Interferon gamma Profile in Egyptian Infants with Respiratory Syncytial Virus bronchiolitis The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 1­ 13
Interferon gamma Profile in Egyptian Infants with Respiratory
Syncytial Virus bronchiolitis

Maha E. Omran1, Mohamed AE. Fahmy2, Manal M. Zaher3
1Microbiology and Immunology Department Faculty of Pharmacy (for Girls),
2Medical Biochemistry Department Faculty of Medicine, 3Pediatric Department Faculty of
Medicine (for Girls) - Al-Azhar University

Abstract

Viral bronchiolitis is one of the leading causes for hospitalization of infants in the world
and causes an estimated one million deaths per year worldwide. Respiratory syncytial virus
(RSV) is associated with the majority of cases. During the last few years it has become
increasingly clear that T cells contribute to the abnormal regulation of the immune response in
viral diseases since these cells are potent producers of a large variety of cytokines. It was
reported that cord blood interferon gamma (IFN-) responses were inversely related to the
frequency of viral respiratory infections. To ascertain whether RSV infection promotes
a different IFN- profile to that induced by other respiratory infections, thirty-two infants with
severe bronchiolitis were enrolled in this study. RSV-IgM was detected by immunofluorescent
technique in 23/32 patients. Serum IFN- levels in RSV+ infants were significantly lower than
RSV- (p < 0.001). In vitro stimulation of peripheral blood cells followed by flow cytometery
combined with intracellular cytokine staining revealed that both CD4+ and CD8+ cells
contribute in IFN- production. The percentage of CD4+ cells producing IFN- in RSV+ was
significantly lower (P < 0.05) than those in RSV-, while the difference in % of CD8+ between
RSV+ and RSV- was non significant. Our conclusions are that RSV infection is associated with
severe decreased IFN- responses. Both CD4+ and CD8+ cells contribute in IFN- production
during RSV bronchiolitis. RSV infection promotes a different IFN- profile from that induced
by other respiratory infections.

Introduction

Respiratory syncytial virus (RSV) is
children and adults, symptoms are usually
a non-segmented, single-stranded RNA
restricted to the upper respiratory tract.
virus belonging to the Paramixoviridae
Immaturity of the immune system in infants
family (Collins et al., 1996). RSV infection
has been proposed as one of the reasons for
is one of the main causes of respiratory
the decreased virus-specific clearance
illness worldwide. Almost all children
(Everard and Milner 1992). Certain other
become infected with RSV within the first 2
underlying conditions reported to increase
years of life (Avendańo et al., 2003) and
the risk of contracting and developing
30% of them develop lower respiratory
severe RSV disease including prematurity
tract illness, including bronchiolitis, or
with
or
without bronchopulmonary
respiratory failure (Holberg et al., 1991).
dysplasia,
congenital
heart
disease,
The later is the reason for hospitalization in
immunosuppression, or another underlying
0.5%­2% of the infected children (Collins
respiratory condition (Collins et al., 1996).
et al., 1996; Leader and Kohlhase, 2002),
The difference between disease severity in
and occasionally may lead to death in 1%
previously healthy infants who are infected
of hospitalized children (Simoes, 1999;
with RSV in the first year of life may be
Hall, 2001).
attributed to airway size (Young et al.,
Primary RSV infections in young
1995), high levels of passively acquired
infants are frequently manifested as
maternal IgG antibody (Everard and Milner
bronchiolitis or pneumonia. In older
1992; Yamazaki et al., 1994) and consistent
1

www.000webhost.com

Full Paper


Histological and histochemical study of effects of storage on blood cells morphology and their importance The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 14­ 24

Histological study of effects of storage duration and temperature on the
rabbits blood cells

Ibrahim K. I. Ragab
AL-Azhar Faculty of Medicine in Assiut
Abstract

Introduction:
The temperature of the blood and its components during storage or
processing is a very important factor affecting hemolysis. During storage, leukocytes break
down and release a number of chemicals and enzymes, that have been reported to lysis RBC.
With increasing duration of storage, the change of RBC shape becomes permanent. RBCs from
different species behave differently during storage. So, this study aimed to investigate the
histological effects of storage duration and temperature on the rabbit blood cells.
Material and Methods: Blood samples from five adult male healthy rabbits were divided
into (Group I) stored at 4 for 12 and 48 hours, (Group ) at a room temperature of about 24
for 12 and 48 hours and (Group ) at 36 for 12 and 48 hours. Blood films made and
stained by Leishman's stain immediately as a control group (A), after 12 hours (B) and after 48
hours (C) from each group respectively and examined for any morphological changes.
Leukocytes counted totally immediately as a control group (A), after 12 hours (B) and after 48
hours (C) from each group respectively for detection of any histological changes.
Results: no morphological changes of red blood cells, leukocytes and platelets of group
was observed. The changes of mean of total leukocytic counts of group were non significant.
Changes in total leukocytic counts and morphology of red blood cells, leukocytes and platelets
of groups and were observed. The morphological degenerative changes of group
involved red blood cells, neutrophils and platelets at 12 and 48 hours. The morphological
degenerative changes of group involved red blood cells and leukocytes at 12 and 48 hours.
The mean of total leukocytic counts of group was significantly decreased at 48 hours while
the mean of total leukocytic counts of group was significantly decreased at 12 and 48 hours.
Conclusion: blood samples from rabbits should be tested within 12 hours of collection if
stored at a room temperature of about 24 . Where testing is to be delayed for more than 12
hours, samples should be refrigerated as soon as possible. Exposure of samples to heat in excess
of 24 should be avoided at all times.

Introduction

The temperature of the blood and
and enzymes such as hydrogen peroxide
components during storage or processing is
and proteases. These proteases released by
a very important factor affecting hemolysis.
leucocytes during storage have been
The temperature greatly affects membrane
reported to cause RBC lysis during storage
deformability and therefore the stability of
(Heaton et al., 1994). There is substantial
the membrane during processing. Such
evidence from in vitro studies documenting
thermally damaged RBC's may be broken
the changes that RBCs undergo during
down during processing, centrifugation and
storage (the so-called `red cell storage
separation of blood units into different
lesion'). Red cell adenosine triphosphate
components. Hemolysis of the red cells
decreases by 50% during storage and 2,3-
increases due to processing and during
diphosphoglycerate
(2,3-DPG) is
not
storage and is maximum during the first
maintained beyond 10 days. These changes
week. Adequate process control and proper
increase the affinity of haemoglobin for
storage facilities should be ensured to
oxygen and shift the oxygen dissociation
minimize the hemolysis of red cells during
curve leftwards. Red cells also undergo
processing and storage (Sawant et al.,
marked morphological changes during
2007). During storage leukocytes break
storage. These begin immediately after
down and release a number of chemicals
collection and consist largely of echinocytic
14

Full Paper


BIOCHEMICAL STUDIES ON THE EFFECT OF SODIUM NITRITE AND/OR GLUTATHIONE ON RATS
The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 25­ 38

Biochemical Studies On The Effect Of Sodium Nitrite And/Or Glutathione
Treatment On Male Rats

*Eman Helal; *Zahkok, S; **Ghada Z A Soliman; * Al-Kassas, M;
*Abdel Wahed, H.
* Zoology Dep. Faculty of Sceince, Al-Azhar University (Girls),
**National Nutrition Institute, Cairo, Egypt;

Abstract

Introduction:
Using food preservatives as sodium nitrite are increased in industrial food
productions. Teratogenic, mutagenic and carcinogenic effects have been related to using of
some food preservatives.
Purpose: To study the effect of sodium nitrite (food additives) and treated with
glutathione (nature antitoxic) on rats.
Material And Methods: Certain parameters were measured as percentage of body weight
change, body temperature, heart rates, Red & white blood cells count (RBCs & WBCs),
hemoglobin (Hb) level, hematocrite (Hct) value, serum total lipids, serum cholesterol, serum
total protein, serum albumin, serum glucose, serum alanine transaminase and aspartate
transaminase (ALT & AST) activity and serum total cholinesterase. The organs, body weight
were detected. Organs were prepared for biochemical analysis.
Results:
Body weight, respiration rate, hepatosomatic index, RBCs & WBCs count, Hb,
Hct, serum total lipids, protein, albumin, A/G ratio, liver and muscle total lipids and cholesterol
were significantly reduced while serum cholesterol, kidney total lipids and cholesterol, serum
ALT & AST was significantly increased. Supplementation of sodium nitrite to rats had no effect
on serum glucose level or cholinesterase activity
Conclusion: Due to the hazardous effect of food additives as sodium nitrite, it is
recommended that the use of sodium nitrite as food additives must be limited and gluathione has
the ability to prevent its toxic effect.
Key Words: Glutathione, Rats, Sodium nitrite

Introduction


Food
additives
are
substances
endogenous synthesis and most, if not all
intentionally added to food. They may be
are of dietary origin (Bartholomew and
natural or synthetic (Harris, 1986). The
Hill, 1984).
principal classes of food additives are
Nitrites are used as human food
coloring agents, preservatives, flavors,
additives mainly for production of specific
emulsifiers and stabilizers (Lindsay, 1985).
flavor and for preservation of meat
One of the principal preservatives is the
products. Several organic nitrites and
nitrite, which used in the form of salts or
nitrates have been used clinically but the
free acids (HMSO1, 1987). The use of
only inorganic nitrites of therapeutic are
sodium nitrite as a preservative is common
sodium nitrite (Heibashy and Abd El-
in cooked meat and sausages. Because of
Moneim, 1999). Nitrites and nitrates are
the use of more than one type of such food,
environmental pollutants present in food
the percentage of nitrite content of the daily
and water and it is suggested that they may
food consumption may be higher than the
contribute to the etiology of liver and
admissible level (Bilczuk et al., 1991).
kidney diseases and problems related of
Apparently very little nitrites are formed by
immunity in domestic fowls (Ibrahim et al.,
1999). Glutathione (GSH) may act as free

radicl acceptor to counteract oxidant
1 H M S O: Her majesty's stationary office,
damage. Favilli et al. (1997) have noticed
London
25

Full Paper


CURRICULUM VITAE
The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 39­ 50


Diabetes Mellitus and Some Egyptian's Volatile Oils

Fahmy Gad Elsaid
Zoology Department, Faculty of Science, Mansoura University, Egypt

Abstract

Background:
Diabetes mellitus as a metabolic disorder is characterized by
hyperglycemia, dyslipidemia and deflection in protein metabolism. Natural products as a
fashion remedy was undertaken and this study was designed to search the role of anise, fennel,
thyme volatile oils and -terpinene (a bioactive constituent extracted from caraway and cumin
volatile oils) to deal with the biochemical changes in sera, liver and muscle of streptozotcin
(STZ)-induced diabetic rats.
Material and methods: Thirty rats (Sprague dawelly) were divided into three groups:
control group; diabetic group, STZ-induced diabetic rats and diabetic & volatile oils group. The
STZ-induced diabetic & volatile oil group was orally administered with different volatile oils by
gavage (2 ml/ kg body weight) and subdivided into four subgroups: diabetic & anise; diabetic &
fennel; diabetic & thyme and diabetic & - terpinene.
Results:
There were highly significant increase in sera glucose, total lipids, total
cholesterol, and triglycerides in diabetic rats. Liver and muscle malondialdehyde (MDA) and
protein carbonyl (PC), superoxide dismutase, catalase and glutathione-s-transferase activities
were remodeling after administration of different volatile oils. Sera insulin, liver glucose-6-
phosphate dehydrogenase, liver and muscle glycogen was highly significantly decreased in
diabetic rats. On the other hand, the alleviation in these parameters was highly noticed in the
different diabetic & volatile oil subgroups.
Conclusion: The counter effects of different volatile oils upon these changes reflect the
antihyperglycemia and antioxidant roles of these volatile oils with a different range in STZ-
induced diabetic rats.
Key words: Diabetes mellitus, streptozotcin, volatile oils, oxidative stress, antioxidants,
glucose metabolism.


Introduction

Diabetes mellitus is a group of
In streptozotocin (STZ) induced type
metabolic
diseases
characterized
by
1 diabetes, hyperglycemia and oxidative
hyperglycemia, dyslipidemia, and protein
stress have been implicated in the etiology
metabolism that results from defects in both
and pathology of disease complications
insulin secretion and/or insulin action
(Baynes, 1991). Diabetes mellitus is associ-
(Adisakwattana et al., 2005). Activation of
ated with oxidative stress, leading to an
multiple metabolic pathways in diabetes
increased production of reactive oxygen
leads to increased of generation of supero-
species (ROS), including superoxide radical
xide and derivative reactive oxygen species
(O2·-), hydrogen peroxide (H2O2) and
(ROS). These include increased mitochon-
hydroxyl radical (OH·) or impaired and
drial electron transport activity that induced
reduction of antioxidant enzyme (Pari and
by hyperglycemia and fatty acids and
Latha 2004; Vincent et al., 2004; Rahimi et
enhanced glucose auto-oxidation (Desco et
al., 2005). During pathogenesis of diabetes
al., 2002). Insulin resistance includes decre-
mellitus, oxidative and nitrosative stresses
ased stimulation of muscle glycogen
contribute to the destruction of insulin-
synthesis, defects in glycogen synthesis and
producing -cells (Denaly et al., 1997).
hexokinase activity (Muller et al., 1973)
Lipid peroxidation (LPO) is a key
and decrease glucose-6-phosphate dehydro-
marker of oxidative stress is a free radical-
genase (G6PhD) (Wan et al., 2002).
induced
process
causing
oxidative
39

Full Paper


BILIARY ANATOMY IN LIVING RELATED DONOR TRANSPLANTATION AND ITS SIGNIFICANT OUTCOME The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 51­ 61


Significant Outcome Of Biliary Anastomosis In Living Related Donor
Liver Transplantation

Mohammed Hassan MD, Wael L. Tobar MD, Amr Aiad MD, Adel Hosny
MD, Mostafa El-Shazly MD,Ahamed Hussein,MSC
Department of General Surgery, Cairo University

Abstract

Variations in the anatomy of the intrahepatic bile ducts have long been recognized.
Serious consideration of the surgical anatomy of the liver began, however, with the advent of
minimally invasive therapeutic intervention for bile duct or hepatic resection, or partial liver
transplantation. Thus, accurate knowledge of the anatomy of IHDs is critical. 30 cases were
included in this study. Right lobe donation in 27 cases and left lobe donation in 3 cases. The
main indication for transplantation was end stage liver disease: hepatitis C end stage liver
cirrhosis in 29 cases, while hepatocellular carcinoma on top of liver cirrhosis was the remaining
case. Pretransplantation preparation of both donors and recipients was done.No mortality was
reported to either any of the donors or the recipients. Postoperative donor biliary complications
occurred in 1 case and conservative treatment was followed with complete resolution of the
condition .Postoperative recipient biliary complicatioins occurred in eleven cases in the form of
biloma, biliary leakage, biliary stricture, cholangitis and peritonitis, six of them with two ducts
anastomosis. They were managed and cured without residual pathology.

Introduction

Living donor liver transplantation
Patients & Methods
(LDLT) has become an acceptable

alternative for adults in need of orthotopic
Thirty (30) cases were included in this
liver transplantation (OLT) who are not
study. RT. Lobe donation 27, LT. Lobe
likely to receive a deceased donor
donation 3, range of age 25-45 mean age
(cadaveric) organ in a timely fashion. The
30, indications for transplantation are End
need for LDLT has arisen because of a
stage liver disease: HCV related liver
persistent shortage of adult deceased donor
cirrhosis in 29 cases, Hepatocellular
livers (Schroeder et al.,2005).
carcinoma on top of liver cirrhosis and
In hepatic resection for living donor
HCV in 1 patient. This patient had no extra-
liver transplantation (LDLT), an accurate
hepatic spread or portal vein thrombosis. 3
knowledge of the anatomy of intrahepatic
steps evaluation of both donor & recipient.
bile ducts (IHDs) is thus critical if the liver
Donor (step 1) Liver functions: total
is to be successfully harvested and postop-
bilirubin, direct bilirubin, ALT, AST, total
erative complications minimized (Ching
proteins,
serum
albumin,
alkaline
and Sheung, 2006).
phosphatase, GGT, Kidney functions: blood
The normal biliary anatomy is thought
urea, creatinine, uric acid, Na , K, Urine,
to be present in 58% of the population.
Stools analysis, Blood Grouping ,CBC &
Biliary anomalies are common and may
ESR. PT, PC & INR, PTT. HCV Ab.
lead to exclusion of many donors and it also
HBsAg & HbcAb total, Abdominal and
affect the outcome for both donors and
pelvic ultrasonography vascular hepatic
recipients. Evaluation of the donor liver is
Doppler, CT volumetry. Donor (step 2)
expensive and often leads to the exclusion
Bleeding
time,
clotting
time,
TT,
of potential donors( Ramacciato et al. ,
Fibrinogen , ATIII, Protein C, Protein S,
2006).
Factor V ,ASO, CRP, VDRL, LDH,




51

Full Paper


Immunostimulatory effect of extracts from, Pulicaria crispa and Citharexylum quadrangular, plants before and after Schistosoma mansoni infection The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 62­ 69


Alpha-fetoprotein as a differential marker between bladder cancer and
Schistosomasis among Egyptian patients
Maghraby A.S*#, *Samia, A. Ahmed, **Ayman, M. Metwally, and **Khalid, H.
*Therapeutical Chemistry Department National Research Center, Dokki Cairo. #Infectious
Diseases and Immunology group, Center of Exellence for Advanced Studies.
**Technology of Medical Laboratory Department, College of Applied Medical Sciences, Misr University For Science and Technology, 6th October, Egypt

Abstract

Introduction
: Schistosomiasis is considered as a widespread problem that affects
Egyptians at different ages (WHO, 1993). It is well known that the high incidence of bladder
carcinoma in schistosomal patients also represents a great risk to Egyptian society.
Objective: This study represents a survey on the changes which took place in Alpha-
Fetoprotein (AFP) levels as a differential marker among Egyptian patients suffering from
urinary bilharzial infection and bladder cancer.
Methodology: A partial study was carried out on four patients post operative and followed
up for sixty three days after chemotherapeutic treatment using immunoenzymatic mediated
assay.
Results: It was found that bladder cancer leads to obvious significant increase in AFP
levels, while schistosomal infection causes a non significant decrease as compared to healthy
control. Although the combination between schistosomal infection and cancer leads to a
significant decrease in AFP level compared to non bilharzial cancer cases, there was no
significant correlation with healthy cases.
Conclusion: It should be pointed out that the somewhat constant level of AFP in the sera
of all patients was due to chemotherapeutic treatment. Also, it can be noticed that there is a
significant positive correlation with progress of cancer grades.
Key words: Alpha-Fetoprotein, Schistosomal infection, urinary bilharzial infection and
bladder cancer.
Abbrevations:
AFP: Alpha-Fetoprotein

Introduction

Where
schistosomiasis
remains
et al., 1999). So, the size of bilharzial
endemic. A great deal has been published
problem and its complication needs more
from Egypt about the role played by
careful studies to demonstrate new marker
schistosoma parasite in development of
to clarify the effect of bilharziasis in the
malignant lesions in bladder (Ammal et al.,
development of carcinogenesis (Gu et al.,
1992).
1987). So, alpha-fetoprotein (AFP) is the
Carcinoma of the urinary bladder is
marker of choice to study in this research.
the most common malignancy in the
AFP is a serum glycoprotein, initially
Middle-East and parts of Africa where
identified in human sera in 1956 as one of
schistosomiasis is a widespread problem.
the two major protein in fetal blood
Much evidence supports the association
(Bergstrand and Czar, 1956). It is marked
between schistosomiasis and bladder
for
hepato-cellular
and
germ
cell
cancer: this includes the geographical
carcinoma. Its synthesis by embryonal liver
correlation between the two conditions, the
cells is virtually inhibited during adult life.
distinctive pattern of gender and age at
Thus, it is not demonstrable in normal
diagnosis, the clinical and pathological
tissues but has been found in traces in adult
identity of schistosoma- associated bladder
human sera, this ratio began to increase
cancer,
and
extensive
evidence
in
with some body disorders and can be
experimentally infected animals (Mostafa
determined by some more sensitive
62

Full Paper


Oral Terbinafine in the treatment of fungal infection of nails The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 70­ 77


The Treatment Of Onychomycosis By
Oral Terbinafine: The Efficacy And Adverse Evevnts

H. M. Hassan; A.M. Osman* and E. A. El-Moselhy**
Departments of Dermatology & Venereology;
Microbiology & Immunology* and Community Medicine**
Faculty of Medicine, Al-Azhar University
Abstract

Onychomycosis contributes to approximately half of all nail disorders and appears to be
increasing in frequency. The main aim of this study was to access efficacy and adverse events of
oral terbinafine in the treatment of adult patients with onychomycosis of the fingernails and
toenails. Forty patients with onychomycosis, aged 22-48 years were enrolled in this study. The
patients were divided into two groups; group I, consisted of 20 patients with fingernail
onychomycosis and group II, 20 patients with toenail onychomycosis. The two groups (I-II) of
patients were received, freely, oral terbinafine in a dose of 250 mg/day for 6 and 12 weeks,
respectively. The patients were examined clinically and mycologically before start of the
treatment, at end of the treatment and after a follow up period of 18 weeks from the treatment in
both groups. The results of the study showed marked clinical (75.0%) and mycological (85.0%)
cure rates in the total patient group. The clinical and mycological cure rates in group I were
80.0% and 90.0%, respectively. While, in group II the clinical and mycological cure rates were
70.0% and 80.0%, respectively. Also, 17.5% of the total patient group had adverse events,
71.4% of these events were mild and 42.9% were drug related. Lastly, complete cure rate at
follow up at 18 weeks from the treatment was 87.5% of the total patients group. It could be
concluded that terbinafine appears to be safe and effective in the treatment of fungal infections
of the fingernails and toenails.

Introduction

Onychomycosis contributes to 40.0%-
infections of the nail have been difficult to
50.0% of all nail disorders and appears to
treat, requiring long courses of therapy and
be increasing in frequency (Baran et al.,
having high recurrence rates (De Backer et
1997; Tom & Kane, 1999 and Vinod,
al., 1998 and Tom & Kane, 1999). Also, it
2000). In the United Kingdom 2.7% of the
may have a substantial impact on the
population suffers from onychomycosis
patient's quality of life (Tom & Kane, 1999
(Heikkila, 1995). Also, in the United Stats
and Drake et al., 1999).
an increase in the number of patients with
Previously, griseofulvin was the drug
onychomycosis has been reported (De
of choice for onychomycosis. This drug
Cuyper, 1996).
cures about 70.0% of the fingernail
Mycotic nail infections are usually
onychomycosis but less than 40.0% of the
caused by dermatophytes, yeasts and
toenail onychomycosis (Blafour and faulds,
nondermatophyte moulds. Most cases of the
1992; Faergeman et al., 1995 and Hotman
toenail onychomycosis are caused by
et al., 1995). But recently, terbinafine
dermatophytes (Tom & Kane, 1999 and
(lamasil) that is active orally as well as
Veer et al., 2007). Also, it is predominantly
topically has been used in the treatment of
caused by Trichophyton rubrum (T. rubr-
onychomycosis. Its mode of action is
um) (Heikkila, 1995 and Veer et al., 2007).
inhibition of fungal squalene epoxidase.
Mycotic nail infections are a
This enzyme is active in the synthesis of
therapeutic challenge and do not always
ergosterol, an essential lipid component of
resolve
spontaneously.
Dermatophyte
the fungal cell wall. The accumulation of
70

Full Paper


ENFLUENCE OF ROYAL JELLY ON SOME The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 78­ 89

Biochemical, Histological And Histochemical Studies On The Effect Of
Sodium Barbital On The Renal Tissue Of Albino Mice

Samia M. Sakr*, Shadia Ali Radwan*, Aziza M. El Wessemy*
and Samira E El-Harras**

*Department of Biological Sciences, Faculty of Education, Ain Shams University,
**High Institution of Applied Arts, 6th October City, Cairo, Egypt.

Abstract

Introduction:Anaesthetic drugs are nowadays used on a large scale in surgical
operations as well as in other various medical purposes. Sodium barbital is a derivative of
barbituric acid and is widely used on short surgical operations and other various medication.
However, such anaesthetic drug has been reported to evoke many serious alterations as a result
of its application.
Materials and Methods:The experimental animals (30 mice-weighing 25-30 g) were
divided into 3 groups (10/group), the first group served as a control group (i.e. injection with
saline), while the other two groups were treated daily with the therapeutic dose of 60
mg/kg.b.wt sodium barbital (i.p.) for 7 days (short-term group) and 21 days (long-term group)
as repeated daily doses. Blood sera and kidney samples were collected for physiological,
histological and histochemical studies.
Results:The results obtained showed a significant increase in urea, blood urea nitrogen,
uric acid and creatinine levels in all treated groups. On the other hand serum total protein and
albumin levels showed a significant decrease in both treated groups, while the globulin showed
a significant decrease only in the long term group. The applied dose of sodium barbital caused
histophathological alterations in the renal tissue mainly in the cortex such as damage and
shrinkage of the Malpighian corpuscles, cloudy swelling and necrosis of the cells of the
proximal convoluted tubules. Also, distal convoluted tubules exhibited degenerated features. In
the histochemical studies, polysaccharides were progressively reduced in both short and long-
term groups, while the total proteins showed a reduction in the short term group and
considerably increase in the long term group.
Conclusion: So these results came to conclusion that barbiturates should be prohibited
and carefully used specially when prescribed as tranquilizer.
Key words: Barbital sodium, kidney function, histopathology, histochemical (protein-
polysaccharides.- Albino mice.

Introduction

Many
authors
reported
that
According to the results of El-Negmy
anaesthetic, sedative and narcotic drugs
et al., (1994), injection of heroin (diacetyl
affect kidney functions according to the
morphine) at dose levels 0.5 and 1.0 mg/kg
duration and period of drug administration
for 10, 20 and 30 days caused a significant
(El- Banhawy et al., 1989; Abdel Baset et
reduction in serum creatinine, urine
al., 1993; El Negmy et al., 1994, Abdel
creatinine and creatinine clearance rates in
Moneim, 2001 and El-Sherif et al., 2002).
both treated groups of adult female rabbits.
Neugarten et al., (1986) revealed that renal
The authors also added that both serum and
tubular dysfunction, diabetes inspidus,
renal uric acid concentrations were
progressive
renal
insufficiency
and
significantly decreased in both heroin-
systemic amyloidosis occur in subcuta-
treated groups all over the experimental
neous heroin abusers.
periods. Besides, Labib and Zahran (1995)
78

Full Paper


RISK FACTORS AND QUALITY OF LIFE The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 90­ 103


Risk Factors And Quality Of Life
Of Adult Patients With Chronic Voice Disorders

E. A. El-Moselhy, Y. A. Barka, E. S. Abd-Allah*;
T. S. Alshorbagy**; M. M. El-Sawy** And T. M. Farghaly**
Departments of Community Medicine;
Community Health Nursing* and Oto-Rhino-Laryngology**
Faculty of Medicine and Nursing, Al-Azhar and Zagazig University

Abstract

The aim of the present research is to determine the common causes of chronic voice
disorders, to determine the sociodemographic and behavioral risk factors for patients with
chronic voice disorders and to study the QOL of them. The ORL Outpatient Clinics, Al-Azhar
University hospitals were chosen to carry out this study. A total of 495 patients with chronic
voice disorders and a control group of the same number were enrolled in the study. A case-
control, hospital based study design was used. The most common causes of chronic voice
disorders among these patients were chronic laryngitis (35.6%), vocal fold nodules (22.6%),
functional dysphonia (18.6%) and vocal fold polyps (13.5%). The 25-44 years age group, low
social class, sale man occupation, urban residence and female gender were the most important
significant sociodemographic risk factors for patients with chronic voice disorders (ORs= 4.17,
2.01, 1.71, 1.60 and 1.32, respectively). The +ve reflux symptoms index, voice abuse and
smoking were an important significant clinical risk factors (ORs=16.94, 8.33 and 6.01,
respectively). Also, patients with chronic voice disorders had a significantly poorer self-reported
health related domain scores than the controls on all eight SF-36 domains (P=0.00). Moreover,
patients with chronic voice disorders due to different laryngeal diseases had a significantly
poorer self-reported health related domain scores than the controls on all eight SF-36 domains
except in the miscellaneous diseases group.

Introduction

Voice is one of the unique attributes
relatively scarce, outdated and provide
of humans. It provides a principal means of
conflicting
information
(Miller
and
communication, emotional expression and
Verdolini, 1995; Smith et al., 1997 and
identity (Solomon et al., 2003). Voice
Titze et al., 2007). An update of such data
disorders exist when quality, pitch or
may lead to further identification of
loudness differs from others of the same
subjects at risk for developing chronic voice
age, gender, cultural background and
disorders, information to enhance public
geographic location, thereby drawing
education about voice disorders and
attention to the speaker. Voice disorders
identifying of risk factors associated with
may results from changes in the structure
various demographic and clinical variables
and/or function of the laryngeal mecha-
(Coyle et al., 2001 and Titze et al., 2007).
nism (Stemple et al., 1996). Laryngeal
Moreover, over the past 20 years there
pathologies that cause voice disorders
has been an increased recognition of the
comprise a group of diseases; the most
patient's point of view as an important
frequent are chronic laryngitis, nodules,
component in the assessment of health care
polyps, edema, functional dysphonia ...etc
outcomes (Watson et al., 1996). Quality of
(Herrington-Hall et al., 1988 and Coyle et
life (QOL) has become accepted as an end
al., 2001). Epidemiological reports on the
point in clinical research trials, as interest in
occurrence of chronic voice disorders have
patients' experiences and preferences has
been few in number. Also, reports are
grown (Patrick and Bergner, 1990). Reports
90

Full Paper


Cytogenetic Studies in Children with Developmental Delay The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 104­ 114



Cytogenetic Studies in Children with Developmental Delay

*Hassan S.A. El-Dawi, *El-Sayed G. Khedr, *Tarek A. Atia, **Hassan Ali,
and *Mostafa E. El-Sawy
Departments of Histology* and Pediatrics**, Faculty of Medicine,
Al-Azhar University, Cairo

Abstract

Introduction:
Developmental delay (DD) could be syndromic or non-syndromic, and
collectively it affects 10% of all children. There are numerous causes of DD that could be
genetical, hormonal and/or neurological. The frequency of defected chromosomal anomalies in
patients with DD is variable and estimates between 9% and 36%. However, the accurate
diagnosis needs further tests based on the information gather from parents and the findings on
physical examination.
Objective: We aim to evaluate the pattern of chromosomal abnormalities in children with
non-syndromic DD, in order to detect the treatable cases, and offering an appropriate genetic
counseling.
Methodology: 50 children suffering from DD with or without mental retardation(MR)
and/or congenital anomalies were subjected to the present study. Additionally, another 50
normally developed children were considered as control group. Peripheral blood samples were
collected, cultured, harvested, metaphase spread and then chromosomes were stained for G-
banding using Trypsin-Giemsa technique. Chromosomes were analyzed, metaphase spreads
were captured, and karyotyping has been done.
Result: Seven cases (14%) out of the 50 affected children carried structural chromosomal
rearrangements. Six (85.7%) out of the seven structural chromosomal abnormalities were
detected in autosomal chromosomes and one (14.3%) in sex chromosome. Surprisingly, we
have found a case (2%) carrying pericentric inversion of chromosome 3 within the normal
control group.
Conclusions: Chromosomal studies are valuable in detecting such cases with DD.
Prenatal genetic diagnosis is of clinical importance to prevent and offer genetic counseling.
Additionally, small proportion of apparently normal population could carry some types of
structural chromosomal anomalies.
Key words: developmental delay, mental retardation, congenital anomalies, chromosomal
anomalies.

Introduction

Development refers to how a child
development, in which a child exhibits a
becomes able to do more complex things as
functional level below the norm for his/her
he gets older. Human development runs in
age (Leonard et al., 2002). Significant delay
three parallel lines: physical, cognitive, and
in two or more of the developmental
behavioral, and so, any defect of one of
domains; gross/fine motor, speech/lang-
these parameters could affect the normal
uage,
cognition, social/personal,
and
development. Developmental delay is
activities of daily living; is defined as
characterized by cognitive impairment or
Global Developmental Delay (GDD). The
mental retardation (MR); growth retarda-
term GDD is usually reserved for young
tion (intra-uterine or extra-uterine); and/or
children (i.e., typically less than 5 years of
behavior
abnormalities.
Developmental
age), whereas the term mental retardation
delay (DD) shows slower rate of
(MR) is usually applied to older children
104

Full Paper


Antimutagenic effect of against ivermactin toxicity in blood lymphocytes The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 115­ 125

Antimutagenic Activity of Some Natural supplements on Ivermectin ge-
notoxicity in Lymphocytes of Buffalo


Aida I. El-makawy and Karima F. Mahrous
Cell Biology Department, National Research Center, 12622 Dokki, Giza, Egypt

Abstract

Ivermectin is a veterinary anthelminthic drug, highly effective against a number of arthropod
and nematode infestations in vertebrates. The literature reported that ivermectin have mutagenic
activities. The extensive use of ivermectin in food producing animals can cause potential hazard
to humanity by causing gene mutation or chromosomal aberrations. Recently, there have been con-
siderable efforts to search for naturally occurring substances that can inhibit, reverse, retard or pre-
vent mutagenicity. A wide array of substances derived from edibles and medicinal plants reported
to possess anticarcinogenic and antimutagenic activities. Therefore, the aim of this study was to
evaluate the modulator role of each of garlic, L-carnitine and wheat germ oil (WGO) against geno-
toxicity of ivermectin in buffalo lymphocyte cultures by using the cytokinesis block micronucleus
assay and chromosomal aberrations test as cytogenetic end-points. Results showed that ivermectin
induced dose dependent increase in the frequencies of the binucleated lymphocytes with micronuc-
lei as well as the number of micronuclei in lymphocytes of river buffalo, while the number of bi-
nucleated lymphocytes significantly decreased. In addition, ivermectin low dose caused non-
significant increase in the frequency of total chromosomal aberrations in lymphocytes of river buf-
falo as compared to control. Whereas, in medium and high doses the frequencies of aberrant cells
increased at a significant level (P 0.001) than control. Meanwhile, the treatment with the three
natural supplements (garlic, L-carnitine, wheat germ oil) in continuous with ivermectin significant-
ly reduced the frequencies of binucleated lymphocytes with micronuclei, the number of micronuc-
lei and the frequencies of total chromosomal aberrations induced by ivermectin tested doses, and
increase the number of binucleated lymphocytes. In addition, the results indicated that there were
non-significant differences between the modulator role of garlic, L-carnitine or wheat germ oil
against the mutagenicity of ivermectin in blood lymphocytes. Finally, we can concluded that regu-
lar consumption of natural antioxidants, antimutagenic compounds is inversely related to the risk of
cancer, since the free radicals scavenger activities of antioxidants are very important due to the de-
leterious role of free radicals in foods and in biological systems.
Keywords: Ivermectin ­ Garlic - L-carnitine - Wheat Germ Oil ­ peripheral blood lymphocytes-
Chromosomal aberrations -Micronucleus formation.

Introduction

Veterinary medicines used widely to
residues (Galer and Monro, 1998). In recent
protect animal health, prevent economic loss,
years, there has been increasing concern that
and to help ensure a safe food supply. Vete-
veterinary drugs may present a potential ha-
rinary medicine active ingredients detected
zard to humanity by causing gene mutation
in various environmental media, including
or chromosomal aberrations and considered
surface and groundwater, sugges-ting the
as potential developmental toxicants (Ardito
potential for indirect human exposure from
et al., 1996; Mailhes et al., 1997; Crebelli,
such residues (Boxall et al., 2006 and Caple-
2000; Adler et al., 2002 and El-makawy &
ton et al., 2006). In addition, the extensive
Radwan, 2003). Ivermectin is a veterinary
use of veterinary drugs in food producing
anthelminthic drug, highly effective against a
animals can cause the presence of drugs resi-
number of arthropod and nematode infesta-
dues in food; thus, consumers of foods drive
tions in vertebrates (Grant and Briggs, 1998).
from animals exposed to veterinary drug
Chemically, it is a form of abam-ectin, origi-
115

Full Paper


Application of prolene hernia system for umbilical hernia in patients with mild to moderate ascitis The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 126­ 132


Application Of Prolene Hernia System For Umbilical Hernia In Patients
With Mild To Moderate Ascites

Mohamed Hassan M.D1, Mohamed Salah M.D.2
Department of general surgery1, Cairo university, Department of tropical medicine2,
Cairo University.


Abstract

Background: In 1998, the Prolene Hernia System (PHS) mesh, consisting of an onlay and
an underlay patch attached with a connector, was introduced as an option for tension-free open
repair of inguinal hernias combining the benefits of a posterior and anterior repair from an open
approach.
Our objective was to evaluate the PHS mesh repair of umbilical hernia in ascetics with
liver cirrhosis.
Patients and methods: non randomized prospective study included 24 cases with mild or
moderate ascites , cirrhotics, with small umbilical hernia were subjected to elective repair using
prolene hernia system(PHS) under local anathesia, patients were followed up for one and half
years.
Results
: no mortality, one case of bleeding varices after 9 months respond to injection,
transient ascetic leak in 6 cases, one case of wound infection respond to antibiotics and dressing
and no hernia recurrence.
Conclusion: Prolene hernia system is easily applicable and effective method for repair of
umbilical hernia with ascites.

Introduction

Ascites is caused by cirrhosis in 75%
morbidity (16.6%) and a significantly
of cases, malignancy in 10%, and cardiac
greater incidence of recurrence (16.6%)
failure in 5%; other causes account for the
(Leonetti et al.,1984)
remaining 10%. The formation of ascites in
The use of a mesh plug in hernia
cirrhosis is due to a combination of
repair is not a new concept with previous
abnormalities in both renal function and
investigators yielding consistently excellent
portal and splanchnic circulation. The main
results in the repair of femoral and inguinal
pathogenic factor is sodium retention.
hernias, mesh plug repair can be performed
About half of patients with cirrhosis
with minimal postoperative complications,
develop ascites during 10 years of
low recurrence rate, minimal post-operative
observation (Krige and Beckingham, 2001).
pain and achieving excellent patient
Umbilical hernias can be found in up to
satisfaction (Sinha and Keit, 2004).
20% of cirrhotic patients with ascites
The PHS is made of polypropylene
(Maniatis and Hunt, 2001). Spontaneous
mesh and consists of 3 parts: an onlay
rupture of umbilical hernias in these
patch, a connector, and underlay patch
patients is an infrequent event, associated
(Cafer et al. ,2005) radical operation using
with a 50% mortality rate with supportive
PHS is useful for adult umbilical hernia
care and a 10­20% mortality rate after
(Makoto et al., 2002).
urgent surgical repair (Kirkpatrick and

Schuber, 1988 ;MacLellan et al, 1990 ;
Patient and methods
Maniatis and Hunt, 2001)

Umbilical hernia in cirrhotic patients
Our study includes 24 cases of non-
with uncontrolled ascites was associated
complicated umbilical hernia with small
with significant mortality (8.3%) and
defect (2 to 4 cm) in patients with mild to
126

Full Paper


Pentoxifylline as a radioprotector against certain biochemical and metal disorders of whole body gamma irradiation in rats The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 133­ 144

Pentoxifylline As A Radioprotector Against Certain Biochemical And Metal
Disorders Of Whole Body Gamma Irradiation In Rats

Esmat A. Shaban and Asrar M. Hawas
Department of Drug Radiation Research, National Centre for Radiation Research and
Technology, Atomic Energy Authority, Nasr City, Cairo (Egypt)

Abstract

Introduction :- The effect of whole body gamma irradiation at 6.5 Gy dose level on
some biochemical indices and metal levels has been investigated in albino rats.
Material And Method:- These included the determination of lipid peroxidation and
metallothionein (MT) in liver and kidney. Iron, copper and zinc were measured in liver, kidney
spleen and intestine. Also the P50 of survival was determined in rats.
Results:- For the control of these radiation-induced disorders, the radioprotective
character of pentoxifylline has been evaluated. Acute -radiation-induced disturbances in trace
metals levels in some organs were studied; specially Fe concentrations which were significantly
increased (p0.05) in liver, spleen and intestine. Also -radiation-induced increase in
malonaldehyde (MDA) levels as lipid peroxidation indicator and decrease metallothionein
(MT)-induction as antioxidant defense induced in the cell. Pre-treatment with pentoxifylline was
not effective against the changes produced by acute -radiation on metals studied, lipid
peroxidation process and MT-induction. While post treatment showed positive effect on liver
iron and metallothionein levels in liver and kidney.
Key words: Pentoxifylline, Radioprotector, Gamma irradiation, Metals.

Introduction

Damage of normal tissue is the most
to alleviate radiation damage. A number of
important limiting factor in radiotherapy. It
substances, generally named Biological
is possible at least theoretically, to eradicate
Response Modifiers (BRMs) with diverse
a localized tumor if it is subjected to a large
mode of actions have been used in post
dose of radiation, but, practically; there is
irradiation modification of normal tissue
always the danger of damaging normal
reactions (Rezvani, 2003). Applications of
tissues adjacent to the tumor. Recently;
anticoagulants, heparin (Fleming et al.,
attempts have been made to modify this
1962), and dicumarol (Macht and Perlberg,
effect by the administration of therapeutic
1950) as BRMs were the earliest attempts
agents after irradiation but before the
in the treatment of radiation-induced
development of the damage (Rezvani,
normal tissues lesions (e.g. pneumonitis),
2003).
One
hypothesis
states
that
however, they were unsuccessful in
supplementation with high doses of
modifying the development of radiation
multiple micronutrients including high
pneumonitis in the lung. Pentoxifylline has
doses of antioxidants (vitamins C and E,
shown significant beneficial effect in the
and carotenoids) may improve the efficacy
prevention of late radiation effects and
of radiation therapy by increasing tumor
recent evidence also suggests that it might
response and decreasing some of its toxicity
be beneficial for the treatment of acute
on normal cells. Another hypothesis, on the
lesions
too
(Rezvani,
2003).
The
other hand, suggests that antioxidants
administration of pentoxifylline as an
(dietary or endogenously made) should not
antiinflammatory may serve as a novel
be used during radiation therapy, because
therapeutic adjunct after hemorrhagic chock
they would protect cancer cells against
(Deree et al., 2007).
radiation damage (Prasad et al, 2002).
The present work was planned to
There are a number of agents, which have
evaluate the biochemical changes (lipid
been used experimentally, some clinically,
peroxidation and metallothionein in liver
133

Full Paper


Helicacter pylori Infection The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 145­ 150



Helicobacter pylori (H.p.) Infection: A possible cause of
Chronic Idiopathic Urticaria
(Prevalence and Effectiveness of Eradication)

Amer Abu El ­ Enin*, Abd El-Wahab Fathe** Mohamed Khedr*** and
Alaa Abu El-Ata****
Departments of Dermatology and Venereology*, Endemic diseases** Clinical
pathology *** and Microbiology **** Faculty of Medicine- Al-Azhar University.


Abstract:

Chronic idiopathic urticaria (CIU) is one of the most frequent skin diseases with an
incidence ranging from 1.2% to 23% , however its causes remains unknown in the vast majority
of cases. A possible relationship between chronic urticaria and Helicobacter pylori (H.p.) has
been recently suggested.
The aim of this study was to determine the prevalence of Helicobacter pylori(H.P.)
infection in patients with C.I.U. and to investigates the effectiveness of eradication therapy of
(H.p.) infection on this skin disease.
100 patients (40 males and 60 females) with C.I.U as well as 45 apparently healthy (age,
sex, matched controls) were enrolled in this study underwent serological testing for H.pylori
infection with the 13C ­urea test as well as by specific IgG antibodies against the H. pylori
(ELISA technique). Positive patients were treated with, Omeprazole ­ Clarithromycin +
Amoxicillin for 10 days. Eradication and clinical course were followed up two months after the
treatment in comparison to the negative cases as a control group. The clinical evaluation and
follow up were demonstrated as worse,. same, less and disappearance of flares.
In our results there was significant difference in the sero prevalence of H.pylori infection
between idiopathic chronic urticaria patients and healthy subjects. H.pylori was detected in 75%
of patients and 20% of controls. Out of 75 patients treated , only 24 showed complete remission
of their urticaria after successfully eradicating H.pylori infection ,the others only having some
improvement in their symptoms.
The mean lgG titer was 86.8 + 42.4 among patients group, where it was 16.+ 42.8 among
the control group (p< 0.05) .
After treating the positive patients with appropriate antibiotics for 10 days there are a
significant decrease of H.P. specific lgG as compared to the negative cases and also bacterium
eradication is associated with a remission of urticarial symptoms. as compared to the negative
cases. In conclusion, Helicobacter pylori affects a high percentage of patients with idiopathic
chronic urticaria and bacterium eradication was associated with a remission of urticarial
symptoms suggesting a possible role of H. pylori in the pathogeneses of this skin disorder.

Introduction

Urticaria is a common disease
urticaria (CIU) is a term used for chronic
affecting up to 15-20% of the population at
urticarial patients in which food and drug
least once during their life time (Carstcn et
allergy, urticarial vacuities and physical
al., 2000). Chronic urticaria presents with
urticaria have been excluded (Liutu et al.,
almost daily occurrence of wide spread
1998). The etiology of urticaria often
itchy, recurrent, urticarial wheals with
remains unknown, it is recognized only in
individual lesions lasting less than 24 hours
minority of cases, it may be provoked by
for at least six weeks. Chronic idiopathic
single
or
severs
simultaneous
145

Full Paper


Compliance with Universal Precautions Among The Egyptian Journal of Hospital Medicine (2008) Vol., 30: 151­ 164

Compliance with Universal Precautions Among Nurses and Laboratory
Technicians in Mansoura International Specialized Hospital

Sahar Mamoud Sayed Ahmed; Salwa Abbas Aly Hassan
and Eman Shokry Abd Allah

Department of Community Health Nursing
Faculty of Nursing, Zagazig University
Abstract

Compliance with universal precautions by nurses and laboratory technicians in hospitals is
very important because it prevent cross infection and decrease costs of antibiotics and
antipyretics. Also, it decreases spread of infection, which leads to decrease morbidity and
mortality rate. A cross-sectional descriptive design was used for conducting this study. The
sample of the study consisted of 150 nurses and lab technicians working at morning shift in a
hospital at Mansoura City, Dakahlia Governorate. Data were collected using a questionnaire
sheet and an observation checklist. The study revealed that majority (86.66%) of the studied
sample of nurses and lab technicians aged less than 30 years. Also, majority of the studied
sample have poor knowledge about sign and symptom and transmission of AIDS. In addition,
about 94% of the studied samples have poor knowledge about signs, symptoms and mode of
transmissions of hepatitis B and C virus infection. All of the studied sample reported that there
are no eye protections in the hospital. Positive correlations between nurses' and lab technicians'
practice and available supplies in the hospital were found, but the relations were not statistically
significant. The exception was the item of the infection prevention ways which has a significant
statistical relation. Also, positive correlations between lab technicians' and nurses' practice and
their attending for training courses about infection control were found, but the relations were not
statistically significant.

Introduction

The term infection was defined as a
and publication of such data (Faria et al.,
condition state that results from the
2007). In Egypt, estimating the burden of
presence of a pathogen in/on the body. A
disease associated with hospital ­acquired
pathogen is a disease producing microor-
infection is challenging because of limited
ganism (Taylor et al., 2001).
surveillance activities and limited microbi-
Nosocomial infection refers to the
ology capacities in some public sector
clinically active infection occurring in a
facilities. In addition, the complexity of
hospitalized patient that was not present or
applying the routine system of reporting
incubating at the time of admission.
infection and complexity of case definitions
Nosocomial infections are common causes
hinders the availability of such data (Talaat
of illness and death among hospitalized
et al., 2006).
patients.
Surveillance
of
nosocomial
Data estimate that among the 35
infection is regarded as an essential part of
million health care workers world wide,
the infection control program (Dewit, 2001
approximately 3 million experience percut-
and Castledine & Close, 2007).
aneous exposures to blood borne viruses
The risk factors contributing to the
each year (2 million HBV; 900,000 HCV
development of nosocomial infections can
and 300,000 HIV). These injuries are
be grouped into three categorgories:
estimated to result in 66,000 hepatitis BV;
environment, therapeutic regimen, and the
16,000 hepatitis CV and 2000 to 5000 HIV
resistance of the patient (Parsons and Krau,
infection (WHO, 2004). More than 90% of
2007). Moreover, nosocomial infections in
these infections are occurring in low-
developing countries is not well recorded
income countries, and most are preventable
because insufficient funding for surveys
(Karmode et al., 2005).
151

Full Paper