Radiation Emitted From Mobile Phone Induces Amyloidosis Features in Some Tissues of Infant Mice The Egyptian Journal of Hospital Medicine (April. 2012) Vol., 47: 132 ­ 144

Radiation Emitted From Mobile Phone Induces Amyloidosis Features in
Some Tissues of Infant Mice

N Hanafi*, F. Eid** and A. El-Dahshan**
* Radiation Biology Department, National Centre for Radiation Research and
Technology (NCRRT), Atomic Energy Authority (AEA), Cairo, Egypt.
**Zoology Department, Faculty of Science for Girls, Al-Azhar University, Cairo,


: Investigating the effects of mobile phone­emitted radiation (MPR) on inducing
histopathological changes associated with amyloidosis feature in liver, kidney and brain of
infant mice.
: Twenty one infant mice (aged 1 day) were assigned to 3 groups, the 1st group
served as control, the 2nd group exposed to mobile phone radiation ( MPR) daily for one
month (¾ h /day) and the 3rd group remained for one month after stopping radiation exposure.
: There were different degrees of damage related to amyloidosis feature in these
organs subsequent to MPR exposure. One month post exposure there was an increase in the
degree of damage related to amyloidosis feature.
Conclusion: the results of this study showed that MPR leads to histopathological changes
associated with amyloidosis feature in the liver, kidney and brain of infant mice.


electromagnetic radiation) is a region in
electromagnetic field (EMF). Amyloidosis
the outer space of the Earth through which
is an abnormal condition whereby protein
energy passes that has been created by
substances are deposited within the tissues
of the body in the form of microscopic
electromagnetic radiations come from
fibres (Westermark, 1998; Gruys, 2004).
photons. The photon energy of a cell
The present study was aims to the role of
phone is more than 10 million times
MPR in amyloidosis production pinpoint
weaker than the lowest energy ionizing
liver, kidney and brain tissues of infant
radiation (Trottier, 2009). Studies have
connected MPR to health problems such

as behavioural changes, birth defects,
Material and Methods
memory loss, and Alzheimer's disease

showed that mice exposed to low
The animals were obtained from breeding
frequency MPR led to underdeveloped
animal's house of the National Centre for
offspring's (Gabriela, 2011). Other studies
Radiation Research and Technology, Cairo
on the relation between mobile phone
Egypt, aged 1 day. They were maintained
exposure and oxidative stress tried to
under controlled conditions of temperature
(20-25C) and lighting (12 hours light, 12
determined adverse effects (Dasdag et al.,
hours dark). The experiments were
2004; Dasdag et al., 2008; Dasdag et al.,
approved by state authorities and followed
guidelines of Egyptian law for animal
Examples of amyloid-related disorders
include Alzheimer's disease (Eisele et al.,
Experimental animals were fed on
2010) and the aging process. Sobel and
mother's milk until weaning and then they
Davanipour (1996) hypothesized that
were fed on bread, vegetables and standard
amyloid beta (A beta) found in cerebral
rodent pellet diet with vitamins, minerals
blood vessels, skin tissue and others were
and were freely supplied with drinking
resulted post exposure to medium to high


Full Paper (vol.47 paper# 1)


The Egyptian Journal of Hospital Medicine (April. 2012) Vol., 47: 145 ­ 157

The role of Pectin in controlling the changes induced by
Mercuric Chloride in albino rats fetuses

Abu Gabal, H*, Haifaa Al Fassam**
*Biology Department, College of Science and Humanities, Salman Bin Abdul Aziz
** Biology Department, College of Science, Princess Nora Bent Abdel Rahman


The present work was planned to investigate the role of Pectin in ameliorating the morphometric,
morphological and skeletal changes induced by mercury in albino rat's fetuses. 50 Wistar wistar virgin
female rats were used in the present study and 25 males for mating. The results of the present work
showed that the exposure of the pregnant rats to mercury chloride at a dose 5mg/kg body weight lead to
significant decrease in fetal body weights as well as body and tail lengths. Also, mercury chloride
administration of the pregnant rats resulted in some changes in experimental morphology of the fetuses.
In addition, the fetal skeletal system was affected as follows; increase of the number of non ossified
bones in the axial and peripheral systems. Pectin treatment of the pregnant rats improved the fetuses'
morphometric, morphological and skeletal changes.

Full Paper (vol.47 paper# 2)

d:\skydrive\Jor\vol47_3 The Egyptian Journal of Hospital Medicine (April 2012) Vol., 47: 158­ 165

Acute Occlusive Mesenteric Ischemia in Taif Province, Saudi Arabia
*Mohamed Al Saeed ** Mohamed Abu Shady *Mohamed Hatem *Khalid Alzahrani
***Mohamed Al Nashar & ****Hala Al Nashar
*Department of Surgery, Taif University**Department of Surgery, National Liver Institute, Menofia
***Department of Radiology, Jazan University **** Department of Pathology, Taif University

Mesenteric ischemia is relatively a rare disorder seen in the emergency department (ED).
Due to the effect of hypobaric hypoxia and higher liability for thrombosis encountered in high
altitude areas, acute occlusive mesenteric ischemia (AOMI) would represent an actual
challenge in Taif and related districts. Another risk factor is that about twenty-five percent of
Saudis are victims of diabetes due to the changes in lifestyle and diet leading to increasing
levels of obesity. Vague nonspecific clinical findings and limitations of diagnostic studies in
addition to cultural and social factors, may lead to late presentation making the diagnosis a
significant challenge and in turn higher morbidity and mortality are expected.

In this study, we review type of AOMI, pattern of presentation, laboratory, radiological,
Intraoperative findings and results of treatment in 36 patients who were admitted to King
Abdul Aziz Specialist Hospital and King Faisal Hospital, Al Taif, Saudi Arabia from January
2009 to January 2012.

36 patients with final diagnosis of AOMI were included in this retrospective study by means
of review of their files and medical records.

The disease was more common in men than women (23 male and 13 females). The mean age
of patients was 54 years. The mean time of presentation was 2.4 days after occurrence of
symptoms. Abdominal pain was the most common symptom of patients followed by nausea,
vomiting, constipation and bloody diarrhea. On physical examination; tachycardia was
prevalent, Oliguria was seen in approximately 69.4% of patients, 11.1% of patients were in
shock status. All patients had abdominal tenderness and 61.1% of patients had marked
peritoneal signs (rebound tenderness with guarding or/and rigidity). Twenty one/36 (58.3%)
patients were diabetics, 17/36 patients (47.2%) were hypertensive and 8/36 patients (22.2%)
with associated cardiac disorders. In laboratory tests, Leukocytosis was present in all patients.
Secondary polycythemia was seen in 38.9% of patients. D-Dimer level was high in all
patients. In 61.1% of patients, exploratory laparotomies were done based on clinical,
laboratory, abdominal ultrasound and plain x-ray findings without performing CT
angiography due to presentation with marked peritoneal signs. In all patients gangrenous
lesions were detected during surgery and resection of these parts was done. Gangrene and in
turn resection, was extensive in 14/36 patients (38.9%) and they developed short bowel
syndrome. There were 22/36 patients (61.1%) with superior or/and inferior mesenteric vein
thrombosis, 10/36 patients (27.8%) with superior mesenteric artery thrombosis, in one of
them there is associated focal thrombosis of aorta and renal arteries and 4/36 patients (11.1%)
with superior mesenteric artery embolism. All patients received postoperative anticoagulant
therapy. Patients with short bowel syndrome were prepared to receive total parental nutrition
(TPN) for life. Intra-operative deaths were 3/36


Full Paper (vol.47 paper# 3)

Assessment of Cord Blood Vascular Endothelial Growth Factor Levels (VEGF) and Circulating CD34+ Cells in Preterm Infants with Respiratory Distress Syndrome (RDS) The Egyptian Journal of Hospital Medicine ( April 2012) Vol. 47 , Page 166­ 175

Assessment of Cord Blood Vascular Endothelial Growth Factor Levels and Circulating
CD34+ Cells in Preterm Infants with Respiratory Distress Syndrome
Azza Tawfeek Moawed, Nihad Ahmed El Nashar
and Nesriene Mohamed El Margoushy
Medical and Radiation Research Department, Nuclears Material Authority Health Radiation Research
Department, National Centre for Radiation Research and Technology, Atomic Energy Authority, Cairo, Egypt


Respiratory distress syndrome (RDS) secondary to surfactant deficiency is a common cause of
mobility and mortality in premature infants. Vascular endothelial growth factor (VEGF) is a major
angiogenic factor and prime regulator of endothelial cells proliferation. So, VEGF may contribute to
surfactant secretion and pulmonary maturation. Additionally, circulating CD34+ stem ­ progenitor cells
are elevated along with its mobilizing cytokines in neonatal RDS. Aim of work: This study aimed to
elucidate the role of cord blood VEGF and the circulating CD34+ cells in preterm infants with and
without RDS.
Patients & method:
This study was conducted on 55 preterm neonates divided into 25 preterm (15 males/ 10 females)
without RDS with mean age of 31.60 ± 1.56 weeks and 30 preterm neonates with RDS (18 males/ 12
females) with mean age of 29.95 ± 1.09 weeks . Twenty healthy neonates (14 males/ 6 females) served
as controls with mean age of 38.20 ± 3.57 weeks. All neonates were subjected to full history taking;
thorough clinical examination and laboratory investigations including determination of VEGF levels in
cord blood samples using ELISA and circulating CD34+ cells in peripheral blood by flowcytometery.

The results of this study revealed that cord blood VEGF levels were significantly decreased in preterms
with RDS versus preterms without RDS and controls with p values of both < 0.0001. Furthermore, the
circulating CD34+ cells were significantly increased in preterm infants with RDS versus preterm infants
without RDS and controls (p < 0.05 & < 0.0001 respectively). Premature rupture of the membrane,
gender of the newborn, birth weight and antenatal steroid administration had neither significant effect
on the cord blood VEGF nor on the number of CD34+ cells. There was inverse significant correlation
between GA and the number of CD34+ cells.

It was concluded that low cord blood VEGF is associated with RDS and its level negatively
correlated with the severity of the disease. Thus, it may play a role in recovery from acute lung
injury in preterm infants. Moreover, the marked high level of circulating CD34+ cells in preterms
wit h RDS may give clear evidence of its promise t herapeutic role in the futur e.
Key words: VEGF- CD34+ - Respiratory distress syndrome

R esp ir a t or y di st r ess s yndr om e (R DS )
and Mead, 1995). The outcome of RDS has
previously known as hyaline membrane disease,
improved in recent years with the increased use
is a common cause of morbidity and mortality
of antenatal steroids to improve pulmonary
in premature infants, the incidence is 56-60% in
maturity, early postnatal surfactant therapy to
infants born between 27-28 weeks of gestation,
replace surfactant deficiency, and gentle
and decreases with increasing gestational age
techniques of ventilation to minimize damage to
(GA). (Hornurubia and stark, 2004). The
the immature lung, these therapies also had
development of RDS in premature infants is
resulted in the survival of preterm infants who
correlated with surfactant deficiency. (Avery
are smaller and more ill (Pramanik, 2002).

Full Paper (vol.47 paper# 4)

d:\skydrive\Jor\vol47_5 The Egyptian Journal of Hospital Medicine (April 2012) Vol., 47: 176 ­ 189

Gene polymorphisms of the DNA Repairing Genes APE1 and XRCC1 among
Smoking Lung Cancer Egyptians
Rezk Ahmed Abd-ellateef Elbaz, Salim Abd-elhady Habib, Maha Ebraheem Esmael Ebraheem, Gamal Kamel EL-
Ebidy, Lamiaa Mohamed Mahmoud Ramadan and Ahmed Settin.
Genetic unit, Children Hospital; Mansoura University, Biochemistry department, Faculty of science, Domiatta;
Mansoura University, Oncology Center; Mansoura University, Gastroenterology Center; Mansoura University,
Ministry of health Laboratories, Mansoura

Lung cancer is the leading cause of cancer-related mortality worldwide and is thus a major public health
problem. DNA base damage or losses caused by endogenous and exogenous agents occur constantly at a
high frequency in human cells. The removal or repair of damaged bases is an important mechanism in
protecting the integrity of the genome.
APE1 (Apurinic/Apyrimidinic Endonuclease 1) and XRCC1 (X-ray cross-complementing group1) are
DNA repair proteins that play important roles in the base excision repair (BER) pathway. The focus of
this work is limited to the association between polymorphisms in the DNA repair genes, (APE1
Asp148Glu (2197 TG) and XRCC1 Arg399Gln (28152 GA) genotypes), cigarette smoking and lung
cancer. This study has included 131 cases affected with lung cancers include; 33cases with small cell
carcinoma (25.2%) and 98 cases with non-small cell carcinoma (74.8%).
They were recruited from oncology Center, Mansoura University, Egypt; in the period between April
2008 to March 2010. For comparison, a negative control group including 150 healthy individuals
randomly selected from blood donors. Controls were selected by random sampling cancer-free individuals
without a past history of cancer, who visited Mansoura University hospitals and provided peripheral
blood between April 2008 and March 2010.
DNA was extracted from the whole peripheral blood using generation DNA purification capture column
kit (Gentra system, USA) and genotyping for APE1 Glu148Asp and XRCC1 Arg399Gln polymorphisms
was performed by a PCR--CTPP (PCR with confronting two-pair primers) method.
The collected data were organized and statistically analyzed using SPSS statistical computer package
version 10 software. we observed that, There were no significant differences in the frequencies of the
APE1 Asp148Glu (2197 TG) polymorphism of all genotypes and alleles in all lung cancer cases
compared to all healthy controls. Also, there were no significant differences in the frequencies of all
genotypes and alleles in lung cancer cases compared to controls of all smoking status. While, in former
smoking individuals; significant difference in the frequency of the mutant GG genotype in lung cancer
cases compared to controls (p-value=0.003).
We observed that, There were no significant differences in the frequencies of the XRCC1 Arg399Gln
(28152 GA) polymorphism of all genotypes and alleles in all lung cancer cases compared to all healthy
controls. Also, there were no significant differences in the frequencies of all genotypes and alleles in lung
cancer cases compared to controls of all smoking status. While, in never smoking individuals; significant
difference in the frequency of the mutant AA genotype in lung cancer cases compared to controls
Keywords; Gene, polymorphisms, DNA Repairing Genes, APE1, XRCC1, Lung Cancer.


Full Paper (vol.47 paper# 5)


Study Of Cardic Valvular Calcification In ESRD Patients On
Regular Hemodialysis (A Single Center Study)
Abdel-Bassit El Shaarawy1, Mona Hosny1, Manar Raafat2 and Nelly Gendy2
1Internal Medicine Department, Faculty of Medicine, Ain Shams University;
2Internal Medicine Department, Theodor Bilharze Institute.

Cardiac valve calcification are common among patients with chronic kidney disease
(CKD). Risk factors include alterations in calcium and phosphorus metabolism, elevated
calcium phosphorus product and persistent elevations in plasma parathyroid hormone (PTH).
Echocardiography is a simple and inexpensive method for detection of valvular calcifications
as suggested by KDIGO guidelines.
60 Patients on regular HD constituted group A (36 males and 24 females) and 25 healthy
volunteers constituted group B. Group A was subdivided into: Group I: 21 patients with no
valvular calcification, group 2: 26 patients with aortic valve calcification and group 3: 13
patients with aortic and mitral valve calcification. For all, the following was done: clinical
examination, serum Ca, serum P, serum albumin, serum creatinine, BUN and PTH level in
blood. M-mode echo cardiography was done for all.
Age, duration of dialysis and duration of 1ry kidney disease was higher in group 2 and 3
compared to group 1 (p = 0.0001). Calcium was higher in group 2 than group 1 (p = 0.09) and
group 3 (p = 0.004) than group I phosphorus was higher in group 2 and 3 than group 1 (P =
0.001). P was higher in group 3 than group 2 (p = 0.0001). Ca x P was higher in group 2 and 3
than group 1 (p = 0.0001), in group 3 than group 2 (p = 0.01) PTH was higher in group 1 than
group 2 (p = 0.06). Cardiac dysfunction by echocardiography was least in group 1, increasing
in group 2 and being highest in group 3. It was found that calcified valve groups has taken
higher doses of Calcium and Vitamin D3 .
We have to take care on prescribing Ca and vitamin D3 to ESRD patients on regular HD.
KEY WORDS: Valvular Calcification - Ca- P- PTH ­Ca x P- HEMODIALYSIS.
Patients with end-stage renal disease
in those with normal renal function (Ernesto
(ESRD) are frequently burdened with
et al., 2003).
calcific valvular heart disease (Adragoa et
KDIGO provided a new definition of CKD-
al., 2004). Valvular involvement in ESRD is
MBD: a systemic disorder of mineral and
most commonly manifested as mitral
bone metabolism due to CKD, manifested by
annular calcification and aortic valve
abnormalities of calcium, phosphorus, PTH or
calcification. Both mitral and aortic valve
vitamin D metabolism, abnormalities in bone
calcification (MAC) occur more frequently
turnover, vascular or other soft-tissue
and at younger age in those with ESRD than
calcification. The prevalence and severity of

Full Paper (vol.47 paper# 6)

d:\skydrive\Jor\vol47_7 The Egyptian Journal of Hospital Medicine (April 2012) Vol., 47: 217­ 225

Is the use of gonadotrophin-releasing hormone agonists facilitates vaginal
hysterectomy in moderate enlarged uterus?

Mohamed AbdElzaher, a,dAshraf Moawad, a,eMohamed Ali, a Wael A. Ismail
Madkour,b and Hena Zaheer, M.D. d

a Obstetrics and Gynecology department (Al-Azhar University, Cairo, Egypt),b Obstetrics
and Gynecology department (Ain-Shams University, Cairo, Egypt) c Obstetrics and
Gynecology department (Shadan Medical College, India), d Salman bin-abdulaziz University,
Medical Teaching Centre (KSA), eEnjab Hospital (UAE).


Vaginal hysterectomy is considered to be the method of choice for removal of the
uterus but most gynecologists still prefer the abdominal route for removal of benign large uteri >14
weeks. GnRH agonists such as goserelin can reduce uterine bulk by up to 60% and was initially used
to convert a midline to Pfannenstiel incision in abdominal hysterectomy. The conversion of an
abdominal to a potential vaginal hysterectomy by uterine size reduction would prove advantageous.

To evaluate the efficacy of the preoperative administration of GnRH agonist for women
with enlarged uteri without prolapse in order to facilitate vaginal hysterectomy; in comparison with
patients with enlarged uteri who underwent to direct Total abdominal hysterectomy for a similar
indication (i.e. Menorrhagia).

Prospective multicentre randomized controlled trial

Tertiary Center Hospitals

Women scheduled for hysterectomy for menorrhagia with non-prolapsing clinical uterine
size of >14 weeks were offered an attempt for vaginal hysterectomy after pre-treatment with
Goserelin for 3 months (Study group= 30). A group of women with comparable uterine size who
underwent abdominal hysterectomy for similar indication served as (Control group=30). Pre- and
postoperative data such as hemoglobin, myoma size, uterine weight, duration of procedure and
complications, pain score, and length of hospital stay were collected prospectively.

Both groups had comparable preoperative hemoglobin, body mass index and subjective
preoperative uterine bulk (16.7±2.4 vs16.9±2.2 weeks). The uterine weight was lower in the study
group (507.6±211 g) compared to the control group (728.8±189 g), P<0.001.The subjective mean
decrease in clinical uterine bulk was 20%. The duration of surgery was nearly twice as long in vaginal
(123.3±34.9 min) compared to abdominal hysterectomy (73.9±23.9 min), P< 0.001, but analgesia use
and the length of inpatient stay were lower in the study group (2.4±1 days) compared to control group
(4.97±1.5 days), P<0.001. No significant difference between the two groups as regards the rate of
occurrence of surgical complications.

In women with >14 week size uteri, treatment with gonadotrophin agonists reduces
uterine size sufficiently to allow safe vaginal hysterectomy. Although duration of surgery was longer,
women who underwent vaginal hysterectomy required less analgesia and had shorter inpatient stay.

Keywords: Non-descent vaginal hysterectomy, Gonadotrophin-releasing hormone agonist.


Full Paper (vol.47 paper# 7)

INTRODUCTION The Egyptian Journal of Hospital Medicine (April, 2012) Vol., 47: 262­ 237

Antibacterial Effectiveness Of Low Energy Diode Laser Irradiation
On Management Of Periodontitis In Down Syndrome

Howida M. Sharaf *, Adel M. Elkhodary**, Ali E. Saafan***, Mostafa I. Mostafaº,
Sahar M.El Hadidyº and Hanaa M. ElShenawyº

Department of Clinical Pathology, Ain Shams University Hospitals*,
Department of Orodental Biomaterials, Faculty of Dentistry, Cairo University**
Department of Dental Laser Application, National Institute for Laser Science***.
Department of Orodental Genetics, Human Genetics & Genome Research Division,
National Research Centerº


Background: With the poor oral hygiene exhibited by patients with Down syndrome, the potential for a robust
flora arises causing Periodontitis. Along with periodontal disease, the patient population has other medical
conditions that limit treatment. This study was conducted to evaluate the antibacterial effectiveness of an 870-nm
diode laser on periodontitis in patients with Down syndrome.

Subjects & methods
:Thirty five patients with Down syndrome suffering from periodontitis were included in this
study and divided into two groups, Group I (25 patients) laser was applied to one half of the mouth and the other
half was considered as a control & Group II included (10 patients) basic periodontal treatment was applied to
evaluate the systemic effect of laser. Quantification of A. actinomycetemconcomitans, P. Gingivalis and
Capnocytophaga were carried out using real-time PCR technique at baseline and at 2 weeks, at 6 weeks and at 12
weeks post periodontal and laser treatment.

: A. Actinmycetcomitans and P. gingivalis were the most common organisms found in the studied
patients and Capnocytophaga was the least common organisms. In group I the quantitative results of A.
actinomycetemconcomitans, P. Gingivalis at 2 weeks were significantly lower in both sides of mouth than that of
baseline level.After 6 week, it was still significantly lower than that of the baseline in the right side of the mouth,
but at 12 weeks no significant difference was observed in both sides. In group II, quantitative results of A.
actinomycetemconcomitans, P. Gingivalis at 2 weeks were also significantly lower than that of baseline but not at
6 & at 12 weeks. As regards, Capnocytophaga there was no significant difference at baseline, at 2 weeks, at 6
weeks and at 12 weeks post periodontal and laser treatment in both groups I & II.

, scaling and root planning plus laser therapy was better than scaling and root planning alone in the
chosen patients and this antibacterial effect continues to be significant up to 6 weeks after therapy. . Based upon
the results of the study, it was found that Laser therapy could be used for the treatment of periodontitis as a
complementary therapy not to replace mechanical intervention.

Key wards:
Down syndrome, Periodontitis, A. Actinmycetcomitans and P. gingivalis


challenged by the high incidence of early onset of

aggressive periodontal disease in T21; these patients
Down syndrome, or trisomy 21 (T21), was first
have higher levels of periodontal pathogens and
described by John Langdon Down in 1866. Down
periodontitis-associated interproximal bone loss.
identified the phenotypic expression of patients with
The complex anatomy, physiology, immunology,
circulation and coordination problems as having
and microbiology underscore the need for further
Down syndrome.Generally, these patients now live
investigations in specific areas related to their dental
to age 50 and some to age 60. As life expectancy
treatment (Alon Frydman and Hessam Nowzari,
increases, medical and social costs raised more
attention. Also, social changes have allowed for
There is an alteration in immune response that may
better quality of life. Dental practitioners are
contribute to the development of periodontal

Full Paper (vol.47 paper# 8)

INTRODUCTION The Egyptian Journal of Hospital Medicine (April 2012) Vol., 47: 238 ­ 248

Molecular Detection of Epstein-Barr virus in Breast Cancer
Howida M. Sharaf1 and Mostafa F. Gomaa
Clinical Pathology Department 1, Ain Shams University Hospitals
and Gynecology & Obstetrics Department, Faculty of Medicine, Ain Shams University,

Background: The association of Epstein Barr virus (EBV) with breast carcinomas (BCs) is still in controversy.
The aim of this study was to clarify the association of EBV & BC in Egyptian females and to assess its role as
potential contributor to the development and behavioral alteration of BC.
Subjects & methods: EBV-DNA was detected using PCR on breast tissue from 40 female patients with primary
invasive BC; ductal (n=32) and lobular (n=8) and 20 age matched females undergoing reduction mammoplasties
as control.
Results: EBV-DNA was detected in 8/40 (20%) BC specimens. On the other hand all control specimens were
negative As regards prognostic factors, no association was observed between EBV-DNA and patients' age,
menopausal status and steroid receptor expression. However, significant associations were detected between the
presence of EBV-DNA and other poor prognostic factors. All of the EBV-DNA positive BC were significantly
associated with positive nodal status, where 7/8 cases showed more than three tumor-positive LN involvement.
In spite of the small number of invasive lobular carcinoma included in this study there was a significant
correlation between this histological type of poor prognosis and EBV-DNA detection rate where 4/8 (50%) of them
were positive for EBV-DNA compared to 4/32 (12.5%) detection rate in invasive ductal carcinoma. A significant
correlation was found between EBV-DNA detection rate in BC and high tumor grade of invasive ductal carcinoma;
(100%, 1/1) association with grade III versus (9.67%; 3/ 31) with grade II.
Conclusions: our results demonstrated the presence of the EBV genome in a considerable subset of BC in Egyptian
patients. The virus was more frequently associated with bad prognostic factors. This indicates that EBV may play a
role in the development and behavioral alteration of some aggressive BC.
Keywords: Epstein Barr Virus, breast cancer.

As the etiology and progression of breast cancer
of humans and is usually carried lifelong as an
remain incompletely understood, novel routes of
asymptomatic infection. It is the causative agent of
disease pathogenesis are important to consider. Viral
infectious mononucleosis (IM) and has been
pathogens have not been much explored, but recent
associated with a growing list of malignancies of
interest has focused on Epstein-Barr virus (EBV).
both lymphoid and epithelial origin including
EBV is a herpes virus; its 184-kb DNA genome
encodes approximately 100 genes that infects >90%
immunocompromised, Hodgkin's lymphoma, and

Full Paper (vol.47 paper# 9)

INTRODUCTION The Egyptian Journal of Hospital Medicine (April 2012) Vol., 47: 249 ­ 259

Detection of a Point Mutation at Codon 12 of the Kirsten-Ras (K-ras) Oncogen
in Myelodysplastic Syndrome
Howida M. Sharaf, Nihal S. El-Kinawy, Ayman Omar* and Manal A. Ali**
Clinical Pathology Department, Ain Shams University Hospitals
Internal Medicine Department Wadi El-Neel Hospital* and Ain Shams Specialized Hospital
Background: Mutations in ras genes have been observed in a variety of cancers and were found to play an
important role in human leukemogenesis and in preleukemic disease as myelodysplastic syndrome (MDS). The
purpose of this study was to determine the prevalence of mutated K-ras oncogene in myelodysplastic syndrome
(MDS); with a special emphasis on their possible role in affecting clinical status, relation to karyotypic pattern;
response to therapeutic measures; its impact on the fate of the disease and overall survival.
Subjects & methods: Detection of point mutation of Kirsten-ras (K-ras) gene in 30 patients suffering from
myelodysplastic syndrome was carried out using quantitative enriched polymerase chain reaction (QEPCR) and
was confirmed by sequencing. QEPCR is a two- stage PCR procedure with modified primers that enriches mutant
alleles, via restriction endonuclease digestion of normal alleles and enables identification of one mutant allele
among 100,000 normal alleles.
Results: Activating mutations of the codon 12 of K-ras gene were detected in 7/30 (23.3%)cases of MDS, the
most common mutation involved a substitution of aspartic acid for glycine (GGTGAT). The incidence of K-ras
mutations was found to be significantly associated with refractory anemia with excess blasts type II (RAEBII) and
unclassified (UC) MDS than other subtypes (p=0.005), and was significantly associated with hypercellular bone
marrow (p=0.04) showing marked dyserythropoitic changes. Furthermore, mutant K-ras gene was found to be
significantly associated with abnormal karyotypes (p=0.04). Patients with mutated K-ras gene were significantly
associated with either high or intermediate risk according to International Prognostic Scoring System (IPSS)
(p=0.001). 6/7(85.7%) of those carrying the mutation showed poor response to treatment compared to non carriers
with a statistical significant difference (p=0.009). Five out of eight (62.5%) patients who were transformed to AML
carried the mutant K-ras gene, their subtypes were RAEB and unclassified MDS with abnormal cytogenetics mainly
Monosomy 7. Overall survival was detected using Kaplan-Meier curve and the mean survival time of patients who
carried K-ras mutations were significantly lower than those without the mutation (Log rank test=12.7; p=0.0004).
Conclusion: MDS patients bearing an mutated K-ras oncogene frequently showed poor response to treatment;
leukemic progression of the disease and shorter overall survival, suggesting that an activated K-ras oncogene is a
critical factor for prognostic evaluation; therapeutic decision and monitoring of response to treatment of MDS
Key words: K-ras, QEPCR, MDS.
Ras genes encode a family of 21-kd proteins (H-ras,
proliferation, differentiation, and survival (Lièvre et
K-ras, and N-ras)( Liu et al., 1987) They play a role
al., 2008) Mutations in these genes usually result
in signal transduction thus regulating cell
from single amino acid substitutions at one of the

Full Paper (vol.47 paper# 10)

d:\skydrive\Jor\vol47_11 The Egyptian Journal of Hospital Medicine (April 201
2) Vol., 47: 260 ­


The effect of Sitagliptin (Januvia) on the liver of adult Albino rats in cases
of experimental diabetes mellitus(Microscopic and laboratory studies)

Moustafa I. Hassan 1 Gamal S.El-Gharabawy 1 and Abdel-Ghany A. Moustafa 2

1- Histology Department, Faculty of Medicine & 2- Histology Department, Faculty of Medicine
(Dommiata) ,Al-Azhar University
The present study was carried out to evaluate the effect of Sitagliptin (Januvia) on the
liver of experimentally induced diabetes in albino rats.
Material and Methods:
Fifteen adult male albino rats were used and divided into three equal groups.
The first group was considered as a control group. In the second group experimental induction of
diabetes was performed by intraperitoneal injection of alloxan and left as a diabetic control for three
weeks. The third group was consisted of rats of experimentally induced diabetes and treated by a daily
dose of Sitagliptin (Januvia) as oral anti diabetic therapy for three weeks.
Two main parameters were performed; the first was microscopic and histochemical studies on the liver
tissue while the second was laboratory evaluation of some liver functions.
The hepatic tissue was affected by the experimental induction of diabetes in the form of
cellular infiltration, hepatic cell cords disarrangement and vascular congestion after three weeks of
The fibrous elements as well as mucopolysaccharides contents were greatly reduced. Histochemical
changes in the liver enzymes showed mild decrease. Liver function tests showed mild changes.
Diabetic changes were gradually returned back to its normal state after the use of daily oral dose of
Conclusions: The antidiabetic drug (Sitagliptin) could be considered a good therapy in limiting the
risk of diabetes Mellitus on liver tissue.
Keywords: Albino rats, Alloxan , Sitagliptin, structural and laboratory findings.

Review of Literatures
The liver has a wide range of functions,
mellitus, IDDM or juvenile diabetes). Type II
including detoxification, protein synthesis and
diabetes, results from insulin resistance, a
production of biochemicals necessary for
condition in which cells fail to use insulin
digestion , glycogen storage, decomposition of
red blood cells and hormone production,
mellitus, NIDDM or adult-onset diabetes).
(Maton et al., 1993). Hepatocytes make up 70
Gestational diabetes; in pregnant women who
to 80 % of the total mass of the liver.
have never had diabetes before and have a high

blood glucose level during pregnancy. It
On year 2000 at least 171 million
occurs in about 2%­5% of all pregnancies and
people worldwide suffer from diabetes
may improve or disappear after delivery
mellitus, or 2.8% of the population, type II
(Rother, 2007).
diabetes is by far the most common, affecting
Diabetic complications may be acute
90 to 95% of the U.S. diabetes population,
in the form of hypoglycemia, diabetic
(Lambert , 2002 and Wild et al, 2004).
ketoacidosis, or nonketotic hyperosmolar

coma. Serious long-term complications include
mellitus, often simply
cardiovascular disease, chronic renal failure
referred to as diabetes which is a group of
and retinal damage, (Rother, 2007).
metabolic syndrome characterized by high
blood sugar level and classical symptoms of
Pre-diabetes indicates a condition that
polyuria ,polydipsia and polyphagia . There
occurs when a person's blood glucose levels
are three main types of diabetes, Type I
are higher than normal but not high enough for
diabetes, results from the body's failure to
a diagnosis of type II diabetes. Many people
produce insulin (insulin-dependent diabetes
destined to develop type II diabetes spend

Full Paper (vol.47 paper# 11)

Effect of Cynara Scolymus L The Egyptian Journal of Hospital Medicine (April 2012) Vol., 47: 279 ­ 290

teeffE of Cynara Scolymus L. (Artichoke) Extraction on Hyperlipidemic Induced by
Gamma Radiation in Male Rats
Amal A. A. Ammar and Tamer M. M. Saad
Medical and Radiation Research Dept., Nuclear Materials Authority, Cairo, Egypt

Excessive free radicals are caused by unnatural environmental influences such as air pollution, radiation,
cigarette smoke, factories, pesticides, food contaminants and a myriad of other factor that are part of our
modern life. Hypercholesterolaemia is directly associated with an increased risk of coronary heart disease
Cynara scolymus L. (Artichoke) grows in Egypt and other countries. It is used as foods and has medicinal
properties. Artichoke extracts have been shown to produce various pharmacological effects, such as the
inhibition of cholesterol biosynthesis and low density lipoprotein (LDL) oxidation.
The present study aims to evaluate the antioxidative activities and radioprotector role of cynara scolymus
L. (artichoke) against hyperlipidemic induced by gamma- irradiation in male rats.
Material and Method
Male Swiss albino rats were orally administrated by artichoke (head or leaves) (10% mg/rat/day) using
suitable stomach tube (6weeks, 45 days) before exposure to a single dose (6.5 Gy) of whole body gamma
radiation. Levels of lipids peroxides (MDA), reduced glutathione content (GSH), superoxide dismutase
(SOD), total cholesterol (TC), triacylglycerol (TG), high density lipoprotein (HDL-C) and low density
lipoprotein (LDL-C) were investigated in serum
The results revealed that gamma radiation led to significant increase in MDA, TC, TG and LDL,
Meanwhile, significant decrease in GSH and SOD, but groups administrated with Artichoke (head and leaf)
before whole body gamma irradiation, artichoke exerted noticeable amelioration against the radiation
induced changes in most of the biochemical tested parameters.
Keywords: Ionizing radiation, Cynara scolymus L. (artichoke), Atherosclerosis; Antioxidant, Lipid profile.
Free radicals are atoms, groups of atoms or
electron. These unbalanced atoms then widely seek
particles having on their last orbital at least on
electrons from other atoms to replace their own,
unpaired electron. The most toxic radicals are
attacking normal cells and causing the chain
oxygen radicals belonging to peroxidal anion
reaction known as oxidation. Oxygen free radicals
radical, hydroxyl radical, peroxidal lipid radical
and singlet oxygen (Durackov et al., 1993).
biomembranes and also to DNA, which lead to
The ionizing radiation can produce free radicals
tissue damage, thus cause occurrence of a number
which are oxygen atoms that contain unpaired
of disease. Antioxidants neutralize the effect of

Full Paper (vol.47 paper# 12)

A/G ratio The Egyptian Journal of Hospital Medicine (April 2012) Vol., 47: 291 ­ 300

Evaluation Of The Toxicological Effects Manifested After Long term
Administration Of Aqueous Calotropis procera Plant Extract In Male And
Female Rabbits
Mohamed A. Shahat1and Ahmed M.A. Shihata2
1Department of Zoology, Faculty of Science, AlAzhar University at Assiut, Egypt.
2Chemical lab -Medico. Legal-Ministry of justise "Forensic chemist"


Background: Treatment with aqueous extract of Calotropis Procera was examined only for short
periods. So, The present study was designed to examine the influences of long term administrations of
aqueous extract of Calotropis Procera on male and female rabbits.
Material and methods: The extract was daily oral administered to thirty adult rabbits divided into
two sets each set contain 3 groups (5/each) for a period of 8 weeks. The doses administered were 80
and 40 mg/kg body weight as high and low doses for both male and female test groups.
Percentage of body weight change, serum biochemistry (Alanine amino transferases (ALAT),
aspartate amino transferases (ASAT) , Alkaline phosphatase, total protein, albumin, globulin, A/G
ratio, urea and creatininre), hematological parameters (PCV, WBCs, RBCs, Platelets and Hb) and the
blood indices (M.C.V., M.C.H. and M.C.H.C.) were examined.
Results: Results showed that there was no mortality or clinical signs observed among the treatment
and the control groups. No significant changes in the percentage of body weight gain, hematological
parameters, blood indices has been noticed in all treated groups
Highly significant decreases in serum total protein and albumin in male and female rabbits has
been recorded at high doses. While the globulin and A/G ratio revealed no significant changes. Serum
ASAT , urea and creatinine levels were highly significant increases (P >0.01) and the activity of
ALAT and ALP was significant increases (P >0.05) in male and female rabbits at high doses only.
Conclusions: Some toxicological effects were observed after administration of aqueous leaves extract
of Calotropis Procera at high doses in the long term for male and females rabbits
Key word: Calotropis Procera, biochemical parameters, Haematology; body weight gains, rabbits


Calotropis procera is a species of flowering
Sodom, a name derived from the Hebrew
Tapuah Sdom also,the plant known as aak for its
Apocynaceae, that is native to North Africa,
medicinal properties in Ayurveda (Oudhia &
Tropical Africa, Western Asia, South Asia, and
Dixit, 1994).The green globes are hollow but the
Indochina (Miller & Morris, 1987). The
flesh contains a toxic milky sap that is extremely
excavation at Helwan in Egypt showed that the
bitter and turns into a gluey coating resistant to
plant was in use in Neolithic period in Egypt
soap (Kumar et al., 2004).
(Greiss, 1955). It is known as Ushar or Madar in
Preliminary phytochemical screening of
Greeco-Arab medicine and known as Apple of
fresh leaves of Calotropis procera in water

Full Paper (vol.47 paper# 13)

POSORIASIS AND PSORIATIC ARTHRITIS: The Egyptian Journal of Hospital Medicine (April 2012) Vol., 47: 301 ­ 320

Essam A. El-Moselhy, Ibrahim Saad Nada, Hamed O. Khalifa,
Hassan M. Hassan* and Throwt M. Abd-Alrhman**
Departments of Community Medicine, Dermatology & Venereology* and Orthopedics**
Faculty of Medicine, Al-Azhar University

: Psoriasis and psoriatic arthritis are common, chronic, immune mediated disease
of the skin and joints. Interaction between genes and environment are important in disease
Objectives: The aim of the present study was to determine the socioemographic and clinical
characters of adult patients with psoriasis and those with psoriatic arthritis, to define psoriasis
and psoriatic arthritis etiological risk factors, and to define the relationship between psoriasis
severity and these items.
Subjects and methods: This study was conducted at Dermatology Clinic, Al-Hussein
University Hospital. A case-control study design was chosen to perform this research. The
study was conducted on 100 adult patients with psoriasis and an equal number of free adults
as controls. Criteria for diagnosis of psoriasis and psoriatic arthritis were used. A
comprehensive questionnaire was used to survey the studied groups. Body surface area of the
affected patients was used as a marker of disease severity.
Results: The study showed that 44.0% of the cases had psoriasis age of onset; 22-45 years.
Stress was the most common etiological risk factor, 67.0%. While, the most important risk
factors were family history of psoriasis, recurrent pharyngitis, smoking 20 cigarettes/ day
and higher level of education, odds ratio (OR)=7.58, 5.94, 2.78 and 2.69, respectively. Also,
32.0% of the patients had psoriatic arthritis. Psoriatic arthritis comes after psoriasis and had
mild severity in 65.6% and 68.7% of the cases, respectively. The most important etiological
risk factors were severe psoriasis, smoking 20 cigarettes/day and early onset of psoriasis,
OR=9.64, 3.06 and 2.72, respectively.
Conclusions and recommendations: The epidemiology of psoriasis is not well defined in
Egypt. The heredity and environmental factors are the most important risk factors. Also,
psoriatic arthritis is an important associated disease. The fact that it has no cure has important
implications for how it should be viewed, prevented and treated. We recommend that more
research should be carried out to understand the true epidemiological features of the disease
in Egypt and its impacts on quality of life of the patients.


Psoriasis is a common, chronic,
year (Sander et al., 1993 and Weiss et al.,
immune mediated disease of the skin and
2002). While, incidence study indicates
joints (Langley et al., 2005 and Griffiths
that 6 subjects/10000/year seeking care for
et al., 2010). It affects about 1.0-3.0% of
psoriasis for the first time (Bell et al.,
the general population (Koo, 1996; Grob
1991). Psoriasis is characterized by thick,
& Folchetti, 1999 and Stern et al., 2004).
scaling, red plaques that can be localized
In the U.S., it affects over 7 million with
or widespread. Morphological variants are
approximately 260,000 new cases each
common (Griffiths et al., 2010). The

Full Paper (vol.47 paper# 14)

d:\skydrive\Jor\vol47_15 The Egyptian Journal of Hospital Medicine (April 2012) Vol., 47: 321 ­ 333

Avoiding mastoid cavity Problems: Mastoid obliteration using Bioactive glass®

** Said Shokry, MD; *Al`Sayed Hossieni Al`Sayed, MD; *Mohammed Fatehy Zidan, MD;
**Adel Ahmed Hafez,MD;**Hanafi Mahmoud Abdulsalam,MD
Background and objective:
The aim of this study was to evaluate bioactive glass as an ideal material for the
purpose of mastoid cavity elimination after mastoid surgery to avoid mastoid cavity problems.
Materials and methods: In 20 patients diagnosed as cholesteatoma or chronic unsafe ear, we used different surgical
techniques according to pathology and situation during surgical exploration, basically adhering to standard
principles of eradicating disease in chronic unsafe ear. After performing the canal wall down (CWD) or the canal
wall up (CWU) technique, mastoidectomy was followed by obliteration of mastoid cavity by particulate form
Bioglass®. Cases were divided according to operative procedures, type of reconstruction and material used into 3
groups A- Canal wall up mastoidectomy followed by obliteration of mastoid cavity by particulate form Bioglass®.
B- Canal wall down mastoidectomy followed by reconstruction of posterior meatal wall and obliteration of mastoid
cavity by particulate form Bioglass®. C- Canal wall down mastoidectomy followed by reconstruction of posterior
meatal wall by conchal cartilage and obliteration of mastoid cavity by Bioglass®.
Results: Bioactiveglass paste is very effective for mastoid obliteration in the three groups with good integration to
the surrounding tissues either connective tissue, bone, meninges or lateral dural sinus without any adverse reaction
on the dura even with contact to Bioglass®. Infection was seen in 2 cases (10%), however was readily controlled by
topical application of antibiotics daily for one week. In both cases no extrusion of the material occurred.
Conclusion: The successful formation of bone with elimination of mastoid cavity problems proved that using
Bioglass is appropriate for performing clinical mastoid obliteration.


The ideal surgical procedure for cholesteatoma
complete disease eradication. However, this
should satisfy the following conditions: first, the
technique has several problems such as the
creation of a dry safe ear; second, the prevention
accumulation of debris, requiring periodic
of recurrence; and the reestablishment of a well-
cleaning and water restriction; dizziness; and
aerated middle ear with a properly functioning
difficulty with fitting in a hearing aid (Birzgalis
sound-conducting mechanism. The choice of
et al, 1994). With the canal wall up technique
surgical technique is mainly based on the
(CWU) these problems can be avoided, although
propagation of the disease, Eustachian tube
the rate of residual and recurrent disease tends to
function, and the status of other middle ear
be higher than when using the CWD (Meuser,
Over the past years, the gold standard for

management of cholesteatoma has been the
Various factors can contribute to a problematic
canal wall down technique (CWD). Removal of
cavity, namely a large cavity, high facial ridge,
the posterior canal wall allows exposure of the
narrow meatus, dependent mastoid tip, residual
entire epitympanum and middle ear and ensures
disease and an open middle ear space. Each of

these problems is amenable to surgical

*ENT Depart, Faculty of Medicine, Al`Azhar University Cairo
** Hearing and Speech Institute _Egypt


Full Paper (vol.47 paper# 15)