d:\skydrive\Jor\vol51_1 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51 , Page 179­ 189
Evaluation of the Biological Effects of Radiations on Pulmonary
functions of NMA Employees in the Black Sand Project at Rashid
and Abou-Khashaba Sites Year 2012
Nesriene Mohamad El Margoushy
Medical and Radiation Research Department, Nuclear Materials Authority

Almost all workers in the Black Sand Project at Rashid and Abou-Khashaba sites
of NMA (Nuclear Materials Authority) are obligatorily exposed to ionizing radiations during
their routine work. The most apparent harmful effects in Rasheed employees were reflected
easily on pulmonary function tests which may occur due to increase registered dust radio
activities than the accepted level for air concentration.
Objectives: This study was done mainly to evaluate the biological effects of ionizing radiations
on lung and pulmonary functions of workers in the Black Sand Project at Rashid and Abou-
Khashaba sites of NMA in the year 2012 and to start follow up of these workers
Measurements: This research was done on 30 male workers aging 25 - 56 years to measure
pulmonary function tests. Certain radiological measurements were also performed to assess the
levels of exposure to radiations
Results: Out of the 30 members; regarding the radiological measurements all levels measured
were within the reference range accepted internationally, except radioactive dust levels were
elevated mildly above the reference range accepted internationally this results in deterioration of
pulmonary function of some workers.
Conclusions: Generally, workers of the Black Sand Project at Rashid and Abou-Khashaba sites
were receiving a good radiological protection protocol. Radioactive dust levels were elevated
mildly above the reference range accepted internationally this result in pulmonary function
disorders in some workers.

The nuclear fuel cycle does not give rise to
exceeding 10 Gy was inevitably fatal; however,
significant radiation exposure for members of the
experience with nuclear accident victims suggests
public. Radiation protection standards assume that
that when patients survive gastrointestinal and
any dose of radiation, no matter how small,
bone marrow syndromes, respiratory failure
involves a possible risk to human health.
become the major cause of death. This effect is
Nuclear radiation arises from hundreds of different
known as a delayed effect of acute radiation
kinds of unstable atoms. While many exist in
exposure (4).
nature, the majority are created in nuclear
Pulmonary Function Testing (PFT) has been a
reactions. Ionizing radiation which can damage
major step forward in assessing the functional
living tissue is emitted as the unstable atoms
status of the lungs as it relates to how much air
(radionuclide) change (decay) spontaneously to
volume can be moved in and out of the lungs and
become different kinds of atoms (1).
how fast it moves, how stiff are the lungs and chest
Radiation to almost any organ can produce both
wall, the diffusion characteristics of the membrane
acute and chronic adverse effects. Sources of
through which the gas moves and how the lungs
exposure include industrial or medical radiation
respond to chest physical therapy procedures.
sources capable of producing high dose rates.
Pulmonary Function tests are used for different
Detrimental effects can occur due to radiation
reasons as: screening for the presence of
exposure, however they are dose dependent (2).
obstructive and restrictive diseases, evaluating the
On the lung, clinical and experimental data are
patient prior to surgery especially in old obese
used to describe the acute and late reactions of the
smoker patients with previous history of
lung to both external and internal radiation
pulmonary disease as vital capacity is an important
including pneumonitis, fibrosis and carcinogenesis
preoperative assessment tool. PFT is important
(3). In situations of accidental exposure, it was
also in evaluating the patient's condition for
initially assumed that a whole-body dose
weaning from a ventilator, documenting the


Full Paper (vol.51 paper# 1)

d:\skydrive\Jor\vol51_2 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51 , Page 190­ 199
Improving Health status of bronchial asthma patients in Nuclear
Materials Authority
Nesriene Mohamad El Margoushy
Medical and Radiation Research Department, Nuclear Materials Authority

Asthma is a common chronic inflammatory disease of the airways characterized by
variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms
include wheezing, coughing, chest tightness and shortness of breath. Asthma can result in variable
restriction in the physical, emotional, and social aspects of the patient's life.
out patient clinic in Nuclear materials Authority
This study was done mainly to Improve health status including symptoms and quality of
life in bronchial asthma patients in Nuclear Materials Authority
Method: The study was carried out on 51 subjects, they were chosen from those attendants of the out
patients clinic in Nuclear Materials Authority in el Katamya in the period from January to May 2012,
by measurement of lung function and bronchial hyperresponsiveness as supplemental tools in
evaluating the efficacy of treatment with inhaled corticosteroids (ICS) and other controller medications
in asthmatic employees.
Results: the asthmatic patients were 51 patients (36 males and 15 females), their ages ranged from 27-
59 (46.2±7.3) years, they were detected from those attendants of the out patient clinic in Nuclear
Materials Authority in El Katamya representing (2.1% ) of workers. 15 (29.4%) patients were smoker,
and 36 (70.6%) patients never smoked, 21 patients (41.2%) were exposed to radioactive materials in
their labs in the form of radioactive substances and 30 patients (58.8%) patients were not exposed.19
(37.3%) patients had intermittent asthma, 11 (21.6%) patients had mild persistent asthma 9 (17.6%)
patients had moderate persistent asthma and 12(23.5%) patients had sever persistent asthma.
11(21.6%) patient used long acting anti-inflammatory medications, 23 (45.1%) patients received other
controller medication in the form of short acting steroids as Clenil inhaler and ketotifen as zaditen
while the majority of patients received rescue medication 34(66.7%) in the form of short acting
bronchodilators and oral steroids.
Patient education, measurement of lung function and review of the treatment plan as
supplemental tools in evaluating the efficacy of treatment with inhaled corticosteroids and other
controller medications in asthmatic employees improve health status including symptoms and quality
of life in bronchial asthma patients in Nuclear Materials Authority.

Asthma is a common chronic inflammatory
investigation and doing pulmonary function to
disease of the airways characterized by variable
classify the degree of the disease whether mild,
and recurring symptoms, reversible airflow
moderate or sever and educating the patients
obstruction, and bronchospasm. Symptoms
about the triggering factors, type of treatment,
include wheezing, coughing, chest tightness
proper use of medication as regard timing, how
and shortness of breath. Asthma is clinically
to use and correcting misconceptions (3).
classified according to the frequency of
The severity of asthma is classified as
symptoms, forced expiratory volume in 1
second (FEV1), and peak expiratory flow rate
persistent or severe persistent (1) and (4).
(1), the disease is characterized by a variable
The most effective treatment for asthma is
degree of bronchial hyper responsiveness and
identifying triggers, such as cigarette smoke,
airway remodeling. Recent evidence indicates
pets, or aspirin, and eliminating exposure to
an important role of inflammation pathways,
them. If trigger avoidance is insufficient,
airways remodeling and epithelium activation
medical treatment is recommended. Treatment
in asthma genetics (2).
n i
s s
dul e
d a c
o r
ng t
o t
he type and
Improving health status of these patients
degree of asthma. Clinical classification of
require close monitoring and follow up by
severity of asthma is done according to
proper history taking, physical examination,
symptom frequency, night time symptoms,

Full Paper (vol.51 paper# 2)

d:\skydrive\Jor\vol51_3 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51 , Page 200­ 215

A Comparative Study Between Whole Body Magnetic Resonance
Imaging and Bone Scintgraphy In Detection of Bone Metastases In
Patients With Known Breast or Lung Cancer
Wafaa Raafat Ali Abdel Hamid;
Department of Radiodiagnosis, Ain Shams University


Purpose: The aim of this work is to compare the ability of whole body MRI including
diffusion study with that of 99m Tc-Methylene Diphosphonate Scintigraphy to detected
skeletal metastases in patients with breast and lung cancer.
Patients and methods: 60 patients comprising 38 females and 22 males ranging in age from
30 to 60 years with a mean age of 48.1 years (mean age 47.3 years for females and 49 years
for males) were enrolled in the study. 29 females are histopathologically proven cases of
breast malignancy, 9 females and the 22 males are histopathologically proven cases of lung
The patients were referred from Oncological departments to perform the whole body MR
study and bone scan at Ain Shams University hospitals MRI units and a private center during
the time interval from December 2008 till December 2012.
All patients were subjected to both whole body MRI and bone scintigraphy. The whole body
MRI was mainly obtained using 4 contiguous coronal stations for body coverage using the
body coil and 2 contiguous sagittal stations for the spine using T1W FSE and STIR
sequences. 48 out of 60 patients toke IV contrast and post contrast T1W imagaes with fat
suppression were taken. The MRI examinations were performed using a superconducting 1.5
Tesla magnet (Achieva: Philips Medical Systems).

Standard skeletal Scintigraphy was performed using a planar one phase technique (delayed
phase). The examination was done 2-3 hours after IV injection of technicium 99m labeled
Methylene Diphosphonate with a maximum dose of 20 mCi.

Results: 42 patients out of 60 were positive for metastases based on histopathological
verification or follow up. On MRI, 39 patients had metastases, 3 were false negative, 12 were
true negative and 6 were false positive. On bone scan, 35 were true positive, 7 were false
negative, 4 were false positive and 14 were true negative.
Based on lesion detection, on comparing bone scan to WB-MRI with and without diffusion,
bone scan had an overall sensitivity of 85.6%, specificity 67.5 %, PPV 61.7% and NPV
66.3%, while WB-MRI had statistical values of 73.4%, 68.8%, 78.1% and 62.6%
On adding DWI, values raised to 88.9%, 82.9%, 93% and 69% respectively.
Quantitative analysis of DWI was also included in this study revealing an overlap between the
Low ADC values of red marrow and metastasis at the range of 0.61 to 0.69 x10-3 mm2/sec and
then between metastasis and other benign pathological marrow entities at the range of 0.9 to
1.03 x 10-3 mm2/sec.
WB-MRI also detected 64 soft tissue metastatic lesions which became 71 lesions on adding
DWI with a distribution of hepatic, pulmonary, brain, adrenal, lymph nodes, pleural,
leptomeningeal and renal lesions.

Conclusion: we don't think that WB-MRI should replace bone scan in the quest for skeletal
metastases. However, we believe that WB-MRI should be the modality of choice when both
skeletal and soft tissue metastases are suspected and in the follow up of a known metastatic
patients for adequate coverage of both skeletal and soft tissue structures combined with
qualitative and quantitative features of DWI helping assess tumors at cellular levels even prior
to gross morphological changes verifying response to therapy as early as possible sparing
patients precious time from drifting with delayed decision making.


Full Paper (vol.51 paper# 3)

Introduction: The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51 , Page 216­ 225

Role of Dynamic Magnetic Resonance Imaging in Assessment of Female
Pelvic Floor Dysfunction
Aliaa S Sheha, MSc*, Ola M Nouh, MD*, Inas M Azab, MD*,
Mohamed A Nassef*, MD*, Ahmed M Ibrahim, MD**.
* Departments of Radiodiagnosis and ** Obstetrics and Gynecology, Faculty of Medicine,
Ain Shams University.


Pelvic floor weakening is a major health problem in older women, with an 11.1%
lifetime risk of women over 50 years old to undergo surgery for pelvic organ prolapse and urinary
incontinence. Clinical examination is the main method of diagnosis, yet imaging is essential especially
in patients with multicompartment defects. Pelvic Magnetic Resonance (MR) Imaging is expected to
play a role in the preoperative planning for complex cases due to its high soft tissue resolution, which
will help perform site-specific repair and so avoid recurrence.

Aim of the work: The aim of this work is to evaluate the role of Magnetic Resonance Imaging as a
non invasive method in the assessment of female pelvic floor dysfunction.

Methods: The studied group included 40 female patients complaining of pelvic organ prolapse and /
or stress urinary incontinence or fecal incontinence. All patients were subjected to full history taking,
clinical examination and Dynamic Magnetic resonance Imaging using 1.5 Tesla Philips MR Scanner.

Results: Good concordance was found between Dynamic MRI and clinical examination in all three
compartments. The concordance was 82.5% in the anterior compartment, 80% in the posterior
compartment, 85% in enteroceles and 65.0% in the middle compartment.

Conclusion: Dynamic MRI is a promising method that can be used as an imaging tool in the
preoperative planning of pelvic organ prolapse.

Weakening of the female pelvic floor is
the clinical and intraoperative findings related
a prevalent and debilitating disorder. It results
to pelvic floor prolapse. Pelvic MR imaging
in abnormal descent of the urinary bladder, the
should also help to document and advance
uterovaginal vault, and the rectum, resulting in
knowledge of surgical repair methodology (4).
urinary incontinence, fecal incontinence, and
pelvic organ prolapse (1). Eleven percent of
The aim of the work is to highlight the
women undergo surgery for pelvic organ
role of MRI as a non invasive method in the
prolapse and/or urinary incontinence during
assessment of pelvic floor dysfunction in
life time, and 30% of them undergo repeat
surgery (2).
Given the paucity of understanding of
This study was conducted over a period
pelvic floor dysfunction pathophysiology and
of 2 years and included 40 female patients,
the high rate of recurrence and repeat surgery,
complaining of stress urinary incontinence,
imaging, like dynamic magnetic resonance
fecal incontinence or pelvic organ prolapse.
(MR) plays a major role in its clinical
Patients of interest were recruited from the
management, especially for the preoperative
obstetrics and gynecology department in Ain
assessment of patients with multi-compartment
Shams University Maternity Hospital. We
defects and failed surgical repairs(3).
excluded patients with bad general condition,
those who had a contraindication for MRI, and
patients with detrusor instability.
weighted single-shot fast spin echo and high
After taking oral consent from all
soft tissue resolution standard T2-weighted fast
patients to undergo dynamic MRI of the pelvic
spin echo techniques has helped to identify soft
floor, these patients were subjected to full
tissue abnormalities that directly correlate with
clinical history, physical examination with

Full Paper (vol.51 paper# 4)

d:\skydrive\Jor\vol51_5 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51 , Page 226­ 239

Role Of CT Virtual Colonoscopy In Diagnosis Of Colo-Rectal Neoplasms
Eman AF Darwish , Mohammed Abu-el Huda Darwish, Hisham H Wagdy, Sahar M Al Gaafary
Radiodiagnosis department, Faculty of Medicine, Ain Shams University

to assess the role of CT colonography (virtual colonoscopy) as a non-invasive imaging
technique in detection and diagnosis of colorectal neoplasia using conventional colonoscopy and/or
operative findings as a reference standard, as well as highlighting its advantages and possible pitfalls.

Methods: sixty patients were examined by CT after standard bowel preparation, rectal insufflation and IV
contrast injection. Imaging was performed in both supine and prone positions. Evaluation consisted of
review of the transverse CT images, sagittal and coronal reformations and 3D endoluminal lmages. CT
colonographic findings were correlated with standard conventional colonoscopic and/or operative

Results: Virtual colonoscopy correctly identified all 6 carcinomas (100%), 12 out of the 13 polyps that
measured 10mm or more (92.3%), 19 of the 23 polyps that measured 6 - 9 mm (82.6%) and 28 out of 48
polyps that measured 5mm or less (58.3%). There were 11 false positive findings of polyps by virtual
colonoscopy and no false positive findings of cancer. Virtual colonoscopy also detected 35 incidental
extracolonic findings in 25 patients while non were detected by conventional colonoscopy. 17 of the 24
patients who had no lesions during conventional colonoscopy were considered free of lesions by CT
colonography yielding a per-patient specificity of 70.8%

Conclusion: CT colonography has high sensitivity for the detection of clinically important polyps and
cancer as well as multiple advantages over conventional colonoscopy in imaging of colorectal neoplasms.

Introduction and aim of work
Colorectal carcinoma is among the leading

causes of malignancy related deaths in the
Though colonoscopy is currently considered the
world. Because of the natural history of the
reference standard for the detection of colorectal
progression from colorectal polyp to carcinoma,
neoplasia it has various potential limitations.
with most frank colo-rectal cancers arising from
First, up to 10% of colonoscopic examinations
pre-existing polyps, early and prompt diagnosis
are technically difficult even for experienced
can have a significant effect on patient mortality
colonoscopists. In addition to poor bowel
(1). Not only will detection and removal of
preparation, an experienced colonoscopist may
precursor adenomas result in a decrease in the
be unable to complete the colonoscopy and
incidence of colorectal cancer, frank colo-rectal
intubate the cecal pole for a variety of reasons
neoplasia has a great potential for cure when
(redundant colon; colonic spasm; marked
detected at an early stage.
diverticulosis; obstructing masses or strictures;

and angulation or fixation of colonic loops, most
There is a continued search for method of early
commonly due to previous pelvic surgery).
detection of colorectal neoplasms that is cost-
Second, it does not allow evaluation of the liver
effective, safe, and acceptable to patients.
and other organs outside the colon. Third, it has
Current methods used to detect colorectal polyps
a blind area, as a colonoscope passes in only one
and colonic cancer include sigmoidoscopy,
direction. For example, the opposite side of a
colonoscopy, and double-contrast barium enema
colonic fold cannot be evaluated exactly.
examination. The effectiveness of each modality
Finally, it is invasive and uncomfortable (3).
remains controversial, and each method has
Therefore, in search for a rapid, less invasive,
inherent limitations (2).
accurate, and well-tolerated technique which can

Full Paper (vol.51 paper# 5)

d:\skydrive\Jor\vol51_6 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51 , Page 240­ 252
Epi- On versus Epi- Off Techniques of Corneal Collagen Cross Linking for
Treatment of Keratoconus
Mona El Sayed Ali Hassan
Al Azhar University, Faculty of Medicine for Girls


Aim of the Work:
The aim of this study is to evaluate and compare the epi-on versus the epi-off techniques
of corneal collagen cross linking as regards their safety and efficacy for treatment of mild to moderate degree

Design: Prospective, non randomized study.

Patients and Methods: Thirty eyes in 15 patients (9 males and 6 females) with bilateral mild to moderate
degree keratoconus were included in this study. Their mean age ± SD was 26.2 ± 3.9 years. Diagnosis of
keratoconus was based on clinical evaluation as well as pentacam examination. All patients were subjected to
corneal collagen cross linking. According to the technique used, eyes were classified into 2 groups:

Group I: Included 15 eyes in 15 patients, where cross linking was performed after removal of the corneal
epithelium (Epi-off).
Group II: included the other 15 eyes of the same patients, where cross linking was performed with intact
epithelium (Epi-on). Comparison between the two groups as regards visual outcome, keratometric readings,
least corneal thickness, refraction outcome and corneal haze was done.

Results: No intra operative complications were reported in our study. Re-epithelialization in eyes of group I
was reported within a week except three eyes were re- epithelialization was reported after 10,14and 21 days.
There was a statistically significance improvement in best corrected visual acuity in both groups (0.36 before
versus 0.60 six months after surgery) but the difference between both groups was not significant.
As regards refraction, there was reduction in spherical error 6 months after surgery in both groups (-6.14D
before,-5.22D 6 months after surgery) as well as cylindrical error (4.87D before 3.79 D 6 month after
Differences between both groups were statistically not significant.
There was increase in the least corneal thickness after surgery (448.6 microns before surgery versus 451.9
microns 6 months after surgery) but statistically the difference was not significant (P=0.75) and the difference
between both groups was also not significant.
Changes in keratometric readings were statistically not significant, and the difference between both groups
was also not significant.
Corneal haze was observed one month post operatively in four eyes in group one versus 3 eyes in group II.
Persistent haze at the end of follow up was reported in three eyes in group I versus two eyes in group II.
The incidence of haze as well as its density was higher in group I than group II with statistical significant

Conclusion: Both epi-on and epi-off techniques of corneal collagen cross linking are safe and effective in
stabilization or even improvement of mild to moderate degree keratoconus as regards best corrected visual
acuity, refraction, keratometric readings, and least corneal thickness. The epi-on technique is easier and more
tolerable by the patient with less postoperative corneal haze.

Key words
: Keratoconus- collagen cross linking- Epi-on, Epi-off - corneal haze.

Full Paper (vol.51 paper# 6)

d:\skydrive\Jor\vol51_7 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 253­ 263

Immunomodulatory Changes Induced By High Doses Of Dextromethorphan
In Male Rats
Hanan Mostafa Rabei
Narcotic Department, the National Centre for Social and Criminological Research, Cairo-Egypt


Dextromethorphan (DXM) is a synthetic opioid analogue, similar to codeine that has antitussive
effect but no opiate-like analgesic activity. It is widely used as an over-the-counter cough suppressant
available in various cough and cold preparations; it is one of the often overlooked types of substance
abuse by adolescents and young adults in the United States and around the world. So, the present study
aims to investigate the side effects of the DXM abuse (sub-chronic and lethal doses) on the immune
functions in rats.
Material and Methods:
The rats were divided into three equal groups, the first one served as control, and the second and
third were treated. Treated groups received oral doses of DXM which increasing per 10 days (double
dose) for a month.
We examined the sub-chronic and lethal effects of DXM administration on the cellular immune
responses in rats. T cell stimulator, Phytohemagglutinin showed a significant suppress on lymphocytes of
peripheral blood proliferation and a highly significant decrease on phagocytic and killing of S. aureus by
PMN and macrophage cells. Moreover, it induced a significant decrease in serum IL-6, and IFN- levels,
but, it exhibited a highly significant increase in serum IL-10 level throughout the period of experiment. In
addition, it induced also a significant decrease in the production of cortisol during the experimental time
except the last period of treatment in the 3rd group, where, serum cortisol level gradually return to normal
These results suggest that sub-chronic and lethal doses of DXM administration in rats disturbed
cellular immune responses, exhibited potent anti-inflammatory actions, suppressed of leukocytes
dependent production of cytokines such as IL-6 and IFN-. Moreover, it has some effects on serum
cortisol concentration presumably via blockade of NMDA receptors.
Key words: Dextromethorphan, IFN-, IL-10, IL-6, Phagocytosis, Lymphocytes transformation,
Cortisol, Albino rat.


Dextromethorphan (DXM) is an over-the-
However, it interacts at non-opioid sites
counter (OTC) cough suppressant commonly
and possesses other pharmacological activity.
found in cold medications (1). DXM is often
For example, DXM is both a substrate and an
abused in high doses by adolescents to generate
inhibitor of CYP450 2D6 (6). It is metabolized to
euphoria and visual and auditory hallucinations
an active metabolite dextrorphan, which, along
(1,2). DXM is an antitussive that has been
with DXM, antagonizes the N-methyl-D-
proposed to have potential utility in the
treatment of various neurological disorders (3).
phencyclidine (PCP) - like effects, inhibiting
Moreover, it has been suggested to be useful in
serotonin reuptake, competing for serotonergic
attenuating tolerance to opioids, reducing opioid
receptors, and eliciting adrenergic effects by
withdrawal and inhibiting the reinforcing
inhibiting peripheral and central catecholamine
properties of a variety of abused drugs (4). Aside
uptake (7). It is well known that the central
from its effects, DXM is essentially devoid of
nervous system and behavior can influence
other opioid-type effects (5).
immune function (8).

Full Paper (vol.51 paper# 7)

Ashraf M The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 264 ­ 274

Waleed S. Mohamed, 1 Ashraf M. Mostafa, 2 Abdel Hamid A. Serwah, 3
And Khaled M. Mohamed 4
Internal Medicine Department1, 3, Anatomy and Histology Department 2, College of Medicine, Taif
University, KSA; Pharmacognosy Department 4, College of Pharmacy, Taif University, KSA.
Author of Correspondence: Waleed S. Mohamed, Internal Medicine Department, College of Medicine, Taif University.E-mail:
wsmohamed1@yahoo.com Mobile: 00966/553420886

Background and aim of the study:
DM represents an important independent risk factor for the
development of and mortality from coronary heart disease (CHD), increasing the risk by 2 to 4 times.
According to WHO data, more than 75% of patients with DM die due to vascular accidents. This study
investigated the effects of some plants used in Saudi Arabia and some other Arab countries as antidiabetic
agents and explores its metabolic effects.
Material and Methods: One hundred fifty adult male Albino Rats were divided into six experimental
groups each consist of twenty five rats. The first group was considered as a control group. The rest of
groups were affected by induction of experimental diabetes by subcutaneous injection of Alloxan. The
second group consisted of diabetic rats without any treatment. The third group was treated by the aqueous
extract of mixture contains Foenugreek, Nigella sativa and Termis seeds. The fourth group was treated with
the aqueous extract of Nigella sativa seeds (100 mg / kg of body weight), while the fifth group was treated
with the aqueous extract of Foenugreek seeds (100 mg / kg of body weight). The sixth one was treated with
the aqueous extract of Termis seeds (100 mg/kg body weight). After four weeks of treatment, different
biochemical parameters were performed including estimation of blood sugar level and serum insulin level.
Pancreatic and liver 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 the Langerhans.
The usage of the mixture or each plant alone corrected the glucose level and insulin level.
Microscopically there was definite decrease in the number and diameter of beta pancreatic cells in the
diabetic group while the other pancreatic cells were not affected (alpha and delta cells). The use of
medicinal plants in the different groups of this study greatly improved such cellular changes and the level of
blood sugar level was corrected. Also, improve dyslipidemia present in diabetic rats. The results showed
that the activity of the mixture was better when compared with Nigella, Foenugreek or Termis seeds alone.
Conclusions: The water extract of the mixture is the most powerful in amelioration hyperglycemia and
most of all damage effects of Alloxan on hematological parameters and lipid profile. Also, it can control
most of the metabolic risk factors of CAD in diabetic rats. So it is advised to use the plant mixture as an
antidiabetic agent rather than the use of each plant separately. Repeating such study with the use of variable
doses may be helpful in better evaluation for the required dose.

Key words: Alloxan - Diabetes - Antidiabetic plants ­ Pancreas ­ coronary artery disease

Coronary heart disease (CHD) has been a global
from heart disease and stroke. Adults with
problem since long. It prevails in high class
diabetes are two to four times more likely to have
society to low class society and affects all ages
heart disease or suffer a stroke than people
specially the middle age group. It is the cause of
without diabetes. High blood glucose in adults
25-30 percent of deaths in most industrialized
with diabetes increases the risk for heart attack,
countries. (1)
stroke, angina, and coronary artery disease. (3)
Diabetes mellitus (DM) is possibly the world's
People with type 2 diabetes also have high
fastest growing metabolic disease. (2) CHD is a
rates of high blood pressure, lipid problems, and
major complication of diabetes and the leading
obesity, which contribute to their high rates of
cause of early death among people with diabetes.
CVD. Smoking doubles the risk of CVD in
About 65 percent of people with diabetes die
people with diabetes. (4)

Full Paper (vol.51 paper# 8)

CHAPTER II The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 275­ 284

Purification of The Antitumor Active Metabolite from Streptomyces xylophagus
Ha.Ph-7 Crude Extract Isolated from Hamam Pharaoh Hot Spring
Saad AM Moghannem1*, Kouka SE Abd-elwahab2, Hussein H Elsheikh3

Botany and Microbiology Department, Faculty of Science, Al_Azhar University,Cairo, Egypt.
2Virology Laboratory, Microbiology Department, Faculty of Medicine for Girls(FMG), Al_Azhar
University, Cairo, Egypt.
: This study aimed at production, extraction, purification and characterization of active antitumor
compound from marine actinomycete secondary metabolites crude extract that was selected as most
potent crude secondary metabolites from the preliminary screening of total fifty one extract.
Material and methods: These tumor cell lines were breast cancer (MCF-7) (ATCC HTB-22) and
Hepato-cellular carcinoma (HepG2) (ATCC 77400), colon cancer (Caco) (ATCC HTB-37) and
cervix carcinoma (HeLa) (ATCC CRL-13011) cells. Purification process was done using silica gel
column chromatography while purity was detected using thin layer chromatography (TLC). The
active fraction was detected using morphological changes (cytotoxicity) by microscopic examination
and anti-proliferative activity using MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium
bromide] assay.
Result: The result indicated that there is only one fraction responsible for antitumor activity. This
active fraction has cytotoxic and anti-proliferative activity against HepG2, MCF7, Caco and HELA
cells with IC50=24.5, 20.1, 27.6 and 17.7µg/ml respectively. The analysis of physico-chemical,
elemental and spectroscopic analysis (UV, IR, H.NMR, Mass spectroscopy) indicated that; the active
compound has the nature of anthracycline compound.
Conclusion: This purified compound has promising broad spectrum cytotoxicity and anti-
proliferative activity in an in vitro system. The next research step shall include different optimization
parameter that maximize productivity with long-term goal; discovery of an antitumor drug from
actinomycetes native to Egyptian hot springshabitat.
Key words: Actinomycete extracts, antitumor, Cytotoxicity, Anti-infectivity, HepG2, Caco, MCF7,
Email: saad_moghannem@yahoo.com

Actinobateria represents one of the largest
microorganisms [16-20], perhaps because of
taxonomic units among the 18 major lineages
currently recognized within the domain
Bacteria [1]. In addition, the isolation of
mammals[2,9]. Polyketides are a large family
marine actinomycetes has been a great source
of natural products produced by step-wise
of new compounds and their isolation all
decarboxylative Claisen type condensation of
around the globe, from shallow costal
acyl-CoA precursors, reactions catalyzed by
sediments to the deepest sediments from the
polyketide synthases (PKSs). Three types of
PKSs are known to date: type I PKSs are
actinomycetes are ubiquitous in marine
multifunctional enzymes organized into
sediments, but at lower numbers than in soil
modules, type II PKSs are multienzyme
[2-14]. Progress has been made recently on
complexes carrying out a single set of
drug discovery from actinomycetes by using
activities and type III PKSs, also known as
high-throughput screening and fermentation,
chalcone synthase-like PKSs, are iteratively
mining genomes for cryptic pathways, and
acting condensing enzymes [21]. In addition
combinatorial biosynthesis to generate new
anthracyclines represent a wide family of
secondary metabolites related to existing
compounds with indicator-like properties, red
pharmacophores [15]. Marine actinomycetes
in acid and blue-violet in alkaline solution,
have attracted great attention since they have
that are produced by cultivation of
developed unique metabolic and physiological
microorganisms belonging to the genus
capabilities that not only ensure survival in
Streptomyces [22] Anthracyclines are among
extreme habitats, but also offer the potential to
the most effective and widely prescribed
produce compounds with antitumor and other
anticancer agents [23]. Anthracycline has
interesting pharmacological activities that
three mechanisms of action: 1- Inhibits DNA
would not be observed in terrestrial
and RNA synthesis by intercalating between

Full Paper (vol.51 paper# 9)

d:\skydrive\Jor\vol51_10 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 285­ 288

Relationship between Peripheral Artery Disease and Cardiac
Function in Elderly Patients with Ischemic Heart Disease
Moatasem S Amer*, Heba M Tawfik*, Manar MA Maamoun*, Ayman M Abd
Elmoteleb #
*Geriatrics and Gerontology department, # Cardiovascular department; Faculty of Medicine,
Ain shams university, Cairo, Egypt


Background: There is high prevalence of combined peripheral and coronary artery disease
(CAD) related to atherosclerosis with associated increase in morbidity and mortality .
Objectives:The aim of our study was to find an association between ankle brachial index
(ABI) and cardiac function in elderly patients with CAD using ejection fraction (EF).
Method: A Case control study. The case group included 100 elderly patients who had
peripheral artery disease ( PAD) divided into 2 groups according to age ( 60- 70 and > 70
years). The control group included 100 elderly subjects who didn't have PAD which were
divided also into 2 groups according to age . Both groups have CAD and underwent coronary
angiography (CA) showing significant CAD lesions. Echocardiography were done to all
patients showing cardiac function. Results: EF was lowest in cases > 70 years (46.84 ± 9.82)
and was highest in controls > 70 years (53.02 ± 5.53) which is statistically significant (P-
Value 0.009).
Also EF is correlated with ABI.
There is a significant positive relationship between ABI and EF.

Keywords: Coronary artery disease ­ Peripheral artery disease ­ Ankle brachial index ­
Ejection Fraction ­ Elderly


Atherosclerosis is a disorder that
Patients with lower extremity PAD
comprises the development of focal
undergoing PCI for CAD have lower
atheromas, within the intima and inner
procedural success rates, higher in-
portion of the media. As the disorder
hospital cardiovascular complication
advances, the atheromas undergo a
rates, and higher longterm rates of MI,
variety of complications as calcification,
target vessel revascularization, and
internal hemorrhages, ulceration, and
mortality [4].
sometimes superimposed thrombosis
Studies have consistently shown that patients
with PAD have more severe CAD, often with
Studies found that in patients with
severe and multivessel involvement, than
PAD, the prevalence of CAD ranges
CAD patients without PAD [5].
from 20% to 60% when based on

medical history, physical examination,
and electocardiography (ECG) and up to
Study design:
90% in patients who have undergone CA
The study is a case control study
conducted to assess the relationship between
In about 99 % of cases, CAD is due
PAD using ABI and EF in elderly patients
with CAD
Atherosclerosis begins as early as the
Selection of Subjects
first or second decade of life and is a
Sample size:

200 male and female elderly patients
Manifestations of CAD are seen as early
60 years known to have ischemic heart
as the second or third decade of life, but
disease are divided into two groups:
as patients age, the severity of the
Case group:
disease increases [3].
100 cases with ABI < 0.9 further
subdivided according to age into:

Full Paper (vol.51 paper# 10)

The Egyptian Journal of Hospital Medicine (April 2013) Vol The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 289­ 299
Expression of Matrix Metalloproteinase 1(MMP1) in HepatoCellular
Carcinoma (HCC): Immunohistochemical and Biochemical Studies
Mohy Eldin abdel Fattah abdel Atty Yassen*, Olfat Ali Ibrahim Hammam** and Hazem Kamel
Abdel-Aziz Mohamed Sarhan***.
Chemistry Dept., Faculty of Science, Suez Canal University, Pathology Dept Theodor Bilharz Institute,
Academy of Scientific Research. Medical and Radiation Research Dept., Nuclear Material Authority.

The present study aimed to evaluate the expression of Matrix Metalloproteinase-1 (MMP1)
in HepatoCellular Carcinoma (HCC) by using the Immunohistochemical technique, which allows us to
integrate the biological aspects of this enzymatic expression in the morphological context of HCCs.

Material and Methods:
The study was performed on 70 subjects from out and in patients of Tropical
medicine Department, Thiodor Billhars Institute during the period from January 2011 until June 2012. The
present study included 60 patients with chronic hepatitis C who had undergone liver biopsy. They consisted
of 42 men and 28 women with ages ranging from 36 to 66 years. The diagnosis of chronic hepatitis C was
made on the basis of positivity for anti-HCV (by the second generation ELISA), and confirmed by HCV-
RNA reverse transcription polymerase chain reaction (RT-PCR). Patients were divided into four groups:
Group I: included 10 normal persons with no history of liver disease with normal liver enzymes and free
ultrasonographic finding as normal control. It included 6 males, 4 females, with ages ranging from 34 to 48
years. Group II: included 20 HCV infected patients without cirrhotic changes. It included 11 males, 9
females, with ages ranging from 39 to 53 years. Group III: included 20 HCV infected patients with liver
cirrhosis, 12 males, 8 females, with ages ranging from 48-63 years. Group IV: included 20 HCV infected
patients with HCC, 16 males, 4 females, with ages ranging from 53-64 years.

Blood Picture, (Hb, WBCs, RBCs, Plts, PC and ESR). Liver Function Test (ALT, AST, ALB,
GGT, ALP, T. BIL and D. BIL). Matrix Metalloprotenase 1(MMP1) Measurements: Serum MMP1.
Histopathological investigation Including histopathological changes in the liver tissue.

our results suggest that MMP-1 is overexpressed in a large proportion of patients with HCC
and the high expression level of protein correlated with the disease progression and poor clinical outcome in
HCC. Furthermore, MMP-1 high expression proved to be a risk factor for tumor recurrence and
independent molecular marker of prognosis in HCC and may become a novel target in the strategies for the
prediction of tumor progression and prognosis of this disease.

Key words: Patients, HCV, Cirrhosis, HCC, and MMP-1


Hepatocellular carcinoma (HCC) is the fifth most
Hepatocellular carcinoma (HCC) is a common
common cancer and sixth leading cause of death
form of cancer that arises from hepatocytes and
among cancers worldwide (1), and HCC is a
whose risk may be affected by several known
heterogeneous group in terms of biological
environmental factors, including hepatitis viruses,
behavior and molecular profiles (2). Recent
alcohol, cigarette smoking, and others. Rare
studies support that tumors may be initiated and
monogenic syndromes, such as alpha1-antitrypsin
maintained by a small population of cells that
deficiency, glycogen storage disease type I,
have stem-like features, and this highly
hemochromatosis, acute intermittent and cutanea
tumorigenic cell subset within the tumor bulk has
tarda porphyria, as well as hereditary tyrosinemia
been considered as cancer stem cell (3). Invasion
type I are associated with a high risk of HCC.
is a characteristic feature of HCC, it frequently
Several common conditions or diseases inherited
shows early invasion into blood vessels as well as
as polygenic traits e.g. autoimmune hepatitis,
type 2 diabetes, a family history of HCC,
extrahepatic metastasis.
hypothyroidism, and non-alcoholic steatohepatitis

also show an increased risk of HCC compared to
the general population. Hepatitis C infection

Full Paper (vol.51 paper# 11)

d:\skydrive\Jor\vol51_12 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 300­ 305

Role of 3-D Conventional Angiography In Evaluation of Intra Carnial
Ahmed M Bassiouny*, Maher M Arafa*, Sameh M Abdelwahab*,
Motaaz M Albeblawy *, Amr M Abdelsamad*.
*Department of Radio-diagnosis, Faculty of Medicine, Ain shams University

intracranial aneurysms are pathological enlargement of the brain arteries that are
most commonly located in the circle of Willis. Intracranial aneurysms are relatively common with a
prevalence of approximately 4%. The real danger of aneurysms is subarachnoid hemorrhage. 3D
digital subtraction angiography has become a critical imaging tool in neuroradiology allowing for
the visualization of detailed cerebral vasculature prior to any intervention.
Aim of the work: The aim of this work is to evaluate the diagnostic performance of 3D
conventional angiography in the evaluation of intracranial aneurysms compared with the
conventional cerebral angiography.
Methods: The studied group included 20 patients (5 men and 15 women) with subarachnoid
hemorrhage or known to have cerebral aneurysms. All patients were subjected to conventional
cerebral angiography and 3D cerebral angiography, using C-arm (Toshiba) rotational technique.
Results: 3D digital subtraction angiography is superior to conventional digital subtraction
angiography in 100% of the cases 3D imaging revealed the proper aneurysmal shape, size, precise
assessment of its neck and relation to the surrounding vessels.
Conclusion: Three-dimensional DSA improves the detection and delineation of intracranial
KEY WORDS: 3-D Conventional Angiography , Intra Carnial Aneurysms.

Intracranial aneurysms are pathological
patients with subarachnoid hemorrhage or
enlargement of brain arteries that are most
known to have cerebral aneurysms 5men, 15
commonly located in the circle of Willis (1).
women; age range 30­70years with cerebral
The incidence of subarachnoid hemorrhage
(SAH) due to rupture aneurysm is 10-
presentations, the most common one was
25:100,000 and is a devastating event
headache (18 cases) 15 after subarachnoid
associated with high morbidity and mortality
hemorrhage. Other complains include eye
from rebleeding and vasospasm (2).
pain and visual deficits (2 cases).Some of
3D digital subtraction angiography (3D DSA)
has demonstrated its clinical efficacy in
investigations including PT, PTT, INR and
precise depiction of the aneurysmal neck and
renal function tests.
its relationship to adjacent vessels. Moreover,
After taking consents from all patients or
it has been shown that 3D DSA reveals
their first degree relatives in unconscious
aneurysms not seen with conventional digital
and emergency cases, patients usually fast 4-
subtraction angiography (DSA) (3). These
8 hours before the procedure but are
features are important to consider when one
permitted to take any regular medications
decides surgical or endovascular treatment(4).
(particularly antihypertensive & antiplatelet
medications) orally with a little water.
Is to assess the diagnostic performance of 3D
Patients receiving long term anticoagulation
conventional angiography in the evaluation
should discontinue warfarin 6 hours prior to
of intracranial aneurysms compared with the
the procedure to decrease the risk of
conventional cerebral angiography
punctural hematoma. Similarly, patients with
preexistent renal disease are admitted on the
3D conventional cerebral angiography was
prior day for intravenous hydration.
performed over a period of 2 years on 20

Full Paper (vol.51 paper# 12)

d:\skydrive\Jor\vol51_13 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 306­ 316
Diagnostic Validity of Serum and Peritoneal TNF-alpha, high sensitivity
CRP and Plasma Cell-Free Nuclear DNA (ccf nDNA) as Biomarkers of
Pelvic Endometriosis- A Case Control Study
Ahmed F Koura, MSc*, Mohamed A Yehia, Waleed H ElTantawy, Adel S Salah El Din, Dina
El-Sayed ElShennawy
* Departments of Obstetrics & Gynecology and** Clinical Pathology, Faculty of Medicine, Ain
Shams University.
Endometriosis is a disease defined by the presence of endometrial glands and stroma
located outside the uterine cavity. These ectopic implants can be found throughout the pelvis, on and
within the ovaries, abutting the uterine ligaments, occupying the rectovaginal septum, invading the
intestinal serosa, and along the parietal peritoneum. Endometrial implantation at distant sites such as
the pleura, lung, within surgical scars, and along the diaphragm also has been reported. (1). It results
often in subfertility and pain, occurs mainly in women of reproductive age (16­50 years) and has a
progressive character in at least 50%, but the rate and risk factors for progression are unknown.
Endometriosis can be classified into four stages: minimal, mild, moderate and severe. The gold
standard for the diagnosis of endometriosis is laparoscopic inspection, ideally with histological
confirmation. (2), however, is an invasive technique and should be performed only after imaging
techniques prove insufficient for confident diagnosis. (3) Lack of a non-invasive diagnostic test
contributes to the long delay between onset of symptoms and diagnosis of endometriosis. (2) Additional
tools are needed for non-invasive classifications in order to reduce the number of unnecessary
laparoscopies without adversely affecting outcomes. Finding specific and more sensitive biomarkers
in endometriosis is critical, because endometriosis is usually diagnosed only in advanced stages, and
there is a high rate of morbidity for this disease. (4)
Aim of the work:
The aim of the current study is to assess the validity of serum and peritoneal high
sensitivity CRP and TNF-alpha and plasma cell-free nuclear DNA (ccf nDNA) as biomarkers in early
diagnosis of pelvic endometriosis.
Methods: This study was conducted at the Obstetrics & Gynecology department, Maternity Hospital,
Ain Shams University. This is a case control study of 120 women scheduled for diagnostic
laparoscopy. Laparoscopy was indicated in these women whether for various causes of subfertility or
for chronic pelvic pain between January 2011 and January 2012. The patients were divided into the
following groups: Group I (endometriosis group/ study group) consisted of 80 patients diagnosed to
have endometriosis during laparoscopy. Group I cases were subdivided into two subgroups, Group IA:
consisted of 34 cases with stage 1or minimal endometriosis and Group IB: consisted of 46 cases with
stage 2 or mild endometriosis. Group II (non-endometriosis group/Control group): consisted of 40
cases with no detected pelvic pathology. During the laparoscopy procedure, both peripheral venous
blood and peritoneal samples were withdrawn. Serum and peritoneal levels of high sensitivity CRP
and TNF-alpha as well as plasma levels of ccf nDNA were compared in both groups and in early
stages (minimal and mild) of endometriosis within the study group.
Results: Serum TNF-a, serum hs-CRP and plasma ccf DNA were significantly elevated in cases
compared with the control group. They were also elevated in patients with group IA and group IB as
compared to control group. However, there was no statistically significant difference between cases
and control group as regards peritoneal TNF-a and peritoneal hs-CRP. There was no significant
difference between the group IA and group IB as regards all biomarkers.
Conclusion: Our results showed that serum TNF-alpha , serum hs-CRP and plasma ccf DNA are
highly reliable biomarkers for screening and early diagnosis of endometriosis, but they can not be
used to discriminate between stage I and stage II. On the other hand, peritoneal TNF-a and peritoneal
hs-CRP are non reliable for early diagnosis of endometriosis and can not be used to discriminate
between stage I and stage II of endometriosis.

Endometriosis is a disease defined by
uterine ligaments, occupying the rectovaginal
the presence of endometrial glands and stroma
septum, invading the intestinal serosa, and
located outside the uterine cavity. These
along the parietal peritoneum. Endometrial
ectopic implants can be found throughout the
implantation at distant sites such as the pleura,
pelvis, on and within the ovaries, abutting the

Full Paper (vol.51 paper# 13)

d:\skydrive\Jor\vol51_14 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 317­ 325
Inass M. Taha *, Sahar M. Ali **, Ahmad Abdelsadek Mohammad ***, and Nany M.S. Nawar ****
*Internal Medicine Department, Faculty of Medicine, Taibah University, Saudi Arabia. **Microbiology and
Immunology Department, Faculty of Medicine, Menufiya University, Egypt. ***Chest Department, Faculty of
Medicine, Benha University, Egypt. ****Immunology Department, King Fahad Hospital (MSC biochemistery),
Saudi Arabia.


Bronchial asthma is characterized by lower respiratory tract inflammation associated
with bronchial hyper responsiveness with variable and reversible airflow obstruction. The majority of
asthmatics are sensitized to at least one common allergen.
Aim of the study:
The aim of this study is to determine the association of high-risk asthma with allergy-related
parameters (total serum IgE levels, serum levels of allergen- specific IgE, eosinophil count,
eosinophil percentage ) and pulmonary functions in children.
Subjects and methods: 50 Children aged 8-15 years diagnosed with atopic asthma were enrolled in
the study. Pulmonary function tests, total leukocyte count (TLC), eosinophil count, and eosinophil
percentage were estimated. Total serum immunoglobulin E (IgE) levels and serum IgE levels
specific to antigens from 1 to 9 allergens with class 1 or higher, namely, Dermatophagoides
pteronyssinus (D. pteronyssinus) , Dermatophagoides farina (D. farina ), cat dander , dog dander,
cockroach, egg white, milk, Aspergillus fumigatus, and fish, were measured using UniCAP
fluoroenzyme immunoassay (FEIA).

Results: This study includes 50 participants, 20 (40%) belonged to the high-risk and 30 (60%) to the
low-risk groups. This study revealed no significant association in peak expiratory flow rate (PEFR,
) values between high-risk and low-risk asthma groups (p 0.05). There was no significant
association in forced expiratory volume in first second [ FEV1 (L)] values between high-risk
and low-risk asthma groups ( p 0.05), whereas there was significant association in FEF 25-75%
(forced expiratory flow 25-75%) values between high-risk and low-risk asthma groups ( p 0.05).
There was a significant association between total serum IgE level and high-risk asthma, but TLC,
eosinophil count, and eosinophil percentage showed non significant association with high-risk
asthma. Serum levels of IgE specific to D. pteronyssinus, D. farina, cat dander, and dog dander were
significantly associated with high-risk asthma. The high-risk group had higher serum levels of IgE
specific to D. pteronyssinus ( p < 0.0001), D. farina ( p < 0.0001), cat dander ( p < 0.0001), and dog
dander antigens ( p < 0.0001) compared with those in the low-risk group. There was no significant
association between high-risk asthma and the serum levels of IgE specific to antigens from other
allergens (including cockroach, egg white, and milk). Serum levels of IgE specific to Aspergillus
fumigatus and fish were both negative (class level < 1) in both the high-risk group and the low-risk

Children with higher serum levels of IgE specific to D.pteronyssinus, D. farina, cat dander and dog
dander antigens, and total serum IgE levels, and lower FEF25-75% values belong to the high-risk
asthma group. The characterization of risk factors has enabled us to identify high-risk asthma in
children , leading to better treatment options.


Full Paper (vol.51 paper# 14)

d:\skydrive\Jor\vol51_15 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 326­ 331

Association of A Novel Adipokine With Insulin Resistance And
Disease Severity in HCV Infected Patients
Wafaa Gh. Shousha 1,*, OM Kolsoum El-Haddad2, Ashraf A. Basuni3, Hatem A. El-
Mezayen1, Amany A. Abdalla1
1Chemistry Department, Helwan University, Egypt
2Clinical Hepatology Department, Menofiya University, Egypt
3Clinical Biochemistry Deparment, Menofiya University, Egypt
Corresponding author: Wafaa Gh. Shousha; Chemistry Deparment, Helwan University, Egypt
Email: hatem_mezayen@yahoo.com . Mobile: 002 01227112178

Retinol-binding protein 4 (RBP4) has been identified as a protein contributing to insulin
resistance (IR). As insulin resistance is present in nearly all patients with liver cirrhosis, we
evaluated RBP4 in patients with chronic hepatitis C virus infected patients (CHC). This study
aimed to evaluate the role of serum retinol binding protein 4 (RBP-4) as a predictor for early
detection of insulin resistance (IR) in patients with CHC infection.
Research Design and Methods: Serum RBP4 was measured in 60 non diabetic CHC
Patients classified according to Child- Pugh classification (Child A, Child B, Child C), 20
diabetic CHC patients and 20 age- and sex-matched healthy blood donors served as control
subjects. RBP-4 correlation with the homeostasis model assessment of insulin resistance
index (HOMA-IR) and metabolic factors was investigated.
Results: Serum RBP-4 levels were significantly lower in HCV infected patients and HCV
diabetic patients compared with controls (HCV 16545.17± 10633.16, Diabetic HCV 10310 ±
4371.31, Control 27820.0 ± 9316.46, P< 0.001). In addition, serum levels of RBP-4
significantly decreased between all stages of cirrhosis, with the lowest level in Child C.
HOMA-IR not significantly higher in HCV infected patients compared to control (HCV 5.54
± 3.67, and Control 4.11 ± 2.42). RBP-4 levels correlate positively with GGT (P<0.01),
CHOL (P<0.05) and TG (P<0.05) in HCV Child C, additionally, it shows significant positive
correlation with TG (P< 0.05) in HCV Child B.
Conclusions: Disease severity may limit the role of RBP4 as a predictor of IR in CHC. These
data demonstrate that RBP4 in CHC patients decreased due to reduced hepatic production,
and it is not associated with insulin resistance.
Keywords: HCV, RBP4, Insulin Resistance
Abbreviations: RBP4: Retinol-binding protein 4, IR: insulin resistance, HOMA-IR:
homeostasis model assessment of insulin resistance index, CHC: Chronic Hepatitis C Virus.

Chronic Hepatitis C Virus (HCV)
of HCV RNA in pancreatic cells which
infection is associated with a wide
has a direct cytopathic effect at the islet-
spectrum of liver histological lesions,
cell level, accompanied by morphological
ranging from mild chronic hepatitis to
changes and functional defects in insulin
cirrhosis and hepatocellular carcinoma.
secretion(12). Therefore, HCV infection is
The highest HCV prevalence in the world
able to trigger autoimmune mechanism(s)
occurs in Egypt at an estimated 12%
against the insulin producing pancreatic
among the general population (13). HCV
beta cells leading to diabetes (10).
infection is recognized as a systemic
disease involving oxidative stress, insulin
(RBP4) has been identified as a novel
resistance, steatosis, fibrosis, apoptosis,
adipokine that mainly secreted by
altered gene expression and hepatocellular
hepatocytes (80%), but also by adipose
tissue (20%). Several mechanisms link
RBP4 to insulin resistance and type 2
metabolism with hyperinsulinemia and
diabetes. It was reported that serum RBP4
insulin resistance. One explanation to the
correlated positively with the presence of
higher prevalence of DM is the presence
insulin resistance in individuals with

Full Paper (vol.51 paper# 15)

d:\skydrive\Jor\vol51_16 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 332­ 345

Structural Adaptations Associated with Osmotic Stress of The Salt
Gland in Birds
Zeinab M. El- Gohary, Fawkeia I. El-Sayad, Hanaa A. Hassan and Aya M. Hamoda
Zoology Dept., Faculty of Science, Mansoura University, Egypt

When the drinking water of many species of ducks is changed from
freshwater to saline, their salt glands hypertrophy and the principal cells showed numerous
lateral cell evaginations and abundant mitochondria, enhancing their capacity to excrete salt.
Aim of the work:The purpose of this investigation was to demonstrate and evaluate the
anatomical, histological, and ultrastructural adaptations of the salt gland of the domestic
female ducks associated with high salt osmotic stress.
Material and methods:
The present study was carried out on two groups of female domestic ducks and one group of
wild ducks. Where as one group of domestic ducks was exposed to osmotic stress; imposed
by replacing drinking tap water with 1% sodium chloride solution for two consecutive weeks.
Morphometric measurements as well as histological and ultrastructural aspects of the salt
glands were considered.
Results: The investigation revealed that the weight and size of the salt glands of the salt-
stressed ducks were markedly heavier and larger in comparison to those of the control and
wild ducks. The number and the diameter of secretory lobules as well as the length of
secretory tubules of the salt-stressed group were greater compared to the control ones.The
degree of the proliferation and differentiation of the peripheral cells was distinctly greater for
the salt-stressed than the control and wild ducks. The basal and lateral surfaces of the fully
specialized secretory cell type in the salt-stressed and wild birds were obviously amplified
and in many cases the folds of adjacent cells meshed with one another forming an elaborate
complex of extracellular spaces and intracellular compartments. The cytoplasm of the fully
specialized principal cells displayed abundant endoplasmic reticulum, numerous well
developed mitochondria and deeply well developed basal foldings which increase the
absorptive surface.
Conclusion: The recorded peculiar features of the salt glands of the salt-stressed birds
may be presented as an adaptive features to satisfy its special demands to eliminate the
remarkable increased levels of sodium chloride load effectively.
Key words: Histology, Supraorbital salt gland, Adaptations, Osmotic stress, Ultrastructure

Active nasal salt glands have been
secretory tubules radiating from central
canals. These, in turn, form secondary and
primary ducts running toward the nasal
Anseriformes, Phoenicopteriformes), in
cavity and discharging the hypertonic fluid
which post-renal transport mechanisms are
through the nares (6). There are no evident
used to conserve urinary water and to
differences in tubule length or in types and
recycle excess NaCl to the nasal salt
distribution of secretory cells within the
glands (1,2). The salt glands are not
medial and lateral segments even though
restricted to birds that live in saline or
they have different embryonic origins (7).
maritime habitats, but are also present in
Since the avian salt gland provides an
some terrestrial avian species (3,4).
extra-renal pathway for the maintaince of
A typical salt gland is a bilateral paired
homeostasis because bird kidneys are
crescent-shaped organ, composed of
generally incapable of excreting all
separate medial and lateral segments (5).
electrolytes (8), many species of ducks be
Each segment consists of several
able to switch seasonally between

Full Paper (vol.51 paper# 16)

d:\skydrive\Jor\vol51_17 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 346­ 360

The Functional Alterations of The Avian Salt Gland Subsequent to
Osmotic Stress
Zeinab M. El­Gohary, Fawkeia I. El-Sayad, Hanaa Ali Hassan and Aya Mohammed
Magdy Hamoda
Zoology Dept., Faculty of Science, Mansoura University, Egypt

Many terrestrial non-marine birds have functional salt glands. Their salt glands
are usually quiescent. However, such glands show remarkable levels of phenotypic plasticity
both morphological and physiological as a consequence of drinking saline water.
: The current investigation was conducted to reveal in more detail the different
functional alterations of the duck`s salt glands subsequent to high salt osmotic stress.
Material and methods: The selected avian species were the domestic female (Anas
) and the wild migratory (Anas clypeata ) ducks. Two groups of domestic and
one group of wild ducks were considered in the present study , each of which included nine
adult ducks. The high salt osmotic stress was induced by replacing drinking tap water of the
domestic ducks with 1% sodium chloride solution for two consecutive weeks. The measured
parameters were included some electrolytes in both serum and glandular tissue. Also, Na-K-
ATPase activity and aldosterone concentrations were considered.
Results: The present study elucidated that serum sodium, potassium, chloride and uric acid of
the wild migratory ducks were markedly higher than those of both salt-stressed and control
ducks. In addition, serum aldosterone concentration of the wild migratory ducks was
distinctly higher in comparison with those of the control and the salt-stressed ones.
Moreover, salt gland tissue homogenate electrolyte contents followed the same pattern as
those of serum electrolyte concentrations. In contrast, the activity of Na-K-ATPase of the
salt gland homogenates was higher in the salt-stressed ducks in comparison to both wild
migratory and control groups.
Conclusion: From the above mentioned results, it was concluded that the peculiar functional
status of the salt gland of the experimentally salt-stressed ducks comparing to the control
may be presented as an adaptive features to satisfy its special demands to eliminate the
remarkable increased levels of sodium chloride load effectively.
Key words: Ducks, Salt gland, Osmotic stress, Electrolytes, Na-K-ATPase

The osmotic regulation in vertebrates is
Because salt gland provides an elegant
largely the result of controlled movements
model of the mechanisms involved in
of water and solutes across epithelial
active transport of sodium and chloride,
membranes. In mammals, the kidneys play
the physiological efficiency of the gland
the critical role in this process. On the
has been exclusively investigated ( 4,5,6).
other hand, in birds the kidneys, intestine,
The salt gland removes sodium chloride
and in some species, the supraorbital salt
from the blood far more efficiently than
glands all play important roles in
does the avian kidney and excretes it as
osmoregulation. Although the presence of
brine through a duct into the nasal cavity
the supraorbital salt gland in marine birds
and is eliminated in liquid form through
has long been known to ornithologists,
the nostrils, often accompanied by
however, its excretory function was not
vigorous shaking of the bird's head or
discovered until 1957-1958 when Knut
forced "sneezing"(7). The concentration of
Schmidt-Nielsen and co-workers found
the secreted fluid is always high, several
that these glands in the herring gulls
times as high as the maximum urine
(Larus argentatus) excreted sodium
concentration in birds (8).
chloride (NaCl) in concentrated solution
All marine birds have salt glands that,
(1). Such glands enable marine birds to
together with the kidneys, maintain body
drink brackish or full seawater, secrete salt
fluid homeostasis, despite the excess
and conserve osmotically free water (2,3).
sodium chloride (NaCl) they ingest. They

Full Paper (vol.51 paper# 17)

d:\skydrive\Jor\vol51_18 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 361­ 366

Pulmonary Functions After Injection Sclerotherapy Of Esophageal
Varices & After Band Ligation
Mohamed A. Metwally*, Ahmad Abdelsadek Mohammad,**Galal A. Moawad,*.
Hepatology, Gastroenterologytious Diseases Department -Benha University (*), Chest
Department -Benha University (** )

Aim of the study:
To study changes in pulmonary function tests after esophageal variceal
injection sclerotherapy in comparison to changes after esophageal variceal band ligation.
Patients & methods:
This study was designed as non randomized controlled study. Thirty patients with hepatic
cirrhosis & portal hypertension who were admitted to Hepatology, Gastroenterology and
Infectious Diseases department , Benha university hospital for elective esophageal variceal
therapy (secondary prophylaxis) were classified into group I:15 patients treated with
sclerotherapy by using 5-15 ml ethanolamine oleate and group II:15 patients treated with band
ligation. Patients were subjected for full clinical evaluation including history, general, chest, and
abdominal examination. Laboratory and radiological investigation including complete blood
count, liver function tests, kidney function tests and blood sugar and plain chest x-ray (P.A. and
lateral views) were done. Pulmonary function tests and arterial blood gasses were done before,
one day after and one week after the procedure.
The results revealed , significant decrease in vital capacity in group I one day after injection ( p
0.05),but no significant decrease in vital capacity in group II. There was a significant decrease
in PaO2 in group I one day after injection sclerotherapy ( p 0.05) but no significant changes in
group II and no significant changes in PaCO2 in both groups one day after the procedures. The
study has also revealed no significant changes in FVC,FEV1/FVC and PaCO2 in group I and
group II after procedures. The study revealed significant linear correlation between the decreases
in PaO2 and the percentage decrease in vital capacity( p 0.05). One week after procedure,
pulmonary functions that has been affected in group I returned back to baseline values.
esophageal injection sclerotherapy produces restrictive defect (decrease in PaO2
and vital capacity) in pulmonary functions one day after injection and improved within one
week, while there was no effect for band ligation on pulmonary functions tests.
Key words: esophageal varices, sclerotherapy, band ligation, pulmonary functions test.


Endoscopic therapies for varices
extremely dilated sub-mucosal veins in the
aim to reduce variceal wall tension by
lower third of the esophagus[1]. They are
obliteration of the varix. The two principal
most often a consequence of portal
methods available for esophageal varices
hypertension, commonly due to cirrhosis
and one of the common causes of upper
sclerotherapy (EST) and endoscopic band
gastrointestinal bleeding. Diagnosis of
ligation (EBL). Endoscopic therapy is a
variceal bleeding or risk of bleeding is done
local treatment that has no effect on the
by upper gastrointestinal endoscopy [2].
pathophysiological mechanisms that lead to
Variceal bleeding is a major complication of
portal hypertension and variceal rupture.
portal hypertension and represents a leading
However, a spontaneous decrease in hepatic
cause of death in patients with cirrhosis.
venous pressure gradient occurs in around
Diagnostic and therapeutic developments
30% of patients treated with either EST or
have led to a significant improvement in the
EBL to prevent variceal rebleeding [4].
prognosis of variceal bleeding [3].
The complications of injection
reviewed [5].They can be divided broadly

Full Paper (vol.51 paper# 18)

ASSESSMENT OF GROWTH AND OXIDIZED HIGH-DENSITY LIPOPROTEIN LEVEL IN CHILDREN ON The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 367­ 375

Assessment of Growth and Oxidized High-Density Lipoprotien Level
in Children on Regular Hemodialysis
Soheir Bahgat Fayed*, Manal Abd EL-Salam*, Iman Mouhamed El-Bagoury**,
Rabab Moussa*
Pediatric department*, Clinical Pathology Department**, Faculty of Medicine (for girls)
Al-Azhar University, Cairo, Egypt

Background: The cause of growth failure in chronic kidney disease (CKD) is multi-factorial
with linear impairment being a final common pathway of various factors including
malnutrition, increased catabolism, loss of nutrients and antioxidants, and aggressive dietary
restrictions during dialysis .Anemia, metabolic acidosis and persistent micro inflammations
are also causative factors.
Objectives: To assess growth in children with CKD on regular hemodialysis and measure
oxidized high density lipoprotein (OX-HDL), highly sensitive C-reactive protein (hsCRP) and
to discuss their roles as a risk factors of malnutrition among studied cases.
Patients and Methods: The study included 25 children with end stage renal disease (ESRD)
on regular hemodialysis more than 6 months. Their ages ranged from 5-15 years with a mean
of 10.76 years, also 25 of apparently healthy, age and sex matched were included. The study
sample was selected from pediatric dialysis unit and outpatients clinic, of AL-Zahraa
University hospital .Anthropometric measurements were assessed with determination of OX-
HDL and hsCRP serum levels in both cases and the controls.
Results: Anthropometry showed significant decrease in weight, height, body mass index, mid
arm circumference and triceps skin fold thickness in patients when compared to the controls.
100% of patients had high level of OX-HDL and hsCRP, and positive correlation between
OX-HDL and Z-score for Wt and Ht were detected.
Conclusion: Malnutrition, and growth delay are common in children with chronic kidney
disease on regular hemodialysis. High rate of inflammation in dialysis children as there were
high level of hsCRP and OX-HDL. HDL, in regular hemodialysis children loses its protective
function as an anti-oxidant, anti-inflammatory and becomes pro-inflammatory factor.
Key words:
CKD, dialysis, OX-HDL, malnutrition
Corresponding author: Manal Abd El-Salam
e-mail: manal_679@yahoo.com


The growth failure in CKD

High-density lipoprotein ( HDL) is
children is multi-factorial, the age at onset
known as a "good" lipoprotein, because high
of the disease, primary renal disease,
levels seem to protect against advancing
severity of CKD, hormonal resistance,
atherosclerosis by carrying cholesterol away
chronic anemia, metabolic acidosis,
from the arteries and back to the liver. HDL
possesses antioxidant and anti-inflammatory
persistent micro-inflammation, recurrent
activities in interactions with circulating
cells, inhibiting leukocyte and platelet
inadequate dialysis are all implicated ¹.
activation and thus exerting further systemic
Despite good progress with regard to
anti-inflammatory actions .
both conservative treatment and renal
In the presence of systemic
replacement therapy (RRT), 30% to 60%
inflammation and oxidative stress, these
of children with end stage renal disease
antioxidant enzymes can be inactivated
(ESRD) still grow up to become stunted
and HDL can accumulate oxidized lipids
and proteins that result in a pro-
children with CKD, the age at onset of
ESRD, the duration of chronic renal
conditions, the main protein of HDL, apo-
failure, gender and primary disease were
lipoprotein (apo) A1, can be modified by
related to final height³.
reactive oxygen species. Alterations of

Full Paper (vol.51 paper# 19)

Introduction: The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 376­ 384
Value of Multidetector Computed Tomography in Evaluation of Thoracic
Venous Abnormalities among Pediatrics with Congenital Heart Disease
Dalia F Elbeih*, Mervat M El-Gohary *, Naglaa H Shebrya*,Mohammed A Saleh **
* Departments of Radiodiagnosis and** Cardiology, Faculty of Medicine, Ain Shams University.
Venous anomalies of the thorax can involve systemic or pulmonary veins and range
from isolated incidental findings to components of more complex anomalies, most often congenital
heart disease (CHD). Although echocardiography and catheter directed cardiac angiography are
generally accepted as the primary imaging techniques for evaluation of CHD, CT and MRI are
important complementary diagnostic tools. Multi-detector computed tomography (MDCT) with its
increasing availability and utility is now becoming a further method of imaging CHD. In light of its
widespread availability, MDCT and 3D imaging are increasingly considered as a viable "one-stop
shop" for preoperative imaging evaluation of cardiovascular structures in selected pediatric patients.
Aim of the work: The aim of this work is to evaluate the role of MDCT in visualization of the
thoracic venous system in pediatrics with congenital heart disease, show prevalence and types of
venous anomalies and to compare this data with echocardiographic findings.
Methods: The studied group included 30 cases referred to us by pediatric cardiologists to be examined
by MSCT angiography of the heart and thoracic vessels. All the patients were known cases of
congenital heart disease and underwent echocardiography. They were referred to answer specific
anatomic question raised by inconclusive echocardiography, to assess suspected systemic and
suspected pulmonary venous anomalies. All patients were subjected to full history taking, clinical
examination and MDCT examination with CT lightspeed VCT XT 64-detectors row scanner (General
Electric, Medical Systems, Milwaukee, Wisconsin, USA).
Results: CTA findings had 77.8 % concordance with echocardiographic findings regarding SVC
anomalies, 66.7 % concordance with echocardiography regarding IVC anomalies and 90 %
concordance regarding pulmonary venous anomalies.
Conclusion: Low dose protocol CTA is a promising method that complementary to Echocardioraphy
for imaging of extracardiac vascular structures in pediatrics with congenital heart diseases.
Key words: Congenital heart disease. Computed Tomography Angiography. Systemic venous
anomalies. Pulmonary venous anomalies.


Anomalies of the heart and the great
functional assessment of patients with CHD.
vessels are mostly present from birth. The
However, the clinical decision to precede with
majority of such disorders arise from faulty
such an investigation needs to be balanced
embryogenesis during gestational weeks 3­8,
with the risks associated with an invasive
when major cardiovascular structures develop
procedure, which also involves exposure to
(1). Venous anomalies of the thorax can involve
ionizing radiation (4). Despite the great
systemic or pulmonary veins and range from
capabilities of MR imaging for anatomic and
isolated incidental findings to components of
functional assessment of the heart, an
more complex anomalies, most often
examination with this modality is time-
congenital heart disease (2).
consuming and may require a lengthy period of
Echocardiography, which can provide
patient sedation(5).
both anatomical and functional information, is
Multi-detector computed tomography
the mainstay of imaging for evaluating
(MDCT) with its increasing availability and
intracardiac lesions in infants and children (3).
utility is now becoming a further method of
.In addition to being highly operator
imaging CHD (6).
dependent, echocardiography may not be

structures, such as the pulmonary arteries,
The aim of the work is to evaluate the role of
pulmonary veins, and the aortic arch and great
MDCT in visualization of the thoracic venous
vessels due to acoustic window limitations(4).
system in pediatrics with congenital heart
Cardiac catheterization remains an
disease, show prevalence and types of venous
important component of both anatomical and

Full Paper (vol.51 paper# 20)

Abstract: The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 385­ 394
Role of Multidetector CT in Evaluation of Acute Chest Pain: Non-
Cardiac Vascular and Pulmonary Causes
Rania S Sayed *, Hisham M Mansour **, Mohammad H Khaleel ***, Sherif H Abo Gamra **
and Merhan A Nasr **
Radiodiagnosis Dept., Nasr City Health Insurance Hospital, Ministry of Health*,
Radiodiagnosis Dept., Ain Shams University** and Cardiology Dept., Nasr City Health
Insurance Hospital, Ministry of Health***

Triage of patients with acute chest pain is one of the most important issues
currently facing physicians in the emergency department. Acute chest pain may be a symptom
of a number of serious conditions and is generally considered a medical emergency. The causes
of acute chest pain range from non-serious to life threatening. A rapid, accurate and cost-
effective approach for the evaluation of emergency department patients with chest pain is
Aim of the work: This work aims to emphasize the role of multidetector CT in assessment of
non-cardiac vascular and pulmonary causes of acute chest pain.
Method: The studied group included 89 patients (59 men and 30 women) presented by acute
chest pain. All patients were subjected to MDCT and/or MDCT angiography using a Toshiba 64
detectors CT scanner.
Results: The high spatial resolution and relatively non-invasive nature make MSCT
angiography a strong and serious competitor to established vascular imaging techniques. Having
the additional ability to simultaneously acquire information on other organs, which enables the
early diagnosis of complications.
Conclusion: Continued technical improvements in acquisition speed and spatial resolution of
computed tomography images, and development of more efficient image reconstruction
algorithms which reduce patient exposure to radiation and contrast result in increased popularity
of MDCT.
Keywords: Acute chest pain, Aortic dissection, Pulmonary embolism, Pneumothorax,
Computed tomography angiography.

Chest pain is one of the most
potentially life saving treatment that is
common presenting symptoms for patients
markedly different than treatment for
coming to the emergency department
The consequences of diagnostic
As the spectrum of acute chest pain
failure are extremely serious and have
causes is broad and not all life threatening
resulted in expensive, time consuming
causes are of cardiac origin. Our study
strategies to categorize patients presenting
concerned with non-cardiac vascular and
to the ED with acute chest pain. There is a
pulmonary causes. Pulmonary causes of
clear need for an accurate, rapid and
chest pain include: pulmonary embolism,
economical way to reduce unnecessary
admissions without compromising the care
pneumothorax and pleurisy while vascular
of patients in need(4,5).
causes include acute aortic syndrome(2).

The proper diagnosis of the cause
Patients & Methods
of chest pain in ED patient is further
The studies were performed with
complicated by the often difficult challenge
64 slice, multidetector CT scanner
of recognizing patients who have an acute
(Toshiba, Aquilion) over a period of two
aortic syndrome (AAS), or pulmonary
years on 89 patients with acute chest pain,
embolus (PE), which, while less frequent
59 men and 30 women. The mean age of
than acute coronary syndrome (ACS),
patients was 47 years, with a maximum of
necessitate rapid diagnosis for institution of
77 years and minimum of 13 years.

Full Paper (vol.51 paper# 21)

TNF-@ Gene Expression in Chronic Hepatitis C virus infection The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 395­ 404

Tumour Necrosis Factor-Alpha Gene Expression in Chronic Hepatitis
C Virus Infection.
Saadia Farid, Laila Rashid, Samya Swelam.
Department Of Medicine, Biochemistery. National Hepatology and Tropical Medicine Research
Institute and Faculty of Medicine Cairo University.

Tumour necrosis factor (TNF)-alpha, a prototype proinflammatory cytokine, has been
implicated as an important pathogenic mediator in a variety of liver conditions. Some genetic
polymorphisms in the human TNF-alpha promoter region, such as the G-A transitions -308 and ­
238, have been shown to influence TNF-alpha expression in chronic hepatitis C virus infection.
Aim of the work: The present study was to investigate the influence that the ­ 308 and ­ 238
TNF- alpha promoter polymorphisms have on the response to interferon and ribavirin therapy in
chronic hepatitis C virus infection.
Patients and methods: One hundred forty patients with chronic hepatitis C virus infection, their
age ranges between (20-56) years, selected from the National Hepatology and Tropical Medicine
Research Institute were included in this study, during interferon and ribavirin therapy and thirty
five healthy individuals were included to serve as controls, the patients and controls were divided
into two groups the first group forty patients and fifteen controls for the detection of TNF-alpha -
308, -238 genotypes polymorphisms, the second group were one hundred patients and twenty
healthy controls for the detection of serum levels of TNF-. All the patients and controls were
subjected to the following history, clinical examination, abdominal ultrasonography and
collection of blood samples for routine laboratory investigation, CBCs and serological assay,
genotyping of 308, 238 TNF-alpha promoter polymorphism and serum levels of TNF-.
Results: There was no statistically significant difference between chronic HCV patients and
healthy controls as regarding TNF-alpha -238 different alleles.
The frequencies of TNF-alpha gene polymorphism with A/G and G/G mutation at ­ 308 were
significantly higher in chronic HCV patients than those in the controls.
The serum level of TNF-alpha was markedly higher in the chronic HCV patients than in the
healthy controls.
There were significant association between TNF- alpha gene polymorphism in the ­ 308 A/G,
G/G alleles and increased serum TNF- alpha in CHCV infection.
Conclusion: The results indicate that the TNF-alpha gene polymorphism at position -308 is
associated with susceptibility of chronic HCV infection.
Recommendations: Our major concern was to improve the response to treatment in patients with
chronic HCV infection, whether the disadvantage of having the TNF-alpha -308 allele became
more apparent after interferon and ribavirin therapy is unclear and needs further study that
detecting the polymorphism of the -308 TNF-alpha allele before administering interferon therapy
may be valuable for predicting the treatment response, especially in difficult- to treat patients.
Key Words: TNF-alpha, a promoter polymorphism at position 238, 308, chronic hepatitis C virus
infection therapy.

The hepatitis C virus (HCV) is a major
ribavirin are unable to clear virus from the
public health problem and a leading cause of
serum (3,4). When host genetic factors are
chronic liver disease (1). An estimated 180
considered in disease and treatment
million people are infected worldwide (2).
response, the role of single-nucleotide
Approximately thirty percent of patients
treated with pegylated interferon and
increasingly important (5). Proinflammatory

Full Paper (vol.51 paper# 22)

ž’/H1 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 405­ 421

The Role of Bee Venom in Controlling Albino Rats Fetal Morphometric and
Morphological Changes by Carbimazole Induced Hypothyroidism
Abu Gabal H*, Moamena M** and Al Moalla H**
* College of Science and Humanity Studies, Salman Bin Abdul Aziz University.
**College of Science, Princess Nora Bent Abdul Rahman University.
Aim of the work. The present study was planned to investigate the role played by Bee venom in
improving the morphometric and morphological changes induced by carbimazole in pregnant
albino rats and their embryos.
Materials and method .A total number of 60 mature virgin female and 30 male Wistar wistar
albino rats (for fertilization) were used in this study.Pregnancy was ascertained by vaginal
smears.The experimental animals were divided into the following groups:
- (Normal group): in this group the pregnant rats were injected intraperitonealy by distilled water
(The solvent of both carbimazole and bee venom) by dose 1ml/200g.body weight, from day 1 to
day 18 of gestation.
II-The group of treated animals: this group was divided into 3 subgroups:
1-The carbimazole group: this group was divided into2 subgroups, the pregnant rats were orally
injected at a dose 2 and 3mg /200g.body weight, daily from day 1 to day 18 of gestation.
2-The Bee venom group: the pregnant rats were intraperitonealy injected with a dose 0.6
mg/200g. body weight on days 2,3,4,7,8,9,10,11,12,15 and 16 of gestation.

3-The treatment group: the pregnant rats were intraperitonealy injected with Bee venom
at a dose 0.6 mg/200g. body weight 1 hour after the intraperitonealy injection by the 2 doses of
carbimazole (2 and 3mg /200g. body weight).The days of injection for both treatments (Bee
venom and carbimazole) were as mentioned before.
Results. The results of the present study showed that carbimazole treatment with its 2 doses
induced highly significant increase in the body weights of pregnant rats, highly significant
reduction of the uterus weight with shortness of the horns as well as unequal distribution of the
embryos between them, increased number of the resorbed fetuses when comparing with the
control group, Bee venom injection revealed improvement of these changes .The orally
injection of the 2 doses of carbimazole resulted in very highly decrease in fetuses body weights
and lengths; however Bee venom induced obvious improvement as compared with the
carbimazole effects. Orally injection of carbimazole at the dose 3mg /200g body weight showed
increased fetal mortality rate as compared with the control group; however, intraperitonealy
injection of Bee venom resulted in improvement in the rate of live fetuses and never of dead ones
was observed after Bee venom treatment. The 2 doses of carbimazole induced lots of
malformations of embryos such as variations in the size of embryos of the same mother, the
embryos exhibited fragile skin, sub dermal blood coagulation beside edema in different regions
of the fetal body ,as well as malformations of the regions of the eye resembled in exophthalmos
and rostrum region such as cleft lips, beside clubbed fore and hind limbs , kyphosis of the body
of the embryos, exencephaly.Bee venom treatment resulted in control of the changes induced by
carbimazole injection. The fetuses were resembled to those of the control group.
: It is clear that bee venom plays an important role in controlling the morphometric
and morphological changes in fetuses of albino rats suffering from hypothyroidism
induced by carbimazole
Key words: Carbimazole, Thyroid gland, Bee venom. Pregnant Rats, fetuses.

Full Paper (vol.51 paper# 23)

d:\skydrive\Jor\vol51_24 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 422­ 433

Chronic exposure to MDMA (ecstasy)induces DNA damage, impairs
functional antioxidant cellular defenses, enhances the lipid
peroxidation process and alters testes histopathology in male rat.
*Nadia Gamal Zaki, ** Laila Abdel Kawy
Narcotic Research Department, the National Center for Social and Criminological Research,
Cairo, Egypt
3,4-Methylenedioxymethamphetamine (MDMA or "ecstasy") is consumed mainly by young
population. For this reason, it is especially relevant to take into consideration the effects on the
reproductive system. The influence of MDMA on the fertility and reproduction of the male rat
was assessed in this study.
Material and methods: MDMA was administered orally at 0 mg/kg (control), 10 and 30
mg/kg to male rats for 15,30,45 consecutive days followed by 15 days withdrawal. Hormonal,
biochemical, histological and testicular were evaluated in the rats. The present study aimed to
investigate if daily oral administration of ecstasy at low doses(10mg) for 45 days has any
deleterious effects on reproductive functions of male rats. Animals were randomly divided into
four groups of ten rats each, assigned as control rats, or(0mg ecstasy), rats treated with 10mg
ecstasy for, (15,30,45) days, rats treated with 30mg/kg body weight ecstasy for(,15,30,45)days
by oral gavage. The third group(45 days) was followed by 15 withdrawal period(W15).
Results: The activities of superoxide dismutase, catalase, glutathione reductase and glutathione
peroxidase in testicular homogenate were decreased while the levels of lipid peroxidation
increased significantly in the treated rats as compared with the corresponding group of control
animals. In group 30mg, only, arachidonic acid was significantly elevated in the testicular
homogenate while linoleic acid was decresed when compared to control. Testis DNA
fragmentation was observed in 30mg group, but not 10.mg. It is concluded that low doses of
ecstasy exposure(10 mg/Kg) had moderate detrimental effects on reproductive organ system
and more severe effects are likely to be observed at higher dose levels. These results indicate
that ecstasy is directly toxic to primary Leydig cells, and that the decreased percentage of
normal cells and the increased level of DNA damage in ecstasy -exposed Leydig cells may be
responsible for decreased testosterone secretion. The results suggested that graded doses of
ecstasy elicit depletion of antioxidant defence system and induce oxidative stress in testis of
In conclusion: the adverse effect of ecstasy on male reproduction may be due to induction of
oxidative stress.
Key words:MDMA(ecstasy),testes,free fatty acids,oxidant/antioxidant status

in it(3,4). MDMA is almost taken by
(MDMA, Ecstasy) is a psychoactive drug
mouth and is prepared as single-dose
with significant abuse liability and
tablets for this purpose, though the great
neurotoxic potential (1). A recent national
majority consist of a single active drug.
survey indicates that recreational MDMA
The typical dosage range of MDMA for
use may be once again on the rise (2).
recreational use varies from 50 mg to 150
Ecstasy" (MDMA) and related drugs are
mg, but the amount per tablet in different
amphetamine derivatives that also have
batches of tablets may vary 70-fold or
some of the pharmacological properties of
more, from almost zero to well over 100
mescaline. They have become popular with
mg ( 5,6,7). MDMA and the other ring-
participants in "raves," because they
substituted amphetamine derivatives act by
enhance energy, endurance, sociability and
increasing the net release of the
sexual arousal. This vogue among
monoamine neurotransmitters (serotonin,
teenagers and young adults, together with
noradrenaline and, to a smaller extent,
the widespread belief that "ecstasy" is a
dopamine) from their respective axon
safe drug, has led to a thriving illicit traffic
terminals. MDMA does not act by directly

Full Paper (vol.51 paper# 24)

EFFECT OF BOSWELLIA ON ALLOXAN-INDUCED DIBETES MELLETUS IN MALE ALBINO RATS The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 434­ 447

Comparison between the effect of ozone and vitamin C in treatment
of diabetes mellitus
Eman G. E. Helal*, Samia M. Abd-Elwahab **and Anwaar Alkamel Mohammad ***
Departments of Zoology ­Faculty of Science-Al-Azhar University (Physiology* & Histology **) and
Department of Medical Science- Faculty of dentistry Sinai University***

There is strong evidence that diabetes results a state of oxidative stress and that
reactive oxygen species contribute to the production of insulin resistance, -cell dysfunction
and both the microvascular and macrovascular long-term complications of diabetes.
Antioxidants are used as supportive therapy in the treatment of DM, so, we use ozone and
vitamin C to study if they can regulate the oxidative complications of DM.
Material and method: twenty male adult albino rats were divided into two groups; group 1:
control group, group 2: alloxan induced diabetic rats which divided into three subgroups.
subgroup1: diabetic untreated rats, subgroup2: diabetic treated with ozone and subgroup 3:
diabetic rats treated with vitamin C. After thirty days of treatment the body weight gain was
detected. Blood sample were collected to1- estimate biochemical parameters as: glucose,
serum insulin, lipid and protein profiles and liver and kidney functions 2- estimate some
hematological parameters. Also, liver samples collected to determine their glycogen content
and pancreatic samples were obtained for microscopic and quantitative evaluation.
Results: in diabetic untreated rats the results showed reduction of gained body weight,
hyperglycemia, and hypoinsulinemia, significant increase in liver and kidney functions and
change in lipid and protein profiles and decreased liver glycogen content. While, O3 and
vitamin C treated rats reported an amelioration of the most toxic effect of alloxan and
returned most of these parameters nearly normal. Microscopically pancreatic beta cells
showed definite vaculation, degeneration, karyolysis and pyknosis in the diabetic group while
pancreatic alpha and delta cells were not affected. The use of O3 and vitamin C treatment in
this study showed significant improves of such cellular changes when compared to diabetic
untreated rats but still abnormal when compared with normal rats. Conclusion: it was
recommended that the use of the O3 or vitamin C as a supplementary agent to reduce
oxidative stress damage of hyperglycemia and recommended to use variable doses and
different periods of treatment to evaluate the best dose and period.
Key words:
Alloxan; Hypoglycemia; Diabetic; antioxidant.


WHO estimates that more than
peroxidation (LPO) [3], DNA damage [4],
180 million people worldwide have
and protein degradation [5]. Host survival
diabetes. This number is likely to more
depends upon the ability of cells and
than double by 2030 without urgent action.
tissues to adapt to or resist the stress and
In 2005, an estimated 1.1 million people
repair or remove damaged molecules and
died from diabetes, almost 80% of them
occur in low and middle-income countries,
Presently available oral hypoglycemic
and half of them in people under the age of
agents do not show marked improvement
70 years; 55% of diabetes deaths are in
in oxidative stress in diabetic patients [4].
Ozone (O3) has been used as a therapeutic
In clinical and experimental research,
agent and beneficial effects have been
attention is paid to the role of antioxidant
observed. However, so far only a few
defense systems in the prevention of
human diseases such as cancer, diabetes
mechanisms have been elucidated. The
mellitus, and cardiovascular pathologies
possibility that ozone could induce a
[2]. During the progression of these
useful adaptation to chronic oxidative
diseases, oxidative stress events occur, and
stress was described in 1996 [6]. Other
free radicals and reactive oxygen species
studies [7-9] reported that controlled
(ROS) are generated. These free radicals
ozone administration may promote an
and ROS are thought to contribute to lipid
oxidative preconditioning or adaptation to

Full Paper (vol.51 paper# 25)

Materials and methods The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 448­ 460

Antioxidant effect of Flaxseed against liver Cirrhosis induced in
Thioacetamide intoxicated rats
WafaaGh. Shousha1, Hatem A. El-mezayen1 , Shawkia S.Abdul-Halim2 ,Elham A.
1Chemistry department, HelwanUniversity,Egypt.
2 Nutritional Biochemistry, National Nutrition Institute, Egypt.
Corresponding author:Prof Dr/ WafaaGh. Shousha., Chemistry department, Helwan
University, AinHelwan ­ Egypt


Background/Aim:There has been a current upsurge in the medical implications of free
radicals and related species during the past several decades. These chemical species are
integral components produced during normal biochemical and physiological processes but
leads to oxidative stress when produce in excess and causes potential damage to cells. A wide
range of non-enzymatic and enzymatic antioxidant defenses exists to counteract the damaging
effects of free radicals. There exist epidemiological evidences correlating higher intake of
antioxidant rich foodstuffs with greater free radical neutralizing potential to lower incidence
of several human morbidities or mortalities.

Material andMethods: liver cirrhosis model was induced by TAA,hepatobichemical and
antioxidant parameters were assayed.
Results: Flaxseed induced enhancement in liver function test, antioxidant status and lipid
Conclusion: Flaxseed can be used as hepatoprotective against liver cirrhosis induced with
TAA as compared to reference drug Silymaringroup.
: liver Cirrhosis, Thioacetamide , Flax seed , Silymarin, Antioxidant.

The liver plays a crucial role in the
etiology and pathology comparable to the
metabolic elimination of most drugs and
one seen in humans [4].
other foreign compounds, thus making it

In recent years, flaxseed is gaining
Hepatotoxic agents can react with the
importance in diet supplements, as they
possessnutraceutical properties. Flaxseed
consequently induce almost all types of
is one of the oldest domesticated crops and
liver lesions [1]. Toxins and drugs are
it is being increasingly used in the human
among the basic etiopathogenet- agents of
diet because of its potential health
acute liver failure in Western countries [2].
benefits, particularly for cardiovascular

protection [5].
Thioacetamide (TAA) was originally used

as a fungicide to preserve agricultural
Flaxseed is the richest natural source of
citrus products, but later it was determined
that it was a potent hepatotoxin and
carcinogen because its thono-sulfur-
being the principal lignan compound,
containing compound endowed with liver-
chemically 2, 3-bis [4- hydroxy-3-
damaging and carcinogenic activities [3].
On a prolonged exposure, TAA leads to
diglucoside. The concentrations of SDG in
the formation of hyperplastic nodules, cell
flaxseed vary with different cultivars. SDG
concentrations in twenty-seven flaxseed
andcirrhosis. TAA-induced cirrhosis in
speciesranged from 1.19 to 2.59% for
rats has been shown to be a suitable
SDG and 0.22 to 0.5% (w/w) for its
experimental model of this disease with
diastereoisomer [6] . Flaxseed commonly
contains 34­45.6% total fat, and a-

Full Paper (vol.51 paper# 26)

d:\skydrive\Jor\vol51_27 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 461­ 472

Unmet Health Care Needs Among Clients from Outpatient Clinic of Ain
Shams University Hospitals , Cairo, Egypt
Ismail, N. A* Abdlrhman, S.I.**1, Abd El-Maksoud, M. M**2., Bakr, I.,* Dewedar,S.*
Department of community, environmental and occupational medicine, Faculty of Medicine, Ain Shams
University* Community Health Nursing, faculty of Nursing**, Zagazig University1, Helwan University2,
Cairo, Egypt

The concept of unmet needs refers to the difference between health services necessary to
treat a particular health problem and services actually received. Aim: This study examined the prevalence
of self-reported unmet needs for health care and the extent to which they were attributable to perceived
problems with service availability or accessibility or acceptability. Study design: descriptive analytical
study. Sample: 1316 individuals Clients from some out patients, clinic of Ain Shams University
hospitals. Setting: out patients, Clinic of Ain Shams University Hospitals, Cairo, Egypt. Subjects:
patients randomly chosen from out patients, clinic of Ain Shams University hospitals. Tools of the study:
A questionnaire tool developed to collect data about the prevalence of unmet needs for health care in the
previous 6 months. Results: This study conducted on 1316 individuals where 580 (44.8%) reported
unmet health care needs. As regard causes of unmet needs, 33.6% of unmet needs attributed to
accessibility problems, while service availability problems accounted for 57.4% of the unmet needs. The
largest group, accounting for 92.4% of unmet needs was acceptability problems. Conclusions: The
causes of unmet needs attributed to accessibility and availability problems. The most common reported
reason for an unmet health care need was that the too long waiting time, and the high cost of examination.
Recommendations: Re-plan health care service to treat causes of unmet needs, which attributed to
accessibility and availability problem.

Key words :Prevalence - Unmet health care needs- availability, accessibility, acceptability reasons


The concept of unmet needs refers to the
complications, a worse prognosis, and longer
difference between health services thought
hospital stays. (3, 4)
necessary to treat a particular health problem
The number of people reporting unmet needs has
and services actually received (1). A person who
increased over the last few years. According to
perceived the need to receive medical services
Statistics Canada, reports of unmet needs have
but who has not obtained these services has
risen across the country from 4% in 1994-1995
unmet health care needs. Unmet health care may
to 6% in 1998-1999 and to 13% in 2000-2001 to
result from limited availability or unavailability
18% in 2004. (1)
of health care services, when or where they were

In United States, the prevalence of
required. Also it can be caused from individual
unmet varied from 25% in 1999 to 7% among
accessibility problem, such as cost or
insured population and 18 % among uninsured
transportation, or from acceptability problem,
population in 2001. (5) Therefore, to assess unmet
such as attitude toward and knowledge about
health care needs, it is important to understand
health care. (2)
the barriers associated with them based on
While a country's health policy aims to
existing literature. (3,4) These factors examined
provide health services to all who need them, an
in relation to the three types of unmet needs are:
appreciable proportion of sick people do not get
age, sex, marital status, household income,
the health services at the time of illness they
education, employment, urban/rural residence,
need in their viewpoints to restore health,
health status, chronic conditions, chronic pain,
particularly in developing countries. Delayed or
distress, physician consultations, and attitudes
non-receipt of medical care may result in more
towards physicians, authority and self-care.
serious illness for the patient, increased
Previous studies have found that the main cause

Full Paper (vol.51 paper# 27)

Anticarcinogenic Effects of Raphanus sativus on 1, 2 dimethylhydrazine (DMH) Induced Colon Cancer in White Rats The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 473­ 486

Anticarcinogenic Effect of Raphanus sativus on 1, 2 Dimethylhydrazine
(DMH) Induced Colon Cancer in Rats
Mohamed A. Abd-Elmoneim*, Ashraf A. Bakar*, Isis M Awad***, Ehab M. Mohamed **,
Sorial A. Moharib ***
Department of Supplementary Medical Science- Faculty of Dentistry Sinai University*,
Department of Biochemistry ­Faculty of Science-Tanta University** and Departments of
Biochemistry ­National Reasearch Center ***).

Colon cancer is a major health problem worldwide and rated among as one of the
top frequent cancers and is a major cause of morbidity and mortality. Treatment outcome is still
not satisfactory and other treatment options are strongly needed. Carbohydrate protein
interactions play a major role in numerous biological processes including cancer. However, the
seeds of Raphanus sativus have never been tested for its anticancer effects on colon cancer.
Therefore, this study aimed at elucidating the anti-carcinogenic effect of Raphanus sativus in
combating chemically (DMH) induced colon cancer.
Materials and methods: polysaccharides extract of Raphanus sativus (RS) was tested for its
ability to reverse the carcinogenic effects of 1, 2 dimethylhydrazine (DMH) which is used for
chemical induction of colon cancer in animal models. Rats were injected with DMH and the
effects of RS extract either concomitant with or after the administration of DMH were evaluated.
. We measured the serum Carcinoembryonic antigen and Carbohydrate antigen as a tumor
markers, Glutathione reducatse and Glutathione S transferase as markers of antioxidant activity
and liver functions.
: RS significantly reduced Serum CEA (P<0.01) and CA19-9 (P<0.01) as an evidence of
its anticarcinogenic effect in colon cancer. Moreover, RS was able to significantly increase
activity of Glutathione reductase (p<0.01) and Glutathione- S- transferase (p<0.01) as a measure
of antioxidant compared with DMH untreated group. Also RS was able to significantly increase
activities of ALAT, ASAT and ALP (p<0.01). Chemical analysis of RS done by NMR and paper
chromatography revealed that the polysaccharide in RS was -galactan and the type of bond that
exists between sugar residues is 1, 3 and 1, 6 glucosidic linkages.
This study shows that -galactan of Raphanus sativus has pronounced cytotoxic
effects on colon cancer cell line. Moreover, it reduces serum tumor markers and enhancing
antioxidant activity in the DMH injected animals. This polysaccharide might be a suitable
candidate as a chemopreventive and as an adjuvant therapy for colon cancer.
Key words:
Raphanus sativus , -galactan, DMH, colon cancer, tumor markers.


Colorectal cancer (CRC) is the third
age 30-34 years. The results also shows
most common cancer in males and second
significantly lower incidence of colorectal
most common in females worldwide [1].
cancer in subjects over age 40 years
Colon cancer is the third most commonly
compared to the same age group in the
diagnosed cancer and the second leading
United States SEER [3].
cause of cancer death in men and women
Most colon cancers are sporadic
combined in the US. The American Cancer
with only a few types having a familial
Society estimates that 142,820 people will
basis, such as the familial adenomatous
be diagnosed in 2013 and that 50,830 will
polyposis (FAP) and hereditary non-
die from colon cancer in the United States
polyposis colorectal cancer (HNPCC) which
[2]. Hospital-based studies in Egypt showed
accounts for about 5 % of all colorectal
low incidence of colorectal cancer and high
cancers, this multistep carcinogeneis
proportion of young-onset disease [3]. In
process starts with normal colonic cells
comparing rates of Egyptian colorectal
which acquire genetic alterations in
cancer to the Surveillance Epidemiology
important genes. The mutated cells can
and End Results Program (SEER) of the
grow stepwise and eventually to carcinomas
United States, Egypt had higher rates up to
and invade other tissues [4].

Full Paper (vol.51 paper# 28)