d:\skydrive\Jor\vol49_1 The Egyptian Journal of Hospital Medicine (October, 2012) Vol., 49: 511­ 520

Role of EUS-FNA and Percutaneous US-FNA in diagnosis of pancreatic
head lesions, Egyptian Experience
Hussein Okasha 1, Mohamed A. Hassanein2, Hany M.Khattab3 Mohamed Naguib1
1-Internal Medicine Department, Faculty of Medicine, Cairo University.
2-Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt.
3-Pathology Department, Faculty of Medicine, Cairo University.
Corresponding author: Hussein Okasha,MD.Internal Medicine Department, Cairo University.
Email: okasha_hussein@hotmail.com

Background: pancreatic carcinoma is one of the leading cancer morbidity and mortality worldwide.
Endoscopic Ultrasound (EUS) provides good direct visualization of the pancreas and EUS-FNA raises
the accuracy for diagnosing pancreatic malignancies. US-FNA is another established method for
diagnosing pancreatic malignancies.
Aim: to determine the Role of Percutaneous US-FNA and EUS-FNA in diagnosis of pancreatic
Subjects & Methods: 131 patients with pancreatic masses were included in the study and sub-
classified into 2 groups according to the imaging tool used, US-FNA (group I) and EUS-FNA (group
Results: using the appropriate statistical tools, sensitivity, specificity, positive predictive value
(PPV), negative predictive value (NPV) and diagnostic accuracy were calculated for both groups. It
was 88.2%, 93.9%, 96.8%, 97.5% and 90.1% respectively in group I. It was 77.8%, 100%, 100%,
75% and 86.7% respectively in group II.
Conclusion: US-FNA/EUS-FNA are safe reliable tools for diagnosis of pancreatic lesions.
Key words: Pancreatic lesions, US-FNA, EUS FNA
Pancreatic cancer is the fourth leading cause of
Southern provinces. The highest mortality
cancer-related death in the United States
rates were observed in the Nile Delta
(Jemal et al., 2008) and the fifth in Europe
compared to southern Egypt and the oasis
(Ferlay et al., 2007). Comparisons of age-
(Soliman et al., 2006). At least 80% of patients
specific mortality demonstrated higher rates in
have unresectable disease at diagnosis owing
Egypt compared to the United States for
to locoregional involvement or distant
subjects under age 20 years and significantly
higher rates in the United States compared to
In comparison to other imaging modalities
Egypt for subjects 40 years and older. In
EUS is able to visualize tumors less than 2 cm
Egypt, the rate of pancreatic cancer mortality
in diameter (Stefan et al., 2007). The ability to
is 2.85 more in Northern provinces than
obtain high quality images and perform fine-


Full Paper (vol.49 paper# 1)

d:\skydrive\Jor\vol49_2 The Egyptian Journal of Hospital Medicine (Oct 2012) Vol., 49: 521­ 538

Protective Effects and Its Relative Mechanisms of Low Dose Ionizing Radiation
on pancreatic cells of Male Diabetic Rat's
*Hanaa F. Waer, **Seham A. Helmy, *Rabab M. Mahmoud
*Atomic Energy Authority. National Center For Radiation Research and Technology, Biology Department - (King
Khalid University Faculty of Science ­ University Center for Girls)
**Suez Canal University, Faculty of Veterinary Medicine, Department of Cytology and Histology.
Back ground & Aim of the work: Diabetes mellitus (DM) is a chronic metabolic disorder brings great
danger to human health. Low-dose-rate radiation modulates various biological responses including
carcinogenesis, immunological responses and diabetes. This study examined the effect of low doses of
irradiation on the pathological and ultrastructural progression of type I diabetes in rats inducted by
Material and Methods: The present study was done on 80 healthy adult albino male rats 9 weeks age, in the
weight range from (150­200 gm). Rats were grouped to 4 groups they were cared according to the Guiding
Principle in the Care and Use of Animals. Diabetes was induced by a single intraperitoneal injection of freshly
prepared Streptozotocin (STZ- 45 mg/kg b.w.).
Whole body gamma irradiation was performed using Caesium -137. Animals were exposed to fractionated
dose levels of 0.5 Gy/week of -radiation for 3 and 6 weeks. The body weight, blood glucose and insulin
levels were measured after 3 and 6 weeks. Small blocks of pancreatic tissues of different groups were
removed and prepared for pathological and ultrastructure examination.
Results: An elevated level of glucose and decreased level of insulin in blood were first detected at 3 and 6
weeks of age in the STZ treated rats. There was significant and remarkable tendency of gaining normal levels
of both blood glucose and blood insulin by irradiation exposure especially after 6 weeks of irradiation. Both
suppression of cell death and cellular injury induced by STZ were also observed by EM examination in 3
week and 6 weeks.
Conclusion: The present results indicated that treatment with 0.5 Gy rays suppresses progression of type I
diabetes in STZ rats.
Keywords: insulin glucose - electron microscope- pathology ­STZ
Streptozotocin (STZ) is a naturally
of STZ is the direct result of irreversible damage
occurring nitrosourea with molecular weight of
to the pancreatic Beta cells resulting in
265 and empirical formula of C14 H27 N5 O12 (Dorr
degranulation and loss of capacity to secrete
and Fritz, 1980). It is widely used to induce
insulin (Gu et al., 1997). STZ given intravenously
or intraperitoneally to laboratory mice in multiple
experimental animals because of its toxic effects
sub-diabetogenic doses, induces pronounced
on islet Beta cells (Punithavathi et al., 2008;
pancreatic insulitis with eventual destruction of
Fadillioglu et al., 2008). The diabetogenic action
insulin-secreting Beta cells and finally cause

Full Paper (vol.49 paper# 2)

EFFECT OF BOSWELLIA ON ALLOXAN-INDUCED DIBETES MELLETUS IN MALE ALBINO RATS The Egyptian Journal of Hospital Medicine (Oct 2012) Vol., 49: 539­ 554

Eman G. E. Helal*, Samia M. Abd-Elwahab**, and Anwaar Alkamel Mohammad ***
Departments of Zoology ­Faculty of Science-Al-Azhar University (Physiology* and Histology **)
and Department of Medical Science- Faculty of dentistry Sinai University***

Back ground: Diabetes is a chronic metabolic disease which affects large number of population
all over the world. Such disease is associated with many complications which may leads finally to
patient's mortality. Camel milk supplementation reduces the insulin requirement in Type I diabetic
patients. So this study was planned to evaluate the effect of camel milk as hypoglycemic agent.
Material and method: Thirty male adult albino rats were used to investigate the effect of camel
milk (CM) treating diabetic rats. Rats were divided into three equal groups, control, diabetic non
treated and diabetic CM treated groups. After thirty days of treatment all rats of each group were
sacrificed. The body weight of each rat was determined at the beginning and the end of each period.
Blood glucose, serum insulin, lipid and protein profiles, liver and kidney functions, blood picture
and liver glycogen were determined for each rat at the end of each period. Pancreatic samples were
obtained and processed for microscopic and quantitative evaluation after staining the prepared
sections with both Heamatoxylin and eosin as well as special stain for demonstration of the
different pancreatic cells in the Islet of Langerhans.
Results: The obtained results showed that the induced diabetes was diagnosed by laboratory
assessment to body weight loss, hyperglycemia, and hypoinsulinemia, significant increase in liver
and kidney functions, lipid and protein profiles and decreased liver glycogen content. While, CM
treatment led to a significant improvement in all these parameter except liver function.
Microscopically there was definite vaculation, degeneration, karyolysis and pyknosis of beta
pancreatic cells in diabetic group while the other pancreatic cells were not affected (alpha and delta
cells). The use of CM treatment of this study greatly improves such cellular changes.
Conclusion: it was recommended that the use of the CM as a hypoglycemic agent may be of
good results besides repeating such study with the use of variable doses may be helpful in better
evaluation for the required doses.
Key words: Alloxan- hypoglycemia- Diabetic- Pancreas.
period of life (Dahlquist, 1999). Its primary
The incidences of diabetes mellitus
treatment is insulin replacement, however, at
have been increased worldwide (Onkamo et
al., 1999). Prevention and early treatment are
replacement cannot be achieved in clinical
important because diabetes interrupts normal
practice and metabolic disturbances cannot be
development in children and carries the threat
normalized. Oral therapy is still the best
of severe complication in the more active
treatment but in some countries like ours in

Full Paper (vol.49 paper# 3)



Community Medicine*, Industrial Health & Occupational Medicine**, and Obstetrics &
Gynecology***, Faculty of Medicine, Al-Azhar University

: Low birth weight (LBW) is an important public health problem. The problem is
prevalent world-wide and has negative impacts. So, its prevention is a major challenge.
Objective: To determine maternal risk factors of LBW in Cairo city.
Design: A case-control, hospital-based, study design.
Subjects: Mothers of 270 LBW neonates were recruited in this study. A control group of mothers
of an equal number of normal birth weight (NBW) neonates was chosen.
Methods: The mothers of LBW and NBW neonates were interviewed using a specially designed
questionnaire. All mothers had been subjected to full examinations. The neonates were weighted
and examined after labor.
Results: Low education, unskilled occupation, and husband unavailability are significant
sociodemographic risk factors of LBW; OR=1.75, 1.62, and 2.21, respectively. Mother's height
(145 cm), BMI (<18 kg/m²), history of previous abortion, and maternal family history of LBW
are significant personal characteristic risk factors of LBW; OR=3.26, 5.11, 3.27, and 3.23,
respectively. The significant obstetric risk factors are congenital malformations, weight gain
during pregnancy 6 kg, multiple gestations, bleeding at first/second trimester, presence of
complications during delivery, gestation age <37 weeks, and birth spacing <2 years; OR=13.61,
7.61, 7.15, 5.92, 3.93, 3.17, and 2.84, respectively. Absence of antenatal care, inadequate healthy
diet intake, physical hard activities, exposure to tobacco smoke, and living nearby heavy air
pollution are significant health care behavioral and life-style risk factors of LBW; OR=2.49, 2.72,
2.96, 3.64, and 4.8, respectively. Anemia, hypertension, and history of recurrent chronic/specific
infections are significant medical risk factors of LBW; OR=2.68, 4.35 and 4.84, respectively.
Anorexia nervosa/stress, oligo/polyhydramnios, and gestational hypertension are significant
gynecological/obstetric conditions risk factors; OR=3.53, 3.32, 3.23, and 3.36, respectively.
Lastly, the most important risk factors of LBW as weighted by partial F-test are multiple
gestations, neonate congenital malformations, weight gain during pregnancy 6 kg, maternal BMI
<18 kg/m², gestation age <37 weeks, and mother's weight at early pregnancy 45 kg, (F test=2.9,
2.7, 2.6, 2.3, 2.2, and 2.2, respectively).
Recommendations: There is a need for improving the quality and utilization of ANC services,
nutritional education, birth spacing, and avoidance exposure to tobacco smoke. Also, increasing
promotion of reproductive health services in relation to safe motherhood at community level in
order to reduce risk factors of LBW is needed. Lastly, further population based studies are needed
in different areas in Egypt.
Key words: Low birth weight, pregnancy, maternal risk factors, Egypt.
Corresponding author; Dr. Essam A. El-Moselhy, Professor of Epidemiology and Community
Medicine, Al-Azhar Faculty of Medicine, E-mail: dr_elmoslhy@hotmail.com


Full Paper (vol.49 paper# 4)

ž’ The Egyptian Journal of Hospital Medicine (Oct 2012) Vol., 49: 573­ 588

Molecular characterization of glutathione S-transferase,
endothelial nitric oxide synthase and Vitamin D receptor genes in
breast cancer cases
Rizk El-Baz(1); Azza Ismail(2) ; Maher Amer(2); Mai Elshahat(3); Amira
Kazamel(2); Ahmad Settin(1)
(1)Genetics Unit, Children Hospital, Mansoura University, Egypt
(2) Physiology Department, Faculty of Science, Mansoura University, Egypt
(3) Clinical Oncology & Radiology, Mansoura University, Egypt

Enzymes of the Glutathione S-transferase system (GST) modulate the effects of
exposure to several cytotoxic and genotoxic agents. Nitric oxide (NO) is constitutively
synthesized in the endothelium by endothelial nitric oxide synthase (eNOS) and acts as a
pleiotropic regulator involved in carcinogenesis. Vitamin D levels may influence breast cancer
development. The vitamin D receptor (VDR) is a crucial mediator for the cellular effects of
vitamin D and additionally interacts with other cell-signaling pathways that influence cancer
Objectives: To check for the association of polymorphisms of GST, eNOS3 and VDR genes
with the susceptibility and severity of breast cancer in Egyptian cases.
Subjects: This work included 100 cases with breast cancer and 100 healthy individuals. The
mean age of cases was 48.31±11.40 years. They included 100 females.
Methods: DNA was amplified using PCR-RFLP for detection of polymorphisms related to
eNOS3 and VDR , also DNA was amplified using PCR-SSP for detection of polymorphisms
related to GST and calculating the odds ratios and their 95% confidence intervals.
Results: Total cases showed high significant frequency of eNOS3-786 CC (P<0.05, OR=18.58)
genotypes, GSTT1(null) (OR = 2.68; CI 95%=1.51-4.75; p=0.001). These were considered risk
genotypes for disease susceptibility. On the other hand, total cases showed low significant
frequency with homozygosity for eNOS3-786 TT (P=0.01) and the GSTT1 gene was present in
42.0% of the cancers and in 66.0% of controls (OR = 0.37; CI 95%= 0.21-0.66; p=0.001). These
may be considered low risk genotypes. No significant difference in frequencies of null and
present genotypes of GSTM1 and VDR FOKI in total cases compared to controls.
Conclusions: Polymorphisms related to eNOS3-786, GSTT1 and VDR FOKI genes may be
considered genetic markers for BC among Egyptian cases. This may have potential impact on
family counselling as well as future management plans.
Keywords: BC: Breast Cancer, eNOS: Endothelial nitric oxide synthase, PCR-RFLP:
polymerase chain reaction with Restriction fragment length polymorphism, PCR-SSP:
polymerase chain reaction with sequence specific primers. SNP: single nucleotide

Full Paper (vol.49 paper# 5)

Computed Tomography evaluation in patients with abdominal pain at emergency department The Egyptian Journal of Hospital Medicine (Oct 2012) Vol., 49: 589­ 595

Routinely Use of computed tomography (CT) scanning in patients with
abdominal pain at emergency Department at King Hussein medical
center. (KHMC)
Abdallah AL- Mherat
Emergency Department, King Hussein Medical Center
Royal Medical Services,

Objective: To evaluate use of abdominal computed tomography in patients with abdominal pain
and accuracy of diagnosis, in patients who attend the Emergency Department at KHMC.
Method: We conducted a retrospective descriptive case series of consecutive patients who
received an abdominal CT scan for abdominal pain. The setting was an Emergency Department at
King Hussein Medical Center, from January to September. 2011. All patients who presented to
Emergency Department at King Hussein Medical Center with Abdominal pain and who received
a CT scan in the ED were included. All CT scans were reviewed by a radiology specialist and all
patients examined by an Emergency physicians.
RESULTS: The number of patients that attended the emergency Department of King Hussein
Medical Center during period of study with abdominal pain was (2060).
930 (45, 1%) of those Patients underwent Abdominal CT scan for abdominal pain. Then the
patients were categorized into groups according to abdominal CT scan findings.
Group A: 570 (61, 2%) patients with Abnormal Abdominal CT Scan.
Group B: 360 (38, 7%) patients with Normal Abdominal CT Scan.
The patients with Abnormal CT scan (Group A) were classified into two subgroups:
Subgroup I: (330) (57, 8%) patients had urinary tract stones.
Subgroup I I: (240) (42, 1%) Patients with variable conditions.
Conclusions: The study showed that the Use of abdominal computed tomography for
Abdominal pain in emergency Department may reduce mortality and Hospitals admissions, but
the use of abdominal computed tomography as a routine diagnostic tool in patients with
abdominal pain is unrecompensed, unless there is an indication. The Clinical assessment remains
the most important first step in evaluating patients with an Abdominal Pain to decide on when to
use CT scans in patients with abdominal pain.
Keywords: Abdominal pain, Abdominal computed tomography, Emergency Department.
Speaker and correspondence:
Dr,Abdallah Al Mehrat MD JBEM.
Emergency department-RMS-KHMC.
PO Box: 1338-11821. Email: abmhairat@hotmail.com. , almherata@hotmail.com,
T. Mobile:00962-777965908,772006555.


Full Paper (vol.49 paper# 6)

d:\skydrive\Jor\vol49_7 The Egyptian Journal of Hospital Medicine (Oct 2012) Vol., 49: 596­ 603

Immune Response to Hepatitis B Vaccine in Health-Care Workers
Maha M. Hussein¹, Manal M. Hussein²
Internal Medicine department Ain Shams University¹, Clinical Pathology Department Ain
Shams University².

Health care workers (HCWs) constitute a high-risk population of HBV infection. There are
limited data on the efficacy of vaccination in HCWs in Egypt.
The aim of this study was to evaluate the immune response to hepatitis B recombinant vaccine
in HCWs in our hospital.
Methods: 100 HCWs who completed three doses of intramuscular immunization with
recombinant DNA hepatitis B vaccine (Engerix-B) at different time periods during the last 5
years were examined for hepatitis B surface antigen (HBs Ag), anti hepatitis B surface
antibodies (anti HBs Abs) and hepatitis B core antibodies (HBc Abs).
Results: 96% of HCWs showed seroconversion (anti HBs 10 IU/L); 92% good responders
(anti HBs > 100 IU/L) and 4% weak responders (anti HBs = 10-100 IU/L). The HBsAg and
HBc Ab were never detected among the entire responders. Younger age had higher anti HBs
titer than older HCWs. The non responders were 4%; two of them had evidence of chronic
hepatitis B infection.
Conclusion: Vaccination against HBV in HCWs in Egypt is cost effective and achieved good
response rate. Screening for Hepatitis B infection before vaccination should be considered to
detect those with undiagnosed infection.
Key word: Hepatitis B vaccine, Immune response, Egypt, HCWs

Hepatitis B virus (HBV) infection has
infection can potentially be eradicated
been a major global cause of morbidity and
through global vaccination (Ni et al., 2001
mortality (Kwon and Lee, 2011). It is
and Chang, 2011). In general, no necessity
estimated that 350 million patients are
for booster doses for fully vaccinated
chronically infected worldwide and that
around half a million die every year from
Damme and Van Herck, 2007 and Gabbuti
end stage complications of persistent
et al., 2007). The post vaccination antibody
infection (Hennig et al., 2008). Health care
testing and regular testing for antibodies is
workers (HCWs) are at increased risk of
recommended only to high-risk subjects,
occupational exposure to HBV infection
especially to health care workers and
(Gholamzadeh and Serati, 2006 and
subjects with immunodeficiency (Zannolli
Thakur et al., 2010).
and Morgese , 1997 and Pallįs Alvarez et
al., 2000).

Fortunately, the currently available
hepatitis B Vaccine are extremely safe and
Although the majority of persons
have an efficacy of >90 percent. Thus HBV
vaccinated against hepatitis B successfully

Full Paper (vol.49 paper# 7)

d:\skydrive\Jor\vol49_8 The Egyptian Journal of Hospital Medicine (Oct 2012) Vol., 49: 604­ 614

Abdel-Salam Mohamed Ibraik Ohaida
Zoology Department. Faculty of Science. University of Misurata Libya.

Material & methods: Forty Fish, Tilapia florida. were injected with insulin (20 IU/Kg body weight) for
different periods. Single dose for 24h and repeated doses (dose every 48 h for 30, 45 and 55 days) were
used in this experiment. Body gain, condition factor (CF), hepatosomatic index (HSI) and gut weight were
calculated . Levels of total lipids, triglycerides and cholesterol were determined in serum, liver and
myotomal muscle. Also, sodium and potassium levels were estimated in both serum and muscle but
inorganic phosphorus was determined only in serum.
Results: Insulin injection increased significantly body gain (P<0.05) and gut weight (P<0.01). While
hepatosomatic index was significantly decreased (P<0.01) in insulin treated group at 30 and 45 days of the
experimental periods. The prolonged administration of insulin in Tilapia florida showed a continued effect
on the stimulation of lipogenic in the myotomal muscle as well as in the liver triglycerides synthesis. The
lowering effect of insulin on liver content of triglycerides but not in the serum.
Conclusion: So, it has been suggested that insulin might promote the triglyceride synthesis in liver to be
removed as rapidly as synthesized to lipid stores in the body. The increasing effect of insulin on serum and
muscle potassium level probably reflect role of such hormone in osmoregulation in this fish.
Key words: Insulin treatment, growth performance, lipid metabolism & electrolytes and Tilapia florida.

Many investigators have studied the
either carbohydrate metabolism or amino acid
metabolic effects of insulin in lower vertebrates,
incorporation into tissues with little attention on
particularly fish (Ottolenghi et al., 1982; Foster
the lipid metabolism.
and Moon, 1989 and Al-Salahy et al., 1994).The
On studying the glucose tolerance test in
majority of these studies were carried out as
many species of fish, many workers concluded
short-term treatment and have been focused on
that fish naturally suffer from insulin deficiency

Full Paper (vol.49 paper# 8)

A Key Regulator For Iron Homeostasis in chronic hepatitis C The Egyptian Journal of Hospital Medicine (Oct 2012) Vol., 49: 615­ 627

A Key Regulator For Iron Homeostasis in chronic hepatitis C.
Saadia Farid, Sameh Mohamed, Lila Rashid and Dina Sbry.
Department Of Tropical Medicine and Medical Biochemistry.
National Hepatology and Tropical Medicine Research Institute and Cairo University
Faculty of Medicine

Hepcidin is a small, cysteine-rich cationic peptide produced by hepatocytes. There
is a single human hepcidin gene; whose essential role in iron homeostasis was confirmed by
identifying homozygous frameshift or nonsense mutations in affected individuals with severe
Juvenile hemochromatosis. IL-6 may be the mediator of hepcidin induction by inflammation.
Hypoferremia is a common response to systemic infections or generalized inflammatory
disorders, anemia of chronic disease occurs in patients with acute and chronic immune activation
and represents an important clinical problem.

Aim of the work: The study will attempt to determine the hepatic hepcidin expression levels in
patients with chronic hepatitis C virus infection.

Patients and methods: Fifty patients with chronic hepatitis C virus infection (CHCV), their age
between (20- 55) years, selected from the National Hepatology and Tropical Medicine Research
Institute were included in this study, before interferon and Ribavirin therapy, and ten healthy
individuals were included to serve as controls. All the patients and controls were subjected to the
following history, clinical examination, abdominal ultrasonography and collection of blood
samples for routine laboratory investigations. CBCs and serological assay for serum ferritin, iron,
transferrin (s-TFR) levels, Liver biopsy for hepcidin mRNA levels and iron deposits in liver by
(PCR) polymerase chain reaction. All subjects gave written informed consent for enrolment in the
study, which was approved by the Research Ethical Committee of the General Organization for
Teaching Hospitals and Institutes. Liver biopsy was taken from healthy subjects during
abdominal surgery.

Results: Our results revealed that hepatic hepcidin expression is considered highly valid marker
in case of CHCV infection.

Conclusion: Our study concluded that there's a highly significant inverse correlation between
hepcidin versus liver iron, serum iron and serum transferrin but there's no significant correlation
versus ferritin.

Hepcidin measuring and manipulating hepcidin levels will, in the future,
have a role in diagnosing and treating any number of iron related disorders. Hepcidin itself has
antimicrobial properties of uncertain importance so that careful clinical trials will be required to
define appropriate indications of hepcidin antagonists.
Key Words:
Hepcidin an iron-regulatory hormone, anaemia of chronic disease, inflammation,
cytokine IL-6, CHCV.

Patients with CHCV infection frequently
Homeostasis. It is induced by infection and
have serum and hepatic iron overload.
inflammation. Hepcidin expression levels
Recently, hepcidin , exclusively
in chronic liver diseases (CLD) were
synthesized in the liver, is thought to
strongly correlated with either the
be a key regulator for iron
serum ferritin concentration or degree of

Full Paper (vol.49 paper# 9)

The possible protective role of bone marrow transplantation against alternations induced by Gamma radiations on fetal gastrointestinal tract of pregnant albino rats The Egyptian Journal of Hospital Medicine (Oct 2012) Vol., 49: 628­ 660

The Possible Protective Role of Bone Marrow Transplantation against Alternations
Induced by Gamma Radiations on Fetal Gastrointestinal Tract of Pregnant Albino Rats

Nahed Mohamed Mansour Emam
Biological and Geological Dept., Faculty of Education, Suez Canal University, Ismailia, Egypt.

Aim of the work:It is well recognized that radiation can be carcinogenic for a wide variety of tumors,
especially, in breast, thyroid, and bone marrow which appear to be radiosensitive.
Bone marrow cells (BM) suppress immune cell responses and have beneficial effects in various
inflammatory-related immune disorders. The present study is designed to evaluate the possible role of bone
marrow to restore certain histopathological and histochemical changes in the fetal gastrointestinal tract of
pregnant rats which exposed to gamma rays. Material and Methods: The experimental animals were divided into
five groups:
1-Control pregnant rats.
2- Group of pregnant rats irradiated with -rays on day 7 of gestation.
3- Group of pregnant rats irradiated with -rays on day 14 of gestation.
4- Group of pregnant rats irradiated with -rays on day 7 of gestation and treated with BM one hour post-
. 5-group of pregnant rats irradiated with -rays on day 14 of gestation and treated with BM one hour
post-exposure. All the previous groups were sacrificed on day 20 of gestation (1 day prior delivery).
Results: Exposure of pregnant rats to -rays on day 7 or day 14 of gestation showed many pathological
and histochemical changes in the fetal gastrointestinal tract. These changes were more pronounced on day 14 of
gestation. The changes include increased proliferation in the mucosal layer, increased signs of lymphocytic
infiltration and pyknotic nuclei in addition to highly distorted circular muscle fibers. Also, altered collagen, total
protein, polysaccharides contents were noted post-irradiation. Bone marrow transplantation post-irradiation
improved the tissue architecture which restored it's normal histological and histochemical pictures.
Conclusion: It can be concluded that bone marrow transplantation post-irradiation showed somewhat a
considerable ability to overcome radiation injuries or damages from the histological and histochemical point of
view on day 7 or 14 of gestation in the studied previous fetal tissues although the healing was incomplete on day 7
or 14 of gestation when compared with the control groups.
Key words: -rays- pregnant rats-fetuses and embryos-bone marrow transplantation.


Full Paper (vol.49 paper# 10)

d:\skydrive\Jor\vol49_11 The Egyptian Journal of Hospital Medicine (Oct 2012) Vol., 49: 661­ 671

Assessment of the Respiratory Muscles Function in Chronic Obstructive Pulmonary
Disease patients
Manal R. Hafez* and Rawda M. Elsheikh **
Chest Department* and Community& Occupational Medicine Department**
Faculty of Medicine for Girls Al-Azhar University

Chronic Obstructive Pulmonary Disease (COPD) is a public health problem worldwide. It is a polygenic disease
and a classical example of gene-environment interaction. Of the many inhalational exposures that may be
encountered over a lifetime, only tobacco smoke and occupational dusts and chemicals (vapors, irritants, and
fumes) are known to cause COPD on their own. Maximal inspiratory pressure (MIP) and maximal expiratory
pressure (MEP) may be impaired in patients with COPD.
Aim of the study: to assess respiratory muscle function in male COPD patients by measuring MIP and MEP
values and to identify possible correlation between MIP and MEP and the anthropometric parameters as well as
degree of airflow obstruction among COPD patients.
Subjects and methods: A case-control study was carried out on 50 COPD male patients and 50 of age and sex
matched healthy subjects as a control group. All participants were subjected to assessment of respiratory muscle
(RM) strength by MIP and MEP, pulmonary function tests {flow/volume spirometry, and MVV}, as well as the
functional exercise capacity (6MWT) and the anthropometric measurements.
Results: the values of MIP and MEP in COPD cases were lower than those of the control group with a statistically
significant difference. In COPD cases the MIP and MEP were positively correlated with VC%, FEV1\FVC,
FEV1%, FVC%, PEF%, MVV%, and 6MWD (p<0.00). Furthermore, COPD patients were subdivided according to
the presence of respiratory muscle (RM) affection into two subgroups: Group A (patients with RM affection) and
Group B (patients without RM affection). There was a significant difference between the two subgroups
concerning smoking index , disease duration, VC% , FVC% ,FEV1\FVC, FEV1%, PEF%, MVV%, and 6MWD
(P< 0.05).
Conclusion: RM is affected in patients with COPD. Measurement of MIP and MEP indicates the state of RM
which is related to smoking index, disease duration, and spirometric-indices (VC%, FVC%, FEV1\FVC, FEV1%,
PEF%, and MVV %).
Recommendation: Health care workers involved in the diagnosis and management of COPD patients especially
those with severe airflow obstruction should consider the possibility of RM deterioration and should have an
access to RM function assessment.
Key words: COPD, MIP, MEP, respiratory muscle function and pulmonary function test.

Abbreviation: MIP: Maximal inspiratory pressure - MEP: Maximal expiratory pressure - PImax: Peak
inspiratory pressure - - PEmax: Peak expiratory pressure - RM: Respiratory muscle- SNIP: Sniff Nasal Inspiratory

Chronic Obstructive Pulmonary Disease (COPD) is
and also in the overall productivity (Ait-Khaled et al.,
a public health problem and is a major cause of
chronic morbidity and mortality throughout the
COPD is a polygenic disease and a classical
world. The World Health Organization (WHO)
estimates that COPD will be the third most common
Individuals may be exposed to a variety of different
cause of death and the fifth most common cause of
types of inhaled particles over their lifetime. Of the
disability in the world by 2020 (Barnes, 2000).COPD
many inhalational exposures that may be encountered
imposes a high economic burden on the society and
over a lifetime, only tobacco smoke and occupational
health care system and as one of the risk groups of
dusts and chemicals (vapors, irritants, and fumes) are
the disease is the working age population, this is
known to cause COPD on their own.(Ait-Khaled et
leading to losses in wages and salaries for workers
al., 2001). Pauwels and Rabe (2004) reported that

Full Paper (vol.49 paper# 11)

Echographic evaluation of optic disc excavation The Egyptian Journal of Hospital Medicine (Oct 2012) Vol., 49: 672­ 677

Echographic evaluation of optic disc excavation
Fatma A. Atwa, MD*, Mona Mohamad A. Farag, MD* & Mona N. Mansour,
*Ophthalmology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo,

Purpose: To evaluate the role of high resolution B-scan echography in differentiating the
causes of optic disc excavation.
Methods: A prospective study was conducted on 30 subjects presenting to Al-Zahraa
University Hospital (2009 ­ 2011) with optic nerve excavation. Of these patients 10 with
coloboma, 10 with cup-shaped posterior staphyloma and 10 with glaucomatous optic nerve
cupping were identified. Horizontal and vertical approaches for optic disc excavations were
evaluated using B-scan echography. Specific echographic criteria for excavation configurations
were successfully estimated.
Results & conclusion: High-resolution contact B-scan echography may provide useful
differentiation for optic disc excavations in eyes with opaque media.
The eyeball's fluid content and its superficial
choice in detecting subtle changes in the nerve
position make it ideally suited for examination
and in providing tissue differentiation of its
with ultrasonography (U/S). U/S is the only
lesions (Atta, 1988).
practical method for obtaining images of the
The current study focused on the
posterior segment of the eye when the media
echographic shape of posterior ocular contour
are opaque; it is a simple, noninvasive tool for
as considering the optic disc in eyes with
diagnosing lesions of the posterior segment of
coloboma, high myopia with cup-shaped
the eyeball. Due to its noninvasiveness, ease of
posterior staphyloma or advanced glaucoma,
access, quick and reliable information and real-
time character, U/S is quite often the first
differentiate between them in patients with
imaging modality used in eye and orbit
clear media, to help later in differentiating
assessment ( Aironi & Gandage, 2009&
these with opaque media.
Dudea, 2011).
Patients &Methods;
Echography is a useful method in the
This prospective, case series study included
investigation of optic nerve diseases. The
30 subjects (12 males and 18 females; with
optic nerve is well suited to echographic
different ages at presentation). The patients
imaging because of its regular tubular
were selected from the outpatient clinic at Al-
structure consisting of "low reflective" nerve
Zahraa university hospital (2009-2011),
proper and "highly reflective" peri-neural
according to fundus examination. They were
sheaths, surrounded by the heterogeneous
classified into three subgroups: patients with
orbital fat. Echography may be a method of
optic disc coloboma, patients with cup-shaped

Full Paper (vol.49 paper# 12)

South African Journal of Clinical Nutrition The Egyptian Journal of Hospital Medicine (Oct 2012) Vol., 49: 678­ 690


Hassan M. Bukhar1, Ibrahim Saad Nada2, 3, Eslam A. Header1, 4

1Dept. of Clinical Nutrition in the Faculty of Applied Medical Sciences, Umm al-Qura University
Makkah, KSA. 2Laboratory Department, Faculty of Applied Medical Sciences, Umm al Qura
University, Makkah, Saudi Arabia, 3Community Medicine Department, Faculty of Medicine, Al Azhar
University. 4Department of Nutrition and Food Science Faculty of Home Economics Minufiya
University, Egypt.

Nutrition is one of the most important factors influencing human health.
Also, nutrition plays a role in the etiology of osteoporosis disease. This disease is a
serious metabolic bone disorder that often results in hip fracture and is usually
asymptomatic in its initial stages.
Assess the prevalence of osteoporosis among female university students.
A cross sectional study was carried out during the period from 1/1/2010 to
30/6/2010 among a random sample of (257) university female students were chosen from
Umm Al Qura of Makkah. The age of sample from 19-24 years old. Data were collected
through an interview with case by using a special questionnaire; bone mineral density
(BMD) and body composition have also been measured.
Results: Osteoporosis was present in 7% of cases while, osteopenia was current in 32.3%
of cases. Moreover there was a highly positive significant relationship at level (1%)
between osteoporosis induced and each of body fat %, fat weight, and BMI.
The prevalence of osteoporosis among university students was positively
and significantly associated (p<0.001) with increased body fat. The study results
suggested that inevitable decrease in body fatness and weight with less consumption of
carbonated beverages, taking into consideration variety and balanced diets and increasing
nutrition education programs will improve bone health and nutritional status.
Key words: Osteoporosis, Osteopenia, Bone mineral density, Body fat, University
students and Umm Al-Qura University.

is lower than -2.5SD which often leading
common metabolic disease in western
to a decrease in quality of life Bennell et
society Ilich et al. (1996) characterized
al. (2000). Lower bone mineral density
by low bone mass, where Diane,
was found in greater proportion among
reported that a normal bone mineral
density BMD is in the range of ±1SD of
intervention inclusive of awareness
the mean value of peak bone mass in
through health education and medication
young adult 30 years old women (Diane,
Baig et al. (2009). Several studies stated
2001). Osteoporosis occurs when BMD
that one in three women and one in 12

Full Paper (vol.49 paper# 13)

Yogurt is one of the most popular fermented foods and traditionally consumed for a long time in many countries (Nakasaki et al The Egyptian Journal of Hospital Medicine (Oct 2012) Vol., 49: 691­ 704


Hassan M. Bukhari 1, Abdelghany H. Abdelghany2,3, Ibrahim Saad Nada3,4 and
Eslam A. Header1,5
1Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm al Qura University
Makkah, Saudi Arabia, 2Department of Anatomy and Embryology Faculty of Medicine, Alexandria
University, Egypt, 3Laboratory Department, Faculty of Applied Medical Sciences, Umm al Qura
University, Makkah, Saudi Arabia, 4Community Medicine Department, Faculty of Medicine, Al Azhar
University. 5Nutrition and Food Science Department, Faculty of Home Economics Minufiya
University, Egypt.
Corresponding Author: Hassan M. Bukhari, Department of Clinical Nutrition, Faculty of Applied
Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia, P.O. Box: 715

Dietary supplementation of yoghurt with plants rich in antioxidants such as propolis
which is an adhesive resinous material collected by honey bees is recently recommended.
This study aimed at investigating the protective effect against the hyperglycemia and
hyperlipidemia. The study showed that yoghurt with propolis had a hypoglycemic effect
together with reduction of the serum levels of cholesterol, low density and very low density
lipoproteins with elevation of high density lipoproteins. The atherosclerosis indices were
affected with reduction of low density lipoproteins-cholesterol/high density lipoproteins-
cholesterol and elevation of the high density lipoprotein-cholesterol/total cholesterol. This
was attributed to the reduction of glucose absorption and inhibition of -glucosidase together
with the antioxidant activity with regain of the pancreatic -cell function. The hypolipidemic
effect and consequently protective effect against atherosclerosis was attributed to the binding,
breakdown and reduction of absorption of cholesterol together with the antioxidant activity of
both yoghurt and propolis. Down regulation of the expression of the angiogenic gene factors
which have a role in the pathogenesis of atherosclerosis may play a role.
Thus, this dietary supplementation may be manufactured and used for its value in
reducing hyperglycemia and hyperlipidemia in cases of diabetes mellitus.
Keywords: yoghurt, propolis, diabetes mellitus, atherosclerosis, hyperglycemia,
hyperlipedemia, cholesterol, lipoproteins antioxidants.

Yogurt is defined by the Codex
bulgaricus and Streptococcus thermophilus
Alimentarius of 1992 as a coagulated milk
(Bourlioux and Pochart, 1988).
product that results from fermentation of
Many investigators have studied
lactic acid in milk by Lactobacillus
the therapeutic and preventive effects of
yogurt and lactic acid bacteria, which are
commonly used in yoghurt production, on

Full Paper (vol.49 paper# 14)

d:\skydrive\Jor\vol49_15 The Egyptian Journal of Hospital Medicine (Oct 2012) Vol., 49: 705­ 717

Effect of Morin against Gentamicin-Induced Nephrotoxicity in Young Male Rats
Hala A.H. Khattab
Nutrition and Food Science Dept., Faculty of Home Economics, Helwan University

Background: Morin, a bioflavonoid with antioxidant properties, is a constituent of many herbs and fruits
that are used as herbal medicines. It exhibits many biological activities and possibly even has protective
effects against chronic diseases. The present study was conducted to determine the protective effect of morin
against gentamicin-induced nephrotoxicity in young male rats.
Material and Methods: Young male rats (n=24) were divided into four groups as follow; (1): control group,
(2): gentamicin (GM) group; rats injected intraperitioneally (i.p.) with GM at a dose of 100 mg /kg body
weight (b.w.) for five consecutive days to induced nephrotoxicity, (3): morin group; rats administered morin
daily at a dose of 30 mg/ kg b. w. via gavage, and (4) GM group pretreated with morin; rats were orally
received morin at the same dose and route in group (3) up to two weeks followed by injected i.p. with GM as
in group (2). Separated serum samples were used for determination of protein metabolism parameters,
kidney functions, malondialdehyde (MDA), and ionic sodium (Na+) and potassium (K+).
Results: GM injection induced marked nephrotoxicity as evidenced by significant elevation in serum levels
of albumin, creatinine, urea, uric acid, MDA and K+, with significant reduction in serum levels of total
protein, Na+ and albumin/creatinine ratio (ACR). Pretreatment with morin protected the rats from GM-
induced nephrotoxicity as evidenced by significant improvement of these investigated parameters.
Histological examination of renal tissues showed marked glomerular thickening, vacuolations of the wall of
blood vessels associated with necrobiotic changes in GM injected group, meanwhile there were amelioration
in rats group received morin pre-GM injection.
Conclusion: Morin exert potential antioxidant activity and offer nephroprotective effect against GM-
induced nephrotoxicity in young rats.
Key words: Morin, gentamicin, nephrotoxicity, antioxidant, young male rats.
Aminoglycosides are natural or semi-
proximal tubules, basal membrane disruption,
synthetic antibiotics with a heterocyclic structure
mesangial cell contraction, proliferation and
formed by two or more amino sugars linked by
apoptosis, thus indicated by decreases in
glycoside bonds to an aminocyclitol ring, the most
widely used drug in this category is gentamicin.
intraglomerular dynamics (Pedraza-Chaverri et
The incidence of renal dysfunction following
al., 2003 and Martinez-Salgado et al., 2007). The
aminoglycoside administration was detected by
many workers. Gentamicin, as an aminoglycoside
nephrotoxicity still remains unclear. Recent
broad spectrum antibiotic, is used against
evidence showed that reactive oxygen species
pathogenic gram negative and positive bacteria.
(ROS) play a pivotal role in gentamicin-mediated
Unfortunately, acute renal failure is major
nephrotoxicity, it induced impairment of renal
complication in 10-20 % of patients receiving the
function through liberation of ROS in rats
drug (Adbel Naim et al., 1999, Avdagi et al.,
(Heibashy and Abdel Moneim, 1999 and
2008, Vanessa et al., 2009 and Ibrahim and Saleh,
Heibashy et al., 2009). Walker et al. (1999) have
2012). It has been demonstrated that gentamicin-
demonstrated that oxidative stress induced by
induced nephrotoxicity is characterized by direct
gentamicin, is the central pathway responsible for
tubular necrosis, which is localized mainly in
renal injury. Some studies have reported that

Full Paper (vol.49 paper# 15)

d:\skydrive\Jor\vol49_16 The Egyptian Journal of Hospital Medicine (Oct. 2012) Vol., 49: 718­ 731

Anxiety and depression among patients with Bronchial asthma, chronic obstructive
pulmonary disease and diffuse parenchymatous lung diseases
Taghreed S. Farag*, Manal R. Hafez*, Taghreed Elshafie**and Omaima I. Abo-Elkheir***
* Chest Diseases Department **Psychiatric Diseases Department *** Community & Occupational Medicine
Department, Faculty of Medicine for Girls Al-Azhar University

Background: Psychosocial stressors, such as death of a spouse or divorce are closely related to relapses and
aggravations of respiratory disease pointing to a link between psychological factors and chronic pulmonary disease.
Patients with chronic obstructive pulmonary disease (COPD) cannot cope adequately with everyday needs. This
inadequacy may lead to heightened anxiety and depression, which in turn may worsen the everyday inadequacy. It
has been reported that this is probably a factor that leads bronchial asthma (BA) and COPD patients to frequent
hospital admissions, lower treatment adherence and even intensive care unit hospitalizations.
Study objectives: to assess anxiety and depressive symptoms among a sample of Egyptian patients with chronic
obstructive pulmonary disease (COPD), bronchial asthma (BA), and diffuse parenchymatous lung diseases
Subjects & methods: A cross-sectional study conducted over a one year period on a sample of 258 Egyptian
patients with chronic breathing disorders who attending the outpatient chest clinic at Al-Zahraa University Hospital.
All patients diagnosed as having COPD, BA or DPLD were enrolled into the study. Anxiety and depression were
assessed by using the Hospital anxiety and depression scale (HADS) and the Beck Depression Inventory (BDI).
Results: Psychiatric disorders were most prevalent among DPLD cases (80.0%), followed by COPD patients
(74.0%), while BA group showed the least reported cases (38.8%) with psychiatric disorders, with a statistically
significant difference among the studied groups (P-value < 0.05).Depression was prevalent among 60.1% (155/258)
of the studied cases, of them 23.2% had severe depression, followed by 38.7 % had moderate depression and 38.1%
had mild depression. DPLD cases had the highest proportion of severe depression (31.8), COPD cases had the
highest proportion of moderate depression (52.4) and BA group had the highest proportion of mild depression
(68.4%), with a statistically significant difference among the studied groups (P-value < 0.05).Conclusion: results of
this study revealed that mixed anxiety depression disorders, depression and anxiety were common co-morbidities
among the studied sample of the Egyptian patients with DPLD, COPD and those with BA. Recommendations:
physicians should take into consideration the assessment of psychiatric co-morbidities among cases with DPLD,
COPD and BA.
Key words: Chronic breathing disorders, COPD, bronchial asthma, anxiety; anxiety disorders; depression;
depressive disorder; lung diseases.
Abbreviations: COPD: Chronic obstructive pulmonary diseases, HADS: Hospital anxiety and depression scale,
HRCT: High resolution computed tomography, BDI: Beck Depression Inventory.


Full Paper (vol.49 paper# 16)

d:\skydrive\Jor\vol49_17 The Egyptian Journal of Hospital Medicine (Oct. 2012) Vol., 49: 732­ 750

Amr M Ismaeel , Mohamed A Nassef, Maha F Azmy and Magdy M Khalil
Radiodiagnosis department, Faculty of Medicine, Ain Shams University


We described the role of MDCT with its new applications for determining the cause and site of bleeding,
and to determine the additional benefit of MDCT angiographic technique in identifying the site of
bleeding and its vascular origin.
PATIENTS AND METHODS: 50 patients suffering from hemoptysis were evaluated by MDCT with
its new applications & MDCT angiographic technique.
RESULTS: MDCT revealed excellent diagnostic method for hemoptysis.
CONCLUSION: MDCT is considered a primary noninvasive imaging modality in the evaluation of
patients with hemoptysis. It also serves as a guide for other diagnostic or therapeutic procedures.
Keywords: MDCT and Hemoptysis ­ MDCT angiographic
Hemoptysis is defined as bleeding originates
prevalence of tuberculosis, and the use of cross-
from the lower respiratory tract. (1) Although
sectional imaging.(5) (6) The bronchial arteries are
hemoptysis may cease temporarily, a possible
the source of bleeding in most cases of
life-threatening condition may still be present,
hemoptysis; while hemoptysis is related to
requiring complete evaluation and treatment. (2)
pulmonary artery injury in up to 11% of cases.(8)
Hemoptysis' severity is classically classified
Contributions from the non-bronchial systemic
based on the amount of bleeding. (3) There are
arterial system represent an important cause of
multiple causes of hemoptysis, from airway
recurrent hemoptysis following apparently
diseases, parenchymal diseases, cardiovascular
successful bronchial artery embolization.
diseases, and other causes. (2) The common
Vascular anomalies such as pulmonary
causes of bleeding from the large vessels
arteriovenous malformations and bronchial
nowadays include cancer, bronchiectasis,
artery aneurysms are other important causes of
tuberculosis, and fungal infections. No cause is
identified in 15% to 30% of all cases, and is
termed idiopathic or cryptogenic hemoptysis. (4)
malignancy, tuberculosis, and chronic fungal
The most common underlying causes of
infection are easily detected with conventional
hemoptysis vary in reported studies depending
CT. (5) MDCT permits a more sensitive, more
on the geographic location of the study, the
rapid and accurate assessment of the cause and

Full Paper (vol.49 paper# 17)

d:\skydrive\Jor\vol49_18 The Egyptian Journal of Hospital Medicine (Oct. 2012) Vol., 49: 751­ 770

Role of MRI in Characterization of Occult Breast Lesions in High Risk
Caroline AY Habib. M.Sc., Hisham MA Mansour. MD, Mohsen G Hassan. MD, Ayman M
Ibrahim .MD.
Radiodiagnosis department, Faculty of Medicine, Ain Shams University

OBJECTIVE: To evaluate the diagnostic validity of breast MRI in discriminating benign from
malignant lesions in women with occult breast lesions who are at a high risk of developing breast
cancer, with histopathologic findings and/or follow up used as the reference standard.
PATIENTS AND METHODS: Contrast-enhanced bilateral breast MRI was performed on 100
women at high risk of developing breast cancer with indeterminate imaging findings by
mammography and/or ultrasonography. Lesions detected by MRI that could represent potential
malignancies in both breasts were evaluated. Morphologic assessment and kinetic analysis (contrast
enhancement and time/intensity curves) were performed on each lesion using dedicated
postprocessing and display software. Functional MR tools were used in about 60% of cases to help in
the differential diagnosis between malignant and benign of suspicious lesions detected at conventional
RESULTS: Among 100 patients included in the study12% of the patients were finally diagnosed as
free of any pathology, 56% had benign findings, while 31% of the patients were malignant. (24 IDC,
4 Invasive Lobular Carcinoma, 1 Medullary carcinoma, 1 Mucinous carcinoma and 1 DCIS.) The
sensitivity, specificity, positive and negative predictive values of CE-MRI, were 100%, 93%, 86%,
and 100% respectively. Overall accuracy of MRI breast was 95%. CONCLUSION: Breast MRI is
highly effective in detection and characterization of occult breast lesions in high risk population, with
excellent sensitivity and high specificity. Development of functional MRI tools contributed to the
improving validity of this modality
Breast cancer is the most common
localization of multiple lesions and screening
malignancy that affects women worldwide and
of high-risk patients (Jagannathan, 2009).
is a significant health care problem. Several
The standard breast MRI examination uses a
well-established clinical imaging modalities
gadolinium contrast agent to highlight lesion
have been in use to study the architecture,
and their extent. In the assessment of breast
physiology and function of breast cancer.
cancer, measurements are usually acquired
Methods such as X-ray mammography,
dynamically before, during and at certain time
ultrasound and physical examination are often
points after bolus injection of the contrast
limited in sensitivity and specificity, especially
agent, allowing the contrast agent uptake and
in young women. MRI is increasingly being
washout characteristics of the lesion to be
characterized. Evaluation is based on the

Full Paper (vol.49 paper# 18)

THE BENEFICIAL EFFECT OF TRIFOLIUM EXTRACTS ON PARACETAMOL- INTOXICATED MALE RATS The Egyptian Journal of Hospital Medicine (Oct. 2012) Vol., 49: 771­ 780

The Beneficial Effect Of Trifolium Flower Extracts
On Paracetamol- Intoxicated Male Rats
Ahkam M. El-Gendy
Zoology Dep. Faculty of science (Girls' branch), Al-Azhar University, Cairo, Egypt.

Acetaminophen known as paracetamol (P) overdose can cause severe hepatotoxicity and even liver
failure and hepatic centrilobular necrosis in experimental animals and humans.
Material and methods:
The male rats (n=36) were allocated into 6 groups (each group n=6 rats). Group I was kept as control.
All animals in groups II-VI were given paracetamol at 2 g /kg bw by gastric gavage on days 3 post
Trifolium alixanderanum (T alixanderanum) flower extracts (TEs) or N-acetylcystiene (NAC)
treatments. Group III, IV and V were treated for three days by hexane extract (THE + P), ethanol
extract (TEE + P) and water extract (TWE + P). Group VI received 100 mg/kg bw of antidote N-
acetylcystiene (NAC + P).
Paracetamol induced a significant rise in Liver weight and hepatosomatic index, serum aspartate amino
transferase (ASAT), alanine amino transferase (ALAT), alkaline phosphatase (ALP), total bilirubin (T
bili), liver lipid peroxides (MDA+ 4-HDNE) with a reduction of liver glutathione (GSH), glutathione
peroxidase (GSHpx) and superoxide dismutase (SOD) enzymes activities. The plant extracts showed a
remarkable hepatoprotective and antioxidant activity against paracetamol induced hepatotoxicity as
judged from the serum marker enzymes and antioxidant levels in liver tissues.

The present investigation indicated that paracetamol damaged liver cells and TEs prevented this
damage when compared with control group.Trifolium flower hexane extract was the most effective
superior to TEE, TWE and NAC.
Key Words: Paracetamol, T alixanderanum flower extracts, NAC, hepatosomatic index, ASAT,
ALAT, ALP, GSH, MDA, Rattus rattus.

considerable attention in recent years due to
pharmaceutical plants and their extracts are
widely studied by many researchers. Plant
including antioxidant and hepatoprotective
derived natural products such as flavonoids,
activity (DeFeuids et al., 2003, Banskota et al.,
2000 and Takeoka and Dao, 2003) Liver is a key

Full Paper (vol.49 paper# 19)

Full Paper (vol.49 paper# 20)

d:\skydrive\Jor\vol49_21 The Egyptian Journal of Hospital Medicine (Oct. 2012) Vol., 49: 793­ 800

Role of Multidetector Computerized Tomography in Coronary In-
Stent Restenosis
Waleed S El-Sharkawe, Sahar M El-Fiky, Khalid A Shoukry, Rania A Maarouf.
Rdiodiagnosis department, Faculty of Medicine, Ain Shams University


We described the role of multi detector computerized tomography in the detection
and exclusion of coronary in-stent re-stenosis compared with the conventional coronary
PATIENTS AND METHODS: 30 patients pretreated with coronary stenting and
complaining of angina like symptoms underwent dual source coronary angiography one day
before performing conventional coronary angiography.
RESULTS: 47 stents were examined 43 of them were assessable by DSCT-CA and the
calculated sensitivity, specificity, negative predictive value, positive predictive value and
overall accuracy of all assessable stents were 100%, 90%, 100%, 81% and 93%, respectively.
When analyzing the results for stents 2.75mm in diameters the results were less
encouraging, The calculated sensitivity, specificity, negative predictive value, positive
predictive value and overall accuracy of all assessable stents were 100%, 70%, 100%, 40%
and 75%, respectively.
CONCLUSION: With the high sensitivity and negative predictive value -reaching up to
100%- with dual source CT scanners, it could be used confidently to rule out in-stent re-
stenosis. However, due to the frequent false positive results, careful patient selection should
be done.
Stent implantation in human
restenosis has developed into a significant
coronary arteries, initiated in 1986 by
clinical problem (Hoffmann and Mintz
Sigwart et al. is intended to reduce
2000). In-stent restenosis is typically seen
coronary restenosis (Hoffmann and
3 to 6 months after the procedure (Dangas
Mintz 2000). The long term outcome of
and Kuepper 2002).
stent implantation is affected by a process
A noninvasive detection of ISR
called in stent restenosis (ISR) (Mitra and
would be of clinical importance in the
Agrawal 2006). Compared with balloon
treatment and follow-up of coronary artery
angioplasty alone, where the chance of
disease. The CTCA is less invasive and
restenosis is 40%, stents reduce the chance
less expensive than ICA, which reduces
of restenosis to 25% (Dangas and
physical, mental, and economical stress, as
Kuepper 2002). As a result, in-stent
well as potential complications, especially

Full Paper (vol.49 paper# 21)

d:\skydrive\Jor\vol49_22 The Egyptian Journal of Hospital Medicine (Oct. 2012) Vol., 49: 801­ 809

Eleven years experience with the use of Contegra®
Zeid Makahleh*, FRCS C-Th
*Queen Alia Heart Institute at King Hussein Medical Center, Amman, Jordan.

The implantation of the Bovine Jugular Vein (Contegra) in the repair of many congenital heart defects
(CHD) had gained a worldwide acceptance. We report our experience in using it over eleven years.
During the period from February 2000- December 2011, we implanted the Contegra in 268 patients
with different congenital heart defects at the position ventricle-Pulmonary artery (RV/LV-PA).
There were 178 males and 90 females in an age ranging between 2 months- 33 years mean of 5.6 yrs.
Echocardiography was performed postoperatively at 3days, 3months, 6months then every year
looking for pressure gradient (PG) across the valve, regurgitation and calcification.
The primary endpoints of operative mortality and morbidity and secondary endpoints of follow-up
haemodynamic performance including severe stenosis, regurgitation and need for reintervention are
The follow up of patients were 100% in 1 yr, 98% in 2 yrs; 82% in 3yrs and 57% in 4 yrs, 40% in
5yrs, 35% in 6 yrs, 20% continued to show up from year 7 to year 11.
The performance of the conduit was as follow: Unchanged pressure gradient (PG) or < 15 mmHg over
2yrs in 98%, PG 15 ­ 25 mmHg over 3yrs in 25%, PG 25 -35mmHg over 4yrs in 18%, PG 35 ­
45mmHg over 5yrs in 14%, and by the end of 11 yrs 10% of pts had PG >55 mmHg, and were
scheduled for redo surgery. The rest of the patients were having minor changes in the pressure
gradients over variable periods of follow up.
The younger the child at the time of implantation, the higher the chance to develop pressure gradient
over the conduit over years.
There were no conduit related adverse events, there were 32 deaths; 12 early deaths (4.5%), late 20
deaths, not related to conduit implantation.
Operative morbidity was 11.2%.
There were mild regurgitation at the valve in 32 cases (12%); moderate regurgitation in 9 cases
(3.4%) and severe regurgitation in 6 cases (2.2%) at variable periods of follow up, calcifications were
detected by X-ray and sonography in 37 cases (13.8%)
Reintervention by redo surgical procedure in 33 cases (12.3%)
The Contegra conduit is s a reliable extra-cardiac conduit for primary and redo- RVOT
reconstruction over eleven years of follow up.

Full Paper (vol.49 paper# 22)

d:\skydrive\Jor\vol49_23 The Egyptian Journal of Hospital Medicine (Oct. 2012) Vol., 49: 810­ 826

Hepatic DNA Damage and Abnormality in Serum Protein Pattern Due to Long
Term Use of Tramadol in Rats
Laila Abd El kawy
Narcotic Department, the National Center for Social and Criminological Research, Cairo, Egypt

Tramadol is a widely used analgesic that stimulates the opioid receptor and inhibits serotonin and
noradrenalin reuptake. In this study, we investigate the effect of chronic administration of 200 and 400mg of
tramal for 15,30 ,45 days followed by withdrawal periods(w15) on protein activity in male rats as manifested
by changes in electrophoretic serum protein patterns and gene expression manifested by DNA damage,
measured by Comet Assay .

Materials and methods:
100 male Wistar rats (100-150 g) were included and divided into three groups, control group (n = 20),
Tramal(I) group (n = 40), received the drug orally at doses of 200mg/kg/day for 15,30,45 days of the study,
respectively(10 rats for each subgroup).TR45 group was followed by 15 withdrawal period(W15)
,Tramal(II) group (n = 40), received the drug orally at doses of400mg/kg/day for 15,30,45 days of the study,
respectively. TR45 group was followed by 15 withdrawal period (W15).


Results exhibited major changes in the protein pattern which included changes in the molecular weight of the
control bands and the relative percentage of protein fraction as well as the total number of bands, as a result
of disappearance of some original bands and appearance of other new one. Serum protein fraction revealed
an increase in total number of protein fractions being in Tr200mg (14 and 16 bands), whileTR400mg
revealed a decrease in total number of bands (except TR15 which exhibited an increase in bands (14). The
changes were observed all over the treated groups as well as in the withdrawal groups In this study, the
alkaline version of the comet assay has been used to determine the effect of tramal administration (200 and
400mg/Kg) on peroxide-initiated free radical-mediated DNA damage in rat liver cells. Indeed, levels of
strand breaks in rat liver cell exposed to tramal400mg/Kg were significantly higher than in cells exposed to
200mg/Kg, especially after a long administration period (TR45 days). The intensity of the comet tail relative
to the head reflects the number of DNA breaks. The rates of tailed cells detected by the comet assay
increased significantly when the rats were exposed to 200 and 400mg/kg of tramal compared with control
(however, the tail length did not differ significantly between the same groups). The intensity of the comet tail
relative to the head reflects the number of DNA breaks.


Full Paper (vol.49 paper# 23)

d:\skydrive\Jor\vol49_24 The Egyptian Journal of Hospital Medicine (Oct. 2012) Vol., 49: 827­ 838

Haemostatic activation in acute coronary syndrome patients in relation to
physical exercise
Amany H. Mansour (1), Maha Ragab , (2 )Rokiah Anwer ,(3) Maha M. Abd El mohsen,(4) and
Mostafa M. Shaaban(5)
Department of Clinical Pathology(1), Departments of internal Medicine(2) ,(3), Faculty of Medicine,
Mansoura University and Department of Clinical Pathology AL-Azhar University (4) (5), Egypt.

Backgound: Thrombosis is regarded to be a key factor in the development of acute coronary syndromes
in patients with coronary artery disease (CAD), Platelets are known to play a fundamental role in acute
coronary syndromes(ACS). After atherosclerotic plaque rupture, platelets can form pathogenic, occlusive
thrombi leading to acute ischemic events. The precise mechanisms of platelet activation in acute coronary
syndromes are still under investigation. Physical activity could regulate the development of ACS via
effects on platelet function. Several studies have shown that acute physical exercise increases platelet
reactivity, typically assessed by aggregation assays, in both healthy individuals and in patients with
cardiovascular disease. The aim of this study was to investigated the effect of moderate and strenuous
exercise on arterial thrombus formation.

Subjects and Methods: Assay of some hemostatic marker as Platelet activation , thrombin generation
(TF(pg/ml),TAT_ µ g/l and dimerand tPA concentration ) von Willebrand factor,platelet aggregation
tests, Coronary Angiography. haemostatic parameters in patients with ACS correlated with other clinical
parameters under physical exercise .

Results: Patients with ACS showed higher values for fibrinogen , tPA , TAT_ , as indicators for a
thrombin synthesis, and a marker for prothrombotic conditions, was elevated in patients with ACS,. Von
Willebrand factor and D-dimer showed no statistical significant differences during rest., Exercise
increased hemostatic parameters in an strenuous physical exercise in ACS Patients( < 0.05). Exercise
also increased plasma levels of fibrinogen and von Willebrand factor ,but there was an increase in the
generation of T-AT complexes,. (P < 0.05). Exercise did not affect platelet aggregation regardless of its
intensity when triggered by the agonists ADP or collagen.

Conclusion: Strenuous but not moderate exercise increases the thrombotic tendency in healthy sedentary
male volunteers

Activation, acute coronary syndromes, adhesion, aggregation, ant platelet agents, platelet, thrombosis.

Full Paper (vol.49 paper# 24)

ž’ The Egyptian Journal of Hospital Medicine (Oct. 2012) Vol., 49: 839­ 856

Ecological studies on the diversity of terrestrial poisonous snakes
"Proteroglyphous" of Jazan region Kingdom of Saudi Arabia
(Reptilia: Ophidia)
Mostafa, F. Masood
Department of Zoology, Faculty of Science, Al-Azhar University (Assiut ­ Egypt)
Department of biology, Faculty of Science, Jazan University, Kingdom
Saudi Arabia
Email: m_f_masood@yahoo.com

The present work was carried out in Jazan region. The region of Jazan in being in the
South-Western part of Saudi Arabia between longitudes 420 and 43.80 and latitudes 5, 16o and
17o, and is bounded on the south and east of the Republic of Yemen, Asir area in the north and
the Red Sea in the west.
The results showed that there are four families of poisonous snakes "Proteroglyphous"
living in Jazan region. They are: Family Atractaspididae, Elapidae, Viperidae and
Hydrophiidae . This work aimed to unveil ecological problems and throw light on diversity of
poisonous snakes in Jazan region and the danger of these species to human life. Despite the fact
that these snakes may be harmful to human life in some cases, it may also be useful to him in
many aspects of life. Since there are no enough studies on the animal species in the region, this
study came to identify the diversity of this animal group. There is no doubt that the study of
these species and identifying them will provide some solutions that could make this group as an
endless source of biodiversity and at the same time, this study provides information on the
feasibility of protection of this species in this region. Discussion of ecological and geographical
affinities of this taxa and taxonomic keys of different types in order to facilitate the process of
identification will be provided.
Key words: Biodiversity, conservation, Reptilian, Serpents, Habitat, Ecology, Survey,
Feeding, behavior and Zoogeographical distribution.
*Permanent Address: Department of Zoology, Faculty of Science, Al Azhar University (Assiut-
Egypt) . Email: m_f_masood@yahoo.com

The Kingdom of Saudi Arabia is
studies have been undertaken on Saudi
mostly desert and its geographical location
Arabian snakes and lizards.
between the temperate and tropical climatic
Reptiles are considered a major part of
regions, together with the extreme
Jazan fauna and have an important
variations in its climatic conditions, make it
economic value in many ways. Reports on
unique in harboring many species of
the Jazan reptile, fauna are relatively few
reptiles. However, very few ecological

Full Paper (vol.49 paper# 25)

Effect of Cholesterol And /Or Methionine On The Testis Of Rats The Egyptian Journal of Hospital Medicine (2012) Vol., 49: 857-878

Effect of Cholesterol and /or Methionine on the Testis of Rats
Nehal Ali Moustafa Abu Elnaga
Zoology Department, Faculty of Science, Al-Azhar University

Aim of the work-Methionine is essential for maintaining proper growth and
development in mammals. Also, cholesterol enriched diets significantly increase cholesterol
level in body tissues. The present study aims to investigate the effects of dietary cholesterol
and /or methionine on the histological and some histochemical changes in the testis and
epididymis of the male rats. Material and methods- sixty adult male rats (5-7 weeks old)
were used in this study and divided into 6 groups. Group 1 served as the control group (C).
The following 5 treated groups administered the diets for four months. Group 2 treated with a
diet enriched with 2% cholesterol, group 3 received 0.5% methionine, group 4 received 2%
methionine, group 4 treated with 2% cholesterol and 0.5% methionine, group 5 received 2%
cholesterol and 2% methionine.Results- Testes isolated from rats fed excessive amount of
cholesterol showed disturbance in spermatogenesis and the epididymal structure with altered
total protein, polysaccharides and collagen fibers. Dietary low doses of methionine with or
without cholesterol improved spermatogenesis and architecture of the epididymis, but
addition of high dose of methionine caused many drastic changes in the testis and the
epididymis.Conclusion-Low dose of methionine (0.5%) showed ameliorative effect against
adverse effects of cholesterol ,but the high dose (2%) showed less protective effect.
Key words: Methionine, Cholestrol, Histopathology, Histochemistry.

Cholesterol and triglycerides are
development of the atherosclerotic plaque,
transported in the blood as lipoproteins.
characterized by reduced receptor-mediated
Plasma concentrations of cholesterol and
clearance, increased arterial wall retention
and increased susceptibility to peroxidation
triglyceride being a potential early indicator
(Holvoet, 2006). The author added that
for hyperlipidemia and lipid metabolic
cardiovascular risk factors such as
disorders, since they reflect the lipid
metabolism state in animals. The severity of
thrombosis contribute to the underlying
hyperlipidemia varied between genders and
mechanisms of atherosclerotic disease,
appeared to be positively correlative with
age (Hisao et al., 2007; Mori et al., 2009).
oxidative stress and pro-inflammatory
The atherosclerosis is a disease of large and
medium size muscular arteries: aorta and its
Lipoproteins are spherical structures
major branches, coronary arteries and
that consist of a hydrophobic core
arteries of the legs (Gamble, 2006).
containing lipids (i.e. triglycerides and/or
Elevated levels of LDL-cholesterol
cholesterol esters), and amphophilic (i.e.
particles have been implicated in the
both hydrophobic and hydrophilic) outer

Full Paper (vol.49 paper# 26)

Epilepsy cases: fMRI and MR tractography as qualitative and quantitative tools for proper localization and pre-operative planning The Egyptian Journal of Hospital Medicine (Oct. 2012) Vol., 49: 879­ 890

Epilepsy cases: fMRI and MR tractography as qualitative and quantitative
tools for proper localization and pre-operative planning.
Ahmed Abdelmoniem Gaber *,Azza M. Sarry El Din**,Eman A.Geneidi, *, Mohamed
KhMitkees, *,Wael Abdelhalim Reda, **and Yasser A Abbas **.
Departement of Biological Anthropology National Research Centre, Departements of
Radiodiagnosis , Neurology and Neurosurgery, Faculty of Medicine, Ain Shams University.
Introduction: Functional MRI is a relatively new noninvasive brain imaging technique that has
been used for neuroscience research applications since the early 1990s. This technique relies on
the blood oxygenation level dependent (BOLD) effect. Diffusion tensor magnetic resonance
imaging (DTI) is a noninvasive technique that can be used to assess the integrity of cerebral
Methods: We evaluated 16 patients with unilateral MTLE. We did MRI for language and
memory areas for localization and lateralization of the dominating cortical areas concerned with
language and memory. Diffusion-weighted images along twelve different directions with a b
value of 1000 s/mm2. A 1.5-T scanner was used to acquire those examinations. For DTI we
compared the mean diffusivity (MD) and fractional anisotropy (FA) from symmetrical voxels by
sampling the basal ganglia, thalamus, hippocampus and parahippocampus regions bilaterally. We
compared measurements with the EEG, high-resolution MR imaging, as well as clinical data. For
MR tractography, various tracts were traced including the Meyer's loop.
Results: Among the study group only 5 patients with partial epilepsy out of 16 are promising
candidates for surgery representing only 31.25 % among the study population 68.75% of our
study population were excluded according to our quantitative and qualitative tools.
Conclusion: Combined fMRI with MR tractography are valuable qualitative and quantitative
tools for proper localization and lateralization of the eloquent areas including memory, language
areas and Meyer's loop in the selection of promising epilepsy surgery candidates and for pre-
operative planning.
Brain surgery is an effective
include upper quadrant visual field defects,
treatment for individuals who suffer from
impairments on naming and other language
medically intractable epilepsy. One common
tasks, and declarative memory deficits. (
surgical procedure for epilepsy is anterior
Binder et al; 2008). Thus it has become
temporal lobectomy (ATL), which produces
part of presurgical work-up in potential
long-term cure rates of approximately 60­
patients to weigh the risk of memory decline
80%. Common complications of ATL
against the chance of seizure relief. The key

Full Paper (vol.49 paper# 27)

d:\skydrive\Jor\vol49_28 The Egyptian Journal of Hospital Medicine (Oct. 2012) Vol., 49: 891­ 895

Screening For Vitamin D Deficiency In Females In Madina Region; Saudi
Arabia. Vitamin D Deficiency In A Sunny Environment

Eman Nagib(1) , and Mahmoud A. Abulmagd(2)
1-Internal Medicine department-Ain Shams,2-Endocrinology department-Banha


Background And Objective
: Poor sunlight exposure leads to vitamin D deficiency even in the
sunniest places. So screening for vitamin D deficiency in outpatient clinics and inhospital setting in
King Fahad Hospital , Al Madina Al Monwara.
METHODS: Screening for vitamin D deficiency by assessment of serum 25(OH)D with
radioimmunoassay in 60 female patients aged 18 ­ 40 years. Serum calcium, phosphorous and alkaline
phosphatase were assessed, too.
Results: 6 female patients (10%) showed significant vitamin D deficiency with 25(OH) D < 20
ng/ml. However 54 female patients (90%) showed severe vitamin D deficiency with 25 (OH) D < 10
Conclusion: Vitamin D deficiency is very common in Saudia Arabia especially females due to poor
sunlight exposure. So being underrecognized and undertreated, vitamin D deficiency represents an
important health problem in MADINA REGION, KSA.
( Key words : Vitamin D , Sunlight exposure , Females )

Ultraviolet radiation produces 90% of
there is a plateau in suppression of PTH
vitamin D in human beings and only very
[Thacher,2011]. So concentrations of 25(OH)
small proportions can be produced through diet
D over approximately 30 ng/ml are generally
[The Lancet (Editorial), 2010]. Poor sunlight
considered sufficient. Those between 8 and 30
exposure leads to vitamin D deficiency as in
ng/ml are insufficient with increased fracture
elderly housebound and Asian women who
risk and decreased calcium absorption.
cover their bodies with clothes [Turner,2009] .
Concentrations less than 8 ng/ml may be
Vitamin D insufficiency although widely
associated with osteomalacia [Painter,2007].
prevalent is still under-recognized and
More recently studies have reported inverse
undertreated [Thacher,2011]. The diagnosis of
associations between levels of serum 25 (OH)
vitamin D deficiency is often missed as
D and the risk of wide range of diseases
symptoms develop slowly and are nonspecific
including cancer, vascular disease, infectious
[Barclay,2009]. A cutoff value of 30 ng/ml is
conditions, autoimmune diseases, osteoporosis,
sometimes used for vitamin D status, at which

Full Paper (vol.49 paper# 28)

EFFECT OF BOSWELLIA ON ALLOXAN-INDUCED DIBETES MELLETUS IN MALE ALBINO RATS The Egyptian Journal of Hospital Medicine (2012) Vol. 49; 896­ 910

Physiological Effect Of Peri winkle (C.roseus) On Diabetic Albino Rat
Eman G.E. Helal*, Samia M. Abd-Elwahab*, Atef M. moussa** and Anwaar A. Mohammad ***
Departments of Zoology ­Faculty of Science-Al-Azhar University*, Department of Physiology-
Faculty of Medicine-Al-Azhar University** and Department of Medical Science- Faculty of Dentis-
try Sinai University***

Back ground: Diabetes mellitus (DM) is a major health problem worldwide in recent time. Asia
and Africa are the most viable areas where the disease is feared to raise 2­3 folds. Many herbal
products have been recommended for the treatment of DM in ancient literature of Ayurveda in In-
dia and other worldwide.
Material and method: Thirty male adult albino rats were used to investigate the effect of
Catharanthus rosea (C.roseus) on diabetic rats. Rats were divided into three equal groups, control,
diabetic non treated and diabetic C.roseus treated groups. After thirty days of treatment all rats of
each group were sacrificed. The body weight of each rat was determined at the beginning and the
end of each period. Blood glucose, serum insulin, lipid and protein profiles, liver and kidney func-
tions, blood picture and liver glycogen were determined for each rat at the end of each period. Pan-
creatic samples were obtained and processed for microscopic and quantitative evaluation after
staining the prepared sections with heamatoxylin and eosin as well as special stain for demonstra-
tion of the different pancreatic cells in the islets of Langerhans.
Results: The obtained results showed that the diabetic rats were diagnosed by laboratory assess-
ment to body weight loss, hyperglycemia, and hypoinsulinemia, significant increase in liver and
kidney functions, lipid and protein profiles and decreased liver glycogen content. While, C.roseus
treatment led to a significant improvement in these parameters except liver function. Microscopical-
ly there was definite vaculation, degeneration, karyolysis and pyknosis of beta pancreatic cells in
the diabetic group, while other pancreatic cells were not affected (alpha and delta cells). The use of
C.roseus treatment of this study greatly improves such cellular changes.
Conclusion: It was recommended that the use of the water extract of C. roseus levies as a hypogly-
cemic agent may offer a new hope to the diabetics in future. It's well recommended to use variable
doses and different periods of treatment to evaluate the best dose and period.
Key words: Alloxan- Hypoglycemia- Diabetic- Pancreas.

The increasing worldwide incidence
of diabetes. Alloxan exerts its diabetogenic
of diabetes mellitus in adults constitutes a
actions when administered intravenous,
global public health burden. It is predicted
intraperitoneal or subcutaneous. The action of
that by 2030, India, China and the United
alloxan on the pancreas is preceded by its
States will have the largest number of people
rapid uptake by the insulin-secreting cells (-
with diabetes (Wild et al., 2004). Alloxan has
cells) (Heikkila et al., 1976), and also due to
been commonly utilized as an animal model

Full Paper (vol.49 paper# 29)

Ezz-Eldin E-Abdalla*, Zienab M. Gebaly**, Abd-Elghany A.Moustafa*, Ibrahim M.
Histology Department, Faculty of Medicine (Damietta)* &Histology Department,
Faculty of Medicine for girls (Cairo) ** Al-Azhar University

Sildenafil citrate (SC or Viagra) is an oral medication widely used to treat erectile dysfunction
and maintains a sufficient erection for satisfactory sexual performance. The side effects of
sildenafil citrate have been reported.
Aim of the work: The present study was designed to investigate the effect of sildenafil citrate
in the therapeutic dose in different regimes.
Materials and methods: This study included forty senile male albino rats divided into four
equal groups. Group (A) was used as a control group (did not receive any treatment). Group
(B) receive the therapeutic dose of Viagra (1.5 mg suspended in 1.5 ml distilled water) orally
using a gastric gavage as daily dose for one week. Group (C) received the therapeutic dose of
Viagra 3 times / week for two weeks. Group (D) received the therapeutic dose of Viagra each
week for 4 weeks. Half of the treated rats of the different groups were sacrificed, other half
were sacrificed after two weeks from the last dose as recovery groups (RB, RC and RD). The
testes were dissected and blocked in paraffin. Hematoxylin and Eosin (HX&E) and Periodic
acid Schiff stain (PAS) were applied and serum testosterone levels in the different groups
were evaluated.
Results: The present study showed that the therapeutic dose of sildenafil caused several
histological findings in the germinal epithelial of the rat testes including degeneration ,
detachment of the spermatogenic cells especially the primary spermatocytes with addition
thickening of the basement membranes of the seminiferous tubules and increased interstitial
Leydig cells. The serum testosterone of the treated rats showed increased level of testosterone
especially in group D. The recovery rats showed relative improvement of parameter toward
Conclusion: Sildenafil produce morphological and histological alterations in the testes.
Key words: Sildenafil, Testes, Senile Albino rats and Testosterone.
Sildenafil citrate (Viagra), have become
Sildenafil citrate is a water soluble citrate
one of the most prescribed and abused
salt that was firstly synthesized by Pfizer
pharmaceutical (Feldman et al., 1994).
in United Kingdom to treat hypertension

Full Paper (vol.49 paper# 30)

d:\skydrive\Jor\vol49_31 The Egyptian Journal of Hospital Medicine (2012) Vol. 49; 933­ 945

Effect of Sitagliptin "a Dipeptidyl Peptidase-4 (DPP-4) Inhibitor" on the Endocrine
Part of the Pancreas in Experimentally induced Diabetes in Adult Albino Rat; A
Light Microscopic and Biochemical Studies
Tamer M. M. Abu-Amara and Zeinab M.Gebaly
Al-Azhar University- Histology Departments (Boys-Girls)

Sitagliptin is highly selective dipeptidyl peptidase-4 (DPP-4) inhibitor that is considered as one of
the new oral therapies for management of type II diabetes. Because of the sitagliptin unknown
effects on the endocrine part of the pancreas, especially on the cellular levels, this study was done to
evaluate its effect on the endocrine part of the pancreas in experimentally-induced type II diabetic
in adult albino rats.
Material and Methods: The present study was carried out on 30 adult male albino rats which were
divided into; Group I (untreated control group), Group II (diabetic group), where type II
diabetes had been induced via alloxan intake) and group III (treated group), where 0.14 mg/100
mg B.W. sitagliptin was given orally per day for 3 weeks after induction of type-2 diabetes.
The specimens were prepared for light microscopic examination. In parallel, the related
biomedical parameters such as serum glucose and serum insulin levels had been estimated,
statistically analyzed and compared between the three groups.
Results: Sections of pancreas taken from diabetic rats showed morphological changes in islets of
Langerhans cells in the form of pyknotic nuclei, cytoplasmic vacuolation, poor differentiation and
abnormal shape and size of the cells. These morphological changes had been partially recovered in
diabetic rats treated with sitagliptin. Also, the hyperglycemia and hypoinsulinemia that was
detected in the control diabetic group had been nearly returned to normal after sitagliptin treatment.
Conclusion: Sitagliptin drug has improved islet functions on both morphological and biomedical
parameters in type II diabetic rats and can be taken into consideration as one of the new oral anti-
diabetic drugs on the human level that need to be more investigated.
Keywords: Sitagliptin, Type II Diabetes, Dipeptidyl Peptidase-4(DPP-4) inhibitors Albino rats,
Currently, there are various pharmaceutical
drugs for the management of type 2 diabetes.
sulfonylureas, and insulin are associated with
According to the UKPDS study, most of the
significant weight gain (UKPDS 1998). New
available oral therapies for diabetes fail with
therapies such as incretins may have an
time. This failure is probably due to the
effective role in reducing hemoglobin A1c
progressive decline in beta cell function
(HbA1c) through keeping beta cell
(UKPDS, 1998). On the other hand, most of
functioning and without causing weight gain.
these medications that are commonly used
Two groups are included in this class;

Full Paper (vol.49 paper# 31)

Serum 25 Hydroxy Vitamin D Levels and Adult Asthmatic Patients The Egyptian Journal of Hospital Medicine (2012) Vol. 49; 946­ 952

Serum 25 Hydroxy Vitamin D Levels In Adult Asthmatic Patients
Mostafa M. Shaaban*, Manal Hashem**
Clinical Pathology Department, Faculty of Medicine, Al-Azhar University* Internal Medicine
Department, Faculty of Medicine, Zagazig University**

Purpose: Patients with chronic lung disease as asthma appear to be at increased risk for vitamin D
deficiency for reasons that are not clear.
Methods: A cross sectional study including 75 asthmatic adults aged older than 18 years and 75 adults
healthy control aged older than 18 years (35 males and 40 females for both groups) assessing the
relationship between serum 25 hydroxy vitamin D levels and lung function.
Result: In our study only (1231%) of our asthmatic adults had sufficient vitamin D levels ( 30 ng/ml) ,
wherase (85%) of healthy control subjects expressed sufficient levels. Vitamin D deficiency (<20 ng/ml)
was observed in 59 (78.66%) asthmatic patients (17.28 ±2.4 ng/ml). Deficiency was not observed in
controls (33.67±6.3). In asthmatic patients Serum 25(OH) vitamin D was positively correlated with
forced expiratory volume in 1 second % ( FEV1 %) predicted &forced expiratory/forced vital capacity
ratio ( FEV1//FVC)(P=<0.05 for all). There was no significant association between serum vitamin D level
and eosinophil count.
Conclusion: Reduced vitamin D levels are highly prevalent in adult asthmatic patients and are associated
with impaired pulmonary functions.
A connection between vitamin D status &
decreased incidence of wheezing during
asthma has been reported.. Vitamin D deficiency
childhood. A decreased risk of doctor-diagnosed
has been blamed as one cause of increased
asthma or recurrent wheezing episodes at three
asthma prevalence in the last decades (Litonjua
years of age was noted in those whose mothers
and Weiss,2007) A recent clinical investigation
had higher vitamin D intake during prenatal
showed that high vitamin D levels associated a
period (Camargoet al.,2007). The underlying
better lung function, less airway higher
mechanisms ,that vitamin D modulates the
responsiveness & improved glucocorticoid
pathogenesis of asthma are not clear. Vitamin D
response (Sutherland et al.,2011).
may protect from developing respiratory
Vitamin D is a nutrient and hormone that can
infections that could serve as trigger for a
be obtained from a few natural foods (e.g. fatty
fish and fish liver oils) and for fortified foods
al.,2010).Interestingly, application of vitamin D
(e.g. Milk and cereal), and it can be generated
is potentially capable to overcome the poor
endogenously from sunlight exposure via
asthmatics by up regulation of IL-10 production
(Holick,2007). Increased maternal vitamin D
from CD4 + T cell (Xystrakis et al.,2006).
intake during pregnancy has been linked to a

Full Paper (vol.49 paper# 32)

d:\skydrive\Jor\vol49_33 The Egyptian Journal of Hospital Medicine (2012) Vol. 49; 953­ 959

Assessment of Serum Concentrations of Vitamin D in Young Male
Patients with Tuberculosis
Amani Ezz Al Arab*, Dina Abaza**, Azza Al Sebaye***
*Chest Disease,** Endocrinology Al Azhar University For Girls,***Clinical Pathology
Zagazig University

Tuberculosis is highly prevalent worldwide, accounting for nearly two million deaths annually. Vitamin
D influences the immune response to tuberculosis, and vitamin D deficiency has been associated with
increased tuberculosis risk in different populations (Bedoya and Ronnenberg, 2009).
The aim of this study has been to determine the possibility of an association between tuberculosis and
low serum vitamin D concentration in young male patientsand to monitor the changes in vitamin D levels
after TB treatment.
Material and Methods: Twenty five (25) Patients aged 20-40 with newly diagnosed TB were enrolled in
this study. They were divided into eleven (11) cases on first line TB treatment for 2-3 months and
fourteen (14) cases before starting TB treatment. Twenty five (25) age and sex matched healthy
volunteers were enrolled as controls. For all groups body mass index (BMI) was calculated. Also serum
calcium (Ca),25-hydroxyvitamin D (25-OHD) and 1-25-hydroxyvitamin D (1-25-OHD) levels were
measured and compared.
Results There was significant difference between groups as regard BMI, serum Ca, 25-OHD and1-25-
OHD (p<0.0001 for all groups). In the TB group both25-OHD and1-25-OHD were lower in patients who
were underTB treatment compared to patients who didn't received treatment (p<0.001).
Conclusion: Low serum vitamin D concentrations may be a consequence of TB disease. The possibility
that low serum 25-OHD and1-25-(OH)² D concentrations may predispose to tuberculosis infection
cannot, be excluded. Antituberculous treatment has been shown to reduce serum 25-OHD and1-25-
(OH)²vitD, which may increase the risk of vitamin D deficiency.
Tuberculosis remains a major public
Egyptian health problem after Schistsomiasis.
health problem worldwide. One-third of the
Both TB and pulmonary fungal infections are
chronic diseases of immune compromised hosts
Mycobacterium tuberculosis, (Bedoya and
(Meawed et al., 2012).
Ronnenberg ,2009). According to WHO reports,
Vitamin D deficiency has been
Tuberculosis (TB) is the second most common
suggested to be a risk factor for activation of

Full Paper (vol.49 paper# 33)

d:\skydrive\Jor\vol49_34 The Egyptian Journal of Hospital Medicine (2012) Vol. 49; 960­ 975

Evaluation of Serum Complement C3 and C4 Levels as biomarkers
for Systemic Lupus Erythromatosus
Fayez Muhammad Shaldoum*, Yousra Refaey Abdo Mohammed, Naglaa
Mohamed El Wakeel and Abeer Saad Gawish**
*Department of Zoology, Faculty of Science, University of El-Azhar, Cairo, Egypt
**Department of Radiology, Faculty of Dental Medicine, University of El-Azhar, Cairo, Egypt

: Systemic Lupus Erthematosis (SLE) is a chronic autoimmune disorder that
affects multiple organ systems and also affects the skin and oral mucosa, with the exact cause
is unknown. Many hypotheses try to explain the role of the complement C3, C4 in the
pathogenesis of SLE. The aim of this study is to determine levels of serum complement C3
and C4 in patient with SLE, so that we may explain its role in diagnosis and pathogenesis of
the disease.
Methods: Twenty patients were informed from outcome patients of Dermatology Unit in El-
Azhar University suffering from SLE. All the patients included in this study fulfilled 4 or
more of the American Rheumatism Association classification Criteria for SLE. Blood
samples from These 20 SLE patients (18 females and 2 males) aged from 20 to 45 years old
were collected. Complement C3 and C4 were measured using radial immunodiffusion plates
system technique. Clinical parameters such as Erythrocyte Sedimentation Rate (ESR), Total
Protein (TPR), Serum Creatinine and Antinuclear Antibody (ANA) of those patients were
considered in order to compare and explain the data obtained for the levels of C3 and C4. The
data were collected and statistically analyzed.
Results: Most of patients were female 90% and only 10% male. Of all patients, 60% have
low level of serum C4, 40% have normal level of serum C4, 25% have abnormal level of
serum C3, and 75% have normal level of serum C3.Statistical analysis of the data on the
correlation between C4, and disease activity revealed significant (P> 0.05) correlation,
however no significant correlation was found between C3 and disease activity. Analysis on
the correlation between C3 and C4 with TPR, S. creatinne, and ESR, showed no significant
correlation. No significant relationship was also found between C3 and C4.All patients have
had high TPR, S. creatinne and ESR. All patients have had positive ANA which is an
important marker of SLE as an auto immune disease.
Conclusions: Patients showed different degrees of oral and systemic manifestations, which
exacerbate and become acute with decreased level of complement C4 and instability of C3
level. Accordingly, the low level of C4 was associated with the development and exacerbation
of SLE. Increased C3 levels is solely due to activity through the alternative pathway in SLE
Key words: Complement, C3, C4, SLE,

Full Paper (vol.49 paper# 34)

ž’/H1 The Egyptian Journal of Hospital Medicine (2012) Vol. 49; 976­ 986




Wistar wistar
06 Mature Female Albino Rats
(Albino Rats
) (





266 6.0




11 1
7 4
0 2

.661 (
(p 6.
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) 6.
661( ) (




Full Paper (vol.49 paper# 35)

Light and Eltctran Micros copic charges of Hepato prative Effect of L The Egyptian Journal of Hospital Medicine (2012) Vol. 49; 987­ 1004

Role of Protective Effect of L-Carnitine against Acute Acetaminophen
Induced Hepatic Toxicity in Adult Albino Rats
(Light and electron microscopic study)
Zeinab M. Gebaly* and Gamal M. Aboul Hassan**
* Histology department, Faculty of Medicine (Girls branch),
** Anatomy department, Faculty of Medicine (Assiut Branch) Alazhar University

Background: Acetaminophen, a widely used analgesic and antipyretic is known to cause
hepatic injury in humans and experimental animals when administered in high doses. It was reported
that toxic effects of acetaminophen are due to oxidative reactions that take place during its
metabolism. L-carnitine is a cofactor in the transfer of long-chain fatty acid allowing to the beta-
oxidation of fatty acid in the mitochondria. It is a known antioxidant with protective effects against
lipid peroxidation. This study aimed to investigate the possible beneficial effect of L-carnitine as an
antioxidant agent against acetaminophen induced hepatic toxicity in rats.
Material and Methods: Four rat groups (N=7 in each group). Group I is the control, group II
received 500 mg/kg/ body weight of L-carnitine for 7 days by oral route, group III received 640/kg/
bw of acetaminophen by oral route, group IV acute acetaminophen group pretreated with L-carnitine
for 7 days by gastric tube gavage tube. The liver of all rats were removed for investigation using light
and electro microscopic studies.
Results: Acetaminophen caused massive centrilobular necrosis and massive degenerative
changes. The electron-microscopic study showed few mitochondria, increased fat droplets and scanty
smooth endoplasmic reticulum (SER), rough endoplasmic reticulum (RER).These changes were
reduced by L-carnitine pretreatment.
Conclusion: those results suggest that acetaminophen results damage in the liver as an acute
effect and L-carnitine ameliorated the adverse effects of acetaminophen via its antioxidant role.
Keyword: Acetaminophen, L-carnitine, Liver & Rat.

fatal cases of acute liver failure are reported
Liver diseases remain one of the serious health
annually in the United States alone (Lee, 2004)
problems. Hepatic dysfunction due to ingestion
and he added that acetaminophen toxicity is the
of hepatotoxin is increasing worldwide
leading cause of drug-induced acute liver
Acetaminophen (N-acetyl-P-aminophenol,
failure in the U.S and Europe.
(APAP), paracetamol) is one of the most
Acetaminophen, a commonly used
commonly consumed drugs available on the
analgesic and antipyretic drug causes fulminate
market, but unfortunately it is also the most
hepatic necrosis in human and experimental
frequent cause of drug ­ induced liver failure
animals when used in high doses. The
world wide (Larson et al., 2005). About 500

Full Paper (vol.49 paper# 36)

Effect of different levels of jojoba meal on the histopathological changes in same organs of Japanese quail The Egyptian Journal of Hospital Medicine (2012) Vol. 49; 1005­ 1025
Histopathological changes in some organs of Japanese quail after
different levels of jojoba meal

Abd El-Hakim ,N.F. 1, Abou-Khashaba, H.A.2 and El-Sayed S. Atia2
1. Anim. Prod. Depart., Faculty of Agric., Al-Azhar Univ.
2. Poult. Nutrit. Res. Depart., Animal Prod. Res. Instit., Agri. Res. Center, Giza, Egypt


Aim of the work-The present study was conducted to investigate the effect of different
jojoba meal as a replace of soybean protein and to detect the histopathological changes in some
organs of Japanese quail (one week old) for 5 weeks.

Material and methods-The present study included two experiments, the first aimed to
investigate the incorporation of treated jojoba meal seed (bentonite + autoclaving + fungus) in
Japanese quail diets as replacer to soybean meal protein and to detect the histopathological
changes in some organs of the Japanese quail .The treated jojoba meal was incorporated in the
experimental diets to replace 0 (control); 4 (T1); 8 (T2) and 12% (T3) of soybean meal protein.
The second experiment, dietary treatment included the control diet (The same control of
experiment I) and groups 2 (UT1), 3(UT2), 4 (UT3), 5 (UT4), which were supplied with untreated
jojoba meal at 0.0, 0.2, 0.4, 0.6 and 0.8% levels, respectively
Results- Observations of the present study showed that liver of T2 group revealed ruptured
endothelial lining of the central vein, and T3 group showed elongated walls of the bile ducts.
Ileum of T2 group showed highly thickened muscle layer and ileum of T3 group showed
distorted tissue. Kidney of T2 group showed congested inters tubular spaces and T3 group
showed normal convoluted tubules with congested and dilated blood vessels. Testis of T2 & T3
groups showed hypocellularity of cells of the spermatognic layers with absence of mature
sperms. Ovary of T3 group showed somewhat normal mature ovum with reduced internal
Results of experiment II showed that the liver tissue was normal.Ileum of birds of UT3
and UT4 groups showed somewhat normal appearance. Kidney of UT3 group showed that some
cells of the convoluted tubules were faintly stained with hemorrhagic areas. Testis of UT3 and
UT4 groups showed decreased Leydig cells with absence of mature sperms and increased
number of primary spermatocytes. Ovary of UT3 group showed reduced stroma, and those of
UT4 showed highly reduced storma in the cortex and medulla of the ovary with malformed
mature follicles and irregular membranes, but somewhat normal growing follicles.
Conclusion-It is clear that 4 %(At the level 1.55) of the treated jojoba meal and 0.4 % untreated
meal give the best results.
Keyword- Treated jojoba; untreated jojoba meal; Japanese quail; Histopathological changes.


Full Paper (vol.49 paper# 37)

d:\skydrive\Jor\vol49_38 The Egyptian Journal of Hospital Medicine (2012) Vol. 49; 1026 ­ 1034
Study of Serum Adiponectin level in Obese and Non-obese Asthmatic Patients
Magdy Mohammad Omar *, Ahmad Abdelsadek Mohammad *, Sahar M. Ali **
Chest Department - Faculty of Medicine Benha University (*),Microbiology and Immunology
department , Faculty of Medicine ,Menufiya University (**)

Background : Asthma is a worldwide problem, with an estimated 300 million affected
individuals. Although central (visceral) adipocytes are the most important source of adiponectin
(APN), there is a tendency for reduced serum adiponectin concentration among obese subjects
suggesting that decreased APN levels may contribute to the increased inflammatory state as in
Aim of the work: The aim of this work was to determine whether serum concentration of
adiponectin changed in asthmatic patients during acute attack and in remission or not.
Subjects and Methods: Fifty five subjects were included in this study from Chest department,
Benha university hospital .40 patients with bronchial asthma(20 obese and 20 nonobese) and 15
age related healthy subject(7 obese and 8 nonobese) as a control. All asthmatic patients and
control group were divided into non-obese and obese according to their body mass index(BMI)
Those with BMI < 25& >18.5 were considered non-obese, Those with BMI> 30 were considered
obese .Those with BMI . 25 and. 30 were considered overweight and were not included in this
study (NIH/NHLBI, 1998). All subjects were submitted to the following, Full history taking
,Complete physical examination(General & Local),Plain x-ray chest P-A & left lateral views
,Complete blood count , Erythrocyte sedimentation rate, Liver and kidney function tests, Fasting
and post prandial blood sugar, Ventilatory function tests , Venous blood samples were taken for
Adiponectin level measurement.
Results : Serum adiponectin(g/ml) in obese control subjects (3.25 ± 0.65 g/ml) was highly
significant lower than that in nonobese control subjects(10.51 ± 1.55g/ml), (P-value < 0.001).
Also serum adiponectin revealed highly significant decrease in obese asthmatics during attack
(1.58 ± 0.724 g /ml) than in obese asthmatics during remission (2.08 ± 0.74 g /ml) and that in
obese control subjects (3.25 ± 0.65 g /ml), (P-value < 0.001).Serum adiponectin(g/ml) was
significantly higher in nonobese asthmatics during remission (9.49 ± 2.49 g /ml) than in
nonobese asthmatics during attack (7.89 ± 2.7 g /ml) and both was lower than that in nonobese
control subjects , (p-value < 0.05 ).Serum adiponectin (g /ml) was highly significant lower in
obese asthmatics during attack (1.58 ±0.72 g/ml) than in obese asthmatics during remission(2.08
± 0.74 g /ml), (P-value < 0.001) and highly significant higher in nonobese asthmatics during

Full Paper (vol.49 paper# 38)