d:\skydrive\Jor\vol54_1 The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 1­ 10

BIRADS 3 Breast Lesions: Can Follow-up Replace Biopsy

Dina H Salamaa, Hanan Gewefelb

a Lecturer of Radiodiagnosis, National Center for Radiation Research and Technology,
Egyptian Atomic Energy Authority, Cairo, Egypt.
b Lecturer of Radiographic Imaging Technology , Faculty of Applied Medical Science,
Misr University for Science Technology, Cairo, Egypt.

To compare the two years follow-up versus biopsy in probably benign breastlesions
(BIRADS3 category) with assessment of the malignancy potential in both conditions.
Patients and Methods: This is a comparative descriptive record survey where records of all BIRADS
3 patients (number=575) who were admitted to the Women and Fetal Imaging (WAFI) center in
Cairo-Egypt during the period from January 2007 to December 2010 were traced, however, only 464
were finally included and divided into: Group A (number = 395), those who were subjected to follow
up protocol and Group B (number = 69), who underwent biopsy.
85.1%of the cases underwent the two years follow up by mammography and
ultrasonography through periodic imaging surveillance (group A), while 14.9% underwent biopsy and
were allocated as (group B). Among the follow up cases 98.48%weretrue negative (benign cases) and
six cases (1.52%) were upgraded in their follow up visits and were confirmed malignant by
histopathology. In group (B) 97.1% were true negative while 2 cases (2.9%) were confirmed
malignant (false negative).No significant difference between both groups as regards false negative
results (p=0.339). When we investigated all false negative cases (cases proved malignant) in both
groups, positive family history was the only variable that counts and favoring the malignant suspicion
in all cases but other parameters like irregular lesions, subtle asymmetry, calcified masses, focal
distortion and parenchymal disruption may direct the radiologists and physicians, to proceed to
Conclusion: In BIRADS 3 breast lesions interpreted by experienced radiologists and surgeons
especially in absence of the parameters favoring malignancy, short term follow up can confidently
replace biopsy.
Keywords: BIRADS; breast lesions; breast ultrasound; mammography.

Breast cancer is one of the well-known causes of
with repeated imaging is usually done as
death among women worldwide. There are
authenticated above. The follow up strategy
number of investigations used for diagnosing
helps to avoid unnecessary biopsies, but if the
this disease: mammography, sonography, and
area does change over time, this necessitates
biopsy, among others. Each of these has
early diagnosis. Moreover, the strategy of follow
illustrious advantages and disadvantages 1.When
up increases the positive predictive value of the
a non-palpable breast lesion, discovered
biopsy, thereby lowering potential patient
morbidity3.On the other hand, it has been noticed
classified as probably benign, BIRADS category
that in another practices, when a palpable breast
3, after a full diagnostic imaging workup, the
mass is detected, a biopsy is usually done even if
authoritative practice is to implement a six-
the mass authenticates probably benign
month-interval follow-up mammography for 2
morphologic criteria on imaging, as there is
years2. Moreover, the data in this category have a
somewhat little data reporting the outcome of
very good probability (greater than 98%) of
such breast masses4.The aim of the current study
being benign (not cancer). The benign findings
was to compare the two years follow-up versus
are not expected to change over time. But since it
biopsy in probably benign breast lesions
could not be documented in BIRADS 3 lesions
(BIRADS3 category) with assessment of the
to be benign, it's wise to see if these suspicious
malignancy potential in both conditions.
lesions do change over time or not. Follow-up
Moreover, another objective is to study the



Full Paper (vol.54 paper# 1)

Relation between Zinc level and one year mortality among elderly patients with heart failure The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 11­ 14
Relation between Zinc Level and One Year Mortality among Elderly
Patients with Heart Failure
Nora Abdel-Khalek Abdel-Salam*, Walaa Wessam Aly*, Sarah Ahmed Hamza*,
Hossam Mosfata Fahmy**, Ahmed Kamel Mortagy*
Geriatric Medicine* and Clinical Pathology**
Faculty of Medicine - Ain Shams University

Zinc (Zn) deficiency in endothelial cells potentiates the inflammatory response
mediated by certain lipids and cytokines, possibly via mechanisms associated with increased cellular
oxidative stress.
Objectives: To assess the relation between zinc level and one year mortality among elderly patients
with heart failure.
Patients and Methods:
Serum zinc level was measured in 100 elderly patients with heart failure
diagnosed by Criteria of New York Heart Association (NYHA). Patients were followed by telephone
for one year to assess relation between Zinc level and one year mortality among elderly patients with
heart failure. Results: Higher mortality percentage was found among patients with high level of zinc
but there was no statistical significant difference. (P-value >0.05). And non significant relation was
found between mean level of zinc and mortality, between age and Zn, and between Ejection
Fraction (EF) and Zn. Zn level was lower among patients with EF >45 but the difference was not
significant (P-value >0.05). Conclusion: Patients who had high level of zinc had greater risk for
mortality. Zn level was lower among patients with EF >45 but the difference was not significant and
the least mean of zinc was among patients with left ventricular (LV) systolic dysfunction.
Key words:
Zinc, mortality, elderly patients, heart failure.

Heart failure is a common, costly,
consequently stops the main mechanism of
disabling, and potentially deadly condition.
atherogenesis. Zinc blocks calcium and its
In developed countries, around 2% of adults
several actions on atherogenesis. Increased
suffer from heart failure, but in those over
amounts of cytotoxic cytokines such as
the age of 65, this increases to 6­10 % (1).
tumor necrosis factor (TNF)-alpha, inter
In developed countries, the mean age of
lukin (IL)-beta and IL-8, often produced in
patients with heart failure is 75 years old. In
the elderly, are blocked by high dose zinc,
developing countries, those 70 to 80 years
low serum zinc level was an independent
old, it occurs in 20--30 percent (1).
risk factor for CHD events(5).
Heart failure is associated with
There is a rising question about the
significantly reduced physical and mental
relation between Zn level and mortality
health, resulting in a markedly decreased
among elderly patients with heart failure.
quality of life (2, 3).
Unfortunately no available literatures discuss
Zn deficiency in endothelial cells
this issue.
potentiates the inflammatory response
Objectives are to assess the relation
mediated by certain lipids and cytokines,
between zinc level and one year mortality
possibly via mechanisms associated with
among elderly patients with heart failure.
increased cellular oxidative stress (4).

Zn plays important roles in the
Patients and methods
protection of vascular system from oxidative
stress and damage. For instance, Zn
A prospective study was conducted.
deficiency in diabetic patients was found to
be associated with increased cardiovascular
One hundred elderly patients with heart
events (5) which may be related to the
failure diagnosed by Criteria of New York
increased inflammatory response in vascular
Heart Association (NYHA)(7). They recruited
system (6).
from the different medical wards in Ain
The anti oxidative action of zinc
Shams University Hospital during a 12
prevents oxidation of LDL cholesterol and


Full Paper (vol.54 paper# 2)

Prevalence of Functional Impairment Among Frail Elderly The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 15­ 19

Prevalence of Functional Impairment among Frail Elderly
Moatassem S Amer *, Randa A Mabrouk **, Tarek Kh Abdel Dayem ***, Tamer M
Farid*, Mohamed ShKhater *, Noha M Farag *
*Geriatrics and Gerontology department, **Clinical Pathology department, ***Department of
Cardiovascular Medicine, Faculty of Medicine, Ain shams university, Cairo, Egypt
Correspondance:Noha Mahmoud FaragMSc, Geriatrics and Gerontolgy department, Faculty of
Medicine, Ain shams university, Abbasia, Cairo, Egypt.


Frailty is a state of vulnerability describes a syndrome characterized by progressive
multi system decline, loss of physiologic reserve, and increase vulnerability to disease and
death. Frailty has emerged as a condition associated with an increased risk of functional
decline among the elderly population, which may be differentiated from aging, disability, and
Objectives: The aim of this study is to assess the prevalence of functional impairment and
cognitive functions among frail elderly.
Methods:We examined104 frail elderly. Frailty criteria included unintentional weight loss,
exhaustion, weakness, low physical activity, and slow walking speed. physical function was
assessed using Activities of daily living (ADL) and Instrumental activities of daily living
(IADL). The cognitive function was assessed using the Mini-Mental State Examination
Results:The mean age of the studied population was 69 years, 53.85% were males,
46.15% were females, the majority of our participants were illiterates (89.4%), and were
living with family (84.62%), only 6.73% were smokers. 36.5% of frail participants were
assisted in activity of daily living (ADL) and 7.7% were dependents, while 63.5% were
assisted in instrumental activity of daily living (IADL) and 8.7% were dependents; the sample
participants in general had borderline scores for MMSE, indicating a cognitive performance
in the lower normal range.
Frail elderly had low normal score on MMSE, and high prevalence of functional impairment.
KEYWORDS: Frailty­ prevalence­ Functional impairment ­ADL ­ IADL ­ MMSE.

population, which may be differentiated
The frailty defined as a syndrome of
from aging, disability, and comorbidity(4).
decreased resiliency and physiologic

reserves, in which a mutually exacerbating
Functional decline can be defined as a new
cycle of declines across multiple systems
loss of independence in self-care activities,
results in negative energy balance,
measured on an activities of daily living
sarcopenia, and diminished strength and
(ADL) scale (e.g. bathing, dressing,
tolerance for exertion. The physical
transferring from bed to chair, using the
phenotype of frailty composed of5
toilet) and/or on an instrumental activities
measurable domains (exhaustion, weight
of daily living (IADL) scale (e.g.
loss, weak grip strength, slow walking
shopping, housekeeping, preparing meals
speed, and low energy expenditure) (1).
Some studies view frailty in a
broader sense as they included cognitive
impairment among the elderly is very
impairment and psychosocial dimensions
important as early screening for functional
in their assessment for frailty (2,3).
impairment may help in reducing
Frailty has emerged as a condition
secondary morbidity such as reactive
associated with an increased risk of
depression, and effective counseling and
functional decline among the elderly
advice can be given to carers of the elderly


Full Paper (vol.54 paper# 3)

Comparative study between the effect of insulin -sensitizer drug and cholesterol lowering agent on some physiological parameters in infertile obese women The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 20­30
Effect of Cholesterol lowering Agent (Lipolax) on Some Physiological Parameters
in Some Infertile Obese PCOS Egyptian Women Undergoing ICSI
Samia M. Abd El-Wahab*, Eman G.E. Helal*, Aziza M. Aly Mansour *
* ,Mervat M. Mahmood**and
Amira B. Mehaney *
Zoology Department, Faculty of Science, Al-Azhar University (Girls)* , International Islamic Center for
Population Studies and Research, Al-Azhar University**

Infertile obese women with polycystic ovary syndrome (PCOS) is a common
endocrinopathy affecting women and characterized by hyperandrogenism, chronic anovulation with
either oligomenorrhea or amenorrhea and hyperandrogenism, and its morbidity may include
hyperinsulinemia, insulin resistance. Lipolax was used to enhance the ovulation response especially
when beginning the intra cytoplasmic sperm injection (ICSI) protocol. This study aimed to enhance the
sexual hormones, lipid profile, ovulation response and pregnancy outcome in infertile obese PCOS
women's treated with Lipolax drug (fenofibrate) before undergoing to ICSI.
Setting: This study was conducted in International Islamic Center for Population Studies and Research-
Assisted Reproduction Unit, Al-Azhar University during the period between 2009 and 2011.
Patients and Methods: A total number of 75 infertile patients with obese PCOS were randomized to
receive oral Lipolax (fenofibrate) for three months before undergoing to ICSI. For each patient FBS and
Hb, hormonal profile included FSH, LH, FSH/LH ratio, E2, PRL and lipid profile evaluation were
performed at baseline and after 3 months of treatment.
There was a significant decrease in the FBS, in cases treated with Lipolax when compared with
control or obese PCOS, no significant differences were noticed in the level of Hb% in both groups. Total
lipids, triglycerides and total cholesterol decreased significantly compared with obese PCOS group.
Significant decrease was also observed in respect to LDL in cases of Lipolax treated group than cases of
obese PCOS, significant increase in the level of HDL was recorded. A significant enhance was detected
in increase FSH hormone level and decrease LH, FSH/LH ratio and E2 hormonal level after Lipolax
treatment, no difference was observed in prolactin hormonal profile. Observed improvement was
detected in the number of HMG ampoules, mature oocytes, and number of grade A embryos and also in
pregnancy outcome.
Lipolax (lowering cholesterol agent) improving the response in obese PCOS women
undergoing ICSI, by enhance their resistance sensitivity in transadipose tissue leads to improve the
function of gonads and sexual hormones and lipids profile which leads to decreased total cost of ICSI by
lowering the number of stimulation ampoules and increase mature collected oocytes and finally the
percent of successful pregnancy rate.
Keywords: PCOS, Obese, Lipolax, ICSI, Lipid profile, Physiological parameters.

of an ovulation
manifested by
Polycystic ovary syndrome (PCOS) is the most
oligomenorrhea or secondary amenorrhea (2).
common endocrine disorder in women of
The sonographic appearance of PCOS may
reproductive age, it is a complex disorder with
occur together, or in isolation with a
multiple components, including reproductive,
biochemical status, which involves metabolic
metabolic, and cardiovascular manifestations,
and hormonal changes. Concentrations of
and also it has long-term health concerns that
luteinizing hormone (LH) are elevated in 45-
cross the life span(1).
75% of cases and raised testosterone levels are
Polycystic ovaries, ovulation-related infertility,
seen in 80% of patients. The above hormonal
excessive secretion of androgenic hormones
levels are the usual indicators of this syndrome.
that cause hirsutism and acne, high cholesterol
Obesity is very common among women with
level, type 2 diabetes, insulin resistance, also
PCOS and 30-60% is overweight to some
obesity and oligo- or amenorrhea. The most
degree. A polycystic ovary has abnormal
important abnormality in patients with PCOS is
number of eggs that can be viewed near its

surface resembling cysts (Fig 1and 2) (3).



Full Paper (vol.54 paper# 4)

BACKGROUND The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 31­ 35
Pulmonary Langerhans Cell Histiocytosis X Presented with Bilateral
Pneumothorax: A Case Report
Majed Al-Mourgi
College of Medicine, Taif University, Saudi Arabia

The report describes the case of a 20-year-old Saudi male patient with Pulmonary
Langerhans cell histiocytosis X (PLCH). He presented with bilateral chest pain of few hours duration
starting first on the right side. The patient had also dyspnea and non productive cough. The patient was
heavy smoker for 6 years. General examination revealed that the patient had tachypnea but he was
hemodynamically stable. Chest examination showed bilateral distant breath sounds but no
hyperresonance. Chest x-rays revealed bilateral pneumothorax and high resolution CT scan of the chest
revealed multiple bilateral pulmonary cysts. Oxygen is given to the patient and bilateral chest tubes were
applied. Video assisted thoracic surgery was performed in 2 sessions with one week interval to resect the
dominant blebs and to perform pleurodesis. The final histopathological diagnosis was pulmonary
Langerhans cell histiocytosis X. Follow-up for more than 5 years revealed no recurrence. Pulmonary
Langerhans cell histiocytosis X is a rare disease and may present by spontaneous pneumothorax, so, high
index of suspicion is required in heavy smoker young males to diagnose the condition and to perform
pleurodesis preventing recurrence of the pneumothorax which is expected to be high in PLCH.

Pulmonary Langerhans cell histiocytosis X, esinophilic granuloma.


Hada Military Hospital, Taif, Saudi Arabia with
Pulmonary Langerhans cell histiocytosis X
bilateral pneumothorax which was eventually
(PLCH) is a rare interstitial lung disease
proved to be secondary to Pulmonary
affecting young adults and is closely related to
Langerhans cell histiocytosis X (PLCH).
smoking (1-3). Langerhans cell are derived from
Case report: Twenty years-old Saudi
dendritic cell system and are normally found in
patient presented to ER of our hospital with
the lungs, pleura, skin, and reticulo-
bilateral chest pain of few hours duration. The
endothelial system (4, 5). The disease is
onset of pain was sudden and starts on right side
characterized by formation of multiple lung
first and became bilateral after 2 hours. The
granulomatous nodules that destruct the terminal
condition was associated with dyspnea and non
respiratory bronchioles producing multiple cystic
productive cough. Systemic review of the patient
spaces (4-6). The bones may be involved in less
and his past history was unremarkable. The
than 20% of cases with rare involvement of other
patients used to smoke 40 cigarettes / day for 7
organs (1). The presentation of PLCH is variable
years. Examination revealed distressed patient
and may be asymptomatic in 25% of cases and
with tachypnea but no cyanosis. Neck veins were
the most common presenting symptom is
not engorged with normal position of the
nonproductive cough followed by dyspnea;
trachea, his pulse was 110/minute, blood
however, spontaneous pneumothorax may occur
pressure was 110/70 mm Hg and his oxygen
due to rupture of the pulmonary cysts (7-8). The
saturation was 90% on room air. Percussion of
recurrence rate for patients with secondary
both sides revealed no hyperresonance, but there
spontaneous pneumothorax in PLCH, may be
was bilateral distant breath sounds on
more than 60% (reaching 79% in some reports),
auscultation with no wheezes. His laboratory
so, interventions to prevent recurrence are
findings were within normal. Chest radiographs
recommended after the first episode of
revealed bilateral pneumothorax. High resolution
pneumothorax (9). In this case report I will
CT chest scan revealed bilateral mid and upper
present a case of young male presented to Al
zonal lung cystic lesions with honeycombing,


Full Paper (vol.54 paper# 5)

d:\skydrive\Jor\vol54_6 The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 36­ 40

Adult Neuroblastoma: A Case Report
Majed Al-Mourgi
College of Medicine, Department of Surgery Taif University, Saudi Arabia


Adult Neuroblastomas are rare tumors and pelvic type represents less than 5% of these tumors. Here, I
will report the case of 38-year old Saudi female patient with adult pelvic neuroblastoma.
Results: the patient presented to the outpatient clinic with lower abdominal discomfort and distension
for 6 months duration. Examination revealed large pelviabdominal mass of limited mobility.
Laboratory findings were within normal, however, CT scan and MRI, revealed retroperitoneal tumor
shifting the pelvic organs anteriorly and to the right. The tumor was resected completely through
anterior midline approach. Pathological diagnosis revealed that the tumor was a neuroblastoma. The
patient received 6 courses of chemotherapy and follow up for more than 6 years revealed no
recurrence or metastasis. Though the outcome of adult neuroblastoma is poor, complete surgical
resection with postoperative chemotherapy may improve the survival; however, a long-term evaluation
of adult neuroblastoma is mandatory.
Key words: pelvic adult neuroblastoma, Saudi female, combined approach.

complaint. The systemic review was
Neuroblastoma is the commonest intra-
unremarkable. General examination showed
abdominal pediatric solid tumor and has been
no abnormality and abdominal examination
detected in less than 10% of cases of patients
revealed irregular large pelvi-abdominal mass
above 10 years old (1-3). The pelvis is
of irregular surface and limited mobility.
neuroblastoma is uncommon site (< 5%), but
Vaginal examination was painful and revealed
it has a more favorable prognosis; though,
the presence of the mass pushing vagina and
recent studies have verified that adult and
other pelvic organs anteriorly and to the right
pediatric patients with neuroblastoma achieve similar
side.The laboratory findings were within
survival outcomes, with good prognosis for early-
normal. Intravenous urography revealed
stage patients (1, 4, 5). The origin tumor is the neural
compressed urinary bladder and dilated left
crest cells, particularly from the adrenal
ureter but with no other abnormalities. Pelvi
medulla, but other sites reflecting the
abdominal CT showed pelvi-abdominal mass
distribution of the sympathetic nervous system
of 17x14x19 centimeters compressing the
may be involved (1).As the tumor is rare in
uterus and the vagina with shift of the pelvic
adults, there is a lack in prospective treatment
structures anteriorly and to right side (Figure
trials, so, the pediatric protocols of treatment
1). Magnetic resonance study revealed that the
are usually applied but with less favorable
mass was composed of solid, necrotic, and
outcome(6-9). In this report; I will present a
degenerated areas (Figure 2). The CT and
case of adult Saudi female patient presented
MRI findings suggested retroperitoneal
by chronic left lower limb pain due to pelvic
schwannoma versus plexiform malignant
peripheral nerve sheath tumor (MPNST),
Case report: A 38-year-old Saudi woman
however, other possible retroperitoneal tumors
presented to the outpatient clinic of Al Hada
were not excluded. The patient and her family
Military Hospital, Taif, Saudi Arabia in
were counseled for resection of the tumor and
January 2007with lower abdominal discomfort
they were informed about the operation with
and distension for 6 months duration. The
all the expected risks and possible
condition was associated with urinary troubles
complications. They gave a written high risk
in the form of day and night frequency and
informed consent. During operation; a midline
attacks of dysuria, but no change in urine color
incision was done, the pelvic organs were
or stream. The patient complained also from
mobilized and the parietal peritoneum
marked dyspareunia. There is no change in
covering the mass was incised and the mass
bowel habits and no other abdominal
was dissected from all surrounding structures


Full Paper (vol.54 paper# 6)

Analysis of Circulating Heamocytes from Biomphalaria alexandrina following Schistosoma mansoni Infection using Flow Cytometry The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 41­ 53
Analysis of Circulating Heamocytes from Biomphalaria Alexandrina
Following Schistosoma Mansoni Infection Using Flow Cytometry
Eman G. Helal1, Shadia M. El- Dafrawy2, Amira H. Mohamed3, Basma M. Abou-El-Nour4,
Hoda M. Abu Taleb5, Samah Ibrahim6
Department of Zoology, Faculty of Science, Al-Azhar University (Girls)1,4, Department of Medical
Malacology2&6 , Electron Microscopy3, Environment5,Theodor Bilharz Research Institute
P.O. Box 30, Imbaba, Giza, Egypt.


Background: The internal defense system of snails consists of both cellular and humoral
components. Circulating haemocytes are the principle line of cellular defense. The susceptibility of
fresh water snails of genus Biomphalaria to infection by Schistosoma mansoni (S. mansoni) is linked
to the haemocytes present in the haemolymph. While the humoral component includes lysosomal
enzymes, that helps in recognition of pathogens and parasites.
Material and Methods: In the present work, Biomphalaria alexandrina (B. alexandrina), snails
were exposed individually to S. mansoni infection; according to their response they were classified
into susceptible group (shed cercariae) and resistant group (failed to shed cercariae). Snails not
exposed to infection were considered as control group. Flow cytometric analysis was carried out for
detecting apoptosis of B. alexandrina haemocytes isolated from pooled haemolymph and tissue.
This study is used to discriminate and count the percentage of viable, apoptotic, necrotic,
and dead cells in haemolymph of all studied groups. Comparing to control group, we observed that
viable cells were the most common cells that significantly decreased in both infected and non-infected
groups (P<0.001, P<0.01 respectively), and showed significant decrease in infected in comparison with
non-infected group (P<0.01). The haemolymph in infected group showed that dead cells were the most
common cells (more than the viable, apoptotic and necrotic cells). At the same time, the apoptotic cells
showed decrease in the condensation and de- condensation of DNA. This means failure to restore
Conclusions: There was a significant variation in the number of the cells between susceptible and
resistant snails. In susceptible snails the defense process failed, this was confirmed with increase of
the dead cells in the infected haemolymph. While in resistant snails the viable spreading cells
described as immunological active, are predominantly found in the haemolymph and tissue.
Key Words: Apoptosis; Biomphalaria alexandrina; Flow Cytometry, Immune response.

recognition of pathogens and parasites by
The internal defense system (IDS) of
marking them for destruction via opsonizing
snails is composed of cellular elements;
or directly killing(3,4). Apoptosis of immune
haemocytes and soluble factors present in
cells can play an important role in protection
haemolymph. They play an important role in
against parasites and pathogens by the innate
the innate immune responses of mollusks and
have important factors in fighting snail
immunologically silent and does not induce
infections(1). It is responsible for the
phagocytosis, cytotoxic reactions, and the
Haemocytes play the prominent role in
synthesis of the humoral factors(2). Humoral
parasite and pathogen elimination. The
factors play a fundamental role in the innate
haemocytes may be circulating in haemlymph
immune responses in mollusks(2). The
or fixed in tissues. Snail haemocytes are able
humoral components of the molluscan
to the mount a cytotoxic response against
immune defense include lysosomal enzymes
such as (- glucuronidase, acid and alkaline
The immune response is complemented
by the generation of highly reactive oxygen
lysozyme), lectins including agglutinins,
species (ROS). Internal defense system is one
fibrinogen-related proteins (FREPS), and C-
of the factors that influence the susceptibility
type lectins, antimicrobial peptides that aid in
pattern of the snails. This system is


Full Paper (vol.54 paper# 7)

Role of Low Density Lipoprotein in The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 54­ 61

Serum Low Density Lipoprotein and Serum High Sensitive C - Reactive
Protein as a Diagnostic Markers for Acute Coronary Syndrome
Samia A. Sadek Elsbai *, Zeinab H. EL-sayed *, Karima Y. Ahmed *, Nagwa A. Ghaffar
Mohamed**and Naglaa S. El-Kholy *.
Departments of Internal Medicine, Al-Azhar Faculty of Medicine (Girls)*, and of Clinical and
Chemical Pathology, National Research Center**, Cairo, Egypt.

Acute coronary syndrome (ACS) remains the major cause of mortality and
morbidity in the worldwide. Low density lipoprotein- cholesterol (LDL-C) level is a major risk
factor for the development of ACS, and pathogenesis of atherosclerosis. Atherosclerosis is a
multi-step disease and characterized by chronic low-grade vascular inflammation, which plays
a role in its every stage from onset, progression and finally to plaque rupture then triggers ACS.
Elevation of high Sensitive C-reactive protein (hs-CRP) is a strong and independent predictor
of cardiovascular disease.
The objective of this work
was to evaluate the role of serum LDL-C and serum hs-CRP in
patients with ACS.
Patients and Method: The current study enrolled 45 patients with confirmed ACS and 30
apparently healthy persons of matching age and sex as control group. The patients were
subdivided into three subgroups each one included 15 patients: Subgroup A: ST-segment
elevation myocardial infarction (STEMI). Sub-group B: Non­ST-segment elevation myocardial
infarction (NSTEMI), Subgroup C: Unstable angina pectoris (UAP). All patients and control
groups were subjected to measurement of low density lipoprotein- cholesterol (LDL-C), high
density lipoprotein- cholesterol (HDL-C), total cholesterol, triglyceride, highly sensitive CRP
(hs-CRP), cardiac troponin I (cTnI), and creatine kinase-MB fraction (CK-MB),
electrocardiography (ECG) and trans-thoracic-echocardiography.
Results: There was highly significant increase of serum LDL-C and serum hs-CRP in group I
as compared to group II (P=0.001) and significant increase of serum LDL-C ((P<0.05) and
highly significant increase of serum hs-CRP (P=0.01) in STEMI and NSTEMI subgroups when
compared to UAP subgroup and highly significant increase of serum LDL-C (P=0.005) and
serum hs-CRP(P=0.003) in UAP sub-group when compared to group II . There was also, a
positive significant correlation between serum LDL-C and both serum CK-MB and serum hs-
CRP in all subgroups.
Conclusion: Elevated serum LDL and hs-CRP may serve as markers of the severity of the
disease which help evaluation and management of ACS patients.
KEYWORDS: Acute coronary syndrome-Lipid profile-Hs-CRP.


The diagnosis of acute myocardial
ACS remains the major cause of
infarction in this setting requires a finding
mortality and morbidity in the worldwide
of the typical rise of biochemical markers
[1], which encompasses ST-segment
of myocardial necrosis in addition to at
elevation myocardial infarction (STEMI),
least one of the following: Ischemic
Non­ST-segment elevation myocardial
symptoms, development of pathologic Q
infarction (NSTEMI) and unstable angina
waves and ischemic ST-segment changes
pectoris (UAP) [2].Elevated demand can
on electrocardiogram [4].
produce ACS in the presence of a high-
grade fixed coronary obstruction, due to
atherosclerosis. Most cases of ACS occur
increased myocardial oxygen and nutrition
from disruption of a previously no severe
requirements, such as those resulting from
lesion (an atherosclerotic lesion that was
exertion, emotional stress, or physiologic
previously hemodynamically insignificant
stress e.g., from dehydration, blood loss,
yet vulnerable to rupture). The vulnerable
hypotension, infection, thyrotoxicosis, or
plaque is typified by a large lipid pool,
surgery [3].
DOI: 10.12816/0002431

Full Paper (vol.54 paper# 8)

boelela et al., 2014 The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 62­ 70

AStudy on APO B100/APO A1 Ratio as A Predictive Parameter for
Assessmentof CAD Risk in Uncontrolled Type 2 Egyptian Diabetic Patients
Magdy I. Aboelela1, Afaf D. Abd Elmajeed2, Hussein Abd Elmaksoud2,
Ahmed A. Sayed3.
1 Medical Sciences Department, Biochemistry - Faculty of Dentistry - Sinai University.
2 BiochemistryDepartment - Faculty of vet. Medicine -Benha University.
3 Clinical Pathology Department - Faculty of Medicine - Al-AzharUniversity.

this study was undertaken to study the biochemical effects of lipoproteins and apolipoproteins
on uncontrolled Egyptian patients with type 2 diabetes mellitus, and to study if Apo B100/Apo A1 ratio can
be used as a predictive factor for assessment of CAD risk in this patients.
Patients & Methods: this study was carried out on a group of 60 patients; 20 were non diabetic controls and
40 diabetic patients, who were subdivided into : controlled type 2 diabetic patients (Group I) and
uncontrolled type 2 diabetic patients (Group II), based on their glycated hemoglobin level. Levels of
triacylglycerols or triglycerides (TG), total cholesterol (TC), HDL-C, Apolipoprotein A1 and Apolipoprotein
B100, in addition to fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) were estimated,and also,
levels of LDL-C were calculated by Friedewald's formula in all studied cases. Blood samples were collected
after an overnight fasting of 10-12 hours, and divided into two parts, the 1st for separation of serum and the
2nd collected in an EDTA-containing tube for HbA1c determination. Results: the obtained results revealed
that, levels of total cholesterol, LDL-C and Apo B100 were comparable with no statistical significance
between uncontrolled type 2 diadetic patients (group II) with controlled type 2 diabetic patients (group I) and
control group.While, a highly significant increase in triacylglycerols levels in group II compared to group I
and control group. In contrast, a highly significant decrease in HDL-C and Apo A1 levels in group II
compared to group I and control group. Highly significant increase in Apo B100/Apo A1 ratio in group II
compared to group I, and a significant increase compared to control group, while it was comparable with no
statistical significance in group I compared to control group.
Conclusion: this study showed that there was an adverse effect of prolonged hyperglycemia on the
apolipoproteins in diabetic patients which is associated with dyslipidemia, good glycemic control is able to
make an improvement on this dyslipidemia. Apo B100/Apo A1 ratio can be used as a predictive parameter
for assessment of CAD risk in type 2 diabetes mellitus.
Key words: Type 2 diabetes mellitus, Apo B100/Apo A1 ratio, CAD.

acid levels and decreased glucose uptake resulting
Diabetes mellitus is a heterogeneous
from elevated insulin levels (1). Also, lipoprotein
chronic metabolic disorder, which is due to
oxidation (especially LDL-C) are more common
combination of insulin resistance and relative
in diabetes and are associated with a poor
insulin deficiency due to pancreatic cell failure,
glycaemic control.
and characterized by hyperglycemia which has a
Apo A1 which is the protein component
lot of various life threatening complications like
of HDL-C, and ApoB 100 which is the protein
atherosclerosis, retinopathy and nephropathy.
component ofLDL-C, have been reported that they
Type 2 DM often have both quantitative and
are better predictors of atherosclerotic diseases
qualitative abnormalities of lipoproteins that are
more than the routine lipid and lipoprotein
responsible for increased incidence of coronary
analysis(2). And, the Apo B100/Apo A1 ratio has
artery disease (CAD), which is three to four folds
been described to be a better parameter for the
higher in patients with type 2 DM compared to
prediction of CAD better than any other lipids,
non diabetics.
lipoproteins and its ratios (3).
abnormalities in non-insulin-dependent DM are
Apolipoproteins and Apo B100/Apo A1 ratio in
diabetic patients. So, this study was undertaken to
cholesterol concentration and decreased HDL
study the biochemical effects of lipoproteins and
levels, which frequently remain unchanged even
apolipoproteins on uncontrolled Egyptian patients
upon the proper treatment of glucose metabolism.
with type 2 diabetes mellitus, and to study if Apo
The alterations are related to increased free fatty
B100/Apo A1 ratio can be used as a predictive
DOI: 10.12816/0002432

Full Paper (vol.54 paper# 9)

d:\skydrive\Jor\vol54_10 The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 71­87
New Insights in the Roadmap of Liver Fibrosis Pathogenesis
Eman El-Ahwany1and Mona Zoheiry1
1Immunology Department, Theodor Bilharz Research Institute


Liver fibrosis is a wound healing scar response following acute and chronic liver diseases
including chronic hepatitis B and C, autoimmune hepatitis, non-alcoholic steatohepatitis and alcoholic
liver disease. The patho-histological findings of liver cirrhosis, the end-stage of liver fibrosis, show
hepatocellular death, a lobular inflammatory cell infiltrate, excessive deposition of extracellular matrix
(ECM) proteins, and the appearance of regenerative nodules that may result in liver failure, portal
hypertension and hepatocellular carcinoma.
The pathophysiology of liver injury has attracted the interest of experimentalists and clinicians
over many centuries. With the discovery of liver- HSC, the insight into the cellular and molecular
pathobiology of liver fibrosis has evolved and the pivotal role of Hepatic Stellate cell (HSC) as a
precursor cell-type for ECM­producing myofibroblasts has been established.. Although activation and
trans-differentiation of HSC to myofibroblasts (MFs) is still regarded as the pathogenetic key
mechanism of fibrogenesis, recent studies point to a prominent heterogeneity of the origin of
myofibroblasts .
The newly discovered pathways supplement the concept of HSC activation to myofibroblasts
(MFs), point to fibrosis as a systemic response involving extrahepatic organs (lung and kidney) and
reactions, and offer innovative approaches for the development of non-invasive biomarkers and anti-
fibrotic agents.
Key words: Liver Fibrosis ­ Myofibroblasts - Epithelial Mesenchymal Transition


The liver holds a unique position with
contribute only to 6.5% of the liver
regard to the blood circulation and it receives
volume, and 40% of the total number of liver
venous blood draining from almost the entire
cells, are localized in the sinusoidal
gastrointestinal tract via the hepatic artery. It is
compartment of the hepatic tissue [1]. The
a meeting point for antigens and leukocytes
walls of hepatic sinusoid are lined by three
circulating in the blood [1].Among the many
different cell types: Sinusoidal endothelial
functions of the liver, clearance of the blood
cells (SECs), Kupffer cells (KCs), and hepatic
from macromolecules and its mobilization are
stellate cells (HSCs), formerly known as fat-
important for the understanding of the liver as
storing cells, Ito cells, lipocytes, peri-
an immune-regulatory organ [2].
sinusoidal cells, or vitamin A-rich cells [4].
Additionally, intrahepatic lymphocytes (IHL),
The liver lobule is divided into both
including pit cells, i.e., liver-specific natural
hexagonal form of parenchymal cells which
killer cells, are often present in the sinusoidal
are the hepatocytes and non-parenchymal cells
lumen [5]. It has been increasingly recognized
. In contrast to hepatocytes that occupy
that both under normal and pathological
almost 80% of the total liver volume and
conditions, many hepatocyte functions are
perform the majority of numerous liver
regulated by substances released from
functions, non-parenchymal liver cells,
neighboring non-parenchymal cells [2] (Fig.1).



Full Paper (vol.54 paper# 10)

d:\skydrive\Jor\vol54_11 The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 88­93

Adipokines in Type 1 Diabetes Mellitus
Mohamed Al Saeed*, Nihad Al Nashar**,Sahar M Al Nefaie*
Hala A Mohamed**, Mohamed Ahmed***, Nesreen Al Margushi****
Department of Surgery, Taif University*, Department of Pathology, Taif University**,
Department of Radiology, Jazan University ***, Department of Medicine, Taif University****

Background and aim of the study: Leptin, resistin and adiponectin are the most important
adipokines which are influenced by body fat status, and their levels are closely related to vascular
dysfunction. This study aimed to estimate the concentration of serum adiponectin and leptin in type 1
diabetic children and to find their relationship to body mass index (BMI) and microvascular
Material and method: Weight (kg), height (m), BMI (kg/ m2) , random blood sugar, mean HbA1c,
urinary microalbuminurea, serum adiponectin and leptin concentration were assessed in 60 children
(34 males, 26 females) with type 1 diabetes and 60 healthy control children. Medical history, clinical
examination, anthropometric and pubertal assessment were done for the patients and controls. The
diabetic patients were classified depending on the pubertal stage into pre-pubertal group and pubertal
group, and according to gender into male group and female group.
Results: The results obtained showed significantly elevated of random blood glucose, HbA1c
(p<0.001), total cholesterol & low density lipoprotein (LD-L) (p<0.05), BUN (p<0.001), creatinine
(p<0.05), urinary microalbuminurea (p<0.001), serum adiponectin and leptin values (p<0.001) in type
1 diabetes children than control. In patients suffering from microvascular diabetic complications as
nephropathy and neuropathy, serum adiponectin and leptin levels showed highly significant increase.
The level of both adipokines was significantly increased with the increase in body mass index (BMI).
Conclusion: Serum adiponectin and leptin concentrations increase significantly in diabetic children
especially in those with increase in body mass index (BMI), than healthy control and in females than
males; puberty has no significant effect on their levels. Increase serum adiponectin and leptin
concentrations were associated with impairment of renal functions and neuropathy and they can be
used as marker for these complications.
Key words: Adipokines, Type 1 Diabetes Mellitus.

in recent years (7). Many authors reported that
Type 1 diabetes (T1D) accounts for about 5-
that in these conditions an elevated adiponectin
10% of all cases of diabetes and its incidence
level may be beneficial in reducing the risk of
is increasing worldwide (1, 2).Adipose tissue is
microvascular complications among type 2
an endocrine organ secreting several hundreds
diabetes patients. (8). Leptin is a polypeptide
of adipokines, and altered secretion of these
hormone synthesized predominantly by the
adipokines is a marker of adipose tissue
adipocyte and is thought to act as an afferent
dysfunction with expected increased risks of
satiety signal regulating weight through
insulin resistance, Type 2 diabetes, fatty liver
suppressing appetite and stimulating energy
expenditures (9). Leptin was found to increase
endothelial dysfunction, and atherosclerosis (3,
the peripheral insulin sensitivity and increase
4). Microvascular complications as neuropathy
the vasomotor sympathetic activity through the
and nephropathy are major complications of
activation of leptin receptors (OB-R) in the
diabetes and it was suggested that vascular risk
ventromedial and dorsomedial hypothalamic
profile such as anthropometric parameters;
regions and exerts a direct vasodilatation
lipid profile and adipose tissue derived
through different mechanisms, which include
hormones (specifically, leptin and adiponectin)
the release of endothelial nitric oxide (NO), as
all impact the development of these
well as the inhibition of the Ang II-induced
complications(4). Adiponectin shares in the
calcium increase and vasoconstriction in the
regulation of lipid and glucose metabolism and
vascular smooth muscle layer (10).In children
it is suggested to play a role in prevention of
with type 1 diabetes, the relationship between
atherosclerosis (5, 6). Diagnostic usage of
adiponectin, leptin, and the presence of
adiponectin was a subject of increasing interest
microvascular complications is not clearly


Full Paper (vol.54 paper# 11)

Axillary Nerve Conduction Study in Paretic Limbs of Patients with Cerebrovascular Stroke The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 94­100

Axillary Nerve Conduction Study in Paretic Limbs of Patients with
Cerebrovascular Stroke
Fahmy Emam Fahmy Emam*, Ahmed Fathy Mohammed Genedy**, Sobhia Ali Mahmoud*
* Rheumatology and Rehabilitation, Al-Azhar University, Faculty of Medicine for Girls
** Rheumatology and Rehabilitation, Director of Physical Medicine and Rehabilitation Centre for Armed
Forces at El-Agouza


To study the axillary nerve injury after shoulder sublaxtion in patients of stroke.

All eligible and consenting patients of stroke (underwent) electrophysiology studies of both axillary nerve.
The parameters include measurement of neuropathy motor latancy, CMAP (compound muscle action
potential) &SNAP (sensory nerve action potential) and the conduction velocity. This study included 33
patients with cerebrovascular stroke who were refered to the Physical medicine, Rheumatology and
Rehabilitation department at Al-Zahraa University hospital between 1st April and 31st December 2012.
They were 23 males and 10 females, their ages ranged from 27 to 72 years. The paretic limbs of the
patients included were classified as case limbs, while the non-paretic limbs were classified as controls.
Results: Axillary nerve latency and amplitude were high significant in shoulder subluxation in the
hemiparaetic side in comparison with control significant.
Conclusion: There is lower motor neuron axillary nerve in stroke patients, mixed type (demylinated and
axonal), the incidence of axillary nerve lesion is mostly with stroke shoulder subluxation .
Keywords: Stroke; axillary nerve; nerve conduction studies.


Cerebrovascular stroke is a sudden onset
balance or coordination. (*) Sudden severe
neurological deficit due to compromised blood
headache with unknown cause(4).
supply to the brain. It is the third most common

Good shoulder function is a prerequisite
cause of death and disabling neurological
for effective hand function, as well as for
damage. Worldwide about 15 million individuals
performing multiple tasks involving mobility,
have a stroke and about one third of them die(1).
ambulation, and activities of daily living. A
There are two types of stroke; ischemic stroke,
common sequela of stroke is hemiplegic shoulder
which occurs in approximately 85% of patients
pain that can hamper functional recovery and
due to occlusion of the vascular supply to the
subsequently lead to disability. It can begin as
brain by a thrombus or embolus. The other type is
early as 2 weeks poststroke but typically occurs
hemorrhagic stroke which occurs in about 15%
within 2-3 months poststroke(3).
of patients when impaired blood flow is due to

Glenohumeral subluxation (GHS), a
hemorrhage in the brain(2). A common sequela of
frequent complication for patients with a
stroke is hemiplegic shoulder pain that can
poststroke hemiplegia, is reported to be present in
hamper functional recovery and subsequently
17 to 81 percent of patients with hemiplegia
lead to disability. It can begin as early as 2 weeks
following stroke (5).
poststroke but typically occurs within 2-3 months

poststroke(3). The most common manifestation of
Patient and methods:
stroke is sudden weakness of the face, arm or leg,
This study was conducted on 33 stroke
most often on one side of the body (Hemiparesis).
patients with hemiparesis who were recruited
Other warning symptoms can include: (*)Sudden
from the Physical medicine, Rheumatology and
numbness of the face, arm or leg, especially on
one side of the body. (
University hospital between 1st April and 31st
*) Sudden confusion,
trouble speaking or understanding speech. (*)
December 2012. The paretic limbs of the patients
Sudden trouble seeing in one or both eyes. (
included were classified as case limbs, while the
Sudden trouble walking, dizziness, loss of
non-paretic limbs were classified as controls.


Full Paper (vol.54 paper# 12)

d:\skydrive\Jor\vol54_13 The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page


Efficacy of Aqueous Extract of Saffron (Crocus sativus L.) in
Modulating Radiation-Induced Brain and Eye Retina Damage in Rats
Abd El-Azime A. Sh1., Sherif N.H.2 and Eltahawy N. A3
Radiation Biology Department1, Drug radiation research Department2 National Centre for
Radiation Research and Technology (NCRRT), Atomic Energy Authority(AEA) , Cairo, Egypt.
and Faculty of Applied Medical Science, Misr University for Science and Technology3 (MUST)

Background: Saffron (Crocus sativus L.) is a plant of the iris family (Iridaceae). Its stigma contains
crocin, anthocyanin, carotene and lycopene which are known to have pharmacological effects on various
illnesses. The aim of present study was to investigate the role of aqueous extract of saffron on the
radiation-induced changes in rat (eye retina, brain) tissues and blood. Material & methods: Saffron was
supplemented orally, via gavages to rats at dose of 100 mg/Kg body wt/day for 2 weeks pre-exposure to
6.5 Gy (one shot dose) of whole body gamma-irradiation. Animals were sacrificed at the 1st day post
radiation exposure. Results: whole body gamma irradiation of rats induce oxidative stress in eye retina
and brain tissues and blood identified by significant elevation in the level of malondialdhyde (MDA),
advanced oxidation protein products (AOPP) and protein carbonyl (PC) contents associated with
significant decreases of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (Gpx)
activities, and glutathione (GSH) content. Oxidative stress was concomitant with a significant decrease in
brain dopamine (DA), norepinephrine (NE) and epinephrine (EPI) contents. Supplemented with Saffron
extract pre- irradiation have significantly reduced the severity of radiation-induced oxidative stress and
catecholamines alteration in the organs under investigations.Conclusion: Saffron exerts its modulating
effect in the organs under investigations due to the presence of associated bioactive compounds with
antioxidant properties.
Keywords: Saffron, eye retina, brain, gamma rays, blood, rats, Lipid peroxidation, Oxidative stress

molecules and cells of Retina and brain are
Exposure of animals to ionizing
approved (2).
radiation as a one shot dose causes a series of
Effects of ROS are usually repaired before
physiological changes known as acute radiation
mutation by two important pathways, one of
syndrome, which is dependent mainly on the
them, when the body's natural defense system
exposure dose and may lead to death. One of
and antioxidants consumed in the diet (3). The
the basic mechanisms of radiation damage is
role of alternative medicine is a phytotherapy in
the production of free radicals, leading to the
various diseases. Phytotherapy is broadly
formation of peroxides and oxidative reactive
defined as the use of natural therapeutic agents
species that damage protein, lipids and nucleic
derived from plants or crude herbal drugs (1).
acids. Free radicals are also known to cause a
Crocus sativus L. commonly known as
pronounced decrease in antioxidant capacity
Saffron is a stemless herb of the Iridaceae
and an excessive increase in oxidative stress (1).
family. Its pharmacologically active and
Radiation damage in biological systems is
important constituents are safranal, crocin,
largely caused by the overproduction of
picrocrocin and crocetin) 4). Saffron has been
reactive oxygen species (ROS), including
constantly used in traditional medicine, as
superoxide anion (O ·-
therapy for several conditions such as
2 ), hydroxyl radical
(·OH), and hydrogen peroxide (H
insomnia, depression, bronchospasm, cardio-
2O2), that
overwhelm the levels of antioxidants, resulting
vascular diseases, gastrointestinal disorders,
in oxidative stress. One of the most important
menstrual pain, menopausal problems, as
consequences of oxidative stress is lipid
analgesic, and even against cancer (5,6). Some of
peroxidation. Damaged effects of ionizing
the medicinal-biologic properties of Saffron or
radiation, free radicals or oxidative stress on the
its components are attributed to its antioxidant


Full Paper (vol.54 paper# 13)

d:\skydrive\Jor\vol54_14 The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 109­116

Influence of Tropaeolum majus Leaves Extract in Ameliorating
Damage Induced by Gamma Radiation in Rats
Drug and Radiation Research Dept., National Centre for Radiation Research and Technology
(NCRRT) P.O. Box: 29, Nasr City, Egypt.

Background:Medicinal plants were commonly used in primary health care.They can
ameliorate the action of oxidative stress and free radical-induced damage. The present study
was proposed to investigate the possible hepatoprotective role of hydroethanolic extract of
Tropaeolum majus leaves (HETM), in modulating the toxicity and the oxidative stress
induced by exposure to gamma radiation (IR) in the liver of male rats.
Material &methods: HETM (300 mg/kg body weight) was administered to male albino rats
via gavages during 21 successive days before whole body exposure to gamma rays (6 Gy) and
during 7 days after irradiation. The animals were sacrificed on the 7th day post-irradiation.
Results:the exposure to gamma-radiation caused liver dysfunction manifested by significant
(p<0.05) increases in the plasma level of the alanine aminotransferase (ALAT), aspartate
aminotransferase (ASAT), alkaline phosphatase (ALP), total cholesterol, low density
lipoprotein (LDL-C) and triglycerides. Moreover, IR induced oxidative stress as indicated by
a significant increase in the level of thiobarbituric acid reactive substance (TBARS) with a
concomitant decrease in the reduced glutathione (GSH) content as well as in the activity of
superoxide dismutase, (SOD) and catalase (CAT) in the liver tissue. Pretreatment with HETM
in IR-treated rats alleviated the previously mentioned alterations in the biochemical and
oxidative stress parameters and restored their values toward the normal value of the control
Conclusion: hydroethanolic extract of T.majus leaves by its bioactive components and
essential trace elements content might attenuate the severity of radiation-induced biochemical
disorders in liver tissues.
Key words: Tropaeolum majus, -radiation, antioxidant, Lipid profile, liver enzymes.

popular practice of food industrialization
Free radicals are produced from normal
and food conversion processes destroy
oxygen metabolism within the body, and

from exposure to certain chemicals,
antioxidants, allowing the body to be
more susceptible to disease and ill health.
radiation, parasites, dietary fats, and more.
Consequently, the body has an extremely
During radiation exposure or as a
antioxidants to combat the contaminants.
metabolic reactions, molecular oxygen
undergoes sequential reduction to form
during radiation exposure has been shown
to reduce the severity of the radiation
superoxide anion and hydroxyl radical, in
injury, yet some of their properties such as
addition to hydrogen peroxide. All are
cytotoxicity (2), pro-oxidant activity(3
implicated in the pathogenesis of aging
)limited their therapeutic application. Use
and diseases including cancer (1).
of plant extracts, food supplement which
The body naturally protects itself against
augment major cellular endogenous
compounds e.g. superoxide dismutase,
administration have been identified as a
promising therapeutic approach to combat
glutathione peroxidase. Antioxidant plays
oxidative stress associated with heart
an important role in scavenging oxidants
According to World Health Organization
Unfortunately, the continual bombardment
(WHO), 65-80% of the world populations
of stress, environmental pollution, and the
rely on traditional medicine to treat
various diseases(5). The WHO recommends


Full Paper (vol.54 paper# 14)

d:\skydrive\Jor\vol54_15 The Egyptian Journal of Hospital Medicine (January 2014) Vol. 54, Page 117­128
Effect of Diclofenac on Plasma Glucose level, Insulin Resistance,
Inflammatory Markers and Hepatocytes in Diabetic Albino Rats
Ashraf M. Mostafa, 1 Waleed S. Mohamed, 2 Abdel Hamid A. Serwah, 2
Mohamed A. Serwah 2
Anatomy and Histology Department,1 Internal Medicine Department,2
College of Medicine, Taif University, KSA.
Author of Correspondence: Waleed Samy, Internal Medicine Department, College of Medicine, Taif University.
E-mail: wsmohamed1@yahoo.com. Mobile: 00966/553420886

Background and aim of the study:
diabetes was proposed to be an inflammatory disease. Growing
evidence has pointed to a correlation between various proinflammatory cytokines, insulin resistance (IR)
and type 2 diabetes (T2DM).
Materials and Methods: This study was carried out on one hundred Albino rats, distributed into four
groups. Group I: control group, Group II: diabetic rats with no treatment, Group III: diabetic rats treated
with Glipenclamid and Group IV: diabetic rats treated with Diclofenac sodium. Blood samples were taken
and the following biochemical parameters were done: fasting blood glucose (FBG), serum insulin,
aspartate transaminase (AST), Alanine transaminase (ALT), serum Alkaline Phosphatase (ALP), serum
protein, serum albumin, serum triglyceride (TGs), serum cholesterol level (TC), High Density Lipoprotein
(HDL), Low Density Lipoprotein (LDL), Tumor Necrosis Factor (TNF-) and C-Reactive Protein (CRP).
HOMA IR and HOMA B were calculated. Liver samples from all rats were obtained and stained with
Hematoxylin and Eosin, Masson's trichrome and Periodic acid­Schiff (PAS) for histological examination.
Results: Declofenac caused significant lowering in FBG, lipid profile, TNF- level, CRP, increased
insulin secretion with improved IR and beta cell function compared to the diabetic group. There was a
positive correlation between HOMA-IR and CRP; HOMA-IR and serum TNF-. Liver of diabetic rats
showed periportal fibrosis, vacuolated cytoplasm and nuclei and glycogen deposition. These changes
improved markedly in Glibenclamide treated groups while liver of Declofenac treated group revealed
parenchymal cell necrosis, sinusoidal dilatation with some pyknotic nuclei and marked glycogen
Conclusions: inflammatory pathways may play an important part in IR of T2DM. Therefore,
antinflammatory drugs may have a role in diabetes therapy through improving IR because of its insulin-
sensitizing and anti-inflammatory properties.
Key Words: Diabetes Mellitus, Inflammation, Insulin Resistance; Diclofenac Sodium, Glibenclamide
Histopathological Liver Changes.


Diabetes mellitus (DM) is possibly the world's
as the compensatory hyperinsulinemia is
fastest growing metabolic disease, so there is a
adequate to overcome the IR, glucose tolerance
great need for more appropriate therapies. (1) A
remains relatively normal. In patients destined to
lot of evidence suggests that insulin resistance
develop T2DM, the beta cell compensatory
(IR), defined as a state of reduced insulin action
response fails, and relative insulin insufficiency
in peripheral tissues, such as the skeletal muscle,
develops, leading to impaired glucose tolerance
adipose tissue, and liver plays a critical role in
and eventually frank T2DM.(3)
the development and onset of T2DM. (1, 2) A
T2DM and the IR syndrome have recently been
number of epidemiological studies have
hypothesized to represent an acute phase
demonstrated that IR exists in the prediabetic
response.(4) This is in part due to the strong
state, often predating the onset of DM by many
correlation between elevations in the local and
years. In the presence of IR, a normal beta cell
circulating proinflammatory cytokines, TNF,
will increase production of insulin, and as long
interleukin-1 (IL-1), interferon, and IL-6 and IR.


Full Paper (vol.54 paper# 15)