Potential markers For Radiation illness The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 1-7
Physiological Markers for Radiation Illness
El Nashar N.A.*, EL Nashar M.A.**,
Mohamed H.A.*, EL Margoushy N.M.*, and Mohamed M.A.M.***
*Faculty of Medicine, Taif University; **Faculty of Medicine, Jazan University;
***Research Center of High Altitude, Taif University

markers are important available markers
adiation illness is defined as the
for radiation effects on tissues;
damage to the organ tissues due to the

excessive exposure to ionizing radiation.

The exposure to radiation interferes with
4. Cytokines appear to play the role of
the process of cell division. Markers can
both causative agent and marker;
be classified into several categories and
5. The evidence has demonstrated a potential
are measured with a variety of techniques.
value of determining the early response of
The most useful markers are those that are
blood markers to ionizing radiation in
easily collected and immediately available,
predicting latent radiation toxicity, which may
be used for planning individualized treatment
inexpensive, diagnostic and prognostic,
regimens. The future of research on markers of
and specific for a given disease These
radiation tolerance is increasingly important
markers might be classified as predictive,
due to the growing number of cancer treatment
prognostic, diagnostic, and dosimetric
survivors. Although no validated blood
markers as regard their effects on normal
markers are currently available for daily
tissues. Markers of physiological effects
practice, further research in this area has
response to radiation:
become important.
1) Markers of Cell Death.
Radiation illness is defined as the
2) Markers of Hypoxia.
damage to the organ tissues due to the
3) Cytokines and inflammatory mediators
excessive exposure to ionizing radiation. The
[these cytokines: TGF-1, Interleukins
exposure to radiation interferes with the
process of cell division(1). Radiation illness
(IL-1, IL-6, IL-10 and IL-8), intracellular
results from excessive exposure to ionizing
adhesion molecule-1(ICAM-1), Pulmonary
radiation when humans (or other animals) are
Surfactant Proteins, Krebs von den
exposed to very large doses of ionizing
Lungen-6 (KL-6), Thrombomodulin, etc]
radiation(2). Radiation exposure can occur as a
4) Polymorphonuclear leukocyte (PMN)
single large exposure (acute), or a series of
and CD34+ markers
small exposure spread over time (chronic) (3).
5). Other protein markers as Amylase,
Poteintial markers of radiation illness:
Flt3-ligand, Citrulline, Plasma oxysterol
Over the past five decades, those interested in
concentrations as physiological markers of
markers of radiation effect have focused
primarily on tumor response. More recently,
however, the view has broadened to include
6) Gene expression and amplification in
irradiated normal tissues--markers that
response to radiation and the status of
predict unusual risk of side-effects,
microarray analysis. Other markers
prognosticate during the prodromal and
therapeutic phases, diagnose a particular
1.Markers leading to radiation-related side
toxicity as radiation-related, and, in the case
effects including those that can be used to
of bioterror, allow for tissue-specific
identify subjects at greater risk than
biodosimetry (4). Markers profiles will vary
with tissue and time due to the complex
2.Markers useful for diagnosis, prognosis,
nature and protracted course of radiation
biodosimetry, and therapy; 3.Physiological
toxicity. Markers are needed at all stages of
the process including markers for both the

DOI: 10.12816/0009354


Full Paper (vol.58 paper# 1)

c:\work\Jor\vol58_2 The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 8-17

Drug Interactions between Phenytoin and Rosuvastatin on Lipid Profile,
Liver Functions and Oxidative Stress Biomarkers in Irradiated Rats
Dina M. Lotfy*, Seham H.M. Hassan, Mostafa E. El Sayed, Thanaa M. Fahim.
National Centre for Radiation Research and Technology, Atomic Energy Authority, Cairo, Egypt.
*Corresponding author. Tel: +201141383375. E-mail address: pharmadinaa@yahoo.com (D.M. Lotfy).

phenytoin is one of the most commonly used anticonvulsants for treating generalized
tonic-clonic seizures and status epileptics. Rosuvastatin is a new generation HMG-CoA reductase
inhibitor. This enzyme converts HMG-CoA to mevalonic acid in the cholesterol biosynthetic pathway
which is the rate limiting step in cholesterol synthesis.
Aim: This study was aimed to investigate the possible interactions between phenytoin and
rosuvastatin when used together in irradiated rats. Methods: The experiments were carried out to
investigate the acute effect of each drug individually and in combination with radiation on lipid profile
[ Total cholesterol, Triacylglycerols, High density lipoproteins, Low density lipoproteins and Very
low density lipoproteins, Risk factor, Atherogenic Index], liver function tests (AST & ALT) and
oxidative stress biomarkers (MDA, NO & SOD).
Data revealed that, phenytoin in irradiated rats significantly increased serum total cholesterol
compared to normal control. Rosuvastatin significantly decreased serum total cholesterol compared to
irradiated control. Combination of two drugs significantly increased serum total cholesterol;
triacylglycerols and serum VLDL-c levels compared to normal and irradiated rats and significantly
increased Atherogenic Index and Risk factor compared to normal control. Phenytoin significantly
increased serum ALT level compared to normal and irradiated rats and significantly increased serum
MDA and serum NO levels compared to normal rats. But phenytoin significantly decreased MDA &
NO levels and significantly increased SOD activity compared to irradiated rats. Rosuvastatin
significantly increased serum ALT level compared to normal control but it significantly decreased
MDA and significantly increased SOD activity compared to irradiated rats. Combination phenytoin
and rosuvastatin in irradiated rats significantly increased serum ALT level compared to normal and
irradiated rats and it significantly increased MDA, NO levels but it significantly decreased SOD
activity compared to normal control.
It could be concluded that administration of phenytoin concurrently with rosuvastatin not
recommended in patients receiving radiotherapy as dangerous side effects may be occurred.
Keywords: Irradiation; Drug interactions; Lipid profile; Liver functions; Oxidative stress biomarkers.


Ionizing radiation has become an integral
diminish the intended effect of one or both
part of modern medicine and is used in
drugs and may modify the diagnostic,
diagnostic as well as therapeutic purposes. In
preventive or therapeutic activity of either
some cases, radiation is the single best
drug. 4
treatment in some cases such as cancer. 1
Epilepsy is a chronic neurological disorder
Ionizing radiation has been known to induce
characterized by spontaneous, recurrent,
oxidative stress through generation of reactive
paroxysmal cerebral discharges collectively
oxygen species (ROS) resulting in imbalance
referred to as seizures.5 Among the potential
of the pro-oxidant and antioxidant in the cell
causes of seizures are congenital defects,
which is suggested to culminate in cell death.2
metabolic abnormalities, stroke, lack of
Free radicals caused lipid peroxidation in the
oxygen to the brain, brain tumors and
membrane of cells reflected in altered physico-
infections such as abscess.6
chemical properties in lipid bilayer and
Dyslipidaemia is a major risk factor for
eventually to cellular toxicity.3
cardiovascular diseases, obesity and mortality.7
Drug interaction is the modification of the
Hyperlipidaemia decreases the strength of the
effect of one drug (object drug) by the prior or
oxidative defence system.8 Statins are the
concomitant administration of another drug
treatment of choice for management of
(precipitant drug). It may either enhance or
hypercholesterolemia, act by inhibition of

HMG-CoA reductase enzyme that enzyme is

DOI: 10.12816/0009355

Full Paper (vol.58 paper# 2)

c:\work\Jor\vol58_3 The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 18- 25

Protective Effects of Onion Oil and Selenium against Cisplatin-Induced
Nephrotoxicity and Oxidative Stress in Rats
Kamel M. Kamel2*, Hala M. Fawzy2, Salwa A. Metwally2, Hekma A. Abd El-Latif1,
Mostafa E. El-sayed1
1Pharmacolgy & Toxicology Department, Faculty of Pharmacy Cairo University,2Pharmacolgy
Department, National Organization for Drug Control and Research, NODCAR, Egypt, Cairo, P.O. BOX 29


Background: Nephrotoxicity is an inherent of certain anticancer drugs. Aim: This study aimed to
assess the protective effect of onion oil and selenium against cisplatin-induced nephrotoxicity in male
rats. Results: Cisplatin (5 mg/kg, i.p.) caused significant increases in serum sodium, blood urea nitrogen,
serum creatinine, total sodium and potassium excreted in urine, urine volume and lipid peroxides
measured as the malondialdehyde content of kidney, with significant decreases in serum total protein,
creatinine clearance, reduced glutathione content of kidney and kidney superoxide dismutase activity as
compared to the control group. On the other hand, administration of onion oil (100 mg/kg, p.o.) or
selenium (1 mg/kg, p.o.) for 14 days with a single cisplatin dose on the 10th day ameliorated the cisplatin-
induced nephrotoxicity as indicated by the restoration of kidney function and oxidative stress biomarkers.
Conclusion: Onion oil and selenium showed protective effects against cisplatin-induced nephrotoxicity.
KEYWORDS: Onion oil; Selenium; Anti-oxidant; Cisplatin; Nephrotoxicity


Cisplatin (cis-diamminedichloroplatinum
preventive abilities against cisplatin-induced
nephrotoxicity. Some researches advised the use
chemotherapeutic agents widely used in the
of enriched diets with natural antioxidants like
treatment of a variety of malignancies including
vitamin E, ascorbic acid, and methionine.9 Other
head, neck, ovarian and testicular cancers.1
studies reported that the use of sulfhydryl-
However, the full clinical utility of cisplatin is
limited by its nephrotoxicity. 2 Approximately
diethyldithiocarbamate, sodium thiosulfate, N-
28% to 36% of patients receiving an initial dose
acetylcysteine, and lipoic acid, could also exert
(50100 mg/m2) of cisplatin develop acute
antioxidant activity.10
nephrotoxicity. Vigorous hydration has not been
Onions (Allium cepa L.) possess strong,
effective in eliminating cisplatin toxicity. Also,
characteristic aromas and flavours, which have
the use of diuretics may complicate the
made them important ingredients of food.
electrolyte disturbance induced by cisplatin.
Onions and onion flavours (essential oil) are
Discontinuation of cisplatin remains the only
important seasonings widely used in food
option in cases of progressive nephrotoxicity. 3
processing. Several studies had demonstrated
In addition to direct tubular toxicity in the form
that onions possess several biological properties,
of apoptosis and necrosis,4 vascular factors,5 and
such as antibacterial,11 antimutagenic12 and
inflammation6 that have been implicated in the
antioxidant activities13. The most important
active constituents in onion oil are organosulfur
compounds which are reactive, volatile, odour
demonstrated that cisplatin induced oxidative
producing and lachrymatory.14
stress is involved in the development of renal
Selenium is a trace element that is essential
tubule injury.7 The involvement of oxidative
in small amounts. Humans and animals require
stress was further supported by the fact that free
selenium for the function of a number of
radical scavengers and antioxidants prevent
selenium-dependent enzymes, also known as
selenoproteins. Selenium maximizes the activity
antioxidants were investigated for their
of antioxidant selenoenzymes such as selenium-

containing glutathione peroxidases (GPx) which

DOI: 10.12816/0009356

Full Paper (vol.58 paper# 3)

c:\work\Jor\vol58_4 The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 26- 31

Impact of Donor and Recipient Sex on Outcomes of HLA-Identical Sibling
Allogeneic Hematopoietic Stem Cell Transplantation.
Hany M. Hegab1, Emad Abdel Mohsen Abdel Hadi1 ,Mohamed Hamdy Attia1,Maha
Mohamed Tawfik El-Zimaty1
1Department of Internal Medicine department-Hematology & SCT unit, Faculty of Medicine, Ain
Shams University, Cairo, EGYPT

hematopoietic cell transplantation (HCT) is well established as therapy for hematologic
malignancies as well as many non-malignant disorders. Donor selection is an important way to decrease
the risks after HSCS and is therefore a key component of the clinical practice of transplantation. There
are many criteria proved or hypothesized to affect outcomes after SCT and one of these, sex is the most
controversial. Some investigators have found an increased risk of acute or chronic graft-versus-host
disease (GVHD) associated with donor sex. Transplantation of stem cells from a female donor to a male
recipient is a special circumstance in which donor T cells specific for minor H antigens, encoded by
genes on the recipient Y-chromosome that are polymorphic to their X-chromosome homologues, may
make a contribution to GVHD and GVL activity.Objective: investigate the effect of donor and
recipient sex mismatch on outcomes of HLA-identical sibling allogeneic stem cell
transplantation.Methods: this study was carried on 82 patients selected from patients who had
underwent a myelo-ablative preparative regimen for a hematologic malignancy and received HSC
transplant from an HLA-identical sibling being divided into 2 groups: 1st one with a female donor to a
male recipient and 2nd one include otherwise. Both groups will be subjected to HLA tissue typing,
CBC, Bone marrow aspirate evaluation, PT & PTT, blood culture when needed, SGPT, SGOT, ALP,
blood urea, s.creatinine, urine analysis, pulmonary function tests, chest x-ray, echocardiography ECG,
CMV-, EBV-, VZV-, Toxoplasma- antibodies (IgG , IgM), HBs-Ag, HBs-Ab, and HCV-Ab.Results:
after variables controlling for patient and donor, there was an increased risk of acute GVHD in patients
who received grafts from female donor being 18% for patients receiving grafts from female compared
with 8% for recipients of male grafts. Donor sex was also an important influence on risk of developing
chronic GVHD with cumulative incidences of chronic GVHD 9.7% for patients receiving transplants
from male donors grafts compared to 24.3% for recipients of female donor grafts.Conclusion: we
found that male recipients of grafts from female donors had a significantly higher probability for acute
and chronic GVHD than male recipients with male donors or female recipients with female donors and
despite the beneficial GVL effect observed in male recipients with female donors, these patients had
significantly reduced survival compared with all patient/donor sex combinations, suggesting that other
variables, particularly GVHD, contribute to transplantation-related mortality.
Key words: Hematopoietic cell transplantation, sex incompatibility, Graft versus host disease, Graft
versus leukemia, donor sex.


Hematopoietic cell transplantation (HCT)
marrow micro-environment, and will then
is well established as therapy for hematologic
malignancies as well as many non-malignant
and differentiate to repopulate all lineages of the
disorders. Over the last several years, the
spectrum of diseases that may be treated with
Donor selection is an important way to
HCT has dramatically expanded, increasing the
decrease the risks after HSCS and is therefore a
importance of this therapeutic modality and
key component of the clinical practice of
extending HCT beyond the traditional bounds of
transplantation.2 In general, HLA-identical
hematology and oncology. HCT is founded on
siblings are the preferred donors, but some
the principle that hematopoietic stem cells
patients have more than one HLA-matched
(HSCs) when infused, will home to and
sibling. Thus, it is important to understand the
engraftin the stem cell niche within the bone

DOI: 10.12816/0009357

Full Paper (vol.58 paper# 4)

c:\work\Jor\vol58_5 The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 32- 38

Effectof Follicular Flushing during Oocyte Retrievalon Clinical
Outcomeof Assisted Reproductive Technology
Mohamed Mahmoud Ahmed Salman, Amr Abdel-Aziz El-Sayed Ali, Amr Helmy Yehia,
Magdi Hasan Ahmed Kolaib andEsam Mohamed Khater El-Sheikh
Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University, Cairo,
Corresponding author: Mohamed Mahmoud A. Salman Email:M7md_salman@yahoo.com

Objective:is to determine whether follicular aspiration and flushing increase the number of
oocytes yield and pregnancy outcome over aspiration alone in women undergoing ICSI.
Study design: prospective randomized controlled trial. One hundred eighty five infertile
women who underwent ICSI were included in the study. They were randomized into two groups
92 cases in (aspiration and flushing group) and 93 cases in (aspiration only group),during the period
from September 2011 to September 2013.
Intervention(S):Controlled ovarian hyperstimulation using long GnRH agonist was the standard
protocol, hCGadministrated 10000 iu when three or more follicles were at least 18 mm in largest
diameter, Trans-vaginal follicular aspiration performed 34-36 hours after hCG trigger.In the
aspiration alone group, a 16 gauge single lumen needle used, with suction continue until a small
amount of blood stained fluid appeared in the tubing or flow stop, When flushing accompany
aspiration of follicular fluid in the study group, the same needle used with a double-way tap
allowing flushing of (2 ml) of embty follicleby Earl's medium till oocyte retrieved or maximum two
Results:The study observed 60.5 % oocyte recovery rate with aspiration only compared with
80.9 % with follicular aspiration and flushing.Operative time (minutes) was significantly longer
among flushing group,the retrieval time was 1.3 fold higher among those undergoing follicular
flushing. Pregnancy was non-significantly more frequent among flushing. Implantation rates non-
significantly more frequent among flushing group than non-flushing group (31.6% versus 26.3%,
P= 0.424) and ongoing clinical pregnancy non-significantly more frequent among flushing group
(27.4% versus 21.1% , P= 0.31).
Conclusion, flushing non-significantly increase implantation and clinical pregnancy outcome
and associated with a significant increase in the procedure time for oocyte retrieval, so patient
groups where a small number of oocytes are available for retrieval may represent patients most
likely to benefit from follicle flushing as only one extra oocyte may affect the outcome.
Keywords: follicle flushing, oocyte retrieval, in-vitro fertilization, assisted reproductive


Assisted reproductive techniques are

an accepted form of treatment for infertility
flushing ovarian follicles, were developed to
and the procedures used are generally assumed
overcome the possibility of oocyte retention
to be relatively constant in the way they are
within the ovarian follicles and retrieval
performed between centers. Transvaginal
collection system. 3,9
ultrasound guided oocyte collection is now
The overall aim of ART is to increase
almost universal.1
the chances of conception, with the desired
In early stages of assisted reproductive
outcome a live baby, while not placing the
technologies (ART), oocyte retrieval was
woman at undue risk. Variations in accepted
performed via laparoscopy, a cumbersome and
methodology are often attempted in order to
improve the desired outcome. It is important
anesthesia. 2 Today, transvaginal oocyte
to evaluate whether these variations do
retrieval for ART is a routine procedure
performed under ultrasound guidance. Double
transvaginal needle collection of oocytes has
lumen retrieval needles, which are capable of
become the preferred method of oocyte
DOI: 10.12816/0009358

Full Paper (vol.58 paper# 5)

c:\work\Jor\vol58_6 The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 39-47

Hypoglycemic and Antioxidant Effects of Cleome Droserifolia (Samwah)
in Alloxan-Induced Diabetic Rats
Eman G.E. Helal*, Nouran Abou Aouf**, Inas Z.A. Abdallah***, ALsayeda
Mohammed Khattab*
*Department of Zoology, Faculty of Science (girls), **Department of Physiology, Faculty of
Medicine (boys), Al-Azhar University, Cairo, Egypt, ***Department of Nutrition and Food
Science, Faculty of Home Economics, Helwan University, Cairo, Egypt.

Diabetes mellitus (DM) is a chronic disease caused by inherited or acquired
deficiency in insulin secretion and by decreased responsiveness of the organs to the secreted
insulin. Recently, some medicinal plants have been reported to be useful in diabetes treatment.
Cleome droserifolia
(Samwah) having a long history in Egyptian folk medicine for treatment of
diabetes mellitus.
Aim of the work:The aim of the present study was to evaluate the possible antihyperglycemic
property of Cleome droserifolia extract (CDE) and its antioxidant mechanism in alloxan induced
diabetic rats.
Material and Methods:This study was performed on thirty male albino rats of Sprague Dawely
strain with an average body weight of 100-110g. Animals were divided into three groups
(ten/cage), control untreated group, diabetic group and diabetic group treated with plant extract that
was given orally (28.5 mg/kg body wt. twice/ day).
Results showed marked decline in levels of serum insulin, body weight, total proteins,
albumin, globulin and high density lipoprotein cholesterol (HDL). These are accompanied with
marked elevation in levels of fasting blood glucose, HOMA-IR, AST, ALT, GGT, urea, creatinine,
uric acid, serum total lipids (TL), total cholesterol (TC), triacylglycerols (TG), low density
lipoprotein cholesterol (LDL), very low density lipoprotein cholesterol (VLDL) and ratios of
TC/HDL and LDL/HDL (risk factors) in diabetic rats as compared to the corresponding controls.
While the daily administration of diabetic rats with CDE showed significant amelioration in most
of these parameters.
It could be concluded that CDE treatment exerts a therapeutic protective nature in
diabetes by decreasing oxidative stress and pancreatic -cells' damage which may be attributed to
its antioxidative potential and antidiabetic property.
Cleome droserifolia, Diabetes mellitus, Antidiabetic medicinal plants, Antioxidant.


Diabetes mellitus is represented by
and Cleome herb[5]. Cleome droserifolia is
hyperglycemia, lipidaemia, and oxidative
used by herbalists in Egypt as a
stress; it predisposes affected individuals to
hypoglycemic agent, and its decoction is
long term complications affecting the eyes,
widely used by the Bedouins of the southern
skin, kidneys, nerves, and blood vessels[1].
Sinai for the treatment of diabetes[6]. It is also
Diabetes is prevalent in all parts of the world
used in various disorders such as diarrhea,
and rapidly increasing worldwide. The
estimated number of adults living with
bronchitis, skin diseases, malaria fever and in
diabetes has soared to more than 371 million,
the treatment of scabies and rheumatic
having a prevalence of 8.3%[2]. Many herbs
and plants have been described as possessing
Previous reports on the biological
hypoglycemic activity when taken orally[3].
activity of the plant extract described its
Cleome droserifolia (Forssk.) Del.
hypoglycemic effects on rats[8]. A variety of
belongs to Family Cleomaceae (Genus:
phytochemicals have been reported for C.
Cleome), grows in different regions of Egypt,
droserifolia, including; alkaloids, tannins,
especially in Sinai[4]. It is known in Egypt as
saponins, coumarins,ocosaniocacid,catechins,
Samwah, Afein or Reeh-El-Bard
amino acids, cardenolides, hydrocarbons,

sterols such as (-sitosterol and stigmasterol),
DOI: 10.12816/0009359

Full Paper (vol.58 paper# 6)

c:\work\Jor\vol58_7 The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 48-54

Utilizers' Satisfaction with Health Care Services Provided By New
Damietta General Health Center
Omar Omar Zidan
Public Health and Community Medicine Department,
Damietta Faculty of Medicine, Al- Azhar University

Utilizers' satisfaction is a multifaceted and a very challenging outcome to define. Patient expectations
of care and attitudes greatly contribute to satisfaction. Other psychosocial factors, including pain and
depression, are also known to contribute to utilizer's satisfaction scores. Objectives: Were to assess
the utilizers' satisfaction with health care services provided by New Damietta Health Center and to
determine health care providers' opinions about the causes of the users satisfaction from their points of
view and how to improve it. Methods: A cross sectional study was conducted on the attendants of
New Damietta General Health Center. The study included 130 health care utilizers and 49 health care
providers from first of April to end of June 2014. Data collection was performed by an interview
questionnaire. Results: The results showed that out of 130 health care utilizers, 96 (73.8%) were
females, 91 (70.0%) were in the age group 19-45 years, and the overall rating of services as reported
by the users was 62.46%. About half (46.2%) of the respondents reported that they had a good care at
the center. While, a minority (3.8%) recorded that the center's services were poor. The users illustrated
that the health care services and health care providers were the best items in the center, 53.9% and
46.0%, respectively. The cheap services were considered the commonest cause of satisfaction as
reported by 47.9% of females and 53.0% of males. While, drug deficiency was the commonest cause
of dissatisfaction as mentioned by 73.0% of females and 55.9% of males. Conclusion: The majority of
our respondents were relatively satisfied regarding different aspects of care. However, still there are
many efforts (e.g. drug adequacy) needed for improvement of patient satisfaction. Recommendation:
Health authorities should paid attention to overcome causes related to utilizers' dissatisfaction as drug
Key words:
Satisfaction, utilizers, health center and New Damietta.


Utilizers' satisfaction is better defined
degree of satisfaction. However, if the
as utilizers' emotions, feelings, and their
perception does not meet the expectation,
perception of delivered health care services .(1)
there will be resulting dissatisfaction.
On the other hand, other authors' defined
Appropriate discussions are necessary to
utilizers' satisfaction as a degree of
address the patient's concerns and priorities,
congruency between patient expectations of
due to the distinct differences that exist
ideal care and their perceptions of real care
between patients and physician regarding
received.(2) Historically, patients place great
expectations and outcomes. Ultimately, when
value on the physician-patient interaction.
patient expectations are met, patients are more
While, physicians have focused on technique
satisfied and have better outcomes.(4) Research
and objective outcomes as measures of patient
of patient satisfaction in advanced as well as
developing countries has many common and
communication has been shown to be the key
some unique variables and attributes that
in improving patient satisfaction. Utilizers-
influence overall patient satisfaction. (2)
physician communication can be challenging,
Generally, health care uses the Serv-
but presents a tremendous opportunity for
improvement. (3)
satisfaction scores. Serv-Qual, short for
The "First Law of Service" provides a
service quality, is the "most complete attempt
useful, simple mathematical model of
to measure quality". Serv-Qual was originally
satisfaction. The formula for this model is
measured on 10 aspects of service quality:
Satisfaction equal Perception in relation to
Expectation. If a patients' perception of their
access, courtesy, communication, credibility,
hospital experience meets or exceeds the
security, understanding the customer and
expectation, there will be a corresponding
tangibles. It measures the gap between

Full Paper (vol.58 paper# 7)

c:\work\Jor\vol58_8 The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 55-62

Out of Pocket Expenditure on Non-Communicable Diseases among Egyptian
Ahmed A. Ghandour
Public Health and Community Medicine Department
Damietta Faculty of Medicine, Al- Azhar University

Non communicable diseases (NCDs) are now the major cause of death and disability
worldwide and increasingly affect people from developing as well as developed countries. NCDs account
for 44 % of premature deaths worldwide. Over the next 20 years, it will cost > US $30 trillion. It was
defined as the total amount of own money respondents spent on both medical expenses and nonmedical
expenses related to care processes pertinent to healthcare. High levels of out of pocket expenditure on
healthcare may leave insufficient income for other necessities, and may impede access to healthcare,
affecting health status and quality of life. Objective: To determine the level of out of pocket expenditure
of Egyptian patients who suffered from non communicable diseases. Methods: A descriptive cross
sectional study was conducted on Al-Hosary Family Health Center (6th October City, Egypt) targeted
chronic patients older than 18 years with one or more of diabetes mellitus, hypertension and dyslipidemia.
An interviewing questionnaire was designed for data collection, which had been gathered during the
period from February, 2014 to end of April, 2014. The number of patients who attended the center in that
time and accepted to participate in the study and were sure about data related to their diseases and costs
were 146 patients. Results: Results showed that mean age of the study participants was 48+6 years.
Majority (76.7%) of the participants was females, 53.4% of the participants were suffering from DM
while those who were suffering from hypertension represented 39.7% and 29.5% of them were suffered
from dyslipidemia. 87% of the studied sample was non smoker while only 1.4% were alcoholic. 36.3% of
the participants had different levels of regular physical activity; 11 % of them reached the required level
of physical activity ( 30 minutes/day). Measuring of the obesity parameters revealed that mean BMI was
27+3 and mean waist circumference was 104+2 cm. Concerning out of pocket expenditure, 44.5% of the
participants spent 500-1000 Egyptian pounds monthly for the management of their chronic diseases (DM,
hypertension, dyslipidemia) while those who spent <500 L.E./month were 49.3%, and few patients (6.2%)
reported that they spent >1000 L.E. monthly. The mean monthly out of pocket expenditure for the studied
patients was 506.3+202.9 L.E. Concerning monthly out of pocket expenditure in relation to gender and
employment, there is no significant statistical differences. There is a statistical highly significant
difference between monthly out of pocket expenditure and number of chronic diseases. Conclusion:
There is a high out of pocket expenditure for Egyptians with NCDs. Recommendations: Searching for
alternatives for financial support of those patients, establishing a national health insurance program,
effective intersectoral action, and improved access to basic healthcare.
Keywords: Non communicable diseases, out of pocket expenditure.


Non communicable diseases (NCDs) are
middle-income countries, where, on average,
now the major cause of death and disability
they now exceed communicable diseases as the
worldwide and increasingly affect people from
major cause of disease burden.(2) NCDs account
developing as well as developed countries.(1) The
for 44 % of premature deaths worldwide. The
2010 WHO Global Status report on NCDs
number of deaths that results from NCDs is
showed that more than 36 million people died
double the number of deaths that results from a
from NCDs in 2008, mainly cardiovascular
combination of infectious diseases (including
diseases (48%), cancers (21%), chronic
HIV/AIDS, tuberculosis and malaria), maternal
respiratory diseases (12%), and diabetes (3%).
and perinatal conditions and nutritional
Nearly 80% of these deaths occurred in low- and
deficiencies. Over the coming decades the

DOI: 10.12816/0009361

Full Paper (vol.58 paper# 8)

c:\work\Jor\vol58_9 The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 63- 73

Protective Effects of Curcumin for Oxidative Stress and Histological
Alterations Induced by Pyrethroid Insecticide in Albino Rats
Fouad Abdel RheimAwad Abbas RagabFatma .M.Hammam
Hossam El-Din Hamdy
Department of biochemistry, Faculty of Agriculture, Cairo University,**Department of Mammalin
Toxicology , Central Agriculture pesticidesLaboratory Agricultural Research Central

esfenvalerate(esfen) is a type II of synthetic pyrethroid that has replaced other groups of
insecticides due to its improved insecticidal potency. The objective of this study was to investigate the
toxicity of pyrethroid insecticides on liver tissues of rats and the possible role of antioxidant plant
(curcumin ) as a protective agent against oxidative stress and histological alterations.
Material and methods: forty male albino rats were divided into 8 groups of 5 rats /each: G1: served as
control and G2: served as positive control received (100mg/kg curcumin ), G3,G4 and G5 had oral
administration (1/20 LD50, 1/40 LD50 and 1/60 LD50 of esfenvelerate ) respectively and the last three
groups(G6,G7and G8) were received the same doses of pesticide plus 100mg /kg curcumin for 28 days
Results: exposure of rats to (esfen) induced significant increase in the levels of MDA and significant
decrease in total protein , GSH ,SOD and catalase whilst the insecticides doses plus curcumin showed
decrease in MDA for high and medium dose and ameliorated the reduction of total protein concentration
in low dose. We showed that curcumin acts as an effective antioxidant for esfen pesticide toxicity by
reducing oxidative stress burden and histological damage.
Keywords: esfenvelerate, pyrethroid, curcumin ,oxidative stress.


Pyrethroid pesticides such as cypermethrin and
imbalances in the equilibrium between pro-
Fenvalerate show high toxicity to a wide range
oxidants/antioxidants status in cellular systems,
of insects, including some pesticide resistant
which results in damaging the cells." Cells have
strains and low toxicity to mammals and birds
an intact oxidation process to detoxify the
but when administered at a high dose,
cellular environment from oxidants, and thus
pyrethroids produce evident neurotoxicity in
create the equilibrium in oxidants and
mammals. However, the current information is
antioxidants from aerobic metabolism. The
not sufficient to adequately assess the risk
formation of pro-oxidants is readily balanced by
posed by fenvalerate to non-target organisms,
antioxidants by a similar rate. The failure in the
though some work has been done to assess its
neutralization events of oxidative status result in
toxicity to non target species.1Synthetic
oxidative stress which leads to the cell death by
pyrethroids, a group of neurotoxic insecticides
lipid peroxidation, carbohydrates oxidation,
have emerged as a new class of agricultural
protein oxidation and nucleic acid oxidation.4
pesticides showing high toxicity to a wide range
Reactive oxygen species (ROS) are formed and
of insects including resistance strains and low
degraded by all aerobic organisms, leading to
toxicity to mammalians and birds. 2Fenvalerate
either physiological concentrations required for
is the most widely used compound of the
normal cell function, or excessive quantities, the
cyanophenoxy-benzyl group of the synthetic
state called oxidative stress. As the term ROS
pyrethroid pesticides and it is used in agriculture
implies, intracellular production of those oxygen
to protect a wide variety of crops including
intermediates threatens the integrity of various
cotton,soybeans, corn, vegetables, apples,
biomolecules including proteins 5 lipids as well
peaches, pears and nuts from insect pests. 3
as lipoproteins involved in atherosclerosis 6 and
oxidative stress is ultimately defined as "the
DNA 7. Oxidative stress is also proposed to be

involved in the process of aging both by
DOI: 10.12816/0009362

Full Paper (vol.58 paper# 9)

c:\work\Jor\vol58_10 The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 74-93

Ameliorative Effect of Two Antioxidants on The Liver of Male Albino Rats
Exposed to Electromagnetic Field
Fatma,A.Eid1; Ahkam,M.El-Gendy1;Samir,A.Zahkouk1;Nomaan, A.El-Tahway2 and
Al-Azhar University,Faculty of Science,Zoology Department1 and Misr University For Science and


Aim of the work-This study aimed to determine the ameliorative effect of silymarin (SIL) and
vitamin E (Vit.E) against changes induced by mobile phone radiation in the liver of male albino rats.
Matrerial and methods-Total of 48 adult male albino rats were assigned for this study. The 1st group
served as control (n=6); the 2nd group exposed to mobile phone generator radiation (900MHz) for 2hr/day
3days/week for two months, 3rd group (+ve control) supplemented with SIL, 4th group (+ve control)
supplemented with Vit.E, 5th group (+ve control) supplemented with SIL and Vit.E, 6th group: exposed
group supplemented with SIL, 7th group : exposed group supplemented with Vit.E and 8th group exposed
group supplemented with SIL and Vit.E.Physiological , histopathological and histochemical changes were
studied.Results- Exposure to mobile phone causes reduction in RBCs, Hb, Hct, MCV, MCH and MCHC.
However, WBCs count, platelets count, lymphocytes % and neutrophil %were increased.Also, there were
increases in liver enzyme activities ALAT, ASAT and ALP in serum and liver tissue significantly and
increased oxidative stress markers (MDA and H2O2).While, antioxidants (CAT and GSH) were decreased
in serum and liver tissue. Numerous histopathological changes were detected in the liver tissue of rats of
the irradiated group with altered collagen fibres, polysaccharides and total protein in hepatocytes of the
central and portal areas of the liver tissue in the exposed group These changes manifested good
amelioration in the exposed groups that supplemented with SIL and/or Vit.E .
Conclusion- Treatment of rats with SIL and/or Vit.E ameliorated the dangerous effect of mobile
phone radiation.
Key words: Mobile phone radiation - Albino rats - Liver -Silymarin - vitamin E.


The evolution of mobile phones is one of
exposed to EMF that has been shown in the
the fastest technology in the history of
experimental studies.10,6
innovation.1 The number of mobile phone users
Liver was used in this study because it's
is constantly increasing. Mobile phone becomes
high iron content. This makes the liver more
a frequent source of contamination of the human
susceptible to the effects of the magnetic fields.11
environment by producing non-ionizing radiation
Recent scientific studies have been focusing
(NIR).2 This phenomenon has raised concerns
on the use of plant products as therapeutic
about the possible hazards of the electromagnetic
field radiation emitted by mobile phones which
El Banna et al. 14 demonstrated that
can affect people's health .3,4The close proximity
extract of Silybium marianum have a significant
of the antenna of this device to the abdominal
hepatoprotective and antioxidant activity and
organ's when carried on the belt has raised
may be useful for patients who suffer from liver
concerns about the biological interactions
diseases , as it increase the activities of
between electromagnetic radiation and internal
antioxidant enzyme SOD, CAT activities and
organs.5, 6 Mobile phones are mainly placed in
GSH level. The protective effect of this extract
the front or side pockets (close to the liver); the
may be attributed to the presence of flavonoid
compounds and their antioxidant effects and free
electromagnetic radiation which may be
radical scavenging properties.15,13 Silymarin
absorbed by various body organs according to
(SIL) effects have also been indicated in various
the places where they are carried.7 It is possible
illnesses of different organs such as prostate,
to say that the deleterious effects of
lung, kidneys, pancreas and skin.16
electromagnetic microwaves are generally
Vitamin E (Vit.E) is an important lipid-
exerted through elevation of body temperature 8 ,
soluble antioxidant. It functions through the
creation of free radicals 9 and disruption of
glutathione peroxidase pathway protecting cell
oxidant /antioxidant balance in various tissues
membranes from oxidation by reacting with
DOI: 10.12816/0009363

Full Paper (vol.58 paper# 10)

c:\work\Jor\vol58_11 The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 94-108

Physiological and Histological Studies on The Heart of Male Albino Rats Exposed
to Electromagnetic Field and The Protective Role of Silymarin and/orVitamin E.
Nomaan, A.El-Tahway2 and Sawsan,A.El-Shamy2.
Al-AzharUniversity,Faculty of Science,Zoology Department1 and
Misr University For Science and Technology2.

Aim of the work:This study aimed to determine the ameliorative effect of silymarin (SIL) and\or
vitamin E (Vit.E) against changes induced by mobile phone radiation in the heart of male albino rats.
Matrerial and methods:Total of 48 adult male albino rats were assigned for this study. The 1st group
served as control (n=6), the 2nd group exposed to mobile phone generator radiation (900MHz) for 2hr/day
3days/week for two months, 3rd group (+ve control) supplemented with SIL, 4th group (+ve control)
supplemented with Vit. E, 5th group (+ve control) supplemented with SIL and Vit.E, 6th group: exposed
group supplemented with SIL, 7th group: exposed group supplemented with Vit.E and 8th group exposed
group supplemented with SIL and Vit.E. Physiological ,histopathological and histochemical changes were
studied.Results: Exposure to mobile phone causes increases in activities of CPK, CK-MB and LDH
enzymes in serum and heart tissue and oxidative stress markers (MDA and H2O2),while antioxidants
(CAT and GSH) were decreased in the heart tissue. Sodium (Na) and calcium (Ca) levels were decreased
While, K level showed non-significant change in serum. Numerous histopathological changes were
detected in the heart tissue of rats of the irradiated group with altered collagen fibres, polysaccharides in
the cardiac muscle fibres of the exposed group. These changes manifested good amelioration in the
exposed groups that supplemented with SIL and/or Vit.E.
Conclusion:Treatment of rats with SIL and/or Vit.E ameliorated the dangerous effect of mobile phone
radiation occurred in the cardiac muscle fibres.
Key words: Mobile phone radiation - Albino rats - Heart -Silymarin - Vitamin E.


Since mobile phones are generally held

and used close to the body, they are considered
Mobile phone induced heart tissue damage,
as the main source of electromagnetic radiation
this damage may be due to the mobile phones
(EMR) that any person is exposed to it. In fact,
which are used in close proximity to the
the whole body could act as an efficient
heart and therefore, EM radiation emitting
antenna for absorption of EMR. Thus, the
mobile phone may be absorbed by the heart.5
signals transmitted by a cell phone can reach
Silymarin is found in the seeds of Silybium
all parts of the body and penetrate into the
marianum. Silymarin is a standardized mixture
living tissues and influence the body at the
of antioxidant flavonolignans. It is a free
cellular level.1 It is possible to say that the
radical scavenger and a membrane stabilizer
that prevents lipidperoxidation.6
microwaves are generally exerted through
El Banna et al.7demonstrated that extract
elevation of body temperature 2, creation of
of Silybium marianum have antioxidant
free radicals 3and disruption of oxidant
activity, as it increases the activities of
/antioxidant balance in various tissues exposed
antioxidant enzymes superoxide dismutase
to mobile phone (MP) that has been shown in
(SOD), CAT and GSH.
the experimental studies.3
Rao and Viswanath8 reported that SIL
The circulatory system is considered as the
protected the endogenous antioxidant enzymes,
main connecting and feeding system of the
suppressed the neutrophil infiltration during
body tissues, it is very sensitive and any
ischemia-reperfusion and limited the infarct
malfunction of this system can create
size in the heart, with concomitant reduction in
disturbances in all the body organs.4
serum and heart tissue MDA. Pretreatment
DOI: 10.12816/0009364

Full Paper (vol.58 paper# 11)

c:\work\Jor\vol58_12 The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 109-119

A Possible Hypoglycemic and Antioxidant Effect of Herbal Mixture
Extraction in Diabetic Rats
Eman G. E. Helal, Noran Abou-Aouf, AL Sayeda M. Khattab
Department of Zoology, Faculty of Science (Girls), Al-Azhar University, Cairo, Egypt

Back ground:
The use of medicinal plants for management of diabetes mellitus is an old practice
which has become even more relevant in modern perspective. The present work was designed to
evaluate the effect of a mixture of five medicinal plants which used in folk medicine in Egypt
especially in Sinai as hypoglycemic agents on the adult male diabetic rats. These plants are Cleome
(Samwah), Ambrosia maritima (Damsissa),Artemisia judaica (Shih kharasani),
Chiliadenus montanus or Jasonia Montana (Neheda) and Artemisia annua (Kaysom).Material and
Thirty male albino rats were divided equally into three groups including control, diabetic
and diabetic treated with a mixture of aqueous extract. A single dose of alloxan (120 mg/kg body
weight) was used to induce diabetes in rats. Diabetic rats were given plant mixture extract orally
twice daily for 30 days (28.5 mg/kg body weight (b. wt.) twice/day). Results: there was a marked
decline (p<0.01) in levels of serum insulin, body weight (4.98 %), total proteins, albumin, globulin
and high density lipoproteins (HDL) accompanied with marked elevation (p<0.01) in levels of fasting
blood glucose, homeostasis model assessment of insulin resistance (HOMA_IR), aspartate
aminotransferase(ASAT), alanine aminotransferase (ALAT), gamma-glutamyltransferase (GGT),
urea, creatinine, uric acid, serum total lipids(TL), total cholesterol (TC), triglycerides TG, low density
lipoproteins (LDL), and very low density lipoproteins(VLDL),risk ratios of TC/HDL and LDL/HDL
in diabetic rats as compared to the control rats. While administration of aqueous extract of plant
mixture to alloxan diabetic rats significantly ameliorated the disturbed biochemical parameters.
Conclusion: These results proved that this plant mixture extract has a significant hypoglycemic effect
and ameliorating metabolic abnormalities induced by diabetes mellitus.
Key words: Diabetes mellitus, Insulin, Hypoglycemic, Alloxan, medicinal plants


Diabetes mellitus (DM) is highly
One of these plants was Ambrosia maritima
recognized as the most common metabolic and
(Damsissa plant) is considered as a very
endocrine disorder worldwide. It is linked to
important herb which used in folkloric
disturbances in carbohydrate, fat, and protein
treatments, widely grown in Egypt especially
metabolism.[1] At least 250 million individuals
in Sinai.[4] Some researchers found that this
worldwide suffer from diabetes and this
medicinal plant exerted hypoglycemic effects
number will double by 2030. Lifestyle and
and increased the level of serum insulin in
food habit changes are known to be the major
alloxan-diabetic animals.[5]
causes of diabetes. Increases in complications
Chiliadenus montanus or Jasonia montana
will undeniably follow increasing diabetes
(Neheda) (Family: Asteraceae), is common in
incidence rates. More than 80% of diabetes
the Sinai.[6] There were more evidences for
deaths take place in low- and middle-income
countries[2] .
antioxidant activities that have been recently
Plant products are known to be rich in
investigated .[7]
phenolic compounds, flavonoids, terpenoids,
The dried herb of Cleome droserifolia
coumarins and other constituents which reduce
locally known as Samwah which is a plant of
blood glucose levels.[3]Sinai deserts in Egypt
the Cleomaceae family. It is present in the
have hundreds of medicinal plants, that were
deserts, especially the Eastern desert, Red Sea
traditionally used in the treatment of diabetes
region, Sinai, Gebel .Its decoction of leaves
and passed down from the ancient Egyptians
and stems is widely used by the Bedouins of
through the generations and till now. Some
the southern Sinai for the treatment of diabetes.
people in the desert of Sinai have great
experiences of treating different diseases by
Artemisia judaica (Family: Asteraceae)
using such plants.
known as "Shih kharasani" which grows in


Full Paper (vol.58 paper# 12)

Experimental rat model of diabetic nephropathy: RAGE detection and effect of spironolactone monotherapy The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 120-128
Experimental Rat Model of Diabetic Nephropathy: RAGE Detection and
Effect of Spironolactone Monotherapy
Malak Nabil1; Manar Raafat1; Emam Waked1; Afkar Badawy2 and Mohamed Salah3
Nephrology1; Pathology2 and Veterinary3 Departments, Theodor Bilharz Research Institute, Imbaba,

The glycation process results in formation of advanced glycation end products (AGEs),
which accumulate in different organs at an accelerated rate in diabetes, resulting in alteration of both
structure and function. This effect is via the receptor for AGES (RAGE), which is a signaling receptor
leading to profibrotic reactions. The renin angiotensin aldosterone system (RAAS) is activated in diabetic
nephropathy (DN) and leads to more renal damage. This is inhibited by angiotensin converting enzyme
inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) and mineralocorticoid receptor blockers
(MRBs).Aim of the study: to show the monotherapeutic effect of spironolactone in diabetic nephropathy
and to detect RAGE. Method: Diabetes was induced in rats by streptozotocin. Three weeks
after,spironolactone (SPL) was given for 4 weeks. Then, control, diabetic and treated rats were sacrificed.
Results: The results of blood chemistry at the end of 4 weeks showed statistical increase in serum
sodium, potassium and urea with no effect on serum creatinine or blood glucose. Kidney pathological
injuries were attenuated by SPL also, RAGE deposition compared to the diabetics. The study showed
RAGE deposition in the experimental DN and confirmed the beneficial effects of MRB in DN.
Keywords: Diabetic nephropathy, receptor for AGES (RAGE),the renin angiotensin aldosterone
system(RAAS), spironolactone(SPL).


Advanced glycation end products (AGEs)
Alzheimer's disease9, arthritis10 and sepsis11, by
have been known as the major factor
its ability to engage many ligands as nuclear
contributing to the pathogenesis of diabetic
factor B (NF- B), MAP kinases and adhesion
complications,1and the receptor for advanced
glycation end products (RAGE) dependent
AGEs are formed due to hyperglycemia,
mechanisms are likely to be responsible.2
through a reaction between sugars and the free
RAGE is composed of a single
amino group of proteins, lipids and nucleic
hydrophobic transmembrane spanning domain,
acids13, to form irreversible crosslinks. The
a highly charged cytosolic tail and an
glycation process (Maillard reaction) is divided
extracellular region.3
into 3 stages: the early reactions resulting in
During embryonic development, RAGE is
formation of a Schiff base and Amadori
highly expressed in a constitutive manner.4In
products, the rearrangements of these chemical
adults, it is expressed in a regulated manner
groups and the final reaction forming the
meaning that expression can be induced in
classical Millard browning products or the
situations, where there is accumulation of
AGEs.14 They are formed over periods of
ligands and inflammatory mediators.5
months on long lived cellular proteins. CML (N
In fact, RAGE is found on numerous
Carboxy- methyl lysine), pentosidine and FFI
immune cells that perpetuate the immune
(fluoryl- furanyl- imidazole) are examples of
response as neutrophils, T and B lymphocytes,
studied AGEs, which accumulate in the skin,
lens and vascular tissue at an accelerated rate in
cells.6RAGE is the most studied receptor for
AGEs, however, many were identified as
DN is characterized by the accumulation of
macrophage scavenger receptor, CD36, LOX-1
extracellular matrix (ECM) proteins in the
and others.7It is not a scavenger of AGEs, but a
mesangium and tubulointerstitium. AGEs
modification results in alteration of both
inflammatory diseases as atherosclerosis8 ,
structure and function.16This is a direct effect via
DOI: 10.12816/0009366

Full Paper (vol.58 paper# 13)

Key Words: Nigella Sativa, Thymoquinone, Antitumor activity, Ehrlich The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 129-142

Protective and Curative Effect of Thymoquinone on Ehrlich Solid Carcinoma
Inoculated Mice
Sayed K. Areida, Amira O. Abd El-Azim and Maggie E. Amer
Zoology Department, Faculty of Science, Mansoura University, Mansoura, Egypt
Corresponding Author: Dr. Sayed Kamel Areida, E mail:areida2002@yahoo.com

Thymoquinone (TQ), the main constituents of the volatile oil from Nigella sativa seeds and
it is reported to protect laboratory animals against chemical toxicity and induction of carcinogenesis. This
study was undertaken to investigate the potential protective and curative effect of TQ on Ehrlich solid
carcinoma cells (ESC) inoculated mice-induced carcinogenesis. Material and methods: (50) Swiss
albino mice were divided into five groups. Control group, Thymoquonone group: animals of this group
were orally treated with TQ (10 mg/kg/day) for 4 weeks, Ehrlich Carcinoma group : animals of this group
were inoculated intramuscularly with 0.2mL Ehrlich Ascites Carcinoma (2.5106 cells) in the right thigh
of the lower limb, Thymoquinone and Ehrlich carcinoma group: animals of this group were pre-treated
with TQ for 14 days then inoculated with (EAC) and Ehrlich Carcinoma and Thymoquinone group : in
this group animals were inoculated with EAC then after 8 days received TQ orally for a month.
Morphological, Molecular as well as histopathological and ultrastructural changes were examined.
Results: Our results revealed that TQ showed a significant anti-tumor activity in ESC bearing mice
represented by a reduction in tumor weight and volume. Flow cytometric analysis illustrated that the level
of apoptosis is significantly decreased in ESC inoculated group. Otherwise, TQ+ESC and ESC+TQ
groups showed a highly significant increase in apoptosis G0/1 peak. The level of P53 protein expression
showed a significant decrease in ESC inoculated group, and this decrease was ameliorated in TQ+ESC
and ESC+TQ groups when compared to ESC inoculated group. Histopathological observations showed a
reduction in tumor size after treatment with Thymoquinone and this tumor was found to be discontinuous
and fragmented with slowly growing. Conclusion: our results revealed that TQ has potential benefits in
the prevention of the onset and progression of solid tumor model in mice.
Key Words: Thymoquinone, Anti-tumor activity, Ehrlich ascites carcinoma, Ehrlich solid tumor


therapeutic dose of TQ is 1015 times lower
Thymoquinone (TQ) is a naturally-
than its LD50value in rats. [8] Thus, it is
occurring volatile oil extracted from (Nigella

sativa) seeds. Previous studies on TQ showed in
reasonable to assume that TQ is a safe
vitro and in vivo anticancer, anti-inflammatory
compound and has the potential to work as a
and anti-oxidant activities. [1] The combination of
therapeutic and hepatoprotective agent. Many
TQ with other natural compounds like diosgenin
potential targets which TQ regulates for its
anticancer activities have been identified
squamous cell carcinoma in vitro and sarcoma-
including p53, p73. [9] In addition, the
180-induced tumors in vivo. [2] Effect of TQ as
combination of TQ with conventional medicine
an immunomodulator was also reported. [3]
can result in greater anticancer effect, for
Toxicity studies showed that TQ can reduce the
example in NCI-H460 non-small cell lung
hepatotoxicity induced by some compounds
cancer cells multiple myeloma cells. [10]
including carbon tetrachloride, [4] tert-butyl

hydroperoxide, [5] and cyclophosphamide. [6]
undifferentiated solid tumor that is frequently
Furthermore, TQ had no effect on liver integrity
used in tumor studies. It is both used to develop
and hepatic enzyme activity when tested on mice
a tumor model and in chemotherapy
and rats. [7] Importantly, the intraperitoneal
investigations. [11] Following subcutaneous
DOI: 10.12816/0009367

Full Paper (vol.58 paper# 14)

c:\work\Jor\vol58_15 The Egyptian Journal of Hospital Medicine (Jan. 2015) Vol. 58, Page 143-166

Effect of Atorvastatin (ATOR) on the Cardiac Muscle Fibres in
Hyperlipidemic Adult Male Albino Rats (Structural and Biochemical Study)
Ezz-Eldin E Abdallah(*), Alsaid A Abd-Elhady(**) ,Magdy Y Elsaid (***)
Histology(*), Anatomy(**) and Physiology (***)Departments
Faculty of Medicine-Damietta- Al-Azhar University
:Atorvastatin (ATOR) used as a cholesterol-lowering drug. Ator is one of statins widely
used, commercially available and increasingly used day by day.Few studies and limited data were
existed on atorvastatin induced histological and ultrastructural changes in the cardiac muscle fibres.
The present study was conducted to evaluate the potential toxicity of the human equivalent
therapeutic doses of Atorvastatin on cardiac muscle fibres in induced hyperlipidemic adult male
albino rats. Material and Methods: thirty adult male albino rats were used in this study, the rats
used weighing (15010) gm. Rats were divided into groups,Group one (5 rats), served as the control
group (C) .Other twenty five rats were subjected to high fat diet (25% fat and 2% cholesterol) for 3
weeksand thenthey subdivided into three groups.Group two (five rats) was considered as a
hyperlipidemic group (H).Group three, treated group one (T1) (ten rats) received atorvastatin(Ator
20mg) (1.5 mg / day / rat)for three weeks , by the end the third week five rats weresacrificed and
other five rats were considered as the recovery group one (R1) , they received normal diet only for
another three weeks. Group four , treated group two (T2) (ten rats) received Atorvastatin (Ator
20mg) (1.5 mg / day / rat)for other six weeks , by the end of the 6th week five rats weresacrificed and
other five rats were considered as the recovery group two (R2) , they received only normal diet for
another six weeks. At the end of each step of the experiment, rats were sacrificed and specimens of
cardiac muscle fibres prepared by different methods for light and electron microscopic studies. Also
blood sampling was obtained forthebiochemical study.Results: the histological data obtained from
the different groups showed many changes, in hyperlipidemic group (H) indistinct and distorted
striation and separation of cardiac muscle fibres , ,vesicular nuclei , presence of myofibroblasts with
congested and dilated blood vessels, loss of some nuclei and condensation of nuclear chromatin with
normal mitochondria were detected. Treated group one (T1) showed that cardiac muscle fibres
restored their striation with separated and splitted myofibres and pyknotic nuclei, increased
myofibrobasts ,lymphocytic infiltration ,congested blood vessels and mitochondrial vacuolation with
disorganization of their cristae. In treated group two (T2) patchy loss of striation was observed with
splitted cardiac muscle fibres ,pyknotic nuclei of cardiomyocytes, margination of nuclear chromatin
,congested blood vessels, lymphocytic infiltration, swelling of mitochondria with disorganization of
their cristae. In recovery group one (R1) cardiac muscle fibres restored their striation. In recovery
group two (R2) cardiac muscle fibres restored their normal architecture. The statistically evaluated
data showed a significant difference in parentage of collagen and optical density of PAS + ve
materials in the different groups when compared to the control group specially in T2.The
laboratory evaluated data
showedsignificant increase inlevels of cholesterol (C) , triglycerides
(TG), low density lipoprotein- cholesterol (LDL-C), Very low density lipoprotein (vLDL),
Atherogenic index(AI) and decrease in high density lipoprotein- cholesterol (HDL-C) between the
control and the hyperlipidemic group. Administration of ATOR to the treated groups induce
significant decrease inlevels of C, TG, LDL-C , (vLDL), (AI) and increase of HDL-C when
compared with the hyperlipidemic group .Also there were significant decreasein levels of C, TG,
LDL-C and increase of HDL-Cin recovery groups when compared with the hyperlipidemic group.
Conclusion: administration of ATOR for long time led to adverse degenerative effects on structure
of the cardiac muscle fibres, although it has a potent lowering effect on lipid profile in
Key words:Atorvastatin (ATOR), Cardiac muscle fibers, Induced hyperlipidemia , Adult male albino


Full Paper (vol.58 paper# 15)