Optimization of Coronary Sinus Lead Position in Cardiac Resynchronization Therapy guided by Three Dimensional Echocardiography The Egyptian Journal of Hospital Medicine (Apr. 2015) Vol. 59, Page 167-171

Optimization of Coronary Sinus Lead Position in Cardiac
Resynchronization Therapy guided by Three Dimensional Echocardiography
Maha Mohamed Mohamed Khalifa*, Ali Ahmed El Abd, Mohamed Amin Abd El
Hamid, John Kamel Zarif,Tarek Rashid Mohamed, Haitham Abd El Fattah Badran
Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Maha Mohamed Mohamed Khalifa,Phone number: 01060366728,
Email address: dr.mahakhalifa@hotmail.com


Background: Cardiac resynchronization therapy (CRT) is now an established effective treatment
for patients with advanced heart failure.
One approach to improve CRT outcome may be determination of the degree of dsynchrony before
CRT as a predictor for CRT response. Conversely, the focus may be on an improved positioning of
CRT left ventricular (LV) lead.
AIM of the study: We aimed at our study to define the rule of three-dimensional
echocardiography in determining the optimal site of LV pacing lead.
Patients and Methods: The current study was conducted on 30 patients with heart failure who
had received CRT in Ain Shams University Hospitals in the period from 2012 to 2014.
All patients were subjected to thorough history taking, complete general and local examination,
conventional 2D echo and 3D echo analysis. The latest wall to reach the minimal volume was
determined. The patients were classified after CRT insertion into group A with concordance
between the delayed LV area and LV lead position and group B with discordance between them.
Our patients were followed up for 6 months duration.
: Our findings demonstrated that the response to CRT resulted in improvement of
NYHA class (p-value 0.04), LV EF by 2D and 3D echocardiography (P value <0.001 for both)
with significant increase in LV 3D SV (p value 0.001), and significant reduction of LA
diameter (p-value 0.03), LVESD diameter, 2D and 2D LVESV (P value 0.026, 0.026
, however there was no any statistically significant difference between both
Conclusions: No additional benefit of selecting LV lead position pre CRT insertion to be
concordant with the latest myocardial segment in reaching the minimal systolic volume assessed
by 3D echocardiography
Keywords: CRT, LV lead, 3D echo, Dyssynchrony.


several studies comparing response to CRT in
Cardiac resynchronization therapy
patients with the LV pacing lead at the
(CRT) is now an established effective
segment with the maximum mechanical delay
treatment for patients with advanced heart
to patients with the LV pacing lead at other
failure. 1 Apart from clinical benefits,
segments. 4
improvements of left ventricular (LV) systolic

Aim of the study: to define the rule of three
remodeling have been well reported.
dimensional echocardiography in determining
The rate of approximately 30% of inadequate
the optimal site of LV pacing lead.
responders remains an unsolved problem. 2 To

improve outcome of CRT, three different and
Patients and Methods:
The current study was conducted on 30
proposed: optimization of patient selection;
patients with advanced congestive heart
optimization of LV lead placement and
failure who had received CRT in Ain Shams
optimization of the programming of the CRT
University Hospitals in the period from 2012
device. 3 The importance of 3DE in optimal
to 2014 according to ESC guidelines. 5,6
LV pacing lead position was discussed in
All patients were subjected to:

thorough history taking with particular stress
on age, gender, risk factors, history of


Full Paper (vol.59 paper# 1)

c:\work\Jor\vol59_2 The Egyptian Journal of Hospital Medicine (Apr. 2015) Vol. 59, Page 172-181

Evaluation of DNA Damage in vivo by Comet Assay and Chromosomal
Aberrations for Pyrethroid Insecticide and the Antimutagenic Role of Curcumin
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 pesticides Laboratory Agricultural Research Central

Background: Esfenvelerate a synthetic pyrethroid insecticide, is widely used in the home environment and
in agriculture because of its high activity against a broad spectrum of insect pests and its low animal
toxicity .Objective of this study was to evaluate the genotoxicity of esfenvelerate and the possible
protective role of curcumin against this genotoxicity. 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 were orally administrated with (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 daily. Animals were sacrificed and bone marrow samples
were collected for chromosomal aberration assay test and liver samples were used for DNA damage
detection by comet assay. Results:chromosome aberration assay revealed that all the tested doses induced
chromosomal aberrations (CA) such as centromeric gaps, chromatid gaps, chromatid deletion, dicentric
chromosome, and ring chromosome. The alkaline comet assay showed significantly increased tail moment,
tail length and tailed DNA % in liver cells of animals treated with esfenvelerate alone compared to control
group. On the other hand, oral curcumin significantly ameliorated the genotoxicity induced by esfenvelrat.
All these results clarified the efficacy of curcumin in amelioration of chromosomal aberrations of
structures as well as DNA damage which may result from its antioxidant properties.
Key words: pyrethroid insecticide, comet assay, chromosomal aberrations, curcumin

pyrethroid pesticide is active against a wide variety
Pesticides have become an increasingly serious
of pests. 5Carbonell et al. 6 found a strong effect of
source of chemical pollution of the environment
fenvalerate on the mitotic spindle apparatus
due to their extensive usage in agriculture .1
resulting in the occurrence of C-mitoses.
Pesticides of the pyrethroid class, such as
Fenvalerate has been reported to inhibit
esfenvelerate are widely used because of their short
intracellular communication measured as inhibited
biodegradation period and their low tendency to
metabolic cooperation between V79 cells.
accumulate in organisms.2 Pyrethroids are a class of
Most of pesticide had been tested for their
neurotoxic pesticides registered for agricultural and
genotoxicity and cytogenicity using different
residential use in the United States. Use of
testing assays. 7 Biological monitoring provides a
pyrethroids has continuously increased during the
useful tool to estimate the genetic risk deriving
last two decades.3 Pyrethroid pesticides such as
from an integrated exposure to a complex mixture
cypermethrin and Fenvalerate show high toxicity to
of chemicals. Studies available in scientific
a wide range of insects, including some pesticide
literature have essentially focused on cytogenetic
resistant strains and low toxicity to mammals and
end-points to evaluate the potential genotoxicity of
birds but when administered at a high dose,
pesticides in occupationally exposed populations. A
pyrethroids produce evident neurotoxicity in
positive association between occupational exposure
mammals. However, the current information is not
to complex pesticide mixtures and the presence of
sufficient to adequately assess the risk posed by
chromosomal aberrations (CA), sister-chromatid
fenvalerate to non-target organisms, though some
exchanges (SCE) and micronuclei (MN) has been
work has been done to assess its toxicity to non
detected in them . Genetic damage associated with
target species. 4Fenvalerate [(RS)--cyano-3-
pesticides occurs in human populations subject to
high exposure levels due to intensive use, misuse or
methyl-butyrate, a third generation synthetic
failure of control measures. 8 The comet assay,

Full Paper (vol.59 paper# 2)

c:\work\Jor\vol59_3 The Egyptian Journal of Hospital Medicine (Apr. 2015) Vol. 59, Page 182-190

Role of Multi-detector CT in Assessment of Patients Suspected with
Chronic Inflammatory Bowel Disease
Ahmed Mohamed Monib ,Sherif Hamed Abu Gamrah ,Amira Mokhtar Bayomi
Department of Radiodiagnosis, faculty of Medicine, Ain Shams University, Cairo, Egypt.

Background: Crohn's disease and ulcerative colitis evolve with a relapsing and remitting
course. Determination of inflammatory state is crucial for the assessment of disease activity and
for tailoring therapy .Computed tomography enterography (CTE) has become a main modality for
the evaluation of inflammatory bowel disease (IBD). It simultaneously offers visualization of the
small bowel and extra intestinal status, which is helpful for diagnosing IBD. Crohn disease has
long segmental enhancing wall thickening related with the eccentric longitudinal distribution. In
addition, mural stratification, fibrofatty proliferation, positive comb sign by increased mesenteric
vascularity and internal/perianal fistula are characteristics of Crohn disease and can be identified
on CTE. Each of CTE findings for the IBDs is helpful for differential diagnosis. The main
disadvantage of this technique is the requisite radiation exposure of patients, particularly in young
patients. However, recent development of advanced CT techniques is promising for radiation
dose reduction without compromising diagnostic image quality
Keywords: Crohn's disease, Ulcerative colitis, Inflammatory bowel disease, Computed
tomography enterography ,multi detector computed tomography.


Inflammatory bowel disease (IBD)
small bowel follow through and small bowel
comprises two major disease entities:
Crohn's disease (CD) and ulcerative colitis
diagnosing active CD in the small bowel
(UC). Its etiology is not completely
because the findings provided by both
understood, but it is characterized by
methods are limited and indirect as regards
chronic inflammation of the gastrointestinal
the bowel wall and the extra-luminal
tract. Typically, these diseases evolve with
manifestations of CD. In addition,
overlapping of bowel loops may hinder the
effectiveness of these methods.5
diarrhea, abdominal pain and rectal
CT enterography is particularly useful
for differentiating between active and
Crohn's disease could be missed by
fibrotic bowel strictures in patients with CD
ileocolonoscopy if the condition skips the
disease, thus enabling selection of the most
distal ileum or is limited to the mesentary
or intramural portion of the bowel wall, but
management or intervention) for an
CT enterography can aid its detection and
improved outcome. CT enterography
can complements endoscopic assessment.2
allows excellent visualization of the entire
CT enterography was first introduced
thickness of the bowel wall and depicts
by Raptopoulos et al 3 in 1997 as a
extra enteric involvement as well,
modification to standard abdomino-
providing more detailed and comprehensive
pelvic CT examination to specifically
information about the extent and severity of
examine the small bowel in detail, notably
the disease process. 6
to assess the extent and severity of Crohn's
This study aims at evaluation of IBD by
disease 3,4 . They combined neutral (low-
computed tomography enterography (CTE)
density) oral contrast with enteric phase
in correlation to endoscopy as well as
CT to optimise contrast resolution between
detection of extra-enteric manifestations
mucosa and lumen, thereby maximizing
and complications of the disease.
conspicuity of abnormalities arising from
the small bowel wall.
Patients selection
Thirty patients were included in this
imaging techniques using oral contrast as
study. They were referred to radiology

departments of Ain Shams university

Full Paper (vol.59 paper# 3)


Risk Factors and Effects of Infestation with Pediculosis Capitis and Scabies
among Primary School Students in Cairo, Egypt
Essam A. El-Moselhy1*; Hassan M. Hassan2; Ayman S. Abdelhady1; Alaa Abdel-
Wahed1; and Abd-Elnaser S. Mohammed1
Departments of Community Medicine1 and Dermatology2, Faculty of Medicine, Al-Azhar University
*Corresponding author: Prof. Dr. Essam A. El-Moselhy (e-mail: dr_elmoselhy@yahoo.com).


Background: Pediculosis capitis (PC) and scabies are an important public health problem in
childhood. They have a worldwide distribution. Also, they have many effects on the infested students.
Objectives: To define the prevalence of PC and scabies, to find out the socio-demographic,
environment, and health care behavior risk factors, and to determine the effects on the studied students
in Cairo, Egypt. Subjects and Methods: A cross-section, analytical study design was chosen to
conduct this work. Three primary schools were the field of this study. Total number of the students
was 1987. The students were clinically examined; for each infested case with PC and/ or scabies a
control student was chosen. Results: Prevalence of PC and scabies was 10.2% and 3.4%, respectively.
These infestations were more common significantly among students in the public school. Significant
social risk factors of infested students were the low level of head of the family education, occupation,
and social status. Also, significant personal hygiene risk factors were poor hair, body, and environment
hygiene. While significant health care behavior risk factors were student never received skin
examination, no early consultation for skin diseases, and no compliance with therapy. Also; female
gender, the last birth order child, had previous infestation with PC, had sibling(s) with PC, and had
parents with history of infestation with PC were significant risk factors. On the other hand; male
gender, the last birth order child, had previous infestation with scabies, had sibling(s) with scabies, and
had parents with history of infestation with scabies were significant risk factors. Further, the PC cases
with crowding index >1, had no sun access, had shared water supply and bathing facilities, co-
sleeping, had no short cut hair, and sharing hair brushes were significant risk factors. On the other
hand, the scabitcs with crowding index >1, had no sun access, had shared water supply and bathing
facilities, and co-sleeping were significant risk factors. Lastly, presences of psychiatric, sleep, and
peers' relations disturbances were significantly more common among the infested students.
Conclusions: Many risk factors of PC and scabies can be manipulated, so these infestations can be
prevented, so many health hazards on the students could be prevented. Recommendations: Improving
students' hygiene, health education, and regular dermatological screening and treatment of students are
important essentiality. Also, dermatological health component should be integrated in school health
program. Lastly, further studies in different rural and urban areas in Egypt are recommended.
Key words
: Pediculosis capitis, scabies, prevalence, risk factors, primary schools.


School children are considered one of the
children all over the world, in developing and
most important sectors of population. They are
developed countries. (5, 6, 7) Skin diseases are
a vulnerable group and great attention should
associated with environmental factors and
be paid for them. (1) Also, school environment
public health approach is particularly
makes children vulnerable to cross transmission
important. (7) Further, infestations with ecto-
of communicable dermatological diseases,
parasitoses are usually considered to be vexing
which can then be passed on to their family
disorders. These disorders do not attract much
members. (2) So, coordinated school health
clinical attention, but they can cause significant
programs in conjunction with community
morbidity. (8)
efforts can prevent many health problems
Pediculosis capitis (PC) and scabies are
among students and help them to establish
lifelong safety skills. (3, 4)
parasitic dermatoses. They have been known
Dermatological disorders are among the
since antiquity and are distributed all over the
most frequently diagnosed conditions in school
world. (9, 10) Depending on the socioeconomic

Full Paper (vol.59 paper# 4)

Adiponectin Levels as a Marker of Inflammation in Pulmonary Tuberculosis The Egyptian Journal of Hospital Medicine (Apr. 2015) Vol. 59, Page 208- 213
Adiponectin Levels as a Marker of Inflammation in Pulmonary Tuberculosis
Gamal M. Elnemr1, 2, Manal A. Elnashar3, 4, Nesriene M. Elmargoushy2,
Nihad A. Elnashar5, Mohamed A. Elnashar6
1Department of Medical and Radiological Researches, Nuclear Materials Authority, Egypt, 2Department
of Internal Medicine, Faculty of Medicine, Taif University, Kingdom of Saudi Arabia, 3General
Administration of Medical and Radiological Supervision, Nuclear Materials Authority, Egypt, 4Medical
and Research Center of High altitudes, Taif University, Kingdom of Saudi Arabia, 5Department of
Pathology, Faculty of Medicine, Taif University, Kingdom of Saudi Arabia, 6Department of Radiology,
College of Health Sciences, Jazan University, Kingdom of Saudi Arabia

tuberculosis (TB) is a multisystem disease with myriad presentations and manifestations
that may be pulmonary or extra-pulmonary. It is the most common cause of infectious diseases related
mortality worldwide. Mechanisms underlying host defense to TB infection are poorly understood.
Adiponectin is a protein produced exclusively in adipose tissue; it is lower in obese subjects than their
lean counterparts. Another adipocyte hormone is leptin which is higher with fat mass and body mass
index (BMI). Wasting is a known feature of TB with a decrease in BMI. Patients with pulmonary TB
disease often suffer from weight loss and BMI and leptin are known to be inversely correlated with
adiponectin. Thus, increased adiponectin may be a promising marker for severity of the disease
independent of the BMI and leptin.
Aims of the work: the work aimed to evaluate the levels of serum adiponectin in patients with pulmonary
TB in both active and latent TB patients as a diagnostic marker for tuberculous inflammation. Also, levels
of serum leptin and measured BMI were evaluated and compared to make a relationship among active
TB, latent TB, and healthy control groups.
Subjects and Methods: the subjects were divided into 3 equal groups. The 1st group included 25 patients
with active pulmonary TB. The 2nd group included 25 patients with latent TB after 6 months of diagnosis.
The 3rd group included 25 healthy control volunteers. Serum levels of adiponectin and leptin were
measured and BMI values were calculated to all groups.
Results: Serum adiponectin levels in patients with active pulmonary TB were very highly significantly
increased compared to both latent TB patients and healthy subjects (P<0.0001), while serum adiponectin
levels in patients with latent pulmonary TB were only significantly increased compared to the healthy
subjects (P<0.05). On the other hand, serum leptin levels in patients with active pulmonary TB were very
highly significantly decreased compared to both latent TB patients and healthy subjects (P<0.0001), while
serum leptin levels in patients with latent pulmonary TB were only significantly decreased compared to
the healthy subjects (P<0.05). Also, BMI in patients with active pulmonary TB were very highly
significantly decreased compared to both latent TB patients and healthy subjects (P<0.001), while BMI in
patients with latent pulmonary TB were only significantly decreased compared to the healthy subjects
Conclusion: the higher levels of adiponectin with lower levels of leptin in association with lower BMI
measurements might indicate activity and severity of the TB disease. On the other hand, the lower levels
of adiponectin with higher levels of leptin in association with higher BMI measurements might indicate
stability and latency of the TB disease. Thus, increased adiponectin in the serum of pulmonary TB
patients may be promising markers for severity of the disease independent of the BMI and leptin levels.
Key words: TB patients, leptin, adiponectin, body mass index.


being preventable and curable for more than
Tuberculosis (TB) is a multisystem
100 years; it might also be a disease of our
disease with myriad presentations and
future. (2) Tuberculosis is likely to have
manifestations. It is the most common cause of
affected humans for most of their history and
infectious disease related mortality worldwide.
remains a major cause of death worldwide
(1) Despite the considerable progress made
despite the discovery of effective and
since discovery of TB, it remains one of the
affordable chemotherapy more than 50 years
world's deadliest diseases. Tuberculosis was
ago. There were an estimated 1.3 million TB

Full Paper (vol.59 paper# 5)

c:\work\Jor\vol59_6 The Egyptian Journal of Hospital Medicine (Apr. 2015) Vol. 59, Page 214- 216

Chronic Diseases and Outcome in Critically Ill Elderly Admitted to ICU
Moatassem Salah Amer, Randa Reda Mabrouk, Tamer Mohamed Farid, Mohamed
Shawky Khater, Rania Mohamed Abd elhamed Alakad , Mohamed Mortada
Mohamed Goda .
Geriartic Departement,Faculty of medicine,Ain Shams University
Corresponding author's E mail: mortadager@yahoo.com


Background: Elderly patients are a significant and increasing proportion of ICU patients.
With advancing age, the comorbidities critically ill elderly patients have substantial mortality.
The early recognition of patients at high risk of mortality is needed to plan care in advance
and to control healthcare costs. Aim: To find out the relation between chronic diseases and
outcome in critically ill elderly admitted to ICU. Study design: A prospective study.
Participants: seventy elderly patients aged 60 years and above. Method: This study was
performed in Geriatric ICU in Ain Shams University Hospitals including 70 critically ill
elderly patients admitted for 24 hours or more. Each patient was subjected to on admission
clinical assessment including detailed history taking, in addition to laboratory investigations.
: The results of our study showed that ischemic heart disease was the only chronic
diseases that had significant statistical effect on mortality in critically ill elderly admitted to
ICU with p. value= 0.002. Conclusion: In the current study we found that mortality was
associated with history of ischemic heart disease.
Keywords: intensive care units, ICU mortality, elderly, chronic diseases.


elderly admitted to ICU, the early
The elderly population is expanding in
recognition of patients at high risk of
Egypt, like in many other countries, There

were 4,400,000 persons aged 60 and over
mortality is needed to plan care in advance
representing 6.9% of the total population
and to control healthcare costs.
in 2006. The expected percentage of older

people may reach 8.9% in 2016 and 10.9%
in 2026. Life expectancy for Egyptian
Study design:
females was 63.5 years in 1986 increased
A prospective single center study was
to 73.6 years in 2006. While, Life
conducted to assess effect of chronic
expectancy in males was 60.5 years in
diseases on mortality in critically ill
1986 and increased to 69.2 years in 2006
elderly admitted to ICU. 70 consecutively
(1). This rapid rise in the elderly
admitted patients were included in the
population worldwide is paralleled by
study. All patients were 60 years and over.
increase in utilization of health care
Patients with ICU stay of less than 24
resources (2). Moreover, elderly will need
hours were excluded. The patients were
ICU admission more frequently and their
divided into survival group (those who
management will be more challenging.
were discharged from the ICU after
Data showed that 55% of all ICU bed-days
improvement) and non-survival group
are occupied by patients aged 65 years
(those who died in the ICU). The study
(3). Old age is associated with increased
was carried out in the ICU of the
mortality in critically ill patients (4).
Geriatrics and Gerontology Department at
However, age alone is not a strong
Ain Shams University Hospital in Cairo
predictor for mortality. There is evidence
suggesting that acute physiological
impairment and associated comorbidities
findings including CBC, bleeding profile,
were predictors of mortality after
kidney function test, liver function test,
adjustment of age (5, 6). The current study
albumin and arterial blood gases.
was designed to study effect chronic
Laboratory measures were all performed
diseases and outcome in critically ill
in Ain Shams University Central

Full Paper (vol.59 paper# 6)

c:\work\Jor\vol59_7 The Egyptian Journal of Hospital Medicine (Apr. 2015) Vol. 59, Page 217- 226

Effect of Prenatal Exposure to Bisphenol A on the Endometrium of Albino
Rats: a Histological and an Immuno-histochemical Study
Essam Eldin A. Salama1, 2, Ali H. Ali 1, 4, Tarek A. El Ghamrawy3,Mohamed S. Farag4,
Lotfy S. Mohamed 5
1-Department of Anatomy, Faculty of Medicine, Al Azhar University
2-Department of Anatomy, Faculty of Medicine, King Saud University, Saudi Arabia nm
3-Department of Anatomy, Faculty of Medicine, Cairo University
4-Department of Histology and Anatomy, Faculty of Medicine,
Salman bin Abdulaziz University, Al-Kharj, Saudi Arabia.
5-Department of Histology, Faculty of Medicine, Al Azhar University

Aim of the work:
bisphenol A (BPA) is a synthetic monomer that is polymerized to manufacture
polycarbonate plastic products and resins, including those used in food packaging and dental sealants.
It is used in the manufacture of a great variety of products including: compact disks, food can linings,
plastic windows, car parts, adhesives, protective coatings and powder paints. This work aimed to
study the effect of prenatal exposure to BPA on the endometrium of female rats.
Materials and methods: thirty adult female albino rats were divided into three groups: rats in group 1
served as a control (G1) and received an equal amount of sesame oil to those of the treated groups;
those in group 2 (G2) were administered by gavage 5.0 g BPA/kg/day (low-dose group); the third
group (G3) received 50 g BPA/kg/day (high-dose group). The female offspring of each group were
weaned at day 21 and maintained until 3 months old. The uteri were dissected for the histological and
immuno-histochemical examination.
Results: low-dose group showed degeneration of the epithelial lining of the endometrium with focal
patches of increased epithelial cell layers. The high dose group revealed cytoplasmic hydropic
degeneration and pyknotic nuclei of the epithelial cells. Estrogen receptors showed a significant
decrease of positive cells in low dose treated group and this decrease markedly accentuated in the
high dose one. Positive nuclei for Ki-67 were markedly increased with increasing doses of BPA.
Conclusion: BPA showed obvious endometrial degenerative and proliferative histological changes.
Therefore, the use of this substance in food packaging materials and in the manufacture of substances
liable to come into contact with food and drink should be phased out.


The use of synthetic chemicals exerts a great
BPA induction of alterations in the male and
influence on the daily life of human beings.
female reproductive integrity has been shown
Some of these synthetic chemicals can act as
in different species. Inhibition of the
endocrine disrupting substances in various
development of seminiferous tubules and
organisms. The reproductive cells are the most
spermatogenesis were observed after BPA
sensitive to toxic environmental materials.
treatment in the male chick [2,3].Toxic effects of
Bisphenol A (BPA) is a synthetic monomer
BPA were observed in female reproductive
system of the brown trout [4]and mussels
polycarbonate plastic products and resins,
including those used in food packaging and
transformation, aneuploidy and DNA adducts
dental sealants [1]. Many countries throughout
in Sirian Hamster embryo cells [7]. It also
the world have large production capacities of
suspected of causing birth defects of the
BPA, especially Germany, Netherlands, USA
reproductive tract (including un-descended
and Japan.
testes) and other hormone related effects, such

as earlier puberty in girls [8].


Full Paper (vol.59 paper# 7)

c:\work\Jor\vol59_8 The Egyptian Journal of Hospital Medicine (Apr. 2015) Vol. 59, Page 227- 232
Effect of Platelet-Rich Plasma Intra Articular Injection on Patients with
Primary Knee Osteoarthritis
Nadia Abdel Salam Elkadery1, Mohammed Aly Elwy1, Eman Mahmoud
Ghaniema1, Hossam Moussa Sakr2, Ahmed Ibrahim Hammad1.
Departments of Physical medicine, Rheumatology & Rehabilitation1 and Radiodiagnosis2
Faculty of medicine, Ain Shams University
Address for Correspondence: Ahmed Ibrahim Kamal Eddin Afifi Hammad, Mob.:01001315507,


Background: Osteoarthritis (OA) is the most common type of arthritis. It is a degenerative joint
disease. OA is usually defined according to radiographic changes. Conventional radiographs (CR)
were considered the most relevant outcome measure to assess the progression of OA in clinical
trials and epidemiological studies. Many modalities are used in treatment of knee OA. There is a
distinct need for new procedures that are cost effective by reducing the need for pharmaceutical
and surgical management, while targeting the biochemical process of OA. Platelet-rich plasma
(PRP) is one of these new procedures. PRP was found to increase hyaluronic acid (HA)
concentration, stabilizing angiogenesis in patients with osteoarthritic knees.
Aim of the study: Was to assess the value of intra articular injection of autologous platelet rich
plasma in management of knee osteoarthritis.
Patients and methods: This study was conducted on 40 patients with primary knee osteoarthritis,
divided into 2 groups; study group treated with 3 injections of PRP, and control group treated
with single dosed high-molecular weight HA. Clinical assessment and visual analogue scale
(VAS) scoring were done pretreatment and 3 months post treatment.
Results: Clinical improvement and reduction of VAS in both groups which is significant at the
study group. Conclusion: PRP injection could be considered as a simple, safe, effective and non-
palliative treatment that may promote cartilage healing in knee osteoarthritis as it improve the
clinical condition and the function of the joint. Hence, it may represent a useful addition to the
available therapeutic options for knee osteoarthritis.
Key words: knee, Osteoarthritis, Platelet-rich plasma.

important role in the pathophysiology of OA
that are closely associated with functional
degenerative joint disease that is considered
alterations in synovium, cartilage and
as a chronic disease of the whole joint. (1)
subchondral bone.(8) Although OA is not a
Pain and other symptoms of OA may have a
profound effect on quality of life affecting
development and progression of OA may
both physical function and psychological
involve inflammation even in the early
parameters. (2) The incidence of knee OA
stages of the disease.(9)
increases by age.(3) Prevalence of knee OA
The onset of OA is frequently
in men is lower compared with women. (4)
insidious. Symptoms may be continuous or
OA has multifactorial etiologies as
intermittent and. At first, the pain may only
age, sports participation, injury to the joint,
be noticed after the joint is used and be
obesity, and genetic susceptibility that
relieved by rest. However, when OA
predispose adolescent athletes to the
becomes severe and advanced, pain is
development of premature osteoarthritis.
experienced at rest and often awakens the
Previous knee trauma increases the risk of
person at night. Joint stiffness is also a
knee OA 3.86 times. (5) Determination of
feature of OA.(10)
risk factors and their modification may
Patients often note that their knees
reduce the risk of OA and prevent
"give way," a so-called instability symptom.
subsequent pain and disability. (6) Also, joint
Knee giving way may indicate the presence
inflammation is a present feature of OA,
of an internal derangement such as a
notably in the early stage. (7) It is believed
meniscal tear or a tear of the anterior
that cytokines and growth factors play an
cruciate ligament and it may also reflect

Full Paper (vol.59 paper# 8)

c:\work\Jor\vol59_9 The Egyptian Journal of Hospital Medicine (Apr. 2015) Vol. 59, Page 233- 243

The Therapeutic Role ofProximol and Lasilactone in Rat Model of Renal
Shadia Ali Radwan1; Yasser A. Khadrawy2; Samia Mohamed Sakr1 and
Enas S. Abdel-Bakey1
1Department of Biological and Geological Sciences, Faculty of Education, Ain Shams
University.2Department of Medical Physiology, Medical Division, National Research Center.

High salt intake induces renal-stress. The present study was carried out to examine the therapeutic
effects of proximol(Halfa bar extract), lasilactonedrug(Spironolactone+Furosemide) and their
combination on renal-stressed rats.
Material and Methods:Thirty five male rats were used and divided into five groups. The first group
served as negative control and received fresh tap water orally for four weeks. The animals in the
other four groups drank hypertonic saline solution (2% NaCl) as a sole source of drinking water for
four weeks to induce the animal model of renal stress. Then the renal-stressed rats were further
divided into: positive control, renal-stressed rats treated daily with proximol (7.8 mg/kg b.wt), renal-
stressed rats treated daily with lasilactone (3.9 mg/kg b.wt), and renal- stressed rats treated daily
with a combination of proximol and lasilactone for four weeks. The levels of aldosterone, sodium,
potassium, calcium, urea, uric acid and creatinine were measured in the sera of rats. Nitric oxide
(NO), reduced glutathione (GSH) and lipid peroxidation (MDA) levels were also measured in the
homogenate of renal tissue.
Results:In the renal-stressed group, there was a significant increase in levels of aldosterone, sodium,
calcium, urea, uric acid, NO and MDA and a significant decrease in potassium and GSH as
compared to control group. Although the treatment of renal stressed rats with proximol, lasilactone
and their combination reduced the increased level of aldosterone induced in renal stressed rats,
aldosterone level was still higher than the control value. In addition, the treatment with proximol,
lasilactone and their combination restored the significant increase in sodium, NO and lipid
peroxidation to non significant changes as compared to control group. Also the decreased levels of
GSH induced in renal-stressed rats returned to non significant changes. However, potassium
decreased significantly below the control and the model groups with the combined treatment.
Furthermore, treatment with proximol, lasilactone and their combination reduced the elevated levels
of uric acid and urea induced by hypertonic saline solution to control- like values in the case of uric
acid and to a significant decrease in the case of urea.
Conclusion:In conclusion, proximol, lasilactone and their combination have an effective role in
ameliorating the changes in the levels of aldosterone, serum electrolytes, oxidative stress and
consequently the disturbance in kidney functions in renal-stressed rats induced by hypertonic saline
Keywords: renal-stressed rats, proximol, lasilactone, aldosterone, electrolytes, oxidative stress.

stress induced by salt overload could stimulate
High-salt diet is one of the major risk factors in
the development of kidney stones, kidney
pathways in normal rats.[3] Consequently, the
disease, and ultimately kidney failure[1]and
deterioration of renal function and impairment
hypertension.[2] Studies carried out in vitro
of salt and water clearance leads to edema and
have recently shown that salt loading induces
volume overload.[4]
an increasing mechanical stretch and a flow-
The effects of a high-salt diet are related to the
induced superoxide production in the thick
function of the renin-angiotensin system,
ascending limb of Henle's loop. In this regard,
which is normally suppressed by a high-salt
it has been hypothesized that the oxidative
diet.[5]Aldosterone, the principal human

Full Paper (vol.59 paper# 9)

c:\work\Jor\vol59_10 The Egyptian Journal of Hospital Medicine (Apr. 2015) Vol. 59, Page 244- 257

Teratogenic Effect of Carbamazepine Administration in Pregnant Rats

Inass El-Gaafarawi and Magdy Abouel-Magd

Narcotic Research Department, National Center for Social and Criminological Research, Cairo, Egypt.

Carbamazepine "CBZ" (Tegretol) is an anticonvulsant and mood stabilizing drug used
primarily in the treatment of epilepsy and bipolar disorder, as well as trigeminal neuralgia. It has been
assigned to pregnancy category D by the U.S Food and Drug Administration (FDA). CBZ can cause
fetal harm when administered to pregnant women. Epidemiological data suggested that there may be an
association between the use of CBZ during pregnancy and congenital malformations, specifically spina
bifida and developmental disorders. The possible malformation-specific risks with CBZ use during
pregnancy need to be considered, so the present work was conducted to evaluate the genotoxicity of two
doses of CBZ (3.6 mg and 10.8 mg/ 100g body weight/ day) in pregnant female rats and their fetuses.
Chromosomal aberration in bone marrow cells and histopathological examination of liver and kidney of
pregnant rats were also determined. Materials and Methods: Fourty five pregnant Sprague Dawley rats
were randomly divided into the groups. The first was administered oral doses of distilled water and
served as control. The other two groups were administered oral doses of CBZ suspended in distilled
water equivalent to 3.6 mg and 10.8 mg/100g body weight/day respectively for 15 day from the 6th day
to the 20th day of gestation. Females were sacrificed on the 20th day of gestation. Results:
Administration of CBZ 3.6 mg and 10.8 mg /100g body weight to pregnant rats from the 6th till the
20thday of gestation. Decreased fetal body weight, crown-rump length, increased resorbed and dead
fetuses were observed compared to the control ones. Moreover, CBZ-high dose group(10.8mg/100g)
causedmalformations that could be described as severe growth retardation. At the same time, bone
marrow metaphases of CBZ-treated pregnant rats revealed structural chromosomal aberrations.
Whereas, histopathological examination of liver and kidney of pregnant rats treated with both doses of
CBZshowed cellular alterations.Conclusion:It has been found that usage of antiepileptic CBZ during
gestational period may create risk, associated with maternal toxicity, hepato- and nephrotoxicity and
chromosomal aberrations in pregnant rats, with intrauterine growth retardation which was manifested by
low body weight, length reduction and malformations. These alterations were dose dependent. The
benefits of taking CBZ must be weighed against the potential risks to boththe developing fetus and the
Carbamazepine, pregnant rats, fetus malformations, chromosomal aberration,
histopathology of liver and kidney.


unrelated to other anticonvulsants or other
Carbamazepine (Tegretol) is an anti-
drugs used to control the pain of trigeminal
convulsant and mood stabilizing drug. It is used
neuralgia. The mechanism of action of CBZ
primarily in the treatment of epilepsy and
has been partially elucidated. It stabilizes
bipolar disorder, as well as trigeminal neuralgia.
It is also used for a variety of indications,
repetitive neuronal discharges and reduces
synaptic propagation of excitatory impulses. It
is conceivable that prevention of repetitive
syndrome, paroxymal extreme pain disorder,
firing of sodium-dependent action potentials in
neuromytonia, intermittent explosive disorder
depolarized neurons via use and voltage
and post-traumatic stress disorder(1).
dependent blockade of sodium channels may be
Carbamazepine (CBZ) is an imino-
its main mechanism of action. Whereas,
dibenzyl derivative, structurally similar to the
reduction of glutamate release and stabilization
tricyclic antidepressants. It is available as
of neuronal membranes may account mainly for
tablets of 100, 200, and 400mg, and as a
its antiepileptic effects .It is extensively
suspension of 100 mg/5ml. It is chemically
metabolized in the liver via the epoxide- diol

Full Paper (vol.59 paper# 10)