d:\skydrive\Jor\vol55_1 The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 129­136

Effect of Electron beam on Prepared HAP-Gel Composition
Naima A. El Gendy*,Tawfik M. S.**, and Asma M. Nour***
Radiation Polymer Chemistry Department*, Radiation Health Research Department*,
National Centre for Radiation Research and Technology (NCRRT) and Radioisotope
Department, AEA, Egypt ***.


Polyvinyl alcohol liquid PVAl was used as the organic carrier for Hydroxylapatite-gel
(Hap-gel) composite. PVAl has the ability to form a nano- hydroxylapatite polyvinyl alcohol
composite gel which has a wide range of uses in different environmental and medical applications.
Prepared Hap-gel is known to have a very similar composition to human bone and is used as a
substitute for bones in compound fractures and artificial dentures.

Matreia and Methods: In this work prepared HAP- gel was exposed to a high ionizing radiation
electron beam (5 kilo Gray) and an aqueous solution containing aluminum ions (Al+). Some
investigations were done to illustrate the effect of radiation exposure and aluminum contamination on
prepared Hap-gel.

Results: Energy dispersive X-ray analysis (EDx) showed that the electron beam used caused an
obvious increase in the calcium ions (Ca++) content of the prepared Hap-gel from 60% to 65.69 %
with a prominent decrease in phosphorus ions (P +) content from 40 % to 34.31 % in addition to an
increase in the Ca/P ratio from 1.5 to 1.91. Exposure of the pre-irradiated Hap-gel samples to
aluminium ions (Al+) resulted in a noticeable decrease in Ca++ content from 65.69 atomic % to 32.14
% atomic % and a further noticeable decrease in P+ content from 34.31 % atomic % to 13 atomic % as
well as an increase in the Ca/P ratio from 1.91 to 2.47. The levels for the original prepared Hap-gel
were Ca++; 60 atomic % and P+; 40 atomic %. It was deduced that exposure of the Hap-gel to Al+ had
a further damaging effect on the pre-irradiated Hap-gel composition in addition to the damaging effect
that the electron beam used induced on the samples.

Conclusions: it could be concluded that electron beams and Al+ have an injurious effect on human
bone tissue taking into consideration the similarity in composition between Hap-gel and bones.
Therefore, this study could be beneficial in the field of osteoporosis research and assist the
understanding of the effects of radiation such as that of electron beams and some pollutants such as
aluminium present in running water on the health of human bone tissue.

Hap-gel, Calcium, Phosphorus, Aluminium, Electron Beam.

architecture of bone tissue, and an increased
Osteoporosis is a systemic skeletal
risk of fragility fractures. Twin and family
disease responsible for the high occurrence of
studies have shown high heritability of BMD
fractures in older subjects, particularly in
and other factors related to fracture risk such
postmenopausal women. Its increasing
as ultrasound properties of bone, skeletal
incidence with population ageing and
geometry and bone remodeling.
prolonged life expectancy raises the rates of

linked morbidity, loss of independence, and
Vulnerability to osteoporosis is ruled
mortality. Bone mineral density (BMD) and
by many different genetic variants and their
preceding fracture history are two main risk
interaction with environmental factors such as
factors allied with osteoporosis such as the
diet and exercise (2).
presence of prior fractures can predict future

fractures (1)Osteoporosis is a common disease
Several epidemiological studies have
with a strong genetic component characterized
shown a positive correlation between
by reduced bone mass, faults in the micro-
osteoporosis and low socioeconomic status. A

DOI: 10.12816/0004497


Full Paper (vol.55 paper# 1)

d:\skydrive\Jor\vol55_2 The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 137­141

Relationship between Coronary Risk Factors, C-Reactive Protein, Bone
Mineral Density and Carotid Circulation Among Frail Elderly
Moatassem S. Amer1, Tamer M. Farid1, Ekrami E. Abdel-rahman1,
Deena M. EL-maleh1*,Omar H. Omar2, Randa A. Mabrouk3
1Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Cairo,
Egypt.2Radiodiagnosis Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt;
3Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding Author: doc_dodi80@yahoo.com

: Frailty may now be regarded as a geriatric syndrome of decreased reserve and resistance to
stressors, resulting from cumulative declines across multiple physiologic systems, causing vulnerability to
adverse health outcomes including falls, hospitalisation, institutionalisation and mortality. The
inflammatory mediators as C-reactive protein have been associated with the development of the geriatric
frailty. Several studies have pointed out increased level of homocystiene in frail elderly Increasing frailty
was associated with lower bone mineral density, as both bone mass and muscle strength decrease during
ageing and this has also been associated with higher risk of osteoporotic fractures in frail elderly.
Objective: To compare frail and non-frail elderly regarding Bone mineral density, carotid circulation and
serum levels of Homocysteine, coronary risk factors and CRP.
Methods: 104 elderly patients, who were assigned to 2 groups. Group A (52 frail participants):
diagnosed by Fried's criteria as applied by Avila-Funes et al., 2008. Group B (52 non-frail
participants).All participants were subjected to the following: through history, physical examination,
ADL, IADL assessment, MMSE ,GDS, laboratory investigations including; CRP, homocystiene and total
lipid profile, measurement of bone mineral density by DEXA and carotid intima-media thickness by
carotid duplex.
Results: There was no statistically significant difference in age, sex, among both groups.Frail participants
had higher ADL and IADL dependence, higher incidence of depression, cognitive impairment and
osteoprosis.They also had higher levels of homocystiene , CRP , CIMT and lower levels of HDL
Conclusion: Osteoporosis is more prevalent among frail elderly also frailty is associated with more ADL
& IADL dependence, higher GDS scores & lower MMSE score in addition to higher mean level of
homocystiene, CRP & triglycerides in addition to low serum HDL & higher CIMT.
Key words: Frailty, comprehensive geriatric assessment, coronary risk factors, osteoporosis.

vulnerability. Hip fracture is the major
Frailty is often conceptualized by health care
complication confronting elderly subjects and
providers as a state of late life decline and
this too is a major public health problem. Frail
vulnerability characterized by weakness and
subjects seem to be particularly exposed to this
decreased physiologic reserve. Frail older adults
complication 3.
are less able to adapt to stressors such as acute
Aim of the study: To compare frail and non-frail
illness or trauma. Their increased vulnerability
elderly regarding bone mineral density, carotid
leads to adverse outcomes including falls,
circulation and serum levels of homocysteine,
institutionalization, disability, and death1
coronary risk factors and CRP.
With aging, cardiovascular (CV) diseases
Patients and Methods: The study is a Case-
become more frequent and complicated. There is
control study. 104 Elderly patients (60 years old
an emerging body of literature linking CVD and
and above), both males and females were
frailty both at the mechanistic level and the
recruited from Ain Shams University hospital
epidemiologic level 2.Osteoporosis appears to be
from January 2011 till December 2012. One
a good marker of frailty. It is a sign of

DOI: 10.12816/0004498

Full Paper (vol.55 paper# 2)

d:\skydrive\Jor\vol55_3 The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 142­145
Hallermann-Streiff syndrome
A case report from Egypt
Fatma A. Atwa*, Mona M.A. Farag*, Mona N. Mansour*& Abeer F. Albadry*
*Ophthalmology department, Faculty of Medicine (For Girls), Al Azhar University

Hallermann-Streiff syndrome (HSS) is a rare genetic disorder that is primarily characterized by
distinctive malformations of the skull and facial (craniofacial) region; sparse hair (hypotrichosis); eye
abnormalities; dental defects; degenerative skin changes (atrophy), particularly in the scalp and nasal
regions; and proportionate short stature. Here we describe a case with HSS.
Keywords; Hallermann-Streiff syndrome, congenital cataract, Microphthalmos.


prominent forehead and sides of the skull) with
Hallermann- Streiff syndrome (HSS) (also
parrot-beak nose (a thin, pinched, tapering nose)
known as oculo-mandibulo-facial syndrome) is a
and micrognathia (a small, underdeveloped
rare congenital disorder characterized by
lower jaw; hypoplastic mandible), with receding
dyscephaly, dental anomalies, proportionate
chin (retrognathia), sparse hair of the scalp,
nanism, hypotrichosis, cutaneous atrophy
eyelashes & eyebrows (hypotrichosis), skin
limited to the head, bilateral congenital cataracts
atrophy and proportionate dwarfism {Fig. 1}. He
and bilateral microphthalmia. [1]
has normal intelligence, with no neurologic
Various ocular findings and fundus
anomalies have been reported, including
Ophthalmic examination revealed right
vitreous degeneration, retinal folds, coloboma,
and Coats' disease. [2]
nystagmus, strabismus, down slanting palpebral
Cataract and microphthalmos are the most
fissures & madarosis.
The measured visual acuity (Lea Gratings:
abnormalities may be the primary cause of poor
253300 depending on preferential looking) was
vision. [3]
0.25(Rt. Eye) & 0.50(Lt. Eye) {Fig. 2}. The used
Case report
distance was approximately 57cm (at this
1.5 years-old male infant was referred to the
distance 1cm equals 1 degree of visual angle).
Ophthalmology Department of Faculty of
On plotting the measured visual acuity of this
Medicine, Al Azhar University because of
infant against his age on the curve, it was below
congenital cataract.
He was the 3rd child of non consanguineous
The average corneal radius of curvature was
parents with old paternal age. His parents were
5.92mm (right) and 5.74mm (left); extreme
healthy. He had one brother & one sister both of
them was totally healthy. He was born by
A-scan Biometry (Mentor-Advent Digital
normal vaginal delivery after uneventful
pregnancy. His family history was irrelevant.
microphthalmia (axial length, 8 mm OU)
On genetic counseling there was no detectable
{Fig.3}, with the use of the contact technique
where the probe was placed on the center of the
Following the initial diagnosis of congenital
cornea with caution not to compress the cornea
cataract, the patient underwent a surgical
till 5 readings were obtained. The provided
intervention in one eye (the Left) at 6 months of
measurements in the automatic mode reflect the
axial length from the corneal gate backwards to
The general examination revealed the
the termination of the orbit instead of the retina
typical features of the Hallermann- Streiff
(17.54mm OD & 18.06 mm OS instead of 8mm
syndrome (six out of the seven diagnostic
OU) reflecting extreme microphthalmos that was
criteria), including dyscephaly (an unusually
DOI: 10.12816/0004499

Full Paper (vol.55 paper# 3)


The Potential Protective and Therapeutic Effects of Aloe Vera Juice on
Malathion Induced Hepatotoxicity in Rabbits
Mohamed S. Al-Shinnawy, Ahmed R. Hassan, Dalia A. Ismail and Mohamed A. Shahin
Biological and Geological Sciences Department - Faculty of Education ­ Ain Shams University


Background: the potential protective and therapeutic effects of Aloe vera juice against malathion
induced hepatotoxicity were evaluated in this study.
Material and methods: one hundred twelve young male rabbits were used ; they were allocated
into two sets of experiments included rabbits treated for short (7 days) and long (21 days) periods.
Animals of the first set (short period of treatment) were divided into eight groups; each consisted of four
treated groups and four control groups (each treated group had its own control). The animals of the first
group were orally dosed with Aloe vera juice (0.84 ml/kg b. wt.). Rabbits of the second group were orally
dosed with malathion (5 mg/kg b. wt.). The third group animals were dosed orally with malathion
concomitant with Aloe vera juice (this group served as the protective group). Animals of the fourth group
were dosed orally with malathion; for 7 days followed by Aloe vera juice for the same period (this group
served as the therapeutic group). The design of the second set (long period of treatment) was exactly
similar to that of the short period experiments (divided into eight groups; four treated and four control
groups) except the duration of treatment which extended to 21 days. Animals of the control groups of
Aloe vera treated rabbits were dosed with distilled water, and those of malathion treated animals were
dosed with the solvent of the insecticide. All the animals were sacrificed, blood samples were collected
and the serum was used to determine the levels of hepatic enzyme markers: lactate dehydrogenase (LDH),
aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT) and alkaline phosphatase (ALP) as
well as the total bilirubin.
Results: the results revealed that treatment of rabbits with malathion caused marked increase in the
serum activity of LDH, ASAT, ALAT and ALP in treated rabbits. Administration of Aloe vera juice (in
the protective and therapeutic groups) was found to be effective in lowering the elevated activities of these
enzymes to approximate near normal levels for both the short and long periods of treatment, especially in
the activity of LDH, ASAT and ALP. The present results suggested that Aloe vera juice has ameliorative
effects against hepatotoxicity produced by malathion in the treated rabbits.
Keywords: Hepatotoxicity; Aloe vera juice; malathion; liver function; rabbits.

animals due to exposure to organophosphorus
The pollution of the environment plays a
insecticides,(6) especially in the liver,(7,8) and the
crucial role in the occurrence of many diseases
kidney. (9)
affecting plants, animals and mankind. One of
Malathion, a prominent organophosphate
the most significant factors which results in the
insecticide, is extensively used to control pests.
pollution of the environment is the irrational use
(10) Malathion has been proven to contain highly
toxic impurities and damage non-target
Organophosphorus insecticides are widely used
organisms and is considered to be mutagenic.(11)
for a variety of agricultural and public health
Several studies have shown that malathion
applications.(2,3) They produce a wide range of
induced various physiological, biochemical,
immunological, and histological changes in
experimental animals.(12)
Aloe vera barbedinesis Miller (Aloe vera)
acetylcholine in synaptic junctions leading to
is a well-documented medicinal plant in the
excessive stimulation of the postsynaptic cells
literature. It belongs to the Liliaceae family
resulting in cholinergic toxicity.(4,5) Many
which includes about 420 species. Common
alterations have been observed in the organs of
names of Aloe barbedinesis Miller include Aloe

DOI: 10.12816/0004500

Full Paper (vol.55 paper# 4)

d:\skydrive\Jor\vol55_5 The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 159­164
Wilms' Tumor in Children : A Single Institution 10-Year Experience
Maher K. Mustafa M , Mufeed K. Hamoury M, Salma S. Hassan R.
Pediatric Hematology/Oncology division, Queen Rania AL- Abdullah Children Hospital, King Hussein
Medical Center (KHMC), Amman-Jordan.
Correspondence should be addressed to Dr. Maher Khader:
E-mail: maherrmostafa@yahoo.com , Mobile number 00962772183106


Objective: To evaluate the disease characteristics and treatment outcome of children with wilms' tumor
at King Hussein Medical Center over a period of 10 years.
Methods: We conducted a retrospective review of the medical files of children ( < 14 years ) with
wilms' tumor who were managed at King Hussein Medical Center -Jordan in the interval between June,
2000 until June, 2010 . Patients' and disease characteristics, treatment modalities and outcome were
analyzed. Staging and histopathological classification were preformed according to the system of the
National Wilms Tumor Study Group (NWTSG). Descriptive analysis using frequencies was used to
describe the study variables.
Results: A total of 61 patients (54.1% female) with wilms' tumor with a median age of 40 months were
identified. Their ages ranged between seven months and 7.8 years. The stage frequencies of our cases
were : stage I ( 27.9 % ) , stage II (34.4 % ) , stage III ( 16.4 % ) , stage IV ( 11.5 %) and stage V ( 9.8 %)
. The 3- year relapse-free survival rate was 100%, 81%, 70%, 57.1% and 83.3% for stages I , II , III , IV
and V, respectively. Favorable histology accounted for 86.9 % (53 cases) of our patients . The 3-year
relapse-free survival rate was 84.9% for the favorable histology and 62.5% for the anaplastic histology
.The 3- year relapse-free survival rate for the entire group was 82%.
Conclusion: Combined modality management including surgery , chemotherapy and radiotherapy
resulted in satisfactory loco-regional and systemic control and better relapse-free survival in pediatric
patients with wilms' tumor . Stage and histopathologic classification of the disease were important as
prognostic factors.
Key words :wilms' tumor , Staging, histology ,Favorable ,anaplastic.


Wilms' tumor was named after the 19th century
currently used systems , the first is a
German pathologist and surgeon Carl Max
postchemotherapy- based system developed by
Wilhelm Wilms.1 It originates from metanephric
the International Society of Pediatric Oncology
blastema cells that are unable to complete
Renal Tumors Study Group (SIOP-RTSG) in
differentiation, resulting in triphasic tumors
Europe , while the second is an up-front,
composed of epithelial, stromal and blastemal
surgery-based system developed by the
National Wilms Tumor Study Group (NWTSG,
Wilms' tumor , or nephroblastoma , is an
now the Renal Tumors Committee of the
embryonal cancer of the kidney that occurs
Children's Oncology Group) in North America.
mainly in young children.3It is the most common
10,11 In our institute at King Hussein Medical
renal tumor in children and represents
Center apply the frequently utilized staging
approximately 95% of all pediatric renal
system developed by the NWTSG ,which
malignancies.4,5 It is rarely found in adults with
includes 5 stages and correlates with prognosis.
less than 1% of all WTs present in adults.6
Histologically , Wilms' tumor is classified into
Nowadays, It accounts for about 6 percent of all
anaplastic histology (AH) and favorable
childhood cancer cases in Europe and the United
histology (FH). Anaplastic histology is
States. 5,7,8 In the United States, Wilms' tumor
identified by the presence of cells with nuclear
accounts for approximately eight cases per
enlargement, nuclear atypia and irregular mitotic
million children less than 15 years of age per
figures , which can be either focal or diffuse
year.9 Wilms' tumor staging relies on two major
anaplasia. The anaplastic histology accounts for

DOI: 10.12816/0004501

Full Paper (vol.55 paper# 5)

d:\skydrive\Jor\vol55_6 The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 165­174

Prevalence of Glucose-6-Phosphate Dehydrogenase and Thyroid
Hormones Deficiency in Neonatal Jaundice
1Wael R Hablas , 2Salwa K El- Nabarawy 2Nadia F Ibrahim and 3Noha M Radwan
1 Clinical Pathology Department, Faculty of Medicine, Al Azhar University (Boys Branch) ,
2Zoology Department Faculty of Science Al Azhar University ( Girls Branch) and 3 Nile
Company for Pharmaceutical & Chemical industries, Research & Control Sector.

G6PD deficiency is the most common inherited metabolic disorder and clinically significant red cell
enzyme defect in man. Severe neonatal jaundice proved to be the most common clinical manifestation
and a globally important most dangerous consequence of G6PD deficiency. Prolonged jaundice is
sometimes associated with congenital hypothyroidism. So the early characterization of G6PD activity
and thyroid hormone levels provides an etiological diagnosis for neonatal jaundice as well as the
opportunity to give the newborn's family information concerning hemolytic crisis prevention and an
early management in case of hypothyroidism.
Aim: This study was conducted in an attempt to evaluate the prevalence of G6PD deficiency and
hypothyroidism in relation to neonatal physiological hyperbilirubinemia.
Subjects and Methods: The study included 50 neonates aged between 6 hr ­ 5 days, forty infants had
jaundice and the other ten (control), were healthy neonates, matching the same age. All infants of the
study were subjected to C-RP test, routine hematological evaluation, and serum total bilirubin levels,
quantitative red blood cells G6PD assay and thyroid hormone levels.
Results: All the fifty cases of both jaundiced and healthy neonates were negative for C-RP test
indicating that the 40 cases had physiological jaundice .The study revealed that G6PD enzyme was
lower than normal level in 2 cases (5%). TSH level was found to be higher than normal in 13
jaundiced neonates out of 40 (33%). Seven jaundiced neonates (18%) had T4 hormone lower than
normal while all the 40 jaundiced cases had normal T3 level. Correlation of the total bilirubin was
significant with TSH and T3 at 0.05 levels, while there was no significance with both T4 and G6PD.
Conclusion: statistically there was no correlation between bilirubin and both G6PD enzyme and
thyroid hormones, but the incidence of hypothyroidism in this study was high (18%) and the incidence
of G6PD deficiency was (5%). This indicates a role of G6PD deficiency and hypothyroidism in
developing neonatal jaundice among neonates. So, early neonatal screening program is recommended
for early management.
Key words: Neonatal jaundice, G6PD deficiency, Thyroid hormones.


Early-onset hyperbilirubinaemia is a high-risk

condition because it often presents with an acute
is a common reason for neonates to present in
and rapid rise in bilirubin values. Although the
the emergency department (5).
outcome for most is benign, infants with
Hyperbilirubinemia is caused both by increased
extremely high serum bilirubin can develop
production of bilirubin as the heme in red blood
acute bilirubin encephalopathy in the absence of
cells is broken down and by decreased bilirubin
urgent intervention (1) depending on the
excretion due to inadequate hepatic conjugation
permeability of the blood brain barrier to
and increased enterohepatic reabsorption (6).
Although physiological jaundice is more
hyperbilirubinemia, (defined as a serum total
frequent as compared to pathological jaundice, it
bilirubin level exceeding 5 mg/dl) is a frequent
is very important to differentiate between the
problem (3). Neonatal jaundice affects 60% of
two, as pathological jaundice may lead to
full-term infants and 80% of preterm infants in
kernicterus and subsequently brain damage.
the first three days of life. Although transient, the
Treatment is dependent upon the amount of
condition accounts for up to 75% of hospital
serum bilirubin and various other laboratory
readmissions in the first week after birth (4) and it
investigations. Thus laboratory workup is very
DO I: 10.12816/0004502

Full Paper (vol.55 paper# 6)

d:\skydrive\Jor\vol55_7 The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 175­183

Effect of Microcytic Hypochromic Anemia and Parasitic Infestations on
Stature in Adolescents
Hanan A.Fathy1, Tawfik M.S1, Nawal M.Khalifa 2
1. Radiation Health Research Department, National Center for Radiation Research and Technology
(NCRRT), Egyptian Atomic Energy Authority (EAEA).
2. Pediatric Department, Research Institute of Ophthalmology, Giza, Egypt.
Correspondence: fathyh2003@yahoo.com


Bakground: Microcytic hypochromic anemia is the commonest form of iron deficiency anemia in
adolescents. The occurrence of this type of anemia among adolescents is around 27% in developing
countries. Clinical management should be based on a full knowledge of the prevalence of this disease
in the age group mentioned.
Subjects and Methods: The present study reported the distribution of this type of anemia across age,
anthropometric guides, and parasitic infestations in a sample of 300 adolescents attending various
schools in Giza region, Egypt. Red blood cell size and iron concentration were assessed by mean
corpuscular volume, hemoglobin levels, serum ferritin and total iron binding capacity from a venous
blood sample. The adolescent was considered to have the microcytic form of anemia when their mean
corpuscular volume was below 80 femtoliters (fL). An adolescent with hypochromic anemia was
defined as any subject with hemoglobin (Hb) below the WHO cutoff for age and sex: 12.0 g/dl for girls
and for boys aged 12.5­14.99 years and 13.0 g/dl for boys aged 15 years. Also, hypochromic anemia
included every subject having either serum iron < 50 µg/dL, or a serum total iron binding capacity
(TIBC) > 400 µg/dL.
Results: The incidence of microcytic hypochromic anemia in this study was 53%. There were highly
statistically significant differences between anemic and non-anemic groups as regards age and height
(P <0.05). Anemic adolescents also had significantly lower values for weight (P < 0.01), BMI (P <
0.01) and hemoglobin concentration (P<0.01) compared to non-anemic adolescents. Also, microcytic
hypochromic anemia was more common in adolescents who did not have lunch regularly. Adolescents
with current parasitic infestations showed a higher frequency of anemia compared to those who did
not. There were no statistically significant differences between adolescents with parasitic infestation
and adolescents without parasitic infestation as regards age, weight, height and BMI (P >0.05). Signs
of pallor were more common in adolescents suffering from microcytic hypochromic anemia. Subjects
with a history of chronic conditions such as cardiac diseases, renal failure or cancer had a significantly
higher incidence of anemia than adolescents who did not.
Conclusion: It was concluded that the anemic group of adolescents enrolled in the study were
susceptible to growth retardation. This type of anemia is more common in adolescents who do not
have lunch, have a chronic disease or a parasitic infestation.
Keywords: Stature, microcytic hypochromic anemia, parasitic Infestation, school adolescents.


Anemia could be defined as an abnormally
period, the iron requirements are increased due
low hemoglobin level due to pathological
to fast growth. In order to enhance the
conditions associated with nutritional and non-
absorption of iron, the level of ferritin
nutritional etiologies. Iron deficiency is one of
decreases. In boys, increased muscular growth
the most prevalent causes of nutritional
leads to increased demand for iron. The onset
anemia. Iron deficiency anemia (IDA) is a
of menstruation in females and monthly loss of
disorder in which severe iron deficiency
iron (around 30 mg/month) leads to reduced
causes anemia (1). Adolescents are one of the
ferritin levels. Unbalanced eating habits and
main risk groups for anemia(2). The prevalence
the lower consumption of animal food adds to
of the microcytic hypochromic anemia form of
the progress of anemia in this age group (4).
iron deficiency anemia amongst adolescents is
The diagnosis of iron deficiency is based
27% in developing countries and 6% in
primarily on laboratory measurements of
developed countries (3). In the adolescence
biochemical iron indicators. Cut-off values for

DOI: 10.12816/0004503

Full Paper (vol.55 paper# 7)

d:\skydrive\Jor\vol55_8 The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 184­196

Serum Leptin Hormone as an Indicator of Bad Prognosis in Colon Cancer
Tawfik M.S.*
*Department of radiation health research, National centre for radiation research and technology
(NCRRT), Egyptian Atomic Energy Authority (EAEA).
Correspondence: mstewfik@hotmail.com

Leptin has been linked to the pathology of several types of cancers related to obesity,
particularly colon cancer. This could be related to leptin' s influence on the equilibrium of specific
intracellular mechanisms that control cellular growth, differentiation, apoptosis, neovascularization
and invasiveness thus participating in the pathophysiology of colon cancer growth and metastasis.
Additionally, ghrelin is a gut peptide secreted from the fundus of gastric mucosa and adiponectin is an
adipocytokine released from adipose tissue and their low levels in obese subjects have been linked to
an increased risk of development of colon cancer.
Subjects and methods: Forty (40) patients were enrolled from Cairo University hospitals and
included in this study beside the control group which comprised 20 age and sex-matched healthy
subjects. Patients were divided into two groups: Group 1: Included 20 patients suffering from colon
cancer (stage II-A) without lymph node involvement or distant metastasis. Group 2: Included 20
patients suffering from colon cancer (stage III-C) with lymph node involvement but no distant
metastasis. Serum Leptin, ghrelin and adiponectin were measured in all patients using a
radioimmunoassy technique.
Serum leptin levels were significantly higher in colon cancer patients compared to that of
control subjects (p<0.001). Serum leptin levels were also significantly higher in stage II-A patients as
compared to stage III-C (p<0.001). Serum ghrelin and adiponectin levels were found to be
significantly lower in colon cancer patients compared to the control subjects (p<0.001). Moreover,
serum ghrelin and adiponectin levels were found to be significantly lower in patients belonging to
stage III-C compared to stage II-A (p<0.001). A negative correlation was noted between seum leptin
levels and both serum ghrelin and adiponectin levels in colon cancer patients enrolled. Conclution:
Serum leptin levels could serve as a good prognostic marker in colon cancer patients in addition to
serum ghrelin and adiponectin levels to predict the severity and the development of colon cancer
Keywords : Serum leptin, serum ghrelin, serum adiponectin, colon cancer, lymph node,

Leptin has been incriminated in the
During the past ten years, adipose
pathology of several types of cancers linked to
tissue has been considered not only as a tissue
obesity, particularly colon cancer (4). This
responsible for calorie storage, but as one of
could be related to leptin's influence on the
the vital endocrine tissues in the body as well
(1). Many cytokines called adipocytokines are
mechanisms that control cellular growth,
produced and secreted by adipose tissue.
Leptin is the most available adipocytokine . It
neovascularization, thus participating in the
is a 16-kDa hormone that plays a key role in
pathophysiology of cancer (5).
regulating energy intake and expenditure,
Leptin promotes the production and secretion
including appetite and hunger thus playing a
of several pro-inflammatory cytokines such as
major part in regulating appetite and satiety
interleukin-6 (IL-6), interleukin-1 (IL-1)
and modifying food consumption, energy
and chemokine (C-X-C motif) ligand 1
storage and body mass index (2). Leptin also
(CXCL1) in humans, which have been linked
makes a significant contribution to lipid and
to colon carcinogenesis (6). Leptin (mediated
glucose metabolism, reproductive, adrenal,
by the effect of CXCL1) promotes vascular
and thyroid functions, cardiovascular system,
endothelial growth factor (VEGF) activity by
immunity and brain functionality (3).
epithelial cells, and thus provides a tool for

DOI: 10.12816/0004504

Full Paper (vol.55 paper# 8)

d:\skydrive\Jor\vol55_9 The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 197­203
Pregabalin Efficacy and Tolerability: A Clinical Point of View
Nairooz H. Al-Momany 1, Nibal M. Abo-Ashour 2, Maysoon L. Al-Hwadi 1, Mahdi H. Al-
farhan 2,
Fardose N. Al-Edwan, BCs in Pharmacy1
1: Clinical Pharmacy, Directorate of Royal Medical Services, 2: Clinical Pharmacy ,King
Hussein Medical Center
Address for Correspondance : Nairooz Hasan Al-Momany, P.O.Box: 2699
Zip code: 11953 Amman, Jordan. E- mail: nmomany@yahoo.com. Phone Number : 00962796764070.


Antiepileptic drugs have been used in pain management since the 1960s. Pregabalin is a recently
developed antiepileptic drug also used in management of chronic neuropathic pain conditions. The aim of
this observational prospective study was to assess the analgesic efficacy and associated adverse events of
pregabalin in treated patients with neuropathic pain. The source of medication was the free samples that
have been provided by the company for evaluation.
Neurologists and Endocrinologists at king Hussein Medical Center prescribed Pregabalin for selected
patients (no. =50) who were diagnosed to have neuropathic pain according to pre-formulated questionnaire
that was developed by researchers. The majority of patients received Pregabalin 150mg as a starting dose,
300 mg as a maintenance dose for three months. then the magnitude of pain was assessed first after one
week of treatment, if the patient had pain relief after one week and maintained on treatment further
assessment was performed at intervals of one, two and three months. Then for each patient the average
score of pain relief was calculated (0=worst value, 10=best value).patients were also encouraged to report
any adverse effect during treatment period.
A total of 50 patients with neuropathic pain were included. During the course of the study 17 patients
terminated treatment during the first week (but were replaced by other 15 patients) either due to lack of
efficacy (12%, n=6) or due to intolerable adverse effects (22%, n= 11). For the remaining patients the
average score of pain relief was 2.8 ±1.2. The average score of pain reduction was higher among patients
with diabetic neuropathy (3.4) than with other types of neuropathic pain (2.2). The most frequently
reported adverse effects were dizziness, fatigue, somnolence, and gastrointestinal disturbances.
Pregabalin is effective in reducing diabetic neuropathy and to a lesser extent than other types of
neuropathic pain. (But) However intolerable adverse effects still face a problem. Further studies comparing
its efficacy and tolerability with other neuropathic treatment choices are needed.
Keywords:Pregabalin, neuropathic pain, diabetic neuropathy, postherpetic neuralgia

radiculopathy, diabetic neuropathy, cancer-
Neuropathic pain, caused by a lesion of the
related neuropathic pain, postherpetic
nervous system is especially problematic. (1,2)

because; it is often experienced in parts of the
neuralgia, HIV-related neuropathy, spinal cord
body that otherwise appear normal, it is
injury, trigeminal neuralgia
generally chronic, severe and resistant to over-
and complex regional pain syndrome type II. (6) The
the-counter analgesics, and it is further
epidemiology of neuropathic pain has not been
adequately studied, partly because of the diversity
pain).(3,4, 5) It may result from various causes
of the associated conditions. Current pooled
that affect the brain, spinal cord and peripheral
estimates suggest that neuropathic pain may affect
as much as 3% of the population. (7­13)

DOI: 10.12816/0004505

Full Paper (vol.55 paper# 9)

Expression of Heparanase Gene (HPSE) In Acute Leukemia Patients The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 204­217

Expression of Heparanase Gene in Egyptian Acute Leukemia Patients
Samir Attia Mohamed Zaahkouk. a, Seham Omar Mohamed Ibrahim b; Amira Ahmed
Hammam b ; Hesham Fathy Hedifa a
a)- Department of Zoology, Faculty of Science, AL Azhar university, AL Azhar, Egypt
b)- Department of Clinical and Chemical Pathology, Faculty of medicine, Beni suef, Egypt

: Heparanase is an endoglycosidase that degrades heparin sulfate, the main
polysaccharide constituent of the extracellular matrix and basement membrane. Expression of
the heparanase gene is associated with the invasive, angiogenic, and metastatic potential of
diverse malignant tumors and cell lines.
Aim of the study: to investigate possible relation/correlation between Heparanase gene
expression and quantitation in pediatric Acute leukemia patients and clinicopathologic
variables as well as patients outcome in an attempt to determine its prognostic value and the
possibility of using it as a new target for treatment.
Patients and methods: Forty pediatric acute leukemia patients (20 acute myeloid leukemia
(AML)&20 acute lymphoblastic leukemia(ALL) as well as 11 normal volunteers were
analyzed for the expression and level of Heparanase gene using real time quantitative reverse
transcriptase polymerase chain reaction (RTQ-PCR) to investigate a possible relation,
association, or correlation with the clinical and laboratory features of patients at diagnosis,
and patient outcome after treatment and follow up.
Results: Comparing the 3 groups as regards the Heparanase gene level there was high
statistical significant difference (p<0.001) being maximum in AML and minimum in controls,
with mean Relative quantitation (RQ) level 2336.2± 10405.2 in AML ,median 8.0 and range
(3.1-46543.0) , while mean RQ in ALL was 1.7±1.0 ,median 1.7 and range (0.1-3.1) and in
controls mean was 0.8±0.3, median 0.8 and range (0.4-1.4).Comparison between each 2
groups as regards heparanase level was of high statistically significant difference, p value
being (p<0.001) when comparing AML/ALL and AML/controls and (p=0.035) when
comparing ALL/controls. Cut off value for heparanase gene was calculated using Roc curve
and was found to be 1.413 with 80% sensitivity and 100% specificity. According to this cut
off level, 20/20 (100%) AML cases were heparanase positive, 12/20(60%) (ALL) cases were
heparanase positive and 8/20 ALL patients were negative, while all controls (100%) were
negative. This was of high statistical significance (p<0.001). Comparing the overall survival
(OS) of AML/ALL there was no statistically significant difference (p=0.2916), while
comparing the disease free survival (DFS) of AML/ALL was of statistical significant
difference (0.0312). Comparing the final status of the disease (complete remission(CR)/
progressive disease(PD) or death) as regards the heparanase gene level RQ , showed a high
statistical significant difference (p<0.005) with the level being higher in patients with
PD/death. There was no significant correlation between all group and heparanase gene level
as regards age, TLC, hemoglobin, platelets and peripheral blood blasts
(p=0.353,0.704,0.844,0.54 and 0.097) respectively, while there was significant negative
correlation on comparing bone marrow blast% and heparanase gene level (r=-0.408 and
Conclusion: Heparanse gene is expressed in acute leukemia being higher in AML than ALL
and controls. Patients with higher heparanase gene showed poorer outcome. These findings
suggest that heparanase gene may be a novel significant therapeutic target for acute leukemia.
Key words:
Heparanase gene, Acute leukemia, RTQ-PCR


Acute leukemia is a heterogenous
target genes and pathways disrupt
hematopoietic transcription factors and/or
abnormalities that define each subtype.
confer a proliferative and survival
Many of the known chromosomal
advantage to leukemia blasts (1).
translocations and mutations in leukemia
DOI: 10.12816/0004506

Full Paper (vol.55 paper# 10)

Oxidative Damage in Embryo and placenta of Streptozotocin-induced Diabetic rats The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 218­227
Oxidative Damage in Embryo and Placenta of Streptozotocin-induced Diabetic Rats
Salwa K El- Nabarawy
Zoology Department, Faculty of Science, Al Azhar University (Girls), Nasr City,Cairo

Maternal type 1 diabetes is associated with an increased risk for fetal malformations. The
mechanism by which diabetes caused teratogenic disorders is not fully known. Previous studies have
demonstrated that many teratogenic diabetic cases were related to free radical oxygen species. This study
was conducted to evaluate the effect of maternal diabetes on both embryo and placenta by estimating the
oxidative and DNA damage in embryo and placenta of diabetic mellitus- induced rats. The possible role of
olive leaves extract of Olea europaea ( O. europaea ) plant in repairing the damage was also assessed.
Material and Methods:. Diabetes mellitus was induced by streptozotocin (STZ) by a single intraperitoneal
injection (35 mg/kg b wt). O.europaea leaves water extract was administered orally (550 mg/ 100g b wt/
day) for 5days before pregnancy and18 days after. Malondealdehyde (MDA) level, glutathione peroxidase
(Gpx) and superoxide dismutase (SOD) activities and glycogen concentration were measured in term
embryo and placenta homogenates of diabetic and control rats. Moreover, the evaluation of DNA damage
was carried out by the Alkaline Comet Assay using embryos and placentas taken from STZ-induced
diabetic and control pregnant rats.
Results: the results showed an elevation in MDA level of the diabetic groups of both embryo and placenta
compared to that of the control. This was accompanied by reduction in Gpx and SOD activities indicating
oxidative damage. Glycogen level was reduced in diabetic groups of embryo and placenta. Both
oxidative and hyperglycemic status were improved in the groups treated with olive leaves water extract.
The percentage of tail DNA and tail moment values were also higher in both embryo and placenta of the
diabetic -induced rats. DNA damage seems to be partly ameliorated in groups treated with O. europaea
leaves water extract.
Conclusion: This study indicated that maternal hyperglycemic condition in diabetic- induced pregnant rats
could generate oxidative and DNA damage to embryo and placenta that could be ameliorated by oral doses
of olive leaves water extract.
Key words: diabetes mellitus, hyperglycemia, oxidative stress, embryo, placenta, DNA damage, Alkaline
Comet Assay, olive leaves.

used.(4,5) However, only a few studies have
Maternal diabetes constitutes an unfavorable
evaluated the repercussions of diabetes on
environment for embryonic and fetoplacental
pregnant rats and/or their offspring (6) using
development. Despite current treatments,
models of mild diabetes (glycemia between 120
pregnant women with either type 1 or type 2
and 300 mg/dL).
diabetes are at increased risk of miscarriage,
Maternal hyperglycemia during the early stages
placental abnormalities, and intrauterine
of development may be sufficient to program
malprogramming.(1, 2, 3, )
changes in physiology and metabolism which
increase in the incidence of diabetes, in women
are later manifested as adverse effects in
at reproductive ages brings about growing
diabetic pregnancy. (7) Hence, it is remarkable
interest in the use of experimental diabetic
that glycemic control from the beginning of
models in order to investigate the mechanisms
pregnancy is important for placental and
of induction of developmental alterations in
embryofetal development. Oxidative stress
maternal diabetes. Experimental models of
plays a pivotal role in cellular injury caused by
severe diabetes (glycemia > 300mg/dL), which
hyperglycemia. High glucose level can
reproduce the clinical conditions of poorly
stimulate free radical production. Weak defense
controlled type-1 diabetes, have been widely
system of the body becomes unable to
DOI: 10.12816/0004507

Full Paper (vol.55 paper# 11)

d:\skydrive\Jor\vol55_12 The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 228­238
Juvenile Dermatomyositis
King Hussein Medical Center Experience
Zeyad Habahbeh
Pediatric Allergy, Immunology, and Rheumatology division, Queen Rania Hospital for Children, King
Hussein Medical Center, Amman Jordan
Correspondence: Zeyad Habahbeh MD, zeyad97@yahoo.com. Senior specialist in pediatric Immunology, Allergy
and Rheumatology Division, Queen Rania Hospital for Children, King Hussein Medical Center, Amman-Jordan.


Juvenile dermatomyositis (JDM) is an uncommon, often chronic, and potentially serious childhood
systemic autoimmune vasculopathy affecting primarily skin and muscles. It is characterized by
pathognomonic rash, and symmetrical proximal muscle weakness.
In this retrospective study, we reviewed the clinical, laboratory profiles, treatment and outcome of
Jordanian children diagnosed with JDM in the past 8 years in a tertiary facility in Amman, Jordan.
Sixteen (16) JDM patients, diagnosed based on criteria of Bohan and Peter, and have attended the
pediatric rheumatology clinic in King Hussein Medical Center, from January 2006 to September 2013,
were recruited. Their medical records were studied for clinical and biochemical profile, radiological and
electrophysiological data were studied as well. Treatment and outcome were also reviewed.
Our cohort includes 16 patients, 9(56 %) males, and 7 (44%) females (M: F 1.3:1), their age ranges
between 2 to 9 years, with average age at diagnosis of 5.4 years. Time to diagnosis varies from 2 months
to 12 months, and averages at 4.6 months. Proximal muscle weakness was present at time of diagnosis in
14(87.5 %) cases. Cutaneous signs in form of either poikiloderma in malar distribution, Gottron's sign
and /or heliotrope sign were apparent in all the 16(100%) patients at time of diagnosis, periungual
erythema was evident in 10(63%) patients while abnormal nailbed capillaries pattern was only reported in
6(38%) cases.
Skin and soft tissue calcification, crusting and ulceration were seen in 3(19 %) patients. Serum Lactate
dehydrogenase, (LDH) was elevated in 94% and creatininine phosphokinase (CPK) in 88%. Elevated
SGOT (AST) was seen in almost all subjects, while ESR was high in 14 (87.5%) patients. All patients
treated with corticosteroids and methotrexate (MTX).
Two (12.5%) patients died in our series, complete remission was achieved in 4(25%) of patients, while
partial remission was seen in 8 (50%) of patients in our cohort.
JDM is a rare disease that has the potential to cause physical disability, poor functional outcome, and
death if not recognized early and treated properly. We focused in our study, on importance of early
referral, and aggressive therapy in improving outcome, aiming to increase awareness of families and
general pediatricians.
Key Words: Juvenile dermatomyositis, Myopathy, Calcinosis, Heliotrope sign

weakness [2].JDM age of onset averages at 7
Juvenile dermatomyositis (JDM) is an
years in most studies, and females outnumber
uncommon, often chronic, and potentially
males by at least two folds [2].The disease has an
annual incidence in USA and UK, of around 3
vasculopathy affecting primarily skin and
per million child [3].
muscles [1]. It is characterized by pathognomonic
The cutaneous manifestations, which are seen in
rash, and symmetrical proximal muscle
almost all patients and might be incapacitating,

consists mainly of photodermatitis, violaceous
DOI: 10.12816/0004508

Full Paper (vol.55 paper# 12)

d:\skydrive\Jor\vol55_13 The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 239­244

Relation between Smoking and Cognition in Egyptian Elderly
Moatassem S Amer *, Sarah A Hamza *, Ekramy E Abd el Rahman*, Heba M Hamed *,
Osama K Zaki **, Wessam E Saad ***.
*Geriatrics and Gerontology department, ** Genetics Unit, ***Clinical Pathology department,
Faculty of Medicine, Ain shams university, Cairo, Egypt
Correspondance:Heba Mohamed Hamed MSc, Geriatrics and Gerontolgy department, Faculty of
Medicine, Ain shams university , Abbasia , Cairo , Egypt.

In spite of numerous studies published in the past few years on the topic, the effect
of smoking on Alzheimer's disease and dementia remains uncertain. Case­control studies have
largely suggested that smoking lowers the risk of AD, whereas prospective studies have shown
that smoking increases this risk or has no effect on the probability of developing AD.
Objectives: The aim of this study is to compare the prevalence of Smoking in elderly with
cognitive impairment and elderly with non-cognitive impairment.
Design: A Case control study. Participants: 88 participants aged 60 years and above. They were
selected from Ain Shams University Hospital from inpatient wards and outpatient clinics. The
studied sample was divided into 3 groups: Group A (32 elderly patients with Alzheimer's disease),
Group B (32 elderly patients with Mild cognitive impairment) and Group C (24 controls with
normal cognitive function).
Measurements: Comprehensive geriatric assessment, including detailed history, physical
examination, and also cognitive assessment using Montreal Cognitive Assessment (MOCA) and
Mini mental status examination (MMSE).
Results:As regards smoking there was a highly statistical significant difference between the 3
groups as non-smokers were more prevalent in Alzheimer's disease and Mild cognitive
impairment groups in comparison to control group with (p-value= 0.001).
Conclusion: There was a highly significant negative association between smoking and cognitive
Keywords: Alzheimer's disease ­ Mild cognitive impairment ­ Smoking ­ Elderly.


Age related cognitive decline affects

people's quality of life and their ability to
studies have largely suggested that smoking
live independently. [1] Alzheimer's disease
lowers the risk of AD, [5, 6] whereas
(AD) is the most common cause of the
prospective studies have shown that smoking
dementia syndrome in later life and has
increases this risk or has no effect on the
reached epidemic proportion with the
probability of developing AD. [7, 8]
explosive growth of the number of the
Smoking could affect the risk of AD via
elderly. [2]
several mechanisms. Smoking may increase
Mild cognitive impairment (MCI), a
the generation of free radicals, leading to
transitional condition between normal aging
high oxidative stress, or affect the
and dementia, is characterized by the
inflammatory immune system, leading to
presence of cognitive dysfunctions in the
activation of phagocytes and further
absence of significant functional loss. [3]
oxidative damage. [9] In addition, smoking
Patients with MCI are at higher risk for
may promote cerebrovascular disease.
developing Alzheimer disease (AD) with an
Evidence also exists, however, that
estimated conversion rate of 10 to 15% per
smoking can have a protective effect against
year. [4]
AD. Nicotine has been suggested to induce
In spite of numerous studies published in
an increase in the level of nicotinic acetyl
the past few years on the topic, the effect of
choline receptors, thereby counterbalancing
smoking on Alzheimer's disease and
the loss of these receptors, and subsequent
dementia remains uncertain. Case­control
cholinergic deficits, observed in AD. [10]
DO I: 10.12816/0004509

Full Paper (vol.55 paper# 13)

Effect of Noise and Crowding Related Stress on Serum Level of Cortisol ACTH, Epinephrine and Insulin in Female Albino Rats The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 245­250
Effect of Noise and Crowding Related Stress on Serum Level of Cortisol
ACTH, Epinephrine and Insulin in Female Albino Rats.
Eman G. E. Helal, Noran Ahmed Abou-Aouf and Neama M.Taha
Zoology Department, Faculty of Science, Al-Azhar University (girls)

Noise and crowding are the most stressful factors for human beings.
Study aimed to clarify their effect on cortisol, ACTH, epinephrine, insulin and the amelioration effect
of Sulpiride.
Material and Methods: Thirty six female rats were divided into six groups (6/each):
1- Rats served as control, 2- Rats treated with Sulpiride drug, 3- Rats exposed to noise (90db, 3hr. per
day) for 45 days. 4- Rats exposed to noise and treated with sulpiride drug, 5- Rats exposed to
crowding. 6- Rats exposed to noise and treated with Sulpiride drug.
Results: Noise and crowding stresses caused a significant increase of cortisol, ACTH and epinephrine
while there was a significant decrease in insulin hormone. Sulpiride drug ameliorated these
Conclusion: it is useful to use Sulpiride drug with people who are exposing to noise and crowding
Keywords: Noise, Crowding, Sulpiride drug, Physiological parameters, Cortisol, ACTH,
Epinephrine, Insulin.

Sulpiride is the most favorite drug which

used to tolerate stress symptom (6). People who
Stress can be defined as a state of

threatened balance, induced by external

stressor and appear as the display of somatic
expose to stress take one or some drugs to
and psychic reaction, struggling to regain
avoid its effect. So, the present study deals
homeostasis (1) among stressful stimuli,
with the possible protective effect of one of the
crowding and noise.
antidepressant drugs (Sulpiride) against noise
Noise is an environmental pollutant capable
and crowding stresses in female albino rats..
of causing hearing impairment (2), behavioral,
Aim of the work: during all the day time Cairo
mental and widespread disturbances at several
is extra crowded and noise city , where it suffer
levels in human organs and apparatus due to
from movement of huge number of especially
chemical and physiological modification of
in the morning about 30,000,000 persons in
endocrine (3).
the morning. Also it is suffer from a very loud
Crowding stress is a type of psychosocial
noise .This study amid at clarifying the effect
stress induced by an increased density of
of each stress on some hormonal pattern. The
population. Population density may be raised
question arise here, could Sulpiride drug
either by increasing the number of species
(which is a favorable and widely used drug)
living in the same area and/or by reducing their
completely ameliorate stress effects or it would
living space (4).
be worsen?
Antidepressant drugs are the most
Material and Methods
successful drugs in patients with clear
Thirty six normal white female albino rats
weighing 150±30 g were purchased from the
Farm of the National Organization for Control
disturbance, poor appetite and weight loss.
and Research. They were kept under
However, a variety of different chemical
observation for one week before the beginning
structures have been found to have
of the experiment acclimation period .The
antidepressant activity. Their number is
chosen animals were housed in cages and kept
constantly growing, but as yet no group has
under to artificial light for 14 hr. and 10 rodent
been found to have a clear therapeutic
hr. complete darkness at normal atmospheric
advantage over the others (5).
temperature. All animals were fed on standard
DOI: 10.12816/0004510

Full Paper (vol.55 paper# 14)

The prevalence of vitamin D deficiency in Ancient Egyptian Population from Baharia Oasis ,the Greco Roman period The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 251­256

The Prevalence of Vitamin D Deficiency in Ancient Egyptian Population
from Baharia Oasis, the Greco Roman Period.
Rokia Abd ElShafy Soliman El-Banna*, , Azza Mohamed Sarry El-Din*, Fatma Ahmed Eid**,
Walaa Yousef Mohamed Ali*
*Biological Anthropology Department , National Research Centre.
**Zoology Department, faculty of Science , Al-Azhar University.


Vitamin D deficiency is considered to be the most common nutritional deficiency and
also one of the most common undiagnosed medical conditions in the world. Vitamin D is naturally
present only in minor amounts in most foods; the great majority is synthesized by the action of
ultraviolet light on chemical precursors in the skin.
The manifestation of vitamin D deficiency in sub adults is referred to as rickets, and in adults,
osteomalacia . Rickets and osteomalacia are the sub adult and adult expressions of a disease in which
the underlying problem is a failure to mineralize bone protein (osteoid). The most common cause of
this disease is a physiological deficiency in vitamin D. The associated problems include deformed
Material and Methods: This study aimed to investigate the skeletal remains of ancient Egyptians
from Baharia Oasis population for lesions indicative of vitamin D deficiency (rickets and
osteomalacia). The material consisted of 1075 commingled bones (38 sub adults and1037 adults).
They were recovered from Baharia oasis.
Results: The results showed that, there was no evidence of rickets in sub adult group. The prevalence
of osteomalacia in adult Baharia populations was 7.4% ; all were adult males.
This result could indicate that this population was subjected to sunlight all over the year and their diet
was rich of calcium and phosphorus.
Conclusion: These few cases that were found may be due to mechanical stress during wine and
textile production.
Key words: Rickets, Osteomalacia, Ancient Egyptians, Greco-Roman Period.


Vitamin D is thought of as the "sunshine vitamin" because it is synthesized by various materials when
they are exposed to sufficient sunlight (1).During exposure to sunlight, 7-dehydrocholesterol in the
epidermis and dermis absorb ultraviolet B radiation resulting in the production of pre-vitamin D3.
Pre-vitamin D3 is rapidly converted by thermally induced rearrangement of the double bonds to form
vitamin D3 (Figure 1).
DOI: 10.12816/0004511

Full Paper (vol.55 paper# 15)

Assessment of Executive Functions in Chronic Hepatitis C Virus Infected Patients The Egyptian Journal of Hospital Medicine (April 2014) Vol. 55, Page 257­260

Assessment of Executive Functions in Chronic Hepatitis C Virus Infected
Tomader Taha Abdel Rahman,
Marwa Abdelazeem Abdel Guaad, and Ahmed Kamel Mortagy
Geriatric medicine Department,Faculty of medicine, Ain Shams University

: Chronic infection with HCV is one of the most important causes of chronic liver
disease, which can progress to cirrhosis and hepatocellular carcinoma (HCC). It is well established that
advanced forms of the disease are accompanied by overt and global cognitive deficits (hepatic
encephalopathy) but now there is a growing evidence that the alterations in cerebral function in
patients with chronic HCV infection may appear long before the development of severe liver cirrhosis,
it has been hypothesized that it is related to a direct effect of HCV on the brain; or the neurotoxic
effect of HCV-related systemic inflammation.
Aim: The purpose of the study was to assess the possible existence of executive dysfunction in chronic
HCV infected patients without cirrhosis. Study design: case control study. Participants: 100 elderly
patients aged 60 years and above, 50 patients are HCV positive (cases) and 50 patients are HCV
negative (controls) both groups have no liver cirrhosis.
Methods: All participants were subjected to the following: Diagnosis of HCV by detection of HCV ab
using ELISA technique, non invasive assessment of liver cirrhosis using abdominal ultrasound, and
evaluation of executive functions using 5 neuropsychological tests (block design, digit span
backwards, animal verbal fluency, clock drawing, and EXIT 25).
Results: The study showed that there is a significant difference between cases and controls regarding
Exit 25 and Digit span backwards tests scores indicating affection of the phonological loop component
of working memory among HCV positive patients.
Conclusion: Executive functions are affected in patients with chronic HCV infection without liver
Key words: executive functions, HCV, no cirrhosis


The World Health Organization (WHO)
negatively influence patient quality of life
estimates 170 million individuals worldwide are
(QOL) (5).
infected with hepatitis C virus (HCV). Egypt had
So, the purpose of this study is to investigate
the highest number of reported infections,
the possible existence of alterations in the
largely attributed to the use of contaminated
executive functions of HCV patients without
parenteral antischistosomal therapy. This led to a
liver cirrhosis.
mean prevalence of HCV antibodies in persons

in Egypt of 22 % (1).
Subjects and Methods:
It is well established that advanced forms of the
Study Design: Case control study.
disease are accompanied by overt and global
Participants: 100 elderly patients aged 60
cognitive deficits (hepatic encephalopathy) (2).
years and above, 50 patients are HCV positive
Recently researchers and clinicians have become
(cases) and 50 patients are HCV negative
increasingly aware of a group of HCV patients
(controls) both groups have no liver cirrhosis.
with mild liver disease that present with a less-
Participants were recruited from patient
overt pattern of neuropsychological impairment
admitted to geriatric department, internal
medicine department and outpatient clinics in
Executive function is a set of high-level abilities
Ain Shams University Hospital. All participants
that control and regulate more basic abilities like
provided informed written consent before
attention, memory and motor skills, they include
participating in the study.
the ability to initiate and stop actions, to monitor
Exclusion Criteria: The exclusion criteria
and change behavior as needed, and to plan
included those who refused to participate,
future behavior when faced with novel tasks and
patients with liver cirrhosis, HBV or HIV
situations (4). So, executive dysfunction can
infection, clinical signs of liver cell failure,

patients receiving antiviral therapy, patients
DOI: 10.12816/0004512

Full Paper (vol.55 paper# 16)