase of C0.5 mg/dL or C50% baseline increase over 2 days. Patients with average serum trough concentrations C10 lg/mL were compared with a lower trough group. Results: Renal toxicity occurred in 72 (27.2%) of the 265 studied pediatric cases. High trough vancomycin levels C10 lg/mL were presented in 59 pediatric patients suffering from nephrotoxicity. Using multiple regression analysis, cases admitted to the intensive care unit (ICU) and to whom aminoglycoside medication was administered concurrently with vancomycin medication showed a significant high renal toxicity incidence [odds ratio (OR) 2.91; 95% confidence interval (CI) 1.70, 8.61; P value\0.03)] and (OR 9.11; 95% CI 4.11, 24.13; P\0.05), respectively. Conclusion: Renal function tests and continuous monitoring of vancomycin trough levels for children receiving vancomycin therapy, especially admitted to the ICU and given other aminoglycoside medications, are essential.

Journal of Environmental & Analytical Toxicology, 2012

ijar.lit.az

... We also acknowledge every member facilitated and or participated in collection of data especi... more ... We also acknowledge every member facilitated and or participated in collection of data especially Dr. Walid Al Johny and Mr. Mohamed Abd-Alsamad. Page 7. Baku, Azerbaijan | 61 ... Washington, DC :National Academy Press, 1993. 8. Bellinger DC, Stiles KM, Needleman HL. ...

International Journal of Legal Medicine, 2012

Human identification is one of the most challenging sciences. Recently, study of lip prints has b... more Human identification is one of the most challenging sciences. Recently, study of lip prints has become slightly fashionable in forensic field. The aim of the present work is to determine the pattern of lip prints and evaluate its uniqueness in a sample of Egyptian population. The study included 955 subjects (2-65 years old). Lip prints were taken by direct rolling methods against hard background and each lip print was divided into six areas to be examined by magnifying hand lens. Thereafter, they were scanned and examined by the Microsoft office picture manager program. The results revealed that the lip print for each individual was unique and the complete vertical pattern was the commonest type among males and females living in Dakahlia Governorate, Egypt. Sex could not be differentiated from the lip print. It can be concluded that lip print analysis is an ancillary tool for personal identification especially in criminal investigations.

Journal of Environmental & Analytical Toxicology, 2014; 4(2) , Mar 10, 2014

"Trace metals and metals induced Oxidative stress have been implicated in breast carcinogenesis. ... more "Trace metals and metals induced Oxidative stress have been implicated in breast carcinogenesis. Our study aimed to evaluate alteration of trace metals in breast tissue, oxidative stress and antioxidant status in breast cancer patients. This study included 120 female patients: 100 with breast cancer and 20 with benign breast diseases. Trace metals in breast tissue, lipid peroxidation and oxidative status were assessed. The present Results showed a signifcant increase in lead, cadmium, chromium, nickel and iron concentrations in malignant breast tissues compared to control group (P < 0.001). Also, a signifcant decline in Glutathione-S transferase (GST), Glutathione Reductase (GR) and Total Antioxidant Capacity (TAC) levels; however a signifcant rise in Malondialdehyde (MDA) and Ferritin levels was detected in patients with breast cancer compared to controls. In conclusion, the alteration of the elemental content in cancerous breast
tissues and the disruption of oxidant/antioxidant balance highlight the role of trace metals in cancer development."

Adults across the globe in majority of the nations consume alcohol in different ratios. Usage of ... more Adults across the globe in majority of the nations consume alcohol in different ratios. Usage of alcohol is linked
with many adverse medical and psychological results for both the drinker and the community in general apart
from resulting in considerable issues for majority of the drinkers. The focus of the current study is to assess the
clinical influence of a set of majority of identified dangerous compound substances including acetone, methanol and
isopropanol, in habitual alcoholics symbolized by severe ethanol alcoholism at the emergency divisions. The extant
research employed an associate reviewing investigation of electronic medical record (EMR) evaluative assessment
of patients currently suffering from severe ethanol harmfulness leading the habitual alcoholic ranking. When the
patient was admitted to the ER division, the average intensity of ethanol, acetone, isoprpanolol and methanol in
assumed ethanol harmfulness with other dangerous compounds were (131.06 mg/dl, 60.5 mg/dl, 9.2 mg/L and 26.6
mg/L). The intense intensities of blood acetone, isopropanol and methanol surpassing their endogenous proportions
were linked uncharacteristically to be “ache in the stomach- 62%, anxiety- 68% and acetone breath smell- 31.25%”
and an overstated severe ethanol harmfulness appearance as “puking -56% and Haematemsis 25%”. Considering
the above, it can be inferred that the intensities of blood acetone, isopropanol and methanol surpassing their
endogenous propositions can be employed as clinical signs of uncharacteristic and/or overstated severe ethanol
poisonous appearance.

Background: Cyclosporine is the backbone of immunosuppression in kidney transplantation. However,... more Background: Cyclosporine is the backbone of immunosuppression in kidney transplantation. However, it
leads to multiple toxic effects, most of which are dose-dependent. In this respect, the quality of renal functions is
undoubtedly linked to cyclosporine drug levels.
Objective: To evaluate the association among cyclosporine trough-peak levels, dosage and its toxic effects.
Methods and materials: In 102 kidney transplant recipients, serum cyclosporine trough-peak levels, serum
creatinine, blood urea, blood urea and nitrogen, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic
transaminase were measured periodically from the beginning of May, 2011 until the end of July, 2012.
The relationships among previous laboratory parameters were detected in relation to the prevalence of toxic
cyclosporine effects.
Results: Consequently, the patients are with renal transplantations; concentrations of cyclosporine trough that
can get lowered safely towards the range of 150-200 ng/ml, added by minimal toxic cyclosporine effects without
increased risk for graft rejection.
Conclusion: The findings of this study showed the detrimental toxic effects of high cyclosporine concentrations
and the efficiency of low cyclosporine trough/peak levels in maintaining of an efficient immunosuppressive effect plus
a minimal toxic cyclosporine effects and positive therapeutic outcomes in the renal transplant patients.

Digitalis toxicity is a complication of the digitalis therapy. It could occur also due to the pat... more Digitalis toxicity is a complication of the digitalis therapy. It could occur also due to the patient taking in a much
larger dose of the drug than prescribed. The general symptoms of Digitalis toxicity are typically gastro-intestinal,
neurologic and non-specific cardiac type manifestations that are strikingly similar to the clinical picture of primary
Congestive Heart Failure (CHF) making a diagnosis of chronic digitalis toxicity in particular relatively difficult. Serum
digoxin measurement is today becoming a crucial subject of concern because of the narrow therapeutic window of
digoxin besides increasing mortality and morbidity due to its intoxication. The present work is focused on evaluating
the clinical value of Serum Digoxin Concentrations (SDCs) in relation to appropriate assessment of chronic digitalis
toxicity in cardiac patients. The current study was conducted in the form of a cross-sectional Electronic Medical
Record (EMR) review study of patients presently on continuous prescriptions for digoxin with there being zero
gaps in therapy for at least 10 days prior to SDC result entered into the Online Analytical Toxicology Request
Result (OTARR). There was also a complete clinical examination report as well as a review of the results of serum
potassium concentration, liver and kidney functions. Patients with digoxin toxicity (11.9%) had a significantly higher
mean SDC (2.75 ± 1.2) than those with subtherapeutic (0.67 ± 0.17 ng/mL) or eutherapeutic SDC (1.19 ± 0.26
ng/mL) (p value ≤ 0.05). About 12% of the total cases showed an abnormal serum potassium concentration of
electrolyte fluctuations. From this, one can conclude that a regular monitoring of serum digoxin level would be seen
as mandatory for the verification
of digoxin’s therapeutic effects and then the subsequent prevention and early
diagnosis of chronic toxicity.

The objective was to study the in-vivo protective effect of Al-Madinah Ajwa (name of the most fam... more The objective was to study the in-vivo protective effect of Al-Madinah Ajwa (name of the most famous date in Al-
Madinah Al-Monwarah City) extract against lead acetate toxicity on the tissues of vital organs. Four rabbit groups were
used as an animal model for this study. Ajwa extract treated group (300 mg/kg/day, for 14 days) were evaluated for
lead acetate (500 ppm in drinking water for 14 days) intoxication compared to lead acetate alone-intoxicated group;
Ajwa extract group and control group. This was done by assessment of liver and kidney functions, blood lead levels,
levels of oxidants-antioxidants and histopathological changes in liver, kidney, heart and lung in different groups. The
lead acetate intoxicated group showed significant elevation of serum glutamic pyruvic transaminase (SGPT), serum
glutamic oxaloacetic transaminase (SGOT), alkaline phosphatase (ALP), total bilirubin (TB), serum creatinine-urea
(Cr-U), lipid hydroperoxide (LPO), protein carbonyl content (PCC), and depression of Superoxide dismutase (SOD)
and Glutathione peroxidase (GPX) levels as compared to control. The Agwa extract showed tissue protective effect
by significant restoration of (SGPT), (SGOT), (ALP), (TB), (Cr-U) (LPO), (PCC), (SOD) and (GPX) levels compared
to the previous group. The histopathological evaluation showed marked vascular congestion, interstitial hemorrhage,
cellular degeneration and necrosis in different organs of lead acetate intoxicated group, while Agwa extract treated
group showed mild congestion and slight focal cellular degeneration. Therefore, outcome of the present study validates
the ameliorative and protective effects of Al-Madinah Ajwa dates against the toxic effects of lead acetate poisoning.

Abstract Human identification is one of the most challenging sciences. Recently, study of lip pri... more Abstract Human identification is one of the most challenging
sciences. Recently, study of lip prints has become
slightly fashionable in forensic field. The aim of
the present work is to determine the pattern of lip prints
and evaluate its uniqueness in a sample of Egyptian
population. The study included 955 subjects (2–65 years
old). Lip prints were taken by direct rolling methods
against hard background and each lip print was divided
into six areas to be examined by magnifying hand lens.
Thereafter, they were scanned and examined by the
Microsoft office picture manager program. The results
revealed that the lip print for each individual was
unique and the complete vertical pattern was the commonest
type among males and females living in Dakahlia
Governorate, Egypt. Sex could not be differentiated
from the lip print. It can be concluded that lip print
analysis is an ancillary tool for personal identification
especially in criminal investigations.

Background: Acute poisonings are common and frequently require acute triage regarding treatment. ... more Background: Acute poisonings are common and frequently require acute triage regarding treatment.
Although most poisonings are treated supportively, the toxicological analysis may be helpful, but it is impossible for
routine clinical laboratories to provide a full spectrum of such tests. Objective: The main purposes of this review
are; i-to assess the usefulness of (Online Toxicology Analytical Results Request) and ii-OTARR systems to
evaluate usefulness of a comprehensive drug screen method as an important line diagnostic tool on clinical
toxicology decision leading to patient admission and further emergency toxicology care. Methods: The present
study was a part of a cross-sectional, multi-center study of all acutely poisoned patients of the online electronic
contact (OTARR) system in Dammam Regional Poison Control Center (DRPCC) which data were collected from
March 8th 2009 until March 7th 2011. Responsible physicians on duty completed a standardized OTARR electronic
form; which involved with several clinical and sociodemographic variables and toxic agents characters.
Toxicological laboratory analysis; gastric, blood and urine samples for toxicological screening were drawn as can as
possible for all; with electronic recording for the type of withdrawn sample (OTARR) and immediately sent to
DRPCC. A drug screen is a panel of laboratory tests performed upon biologic specimens to determine whether
drugs or foreign chemicals are present. Results: Young children age group less than six years was representing
23% of the unintentional poisoning and 74% of the intoxicated patient were male. 36% of unintentional intoxicated
cases were admitted. 44% of unintentional intoxicated cases were presented as asymptomatic presentation with
36% of overall toxicological procedures was positive results. The agreement between the clinical assessment and
toxicological laboratory analytical results were moderate to good with significant statistically for acetaminophen,
salicylates, carbamezapine, tricyclic antidepressant, ethanol and opiate; whereas moderate or fair without stastically
significant for other agents. Conclusions: As regards to its efficacy; it is recommended to activate the usage of
OTARR system in all KSA toxicology centers. The drug screening is a corner stone step in the indicating cases, and
whatever the result of the analytical toxicology procedures; all of them is highly supportive for the decision of
physician.

Background: Lead pollution problem is a subject of great concern because all known effects of lea... more Background: Lead pollution problem is a subject of great concern because all known effects of lead
appear to be adverse effects with especial concern brain and other neurological functions. Objective: The current
study aimed at: screening the blood lead levels (BLLs) and assessing the effects of measured (BLLs) on the
neurological functions in the form of measuring medical students Intelligent Quotient "IQ" and school performance
rates in different medical students grades "faculty of medicine-Al Madinah KSA. Methods: The study was
conducted on all medical students from faculty of medicine-Taibah university in Al Madinah Al Monowarah with the
following exclusion criteria: known neurological or neuro-developmental disorders including mental subnormalities
and severe chronic disease. The determination of blood lead levels were be carried out by taking one ml of
venous blood sample from each student which was digested by using the nitric acid method, then lead was
measured by Graphite Furnace atomic Absorption. Results In 83. 2% of the students BLLs were below or equal
10 μg/dl and in 16. 8% of the students BLLs were above 10 μg/dl. There was a highly inverse significant
correlation (negative correlation) between the BLL and full scale IQ (r = - 0. 157) P = 0. 043). As regards to usage
of canned food; there was statistical significance high BLL among students with high rate of canned food
consumption. Conclusions The problem of the lead pollution in Madinah KSU is not serious because 83. 2% of
the studied medical students had BLL less than 10 μg/dl.

Journal of Environmental & Analytical Toxicology, 2014

Journal of Alcoholism & Drug Dependence, 2013

Journal of Alcoholism & Drug Dependence, 2015

Journal of Clinical Toxicology, 2013

Journal of Clinical Toxicology, 2012

Infectious Diseases and Therapy, 2013

Journal of Environmental & Analytical Toxicology, 2012

ijar.lit.az

International Journal of Legal Medicine, 2012

Journal of Environmental & Analytical Toxicology, 2014; 4(2) , Mar 10, 2014

Adults across the globe in majority of the nations consume alcohol in different ratios. Usage of ... more Adults across the globe in majority of the nations consume alcohol in different ratios. Usage of alcohol is linked
with many adverse medical and psychological results for both the drinker and the community in general apart
from resulting in considerable issues for majority of the drinkers. The focus of the current study is to assess the
clinical influence of a set of majority of identified dangerous compound substances including acetone, methanol and
isopropanol, in habitual alcoholics symbolized by severe ethanol alcoholism at the emergency divisions. The extant
research employed an associate reviewing investigation of electronic medical record (EMR) evaluative assessment
of patients currently suffering from severe ethanol harmfulness leading the habitual alcoholic ranking. When the
patient was admitted to the ER division, the average intensity of ethanol, acetone, isoprpanolol and methanol in
assumed ethanol harmfulness with other dangerous compounds were (131.06 mg/dl, 60.5 mg/dl, 9.2 mg/L and 26.6
mg/L). The intense intensities of blood acetone, isopropanol and methanol surpassing their endogenous proportions
were linked uncharacteristically to be “ache in the stomach- 62%, anxiety- 68% and acetone breath smell- 31.25%”
and an overstated severe ethanol harmfulness appearance as “puking -56% and Haematemsis 25%”. Considering
the above, it can be inferred that the intensities of blood acetone, isopropanol and methanol surpassing their
endogenous propositions can be employed as clinical signs of uncharacteristic and/or overstated severe ethanol
poisonous appearance.

Background: Cyclosporine is the backbone of immunosuppression in kidney transplantation. However,... more Background: Cyclosporine is the backbone of immunosuppression in kidney transplantation. However, it
leads to multiple toxic effects, most of which are dose-dependent. In this respect, the quality of renal functions is
undoubtedly linked to cyclosporine drug levels.
Objective: To evaluate the association among cyclosporine trough-peak levels, dosage and its toxic effects.
Methods and materials: In 102 kidney transplant recipients, serum cyclosporine trough-peak levels, serum
creatinine, blood urea, blood urea and nitrogen, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic
transaminase were measured periodically from the beginning of May, 2011 until the end of July, 2012.
The relationships among previous laboratory parameters were detected in relation to the prevalence of toxic
cyclosporine effects.
Results: Consequently, the patients are with renal transplantations; concentrations of cyclosporine trough that
can get lowered safely towards the range of 150-200 ng/ml, added by minimal toxic cyclosporine effects without
increased risk for graft rejection.
Conclusion: The findings of this study showed the detrimental toxic effects of high cyclosporine concentrations
and the efficiency of low cyclosporine trough/peak levels in maintaining of an efficient immunosuppressive effect plus
a minimal toxic cyclosporine effects and positive therapeutic outcomes in the renal transplant patients.

Digitalis toxicity is a complication of the digitalis therapy. It could occur also due to the pat... more Digitalis toxicity is a complication of the digitalis therapy. It could occur also due to the patient taking in a much
larger dose of the drug than prescribed. The general symptoms of Digitalis toxicity are typically gastro-intestinal,
neurologic and non-specific cardiac type manifestations that are strikingly similar to the clinical picture of primary
Congestive Heart Failure (CHF) making a diagnosis of chronic digitalis toxicity in particular relatively difficult. Serum
digoxin measurement is today becoming a crucial subject of concern because of the narrow therapeutic window of
digoxin besides increasing mortality and morbidity due to its intoxication. The present work is focused on evaluating
the clinical value of Serum Digoxin Concentrations (SDCs) in relation to appropriate assessment of chronic digitalis
toxicity in cardiac patients. The current study was conducted in the form of a cross-sectional Electronic Medical
Record (EMR) review study of patients presently on continuous prescriptions for digoxin with there being zero
gaps in therapy for at least 10 days prior to SDC result entered into the Online Analytical Toxicology Request
Result (OTARR). There was also a complete clinical examination report as well as a review of the results of serum
potassium concentration, liver and kidney functions. Patients with digoxin toxicity (11.9%) had a significantly higher
mean SDC (2.75 ± 1.2) than those with subtherapeutic (0.67 ± 0.17 ng/mL) or eutherapeutic SDC (1.19 ± 0.26
ng/mL) (p value ≤ 0.05). About 12% of the total cases showed an abnormal serum potassium concentration of
electrolyte fluctuations. From this, one can conclude that a regular monitoring of serum digoxin level would be seen
as mandatory for the verification
of digoxin’s therapeutic effects and then the subsequent prevention and early
diagnosis of chronic toxicity.