c:\work\Jor\vol61_1 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 363-370

Validation of New D-Dimer Cutoff Values to Increase its Diagnostic Utility
as Biochemical Marker in Acute Venous Thromboembolic Disease
Dalal Nemenqani1, Manal H Fayek2, Soha Ahmad A2, Hala Elnashar1, Haneen Asaad1
1College of Medicine, Taif University, Saudi Arabia,2Faculty of Medicine, Ain Shams University2


Background: Diagnosis of venous thromboembolic disease (deep venous thrombosis and
pulmonary embolism) is often inaccurate because signs and symptoms are nonspecific. Numerous
clinical management trials using D-dimer which is one of the coagulation markers have shown that it
has a sufficient specificity to assist in the diagnosis of venous thromboembolic disease.
Aim of the work:This study was done to validate the utility of D-dimer as a diagnostic biomarker
for DVT using a higher cutoff values which may improve the test specificity.
Material and method: In this retrospective chart review study, we reviewed the hospital records of
all patients for whom D-dimer assay was done in King Abdul Aziz Specialist Hospital, Al Taif - Saudi
Arabia from January 2011 to October 2013. The study involved 141 individuals; 25 who were proved
to be normal were chosen to serve as control group (Group I), 61 patients who were positive for DVT
by duplex scanning (Group II) and 55 patients who had symptoms of DVT but showed negative results
on duplex ultrasound(group III).
Results: The demographic data revealed statistically insignificant difference between all studied
groups. No significant differences were detected between the studied groups, except for hemoglobin
level which was significantly lower in patients of groups II and III than in control group. However,
highly significant differences were detected between different studied groups as regards D-dimer.
Analysis of the receiver operator characteristic (ROC) curve to establish the cutoff level of the studied
marker in the diagnosis of DVT, verified that D-dimer value of 0.92 mg/L can accurately differentiate
patients who were positive for DVT on duplex scanning from control group. Level of 2.81 mg/L for
D-dimer was considered as a cutoff point that can differentiate patients who were duplex negative and
free from thrombosis from those who eventually developed thrombosis.
Conclusion: This study suggests the importance of the use of modified D-dimer cut-off values
that can safely differentiate patients who are free from venous thromboembolic disease from others
who are positive for the disease sparing patients the unnecessary risks of anticoagulation. In addition it
can detect the patients who will eventually develop thrombosis regardless their primary duplex
ultrasound scanning results, so, they could receive anticoagulation treatment.
Keywords: D-Dimer, New Cutoff, Acute Venous Thromboembolic Disease, Taif


Deep venous thrombosis (DVT) and
diagnosis of VTE, especially in elderly, in
pulmonary embolism (PE) remain significant
addition to the increased plasma D-dimer
but preventable health care problems.(1, 2) In
concentrations in patients with extensive
absence of specific clinical manifestations,
inflammation, wound healing, malignancy, and
diagnosis of venous thromboembolic (VTE)
patients with liver disease make D-dimer
disease is often inaccurate and it is based
primarily valuable when used in conjunction
mainly upon clinical suspicion in patients at
with clinical prediction scores.(5, 6) Recent
studies verified that, the application of age
sophisticated imaging modalities remain
adjusted cutoff values for D-dimer tests
essential for diagnosis, however, these
substantially increases specificity without
procedures may not be readily available during
off-hours making the availability of plasma
suggested that higher D-dimer cutoff values
markers for DVT more desirable.(3) The most
might increase its specificity improving its
widely used test, D-dimer, is a fibrin
diagnostic accuracy and to reduce the use of
degradation product detected in the blood after
venous duplex ultrasound scanning for ruling
a blood clot is degraded by fibrinolysis and is
out DVT in their studied patients.(8-11)This
useful to exclude the diagnosis of DVT due to
study was done to validate the utility of D-
its high sensitivity but its specificity is much
dimer as a diagnostic biomarker for DVT using
lower.(4)The low specificity of D-dimer for
Accepted:17/8/2015 DOI: 10.12816/0017688


Full Paper (vol.61 paper# 1)

c:\work\Jor\vol61_2 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 371-376

A Multi-Level Noncontiguous Vertebral Tuberculosis in Taif Province,
Saudi Arabia: ASingle Center Study.
Abdullah Ali Al-Zahrany1,2
1Department of orthopedics, College of Medicine ,Taif University PO Box 888 Taif 21947, Kingdom
of Saudi Arabia,2Department of Surgery, King Abdul-Aziz Specialist Hospital, PO Box 10127, Taif,
Kingdom of Saudi Arabia
e-mail: abdullazahrani@yahoo.com

Background and aim of the study:
Multilevel noncontiguous spinal tuberculosis is an atypical form
of the spinal tuberculosis, which leaves not less than two adjacent vertebrae intact between the two
foci. The aim of this study is to record the incidence, pattern of presentation, risk factors; and
diagnostic tools of multi-level noncontiguous vertebral tuberculosis in a single center (King Abdul
Aziz Specialist Hospital) Taif, Saudi Arabia.
Patients and method: In this retrospective chart review study, we reviewed the records and data of all
patients presented to King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia from January 2009 to
January 2014 and their diagnosis were proved to be spinal tuberculosis.
Results: the study included76 patients with spinal tuberculosis; multilevel noncontiguous tuberculosis
was detected in 18.4% and a single spinal lesion was identified in the other 81.6%of patients. There
was no statistically significant difference between the 2 groups regarding their demographic, clinical, and
their laboratory findings except for the hepatitis B virus (HBV) positivity and elevated serum
transaminases which were significantly higher in the multilevel non contagious group of patients. Plain
film detected multiple non contagious lesions in 64.3% of patients, and in 35.7%of them, they were first
diagnosed as single lesion but MRI detected the multiplicity. The thoracic and lumbar vertebrae were
involved in 85.7% of the multilevel lesions and in the other 14.3% of patients the cervical and lumbar
involvement was detected. In the single focus group the thoracic and thoracolumbar vertebrae were
involved in 75.8% of cases. Diagnosis was confirmed by culture and histopathology.
Conclusion: This study suggested a strong relation between hepatitis B and spinal tuberculosis, specially
the multilevel non contagious form, however, till similar results of larger series of patients are obtained,
the orthopedic surgeon must be with high index of suspicion in patients with spinal tuberculosis to
detect multiplicity by MRI and any co infection with hepatitis B virus.
Keywords: spinal tuberculosis- multilevel non contagious ­ HBV ­Taif

used if plain x-rays are not conclusive.(6-9)The aim
Spinal tuberculosis which represents 50% of extra-
of this study is to record the incidence, pattern of
pulmonary tuberculosis was first described by
presentation, risk factors; and diagnostic tools of
Percival Pott in 1779.(1, 2)The disease usually results

from hematogenous dissemination of the tubercle
multi-level noncontiguous vertebral tuberculosis
bacilli from primary foci in lung or lymph node to
in a single center (King Abdul Aziz Specialist
the vertebrae leading to destruction and collapse of
Hospital) Taif, Saudi Arabia.
the anterior parts of adjacent vertebrae and the disc
Patients and methods:
spaces in between ending in kyphoscoliotic
This is a retrospective chart review study based
changes, formation of paravertebral cold abscesses,
upon reviewing the records of all patient who
with or without paraplegia.(2-4)The multilevel
were diagnosed as Pott's disease in orthopedic
noncontiguous form leaves not less than two
department from January 2009 to January 2014.
adjacent vertebrae intact between the affected
After approval of the ethical committee of the
vertebrae, and its incidence is reported to be 1-
hospital and taking informed consents from
16% of spinal tuberculosis.(5)Diagnosis of
patients or their relatives, data were collected
noncontiguous lesions can be achieved by plain
from the patient files focusing on demographic
radiology, however, magnetic resonance imaging
factors, pattern of presentation, and imaging
(MRI) and computerized tomography (CT) can be
reports in addition to histopathology and
Accepted:20/8/2015 DOI: 10.12816/0017689

Full Paper (vol.61 paper# 2)

c:\work\Jor\vol61_3 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 377-382

Synchronous Colorectal Neoplasias: A Single Hospital Study
Dalal Nemenqani1,2
1Department of Pathology, College of Medicine ,Taif University
2Department of Pathology King Abdulaziz Specialist Hospital
e-mail: dnemenqani@hotmail.com

Background and the aim of the study:
The presence of more than one primary tumor in the colon at
time of presentation is diagnosed as colorectal synchronous neoplasias (SN) and the largest one is
considered the index tumor. The aim of this study is to identify the magnitude of synchronous colorectal
neoplasias and its relation to different variables as pattern of presentation, age, gender and
histopathology in addition to evaluation of different methods of diagnosis in patients presented to King
Abdul Aziz Specialist Hospital, Taif, Saudi Arabia.
Patients and methods:
This is a retrospective chart review study. The hospital records and the files of
all patients diagnosed to have colonic neoplasms were reviewed from January 2008 to August 2014.
Results: The study involved 87 patients, 53 males and 34 females. Ten of the 87 patients (6 males and 4
females) had synchronous colonic neoplasms (11.5%). Intestinal obstruction was the presenting
symptom in 4/10 patients (40%, Vs 35.6% in patient with single lesion), rectal bleeding in 4/10 patients
(40%) and in 20% mass in right lower quadrant was the presenting symptom. In obstructed patients, SN
was diagnosed after examination of the operative specimen, however; intra-operative palpation detected
multiple colonic polypi in one patient and intra-operative colonoscopy detected SN in another 2 patients.
In the non obstructed patients preoperative colonoscopy and biopsy diagnosed multiple lesions in 5/6 of
the patients (83.3%). Pre and intra- operative colonoscopy helped to guide accurately the extent of
resection in 83.3% of non obstructed patients and in 75% of obstructed patients respectively. Mean
period of follow up was 3. 4±0.8 years.
Conclusion: The incidence of SN is significantly higher in this study than that recorded in English
literature, so a larger study involving all regions of Saudi Arabia is strongly recommended as the
presence of SN worsens the prognosis entailing modification of the treatment options. Thorough
pathological examination is mandatory of any doubtful colonic lesions, and the study verified the
effectiveness of preoperative colonoscopy in patients with non obstructed colorectal cancer and intra-
operative colonoscopy in obstructed patients for visualization and biopsy of these lesions.
Keywords: colorectal tumors, synchronous tumors, colonoscopy, Taif


Synchronous neoplasia (SN) of the colon and
early discovery and prompt management will
the rectum means the presence of more than one
improve the outcome.(5-11)
primary tumor at time of presentation and the
The aim of this study is to identify the
largest one is considered the index tumor.(1)
magnitude of synchronous colorectal neoplasias
Preoperative colonoscopy, virtual colonoscopy,
and its relation to different variables as pattern
and intra-operative colonoscopy are the usual
of presentation, age, gender and histopathology
methods to diagnose synchronous colorectal
in addition to evaluation of different methods of
neoplasia.(2-4) The incidence of SN recorded in
diagnosis in patients presented to King Abdul
English literature is less than 5% and the villous
Aziz Specialist Hospital, Taif, Saudi Arabia.
adenomas is the commonest SN with index

cancer.(4-8) Presence of SN would modify the
treatment options to perform more extended
This is a retrospective chart review study based
colectomy or to combine colectomy with trans-
upon reviewing the records of all patients
anal resection or ablation.(9-11) The presence of
presented to King Abdul Aziz Specialist
SN carries a worse prognosis compared with that
Hospital from January 2008 to August 2014 and
of patients with solitary neoplasm; however,
diagnosed to have colonic neoplasms.
Accepted:20/8/2015 DOI: 10.12816/0017690

Full Paper (vol.61 paper# 3)

ResThe Antioxidant Role of Mulberry (Morus alba L The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 383-388

A Study on The Preventive Effect of Mulberry (Morus alba l.) Fruits in Rats
Exposed to Gamma Radiation
Amal A. A. Ammar
Medical and Radiation Research Department,Nuclear Materials Authority,Cairo, Egypt


Background: Ionizing radiation is known to generate reactive oxygen species. This study was
carried out to investigate the efficacy of mulberry fruit against -irradiation induced oxidative stress in
rats. Materials and methods: Male albino rats were divided into four groups, Group (I): (control group)
rats fed on balanced diet for 4 weeks, Group (II): rats fed on balanced diet contained 5% mulberry fruits
powder (MFP), Group (III): rats were exposed at the 1st week of the experiment to fractionated -
irradiation dose of 8 Gy administered as 2 Gy, every other day and fed on balanced diet for 4 weeks, and
Group (IV): irradiated rats fed on balanced diet contained 5% mulberry fruits powder, at the end of the
experiment, animals from each group were sacrificed, 24 hrs post the last dose of treatment, six rats from
each group were sacrificed. Blood samples were taken and analyzed for Lipid peroxides as
malondialdehyde (MDA) level, Xanthine Oxidoreductase system (XO and XDH), Glutathione (GSH)
content, Superoxide dismutase (SOD), catalase (CAT), Aspartate Transaminase (AST), Alanine
Transaminase (ALT), Gamma Glutamyl Transferase (GGT), Alkaline Phosphatase (ALP) activities and
total bilirubin in rats. Results: The results showed that, irradiation induced high significant decrease in
hepatic Glutathione contents (GSH), Xanthine Dehydrogenase (XDH), Superoxides Dismutase (SOD)
and Catalase (CAT) activity. Moreover, a remarkable increase in the Malondialdehyde (MDA)
concentration, xanthine oxidase activity (XO), the activity of some liver enzymes was observed in -
irradiated rats. In contrast, administration of Mulberry Fruit Powder (MFP) to -irradiated rats was found
to offer protection against -irradiation induced oxidative stress, by elevating the activity of antioxidant
enzymes, enhancing liver function. All results in this study suggested that mulberry fruit had high
potential to be developed as radio protective agent.
Conclusion: Therefore, MFP could have a beneficial role in modulating oxidative stress by
improving the natural antioxidant mechanism.
Gamma-irradiation; Mulberry fruits; Antioxidants.


Radiation exposure produce highly reactive
the cell membrane. Cells may function poorly or
and dangerous molecular species called free
die if this occurs.3,4
radicals in cells and tissues, which have high
All living organisms are exposed to some
energies and can break chemical bonds. Free
amount of radiation coming from outer space or
radicals may be formed within cells as well as in
emitted from the radioisotopes present in the
the extra cellular medium and can interact with
environment.5 Radiations are commonly used in
membrane lipids, nucleic acids, carbohydrates
a number of medical and industrial situations;
and proteins. These reactions disturb membrane
however, their prooxidative effects limit their
structure and transport processes which leads to
histological and biochemical disorders and
The scavenging of free radicals and inhibition
ultimately resulted in acute and chronic disease.1
of lipid peroxidation has been suggested to be the
Free radicals are atoms or groups of atoms
key target activities for developing successful
with an odd (unpaired) number of electrons and
radioprotection strategies.7,8
can be formed when oxygen interacts with
Natural antioxidants play a major role by
certain molecules. Once formed these highly
continuously inactivating ROS, to keep only a
reactive radicals can start a chain reaction, like
small amount necessary to maintain normal cell
dominoes. Their chief danger comes from the
damage they can do when they react with
evidence has been gathered to suggest an
important cellular components such as DNA, or
association between consumption of fruits
Accepted:15/9/2015 DOI: 10.12816/0017691

Full Paper (vol.61 paper# 4)

c:\work\Jor\vol61_5 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 389-405

IFN-Stimulated Genes Upregulation Pattern in Chronic Hepatitis C
1Saadia Farid, 2Amal Ahmed, 3Samya Sweilam and 4Laila Rashed
Departments of Tropical Medicine, Biochemistry and Medical Biochemistry
National Hepatology and Tropical Medicine Research Institute and
Faculty of Medicine, Cairo University

The development of effective tools for the large-scale analysis of gene expression has
provided new insights into the involvement of gene networks and regular pathways in various disease
processes. The chemokine receptor CXCR3 is a G protein-coupled receptor found predominantly on T
cells that is activated by three ligands as follow: CXCL9 (Mig), CXCL10 (IP-10) and CXCL11 (I-
TAC), and play a key role in immune and inflammatory responses by promoting recruitment and
activation of different subpopulations of leukocytes. Aim of the work: The study is a logical
functional approach for the development of serum markers chemokines that bind to CXC chemokine
receptor 3 to determine whether they play a role in the future of immune system to clear HCV, these
chemokines: CXCL9, CXCL10 and CXCL11. Patients and methods: 131 male and female patients
with chronic hepatitis C virus (CHCV) infection, their age ranges between 22 and 55 years, selected
from the National Hepatology and Tropical Medicine Research Institute. The included patients were
divided to two groups, the first group: 80 patients were investigated for the predictive values of
CXCL9,10,11 and CXCR3 chemokines in peripheral blood mononuclear cells (PBMCs), the second
group were fifty one patients analyzed for the expression of surface markers on CD8+T cells. Twenty
healthy individuals were included to serve as controls for each group. All the patients and controls were
subjected to the following: history, clinical examination, abdominal ultrasonography and collection of
blood samples for routine laboratory investigation and serological assay. Results: Chemokine CXCL9,
CXCL10, CXCL11 and their receptor CXCR3 expression levels are induced in PBMCs during CHCV
infection, associated with increased the expression levels of CD8+T cells in CHCV patients.
Conclusion: The interaction between chemokines and their receptors is essential in recruiting HCV-
specific T cells to control the infection. Recommendations: The regulation of chemokines and their
receptors could be a future potential therapeutic target to decrease liver inflammation and to increase
specific T cell migration to the infected liver, the blocking of chemokines and chemokine receptor
engagement is a therapeutic strategy that should be explored in the near future for non-responders to
current anti-HCV therapy.
Key words:
Chemokines CXCL 9, 10, 11, Chemokine receptor CXCR3, Hepatitis C virus infection,
immunoregulation pattern of genes.


Hepatitis C is a major cause of chronic
in only 15-20% of newly infected individuals,
liver disease worldwide. An important and
while the remainder develops chronic
striking feature of hepatitis C is its tendency
toward chronicity. In > 70% of infected
The ability of the virus to persist within a host
individuals, hepatitis C virus (HCV)
is astonishing, and is attributed to its efficient
establishes a persistent infection over decades
ability to evade the adaptive and innate
that may lead to cirrhosis and hepatocellular
components of the host immune System. (3)
carcinoma. (1) The estimated worldwide
Chemokines represent a target for modulation
prevalence of HCV infection is 2% to 3%,
by viruses including the HCV. HCV is known
which translates to an
to modulate chemokine expression in vitro and
estimated 170 million infected individuals. (2)
may therefore enable its survival by
Successful eradication of the virus is achieved
subverting the immune response in vivo

through altered leukocyte chemotaxis resulting
Accepted:12/9/2015 DOI: 10.12816/0017692

Full Paper (vol.61 paper# 5)

c:\work\Jor\vol61_6 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 406-414

Immunohistochemical Studies in Mice Liver Immunized by Attenuated
Schistosoma Mansoni Schistosomules by Gamma Radiation
Mona Mohamed Amin - Eman Naser Hafez - Elham Said Marei
Health Radiation Research Dept., National Centre for Radiation Research and Technology (NCRRT),
E.mail of corresponding author: eman_naser612@hotmail.com Tel. +201068429907 P. O. Box: 29 Nasr
City, Egypt.

Background: Schistosomiasis is an important cause of hepatic fibrosis in man. As etiological
therapy alone is not enough to treat hepatic fibrosis, finding other strategies that can control the
disease is important. Considering the dominant role of vaccination, research on gamma radiation-
attenuated vaccine has become a new focus and has very promising value.
Aim of the work: The objective of this study was to detect the effect of vaccination with
attenuating dose of gamma radiation of schistosomules in controlling immunohistochemical
changes in mice model of human schistosomiasis mansoni. Materials and methods: Forty mice
were divided into four groups (ten each). Group A served as normal control, group B was infected
by subcutaneous (S. C.) injection with 100 S. mansoni cercariae/mouse (infected control), group C
was vaccinated by (S.C.) injection with 500 schistosomulae irradiated with 20 Krad gamma-
radiation (vaccine control) and group D was vaccinated by (S.C.) injection with the same dose of
irradiated schistosomules and then challenged after 4 weeks by S.C. injection with 100 S.
cercariae. Expression of -smooth muscle actin ( SMA), desmin, collagen type-1 and
transforming growth factor-beta1 (TGF-1) in the extracellular matrix (ECM) using
immunohistochemistry were done.
Results: exhibited in infected control group B marked expression of -SMA, desmin, collagen
type-1 and TGF-1. These changes were moderate in vaccinated-control group C while few
changes were detected in vaccinated-challenged group D.

Conclusion:It was concluded that using 20 Krad-gamma irradiated schistosomules as vaccine
is effective in controlling liver pathology and reduces immunohistochemical changes.
Immunohistochemistry, Liver.


transformed schistosomula and it was
Schistosomiasis remains one of the
considered as an important target of protective
most prevalent parasitic diseases in the world.

Despite the existence of an effective
Following gamma irradiation,
antischistosome drug, the disease is spreading
larvae of S. mansoni have been shown to lose
and national control programs do complete
their ability to migrate with normal kinetics
their tasks.(1) Vaccine strategies represent an
through the host's circulation. They were
essential component for the future control of
retarded in the skin or lungs, where the
parasites die.(6) Human immune response to
chemotherapy.(2) Attenuation of infective
schistosome eggs deposited in the liver and the
cercariae has traditionally been achieved using
granulomatous inflammation they evoke are
a gamma source of radiation.(3) Cercaria loses
the initial factors of hepatoschistosomiasis,
some of its potency immediately after artificial
with a peri-parasitic extracellular matrix
conversion to skin-stage schistosomula and
(ECM)-rich 'barrier' that acts to restrict cyst
was considered as the first important source of
growth but, paradoxically, may prevent
antigens in the body.(4) Also most attention has
successful drug interactions with the
been focused on molecules released from or
parasite.(7) This extracellular matrix (ECM)
exposed at schistosomular surface.(5) So
includes collagen and connective tissue
schistosomula was chosen in this study as
there was a complex set of polypeptides

For the liver to function normally, solutes
exposed on the surface of the newly
and growth factors in the blood plasma can
pass through fenestrae in liver endothelial
Accepted:15/2/2015 DOI: 10.12816/0017683

Full Paper (vol.61 paper# 6)

c:\work\Jor\vol61_7 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 415-424

Protective Effect of Olive Oil Against Teratogenecity Induced by Mancozeb in
Albino Rats
*Nahas, A.A. and **Enas A. Abbas*
*Mammalian and Aquatic Toxicology Dep., Central Agricultural of Pesticides Lab. (CAPL),
Agricultural Research Center
** Biochemistry Dept., Animal Health Research Institute, Agricultural Research Center

: this study aimed to investigate the protective effect of extra-virgin olive oil (EVOO) against
teratogenicity of the fungicide mancozeb. Methods: after pregnancy confirmation, 32 pregnant rats were
divided into 4-groups (n=8). The 1st group orally administered tap water (-ve control), the 2nd group (+ve
control) was administered EVOO (0.5ml/dam) from the1st to 20th day of pregnancy. The 3rd and the 4th
groups were administered 200 mg/kg mancozeb during the period of organogenesis, from the 6th to 15th
day of pregnancy. The 4th group received the mentioned dose of EVOO prior to the pesticide
administration. Cesarean section was performed on day 20 of pregnancy and the maternal and fetal
parameters were recorded. Results: mancozeb induced maternal toxicity manifested as lower body weight
gain of dams, increased number of late resorption sites/litter in comparison with the control group and
mancozeb group pretreated with EVOO. Mancozeb evoked a decrease in fetal body weight, altered sex
ratio (M/F) as well as increased incidence of fetal external, visceral and skeletal abnormalities. Treatment
with virgin oil reduced the congenital malformations.
Conclusively, the present study elucidates the protective role of EVOO as a result of antioxidant activity
which scavenges the reactive oxygen species which induced cytotoxicity and increased prenatal
Keywords: Olive Oil, Teratogenecity, Mancozeb, Albino Rats.

significant decrease in blood glucose and
Mancozeb fungicide, a manganese-zinc complex
globulin levels and a significant pathological
of ethylene-bis-dithiocarbamates (EBDCs) is a
changes were observed in liver, kidney, spleen
commonly-used fungicide throughout the world,
while, heart showed congestion with slight
registered for use in many countries. Mancozeb
enlargement and brain revealed few hemorrhage
is used to protect many fruits, vegetables, nuts
and field crops against a wide spectrum of fungal
Olive oil is an integral ingredient in the
diseases, including potato blight, leaf spot, scab
Mediterranean diet, full of nutrients and
and rust. It has been classified by EPA in the
vitamins. Extra-virgin olive oil is derived from
toxicity class IV [1].Although the risk of
the first pressing of the olives. It has the most
intoxication by EBDCs mainly concerns
delicate flavor and antioxidant benefits in
industrial and agricultural workers [2]. Population
reduction of coronary heart disease risk,
can be chronically exposed to dietary residues
prevention of some cancers and modification of
present of such pesticides in food. Mancozeb,
immune and inflammatory responses.[12] Virgin
despite its low acute toxicity, has been shown to
olive oil contains polyphenolic compounds [13]
produce significant toxicological effects on
such as simple phenols (hydroxytyrosol, tyrosol);
thyroid [3] immune system [4] reproductive system
secoiridoids (oleuropein, the aglycone of
[5] and nervous system [6], Moreover, Mancozeb
ligstroside, and their respective decarboxylated
was considered a multipotent carcinogen,
dialdehyde derivatives and the lignans [(+)-1-
inducing a variety of tumors of different origin in
acetoxypinoresinol and pinoresinol] which are of
rats after chronic exposure [7], mutagenic [8] and
high antioxidant activity [14]and they are capable
possibly teratogenic effects [9]. Exposure to
of scavenging free radicals produced, suggesting
mancozeb causes normocytic type of anemia,
the chemoprotective effect of olive oil [15,16]

Received:12/9/2015 DOI: 10.12816/0017694

Full Paper (vol.61 paper# 7)

Studies on Rats Injected With CCl4 and Treated With Propolis and Honey Bee The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 425-436

Immunohistopathological Studies on Rats Injected with CCl4 and Treated
with Propolis and Honey Bee
Nahed A.Omara, Kadry A. Elbakrya, Hoda M. Elemshatyb and Shaymaa M.Nasra
Zoology Dep., Faculty of Science, Damietta University, New Damietta City, Damietta, Egypta
Gastroenterology Center Mansoura Universityb
Corresponding author: Nahed A.Omar E. mail: nahedomar2000@yahoo.com

: liver and kidney play a pivotal role in metabolism of nutrients, drugs, hormones,
metabolic waste products and thereby maintaining body homeostasis. The present study was conducted
to demonstrate the protective effects of honey and propolis on liver and kidney tissues of rats injected
with CCl4.
Material and method: rats were divided into 4 groups (10 rats in each group). Normal control group:
received standard food and water; CCl4 group: injected with CCl4 0.5 ml/kg b. wt. mixed in olive
oil(v/v) twice a week for six weeks; CCl4 & honey group: injected with CCl4 0.5 ml/kg b. wt. mixed in
olive oil(v/v) twice a week for six weeks and 10% honey in drinking water. CCl4 & Propolis: injected
with CCl4 0.5 ml/kg b. wt. mixed in olive oil(v/v) twice a week for six weeks and 200 ml/kg
b.wt/rat/day of propolis. After 6 weeks, rats were anesthetized, then liver and kidney organs were
collected, washed in normal saline, fixed in 10% formalin, then processed for the histopathological and
immunohistochemical examinations.
Results: marked histopathological alterations were observed in CCl4 group, the most common changes
were cloudy swelling of hepatocytes, fatty changes, clear vacuolation of renal cells and congested blood
vessels. Treatment with honey or propolis improved the histopathological changes induced by CCl4 in
liver and kidney tissues of rats.
Conclusion: the present study indicated that CCl4 has a toxic effect on liver and kidney tissues, but
administration of honey and propolis can protect rats against form the toxic effect of CCl4.
Key words: CCL4, histochemistry and immunohistochemistry, collagen fibres, honey bee and propolis.


Carbon tetrachloride is widely used as

hepatotoxic compound in the experimental
Also, honey is bee's products which are
model systems. It has been reported that CCl4-
used in medicine in many cultures since ancient
induced hepatotoxicity is due to its hepatotoxic
times. Honey is known to exhibit a broad
metabolites and trichloromethyl free radicals
spectrum of activities including antiviral,
(CCl3) which induce lipid peroxidation [ 1, 2].
antibacterial and immunostimulant [15,16]. It has
One of the therapeutic strategies against liver
antioxidant activity due to its high content of
injury induced by CCl4 is to find natural
flavonoids [17,18] . The aim of the present study
antioxidant compounds that are able to block
is to evaluate the histopathological changes in
liver and kidney tissues of rats induced by CCl4
trichloromethyl free radicals generated by CCl4
toxicity and the possible protective role of
[2] .
honey bee and propolis for CCl4 treated rats.
Propolis is a resinous hive product that

contains flavonoids, sugar and aliphatic acids
[3,4,5]. Flavonoids are thought to be responsible
for many biological and pharmacological
Forty female Albino Wister rats weighing
activities including anticancer [6], anti-
120-140 gm were purchased from Helwan
inflammatory[7] , antioxidant effects[8,9,10] ,
animal station, Ministry of Health, Egypt.
antimicrobial [11], antiparasitic and immune
Animals were allowed to adapt for two weeks
modularity and immune stimulant effects[12].
and housed in animal house of Zoology
Propolis increases the percentage of protected
Department, Faculty of Science, Damietta
animals suggesting its use in vaccines as an
University, Egypt. CCl4 was purchased from
adjuvant [13,14].
Modern Lab. Co. for Chemicals, Egypt. Honey

Received:12/9/2015 DOI: 10.12816/0017695

Full Paper (vol.61 paper# 8)

c:\work\Jor\vol61_9 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 437-444

Serum Vitamin D Deficiency and Risk of Schizophrenia: A Case Control
Reda Ismail*,Taghreed ElShafei*,Rania Hussein*,Iman K. Ramadan**
*Psychiatry Department, Faculty of Medicine, Al-AzharUniversity,Egypt
**Community Medicine Department, Faculty of Medicine, King Abdul Aziz University and Al-
Azhar University

Schizophrenia is a mental illness with symptoms like delusions and hallucinations. A
recent study concluded that individuals with vitamin D deficiency are twice more likely to have
schizophrenia than optimum level vitamin D people.
Objective: To measure schizophrenic patients` serum vitamin D concentration and compare it to
healthy controls(non schizophrenics), and to investigate the relationship between serum schizophrenia
and related potential risk factors.
Subjects and Methods: Twenty patients with schizophrenia were recruited and compared to 20
controls with no major psychopathology using age and sex matched case control study. The SCID-
1(semi-structured interview for making major DSM-IV Axis 1 diagnoses), was administered and
the blood samples were withdrawn after patient consent on the same day.
Schizophrenic patients showed a significantly lower mean vitamin D level (14.8±4.5 IU)
compared to control group (19.6±3.3 IU) (P<0.001). Higher vitamin D level participants were nearly
80% less likely to have schizophrenia compared to low level ones. Being older and female were
80%and 40% less likely to have schizophrenia respectively. Individuals with large body mass index
were 1.2 times more likely to have schizophrenia compared to normal body weight. Smokers were
10% less likely to be schizophrenic compared to non-smoker participants.
Conclusions: Patients with schizophrenia showed lower serum vitamin D level compared to healthy
controls. Further studies are needed to explore the role of vitamin D in the pathogenesis of
Keywords:Vitamin D and Schizophrenia, low vitamin D as a risk of schizophrenia, role of
vitamin D in Schizophrenia.

is quite likely that a crucial role in disease
neuropsychiatric treatable disorders including
mechanisms mediating the interaction between
symptoms like hallucinations, delusions,
genes and the environment. Until recently, less
was known about the role of vitamin D in brain
speech.(1)This could impose great costs to the
health care system.
sunlight, or vitamin D in the etiology of
Prevalence of schizophrenia is widely
neuropsychiatric diseases.(3)
different across geographic regions.It affects
Vitamin D3 (cholecalciferol) and vitamin D2
more than 21 million people worldwide. One in
(ergocalciferol) are considered to be the two
two people living with schizophrenia does not
most important forms of vitamin D. (4)Both
receive optimum care, though care of persons
forms are at hand in dietary form however;
with schizophrenia can be provided at
vitamin D3 is synthesized in the skin by
community level with active family and
ultraviolet B (UVB) radiation from sunlight.In
community involvement.(2)
part, the human body cannot produce vitamin
Epidemiological evidence suggests that the
D2 which is driven up with fortified food or
etiology of schizophrenia could be due to the
given as supplements.Vitamin D binding
influence of genetic factors specific to the
protein are bound to both forms in plasma and
individual and the impact of the environment. It
then transported to the liver where both are
Accepted:16/9/2015 DOI: 10.12816/0017696

Full Paper (vol.61 paper# 9)

c:\work\Jor\vol61_10 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 445-450

Potential Effect of Aloe barbadensis and Salvadora persica (Miswak)
Mixture Sap as a Contraceptive Therapy in Female Mice

Eman G. Helal1, Hanan A. Jambi2, Gamal M. Elnemr3, and Hoda M. Abu-Taleb4

1 Zoology Department, Faculty of Science for Girls, Al-Azhar University, Egypt.
2 Food and Nutrition Department, Faculty of Home Economic, King Abdulaziz University, Saudi
3 Department of Medical and Radiological Researches, Nuclear Materials Authority, Egypt, and
Department of Internal Medicine, Faculty of Medicine, Taif University, Saudi Arabia.
4 Biostatistics and Demography Medical Statistician, Department of Environment Research, Theodor
Bilharz Research institute, Cairo, Egypt.

Evaluation of herbs has been in progress worldwide for several decades to identify
effective and safe substances for fertility regulation. This approach proved to be a good alternative
to synthetic drugs as the chemicals of plant origin have limited side effects. Various medicinal plant
extracts were investigated for their antifertility activity in female animal models.
Aim of the work: This study was designed to investigate the toxic effects of Aloe barbadensis and
Salvadora persica (Miswak) Mixture sap and to assess them as a contraceptive therapy.
Material and Methods: Twenty female adult albino rats (Sprague dawley strain) were used in this
study. Rats were divided into two groups (10 rats in each group); Group I (control untreated group)
and Group II (mix treated group). Mixture of Aloe barbadensis and Miswak sap was orally
administered (7 mg of Miswak + 7 mg of Aloe per 100 gram body weight) for 30 ± 2 days, where
females were in the diestrus phase). All animals were decapitated after 30 days and blood samples
were analyzed for estrogen, progesterone, tumor markers CA-15.3 and CA-125, kidney and liver
functions, proteins profile and lipids profile.
Results: The mean serum level of estrogen was significantly increased (p<0.01), while that of
progesterone was significantly decreased (p0.01), in the Aloe barbadensis and Miswak group when
compared to the control group. No significant difference was found between the treated and control
groups for the serum level of tumor markers CA-15.3 and CA-125. Also, no significant difference
was found between the two groups regarding kidney and liver function tests and proteins profile.
The results also showed marked significant decline (p<0.01) in levels of the serum total lipids, total
cholesterol, triglycerides, and LDL-cholesterol (LDL-C) in the treated group when compared to the
control group. While, there was a significant elevation in HDL-cholesterol (HDL-C) level in the mix
group when compared to the control group.
Conclusion: It could be concluded that Aloe barbadensis and Miswak extract can be used as a safe
contraceptive therapy that can increase the estrogen level due to its phytoestrogen components such
as beta sitosterol, without deleterious effects on the vital organs (liver and kidneys).

: Aloe barbadensis, contraceptive, fertility, kidney function, liver function, Salvadora
, tumor markers.

population in developing countries lack
Fertility control is an issue of national
regular access to affordable essential drug.(1)
and international public health concern. There
The cost of modern medicine is
is a global need to support individuals in
increasing by modern health technology and
family-planning due to the increasing growth
in many cases is inappropriate to the
rate of the world's population with its
immediate needs of people in developing
negative impact on environment, economic
countries. Traditional medicine is sometimes
growth, and poverty in underdeveloped
the only affordable source of health care
countries.(1) Despite many achievements in
especially for the world's poorest patients. In
human health care in the twenty first century,
addition, there is deficiency of systematic
Received:3/9/2015 DOI: 10.12816/0017697

Full Paper (vol.61 paper# 10)

c:\work\Jor\vol61_11 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 451- 458

Iodine Status of Primary School Children in Different Egyptian
Hanaa H Elsayed1, Mohamed K Abd El-Rahman1and Afaf ATawwfik2
1. Department of Biochemistry of Nutrition and Metabolism
2. Department of Field Studies and Survey
National Nutrition Institute Cairo- Egypt.

: iodine deficiency is the main cause of potentially preventable mental retardation in
childhood. It is still prevalent in large parts of the world. Mild iodine deficiency can affect cognitive
development of the child. Aim of study investigated iodine status of primary school children and
consumption of iodized salt. Subjects and methods: this study included 2105 households, urine
analysis for 1879 primary school children aged (6 - 12 years) from urban and rural sites (975 and
904), seven governorates in Egypt (Behera, Menoufia, Dakahlia, Beni Suif, Minya, Wadi Jedid and
South Sinai). Results: showed that more than 50% of household used iodized salt. In addition, they
were adding iodized salt (65.8%) during the process of cooking food. Beni Suif recorded the highest
prevalence of mild iodine deficiency in both urban and rural sites. Conclusion: iodized salt program
in the seven governments faces some problem/barriers for use of iodized salt at household level.
Government has required the use of iodized salt in processed foods. Recommendation: Surveillance
systems need to be strengthened to monitor both low and excessive intakes of iodine to improve the
iodine nutritional status of the population without risks of iodine excess or deficiency.
Keywords: urinary iodine concentrations (UIC) ­ primary school children - iodized salt

deficiency during pregnancy is associated with
Iodine is an important micronutrient
increased rates of stillbirths, spontaneous
required for human nutrition. Iodine deficiency
abortions, and congenital anomalies 5 and is the
disorders (IDD) refer to a complex clinical and
leading worldwide preventable cause of
sub-clinical disorder caused by the lack of
intellectual impairment in children.6 A global
adequate dietary iodine which is common cause
survey of iodine sufficiency in 2011 identified
that although there were some improvement
retardation, stunted growth and development in
worldwide in iodine sufficiency, 29.8% of
children. Goiter is the most common clinical
school aged children still had insufficient
manifestation of Iodine deficiency in children
iodine intake. 7
and adults.1
Owing to the iodine fortification of salt
Iodine is essential for the synthesis of
in many countries, severe iodine deficiency is a
thyroid hormones. Iodine deficiency can affect
rare condition. Nevertheless; mild-to-moderate
human health in different ways, and is
iodine deficiency is still considered a major
commonly referred to as IDD. These range
public health concern, even in some developed
from defective development of the central
countries. 8
nervous system during the fetal­neonatal life,
The appropriate level of iodine supplementation
to goiter in the adult.2 Synthesis and release of
in dietary supplements will depend on the
thyroxin (T4) and triiodothyronine (T3) are
individual consumption of the iodized food
stimulated by the pituitary's release of thyroid-
(salt, water, bread etc.), the degree of iodine
stimulating hormone (TSH or thyrotrophic).
deficiency in the area and the loss of iodine
When T3 and T4 concentrations are low TSH
from producer to consumer. All these factors
production is increased, and, as the opposite is
will be different in different countries, and for
also true, this creates a negative feedback loop
example, levels of salt iodization have varied
between the hypothalamus, pituitary and
substantially between countries and over time. 9
Also, the response to supplemental
Iodine deficiency affects nearly 2 billion
iodine may be reduced by other factors in the
people globally and is easily preventable with
environment, such as consumption of specific
the use of iodized salt in the diet.4 Iodine
goitrogenic foods (for example, cassava
(manioc), Soybeans and its products, Pine nuts,
Received:11/9/2015 DOI: 10.12816/0018750


Full Paper (vol.61 paper# 11)

In Situ Hybridization and Light and Electron Microscopies of Cervical Squamous Cell Carcinoma Infected with Human Papillomavir The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 459- 478

In Situ Hybridization and Light and Electron Microscopes of Cervical
Squamous Cell Carcinoma Infected with Human Papillomavirus
Monir A. El-Ganzuri (1) , Ali Khalifa (2) , Thanaa Helal (3) ,
Nanice Nabil Rizk (1) and Nora A. Al-Jalaud (4)
(1) Zoology department, Faculty of Science, Ain Shams University
(2) Biochemistry department and Head of Oncology Diagnostic unit .
Faculty of Medicine, Ain Shams University
(3) Pathology department, Faculty of Medicine, Ain Shams University
(4) Department of Biology,Faculty of Science,Dammam University,Saudi Arabia

Aim of the work
-In Egypt cervical carcinoma is ranked as a number 6 of all malignant tumors. There
is growing evidence that the human papillomavirus (HPV) is associated with the development of
cervical cancer. Patients and Methods-The present study hunted HPV in Egyptian biopsies of
cervical cancer by using in situ hybridization (ISH) technique .Light microscopy and ultra-structural
features accompanied by squamous cell carcinoma (SCC) of the cervix were monitored. Results-The
ultra structural study revealed viral particles in some epithelial cell nuclei and cytoplasm in the
moderately-differentiated squamous cell carcinoma. These were suggested to be Herpes Simplex Virus
(HSV). Conclusion-The potential relation between HPV and HSV in the incidence of Cervical
Squamous Cell Carcinoma is discussed.
Key words: Hybridization, Cervical Squamous, Carcinoma, Papillomavirus

Cervical carcinoma is the second most
common malignancy among women
differentiated (grade 3) (9).
worldwide (1,2,3), with an estimated 465,000
In well-differentiated (grade 1) squamous
new cases every year; this accounts for 15
cell carcinoma, the most striking feature is
percent of all malignant tumors diagnosed in
abundant keratin, which is deposited as
concentric whorls (keratin pearls) in the
Reports of developing countries showed
centers of neoplastic epithelial nests. The cells
that cervical carcinoma ranked as one of the
appear mature, with abundant cytoplasm.
most frequent malignancies. In Egypt, cervical
In moderately-differentiated (grade 2)
carcinoma is ranked as number 6 of all
squamous cell carcinoma, the neoplastic cells
malignant tumors, where it accounts for 3.6%
are more pleomorphic than in grade 1 tumor
of all female malignancies (4).
and characterized by having large irregular
Over the past decade, convincing evidence
nuclei and less abundant cytoplasm. Keratin
has accumulated to support an association of
pearls formation is virtually non existent, but
human papillomaviruses (HPVs) with the
individual cell keratinization is seen in the
centre of nests of tumor cells
precancerous cervical intraepithelial neoplasia
In poorly-differentiated (grade 3) squamous
(CIN). It is widely accepted that HPV is the
cell carcinoma, there are large or small,
primary causative agent for the development of
pleomorphic cells with hyperchromatic oval
this type of cancer and its precursor lesions
nuclei and scant indistinct cytoplasm.
Abnormal mitotic figures are frequent and
Previous studies suggested that HPV has
necrosis is common.
also some prognostic implications in invasive
Papillomaviruses are DNA viruses with
cervical carcinoma since patients with HPV
double-stranded circular DNA and icosahedral
had a higher recurrence rate with worse
structure with 72 capsomers. They cannot be
prognosis than in HPV negative patients (8).
cultivated in vitro (10).
It was proposed the most widely used

histological grading system of squamous cell
Papilloma viruses are classified as members
carcinoma that is based on the degree of
of the family Papovaviridae which includes
differentiation. Using this method, squamous
Simian Virus 40 (SV40) and polyoma virus as
cell carcinomas are graded as well-
well as the papillomaviruses. Papillomaviruses
Accepted:22/9/2015 DOI: 10.12816/0018751

Full Paper (vol.61 paper# 12)

c:\work\Jor\vol61_13 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 479- 488

Urinary Markers for Early Detection of Diabetic Nephropathy in Type 1
Diabetes Mellitus
Shawkia S. Abd El-Halim,1,6 Awatif M. Abd El-Maksoud,2 Mohammed A. Abdel-Rahman,3
El-sayed H. El-Tamany,4 Mohammed H. El-Hefnawy,5 and Amal H. Abd El-Razek.1
1Nutritional biochemistry Department, National Nutrition Institute, Cairo, 2Nutritional Requirements and
Growth Department, National Nutrition Institute, Cairo, 3Zoology Department, Faculty of Science, Suez
Canal University, Ismailia , 4 Chemistry Department, Faculty of Science, Suez Canal University, Ismailia , 5
Pediatric Department, National Diabetes and Endocrinology Institute, Cairo, Egypt ,6 Faculty of Art and Science
­ Qilwa ­ El-Baha University.
Corresponding authors: Shawkia S. Abd El-Halim.E-mail address: drshawkia2013@gmail.com.
Background: diabetic nephropathy (DN) is a serious complication of diabetic mellitus associated with
increased risk of morbidity and mortality. Diagnostic markers to detect DN at early stage are important as
early intervention can slow loss of kidney functions and improve patient outcomes. N-acetyl--d-
glucosaminidase (NAG) is a lysosomal enzyme, present in high concentrations in renal proximal tubular cells,
Gamma-glutamyltransferase (GGT) is an enzyme which located along the proximal tubular brush border,
Malondialdehyde (MDA) is a highly toxic product, formed in part by lipid oxidation derived free radicals,
Reactive carbonyl derivatives (RCDS) is an oxidative stress marker in urine, as a measure of the oxidative
modification of proteins and bete-2-microglobulin is filtered by the glomerulus, absorbed and catabolized by
the proximal tubules. The aim of this study is to investigate the urinary outcome of these markers as early
detectors of diabetic nephropathy in type 1 diabetic children.
Subjects and methods: This case-control study included 67 children with type 1 diabetes mellitus (33
male; 34 female), age (11.03±1.05 years) and thirty one age (10.58±1.11 years) and sex (13 male; 18 female)
matched healthy children (13 male; 18 female). Type 1 diabetic children were further subdivided into
microalbuminuric and normoalbuminuric subgroups according to microalbuminuria concentration (30 mg/ g
creatinine). Age, sex, diabetic duration and the current daily insulin dose, and family history of diabetes,
weight, height, body mass index, systolic and diastolic blood pressure were recorded. Fasting plasma glucose,
glycated hemoglobin, blood urea nitrogen, plasma creatinine, urinary creatinine, micoalbumin, N-acetyl-B-D
glucosaminidase (NAG), Gama glutamyl transferase (GGT), Beta-2-microglobulin, Malondialdehyde (MDA)
and Reactive carbonyl groups (RCDSS) were measured in all subjects.
Results: a significant increase in tubular injury markers of diabetes (NAG, GGT, beta-2-microglobulin) and
oxidative stress parameters (MDA, RCDSS) as compared to control subjects was found. Microalbuminuric
subjects showed a significant elevatation in the urinary markers including NAG, GGT, beta-2-microglobulin,
MDA, RCDSS as compared to normoalbuminuric subjects. The studied urinary tubular enzymes (NAG,
GGT), oxidative stress markers (MDA, RCDSS) and Beta-2- microglobulin showed positive correlations with
one another. Conclusion: The results of this study introduced the possibility of depending on tubular enzymes
(NAG, GGT), oxidative stress markers (MDA, RCDSS) and 2 microglobulin as early, reliable, and sensitive
predictors for diabetic nephropathy. The NAG activity index proved to be the most sensitive biomarker, then
beta-2- microglobulin for early discovering the tubule cells damage.
Keywords: Diabetic nephropathy- Micralbuminurea-Type 1 diabetic children- Glucose- N-acetyl-B-D
glucosaminidase (NAG), Gama glutamyl transferase (GGT), Beta-2-microglobulin, Malondialdehyde
(MDA) - Reactive carbonyl groups (RCDSS)

the onset and course of DN can be ameliorated
Diabetic nephropathy is a severe complication
significantly by several interventions, but these
occurring in diabetic patients and it is associated
interventions have their greatest impact if
with an increased risk of mortality, cardiovascular
instituted at a very early stage in the course of the
disease and progression to end stage renal disease
development of DN.(1).
(ESRD). (1) It has demonstrated that
Diagnostic marker to detect DN at early stage is

important as early intervention can slow the loss of
Accepted:22/9/2015 DOI :10.12816/0018752

Full Paper (vol.61 paper# 13)

c:\work\Jor\vol61_14 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 489- 498

Role of Alpha Lipoic Acid on Metabolic Hepatosteatosis: An
Experimental, Biochemical, and Microscopic Study
Awatief A. Edries1, 2 *, Ahmed H. El-Rashedy1,3, Mohamed Wagih4 , M.H.Wahdan1,5
1College of Medicine, Taif, Saudi Arabia, 2 Department of Tropical Medicine, Tanta University,
Tanta, Egypt,3Department of Pathology, College of Medicine, Al-Azhar University, Assuit, Egypt ,
4Department of Pathology, College of Medicine, Beni- Suef University, Beni-Suef Egypt,
5Department of Anatomy, College of Medicine, Cairo University, Egypt
*Corresponding author: dr.a_edrees@hotmail.com

Background and aim of work:
metabolic hepatosteatosis is a common serious prevalent condition
in KSA. The current study investigated alpha lipoic acid (ALA) effects on hepatic lipid accumulation
in severely fatty rats and secondarily on blood lipid profile.
Materials and methods: sixty male Zucker rats were selectively used half of which (Lean) weighed
200±25g & others weighed 375±30g. Fatty animals were allowed free access to food and water for
one week before experiment. The animals were divided into lean untreated (group I), lean ALA ­
managed (group II), fatty untreated (group III) and fatty ALA ­ managed (group IV) (fifteen animals
per each group). ALA was taken orally (20 mg/kg/day) for six months. Animals were sacrificed and
weighed (BW). Their liver was weighed (LW) and its portion was sliced to study its lipid content.
Right tibia length (TL) was measured and LW: TL ratio was calculated.
Results: ZF ALA-untreated rats showed high LW: TL ratio. ALA therapy significantly reduced BW,
TL, LW and LW: TL ratio in managed ZF rats compared to untreated ones while it didn't affect these
parameters significantly in lean (ZL) rats. ZF rats exhibited significant hepatosteatosis evidenced by
excessive liver triglyceride (TG) and total cholesterol (TC) contents and microscopically by large
cytoplasmic vacuoles. Interestingly, 6-months' ALA therapy in ZF caused significantly diminished
serum triglycerides and cholesterol levels as well as diminished hepatic triglycerides and TC
component in addition to decreased its lipid vacuoles compared to untreated ZF rats. The results
were insignificantly changed between managed and untreated lean groups.
Conclusion: our findings support effectiveness of ALA therapy in excessive hepatosteatosis and in
hyperlipidemia via improving abnormal lipid metabolism.
Key words: Alpha lipoic acid- Fatty liver ­ Abnormal fat metabolism- Serum Chemistry ­


Non-alcoholic fatty liver disease

(NAFLD) represented a spectrum of disease
usually associated with inflammatory
ranging from hepatocellular steatosis through
steatohepatitis to fibrosis and irreversible
pathogenesis of NASH were based on 2-hit
cirrhosis.(1) Also, it was considered as part of
hypothesis; the first hit was hepatic
the metabolic syndrome affecting adults and
triglyceride accumulation or steatosis that
children and commonly associated with
increased the susceptibility of liver to injury
mediated by second hit exemplified by
hyperglycaemia and hypertension. Its
importance was delivered from its high
mitochondrial dysfunction and oxidative
prevalence of up to 31% in the general
stress which in turn could lead to
steatohepatitis and/or fibrosis.(6)
hepatosteatosis was clinically important
However, free fatty acids (FFA) had
disorder in Saudi Arabia with estimated
been evidenced to play in directly
prevalence of 7% to 10%.(4) Hepatic steatosis
progressing liver injury and could directly
was also commonly seen in patients with
cause toxicity by increasing oxidative stress
chronic hepatitis C virus (HCV) infection
and had an increased prevalence in women
pathways.(7) An increasing clinical and
with polycystic ovary syndrome when it was
experimental evidences showed a greater
: 10320 /
2 01801301

Full Paper (vol.61 paper# 14)

c:\work\Jor\vol61_15 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 499- 513

The Effect of Clarithromycin Administration on Pregnant Albino Rats
during the Cleavage Period of Gestation and on Their Embryos
Asmaa M. Kandil1, Gabri M.S.2, Maiada Moustafa2, and Nehad Mohamed.2
1Pharmacology Dep., National Organization for Drug Control and Research (NODCAR).
2Zoology and Entomology department, Faculty of Science, Helwan University

Clarithromycin is a macrolide antibiotic used to treat common infections including
respiratory tract, skin and Helicobacter pylori. This work investigates whether the administration of
clarithromycin to pregnant females during the cleavage phase of gestation was associated with a risk of
miscarriages and offspring morphological malformation and skeletal anomalies, histological changes
and DNA fragmentation of embryos and liver of pregnant rats.
Two major groups of pregnant albino rats were used. The animals of the control group received
distilled water from the 1st to 7th days of gestation.One subgroup (C1) was sacrificed on the 8th day; and
the other (C2) was sacrificed on the 20th day of gestation. The treated group was drenched 45 mg/kg
clarithromycin (therapeutic dose) suspension from 1st to 7th day of gestation. The first subgroup (T1)
was sacrificed on the 8th day and the other (T2) was sacrificed on the 20th day of gestation.
Results: The obtained results showed a decrease in maternal body weight gain, increase in the rate of
abortion, resorption and growth retardation of fetuses and some malformation in the skeletal system of
the treated group. Histopathological studies of pregnant and fetal rats revealed congestion and dilatation
of the central vein, fatty degeneration of the hepatocytes and severe DNA fragmentation.
Keywords: Macrolides, Clarithromycin, cleavage phase, teratology, skeletal malformation, rat
and liver histopathology, germ layers, DNA fragmentation.


Macrolides are a group of related
Clarithromycin has been extensively used for
compounds that have a lactone ring (14 to 16
treatment of infections caused by chlamydia,
atoms) bonded to one or more deoxysugar
mycoplasma, legionella, Helicobacter pylori,
molecules [1]. They are generally well tolerated,
and mycobacterium avium complex. [4]
and allergy to macrolides is an uncommon
The type of malformation induced by
event (occurring in 0.4%-3% of treatments) [1].
a teratogen is dependent not only on the nature
Clarithromycin, a new macrolide
and dosage of the agent but also on the precise
antibiotic, is effective in the management of a
developmental stage of the embryo.[5]Animal
wide range of clinical problems, including
studies have shown that clarithromycin can
outpatient treatment of community-acquired
induce fetal loss in rabbits and monkeys when
pneumonia, shortening the course of peptic
used in very low dosages and in high dosages,
ulcer disease associated with Helicobacter
respectively[6]. One observational study
pylori infection and curing previously resistant
concerning pregnant women showed a
respiratory infections in immunocompromised
doubling of the number of miscarriages in
patients. It is generally well tolerated,
women exposed to clarithromycin in early
producing fewer gastrointestinal complaints
pregnancy compared to a match control group
than its parent compound, erythromycin. For
these reasons, it is frequently prescribed in
Only limited data are available
adult and pediatric settings [2].
concerning the effect of clarithromycin on the
Clarithromycin exerts its antibacterial
human fetus when used in pregnancy [6]. The
action by binding to the 50S ribosomal subunit
patient must then be informed of the potential
of susceptible organisms and inhibiting protein
risks involved in the treatment plan. This work
synthesis through translocation of aminoacyl
studies the effect of a therapeutic dose of
transfer RNA [3].
clarithromycin on pregnant rats and their
Received: 9/6/2015 DOI : 10.12816/0018754
Accepted: 30/6/2015

Full Paper (vol.61 paper# 15)

c:\work\Jor\vol61_16 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 514- 521
Comparison of Efficacy of Continuous Erythropoietin Receptor Activator
(CERA) In Chronic Kidney Disease Patients versus Patients on Hemodialysis,
Single Center Experience.
Ayman Aly Seddik
Department of Medicine, Faculty of Medicine Ain Shams University, Cairo, Egypt and Nephrology
Department, Dubai Hospital, Dubai Health Authority.
Corresponding author: Dr Ayman Aly Seddik ,Internal Medicine & Nephrology, Faculty Of Medicine Ain Shams
University, cairo , Egypt P011588,Dubai hospital, Dubai health authority, Dubai, UAE ,email:

Background :
prior to the availability of recombinant human erythropoietin (r-EPO, epoetin), patients
on dialysis frequently demanded blood transfusions and excessive iron therapy, exposing them to the
risks of iron overload, transmission of viral hepatitis, and sensitization, which reduced the chances of
successful transplantation . Recombinant human erythropoietin has been used for more than 20 years for
the treatment of renal anemia, Epoetin-Alfa and -beta representing the common traditional preparations.
By the modification of the molecule's carbohydrate moiety or structure a longer duration of erythropoietin
receptor stimulation was achieved. The continuous erythropoietin receptor activator C.E.R.A. once or
twice a month was found sufficient to achieve serum hemoglobin target levels.
This study was aimed to identify the efficacy of C.E.R.A (Methoxy polyethylene glycol-epoetin beta in
achieving and maintenance of hemoglobin level in patients with chronic kidney disease and patients on
regular Hemodialysis therapy.
Patients and methods: 145 patients with either CKD stage 4 & 5 (e GFR < 45 ml/min) on follow up in
nephrology outpatient department or on regular Hemodialysis in nephrology unit Dubai hospital. In this
center, the CERA approved by the local pharmacy authority was used for treatment of anemia in chronic
kidney disease monthly dose of (100 mg for 70 kg patient) and adjusted according to monthly HB level
during the trial period for reaching and maintaining target HB level of 11-12.5 g/dl.
Results : Patients on HD 78 patients (53.8%) and CKD patients 67 patients the mean HB level at the end
of study period showed statistically significant rise in whole patient cohort with HB START (8.882
±1.272 g/dl) and at the end of 24month (11.119±1017 g/dl) With P-value (< 0.001). HB at start was
(9.013±1.298 g/dl) and (8.769±1.246) g/dl for CKD and HD respectively slightly higher in CKD group
however without statistical difference (P-value 0.250). HB level at the 24 month period (end of trial
period) was found statically higher in HD group (11.305±1.197g/dl) than CKD group (10.903±1.116g/dl)
again without statistical significance P-value (0.038).
Conclusion: It could be concluded that the long acting erythropoietin stimulating therapy using
continuous erythrpoeitin receptor activator ( CERA ) as once monthly dose is effective and safe in
maintaining target HB level in both CKD patients and patients on maintenance hemodialysis and there
was no recorded side effects of its use either by intravenous or subcutaneous use.
Key words: Anemia, CKD, Hemodialysis, Continuous Erythropoietin Receptor Activator (CERA)


The definition of anemia is controversial. The
HB levels starts to fall early in course of chronic
WHO defines anemia as hemoglobin (HB) <13
kidney disease (CKD), at an estimated
g/dL for men and <12 g/dL for women. The
glomerular filtration rate (e-GFR) of less than 75
National Kidney Foundation's Kidney Disease
ml/min per 1.73 m2 in men and 45 ml/min per
Outcomes Quality Initiative, defines anemia in
1.73 m2 in women. (3).Among patients under
adult men and postmenopausal women as
regular care and known to have CKD, the
HB<12 g/dL, or <11 g/dL in a premenopausal
prevalence of anemia was found to be much
woman the recently launched. (1,2)
greater, with mean HB levels of 12.8 ± 1.5 g/dl

(CKD stages 1 and 2), 12.4 ± 1.6 g/dl (CKD

Accepted:9/5/2015 DOI: 10.12816/0018755

Full Paper (vol.61 paper# 16)

c:\work\Jor\vol61_17 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 522- 528

Efficacy of Intravenous Vitamin-D Selective Receptor Activator (Paricalcitol)
In Management of Secondary Hyperparathyroidism in Hemodialysis Patients,

Single Center Experience.
Ayman Aly Seddik
Department of Medicine, Faculty of Medicine Ain Shams University, Cairo, Egypt and Nephrology
Department, Dubai Hospital, Dubai Health Authority.
Corresponding author: Dr Ayman Aly Seddik ,Internal Medicine & Nephrology, Faculty Of Medicine Ain Shams
University, cairo , Egypt P011588,Dubai hospital, Dubai health authority, Dubai, UAE email: Seddik500@gmail.com

: secondary hyperparathyroidism (SHPT), a complication of chronic kidney disease (CKD)
and is characterized by not only increased serum levels of intact parathyroid hormone (iPTH), but also
may cause skeletal and cardiovascular complications. Deficiency of calcitriol (1, 25-hydroxy vitamin D)
caused by impaired renal function, a main factor in the pathogenesis and pathophysiology of secondary
hyperparathyroidism (SHPT) is associated with poor outcomes in hemodialysis patients. Therapy with
vitamin D receptor (VDR) activators, including calcitriol or the selective VDR activator paricalcitol, has
been associated with improved survival in patients with CKD on hemodialysis.
PATIENTS AND METHODS: single center cross over observational study of 28 patients on regular
Hemodialysis in nephrology unit in Dubai hospital, the patient stopped all vitamin-D supplementations
and calcium containing phosphate binder for 2 weeks prior to initiation and for the whole study period,
non calcium based phosphate binder was continued. Initial dose of selective VDRA (PARICALCITOL)
is 0.04 to 0.1 mcg/kg body weight (average total dose 2.8 ­ 7 mcg) administered as a bolus dose post
hemodialysis twice to three times per week according to initial parathyroid hormone level Titration
weekly dose (micrograms) calculated by dividing most recent i-PTH level (pg/ml)/80.
RESULTS : analyzing the data at start and end of trial period 48 weeks showed that there was significant
reduction of serum I-PTH from (491.210±144.690 pg/dl ) at start of the trial to (142.610 ±41.519pg/dl)
at 48 weeks with P- value (<0.001) . Serum calcium increased from ( 8.343± 0.654mg/dl ) at the start of
the study to (8.629±0.534mg/dl ) at 48 weeks but without statistical significance P- value (0.006), same
occurred with serum phosphate which showed insignificant rise with phosphate level at start of the test(
7.264±1.695mg/dl) and at 48 weeks (7.279±1.800mg/dl) with P-value( 0.975).
CONCLUSION: It could be concluded that use of intravenous vitamin D selective receptor activator
(Paricalcitol) is effective in reducing serum I-PTH level in hemodialysis patients. Serum Ca++ and
phosphorus levels were statistically insignificant.
Key words: Paricalcitol, vitamin D selective receptor activator, secondary hyperparathyroidism,


Abnormalities in calcium, phosphorus, PTH, and
bone abnormalities and vascular calcification. (1,
vitamin D metabolism (collectively referred to
2)Secondary hyperparathyroidism (SHPT), a
as disordered mineral metabolism) are common
complication of chronic kidney disease (CKD)
in patients with chronic kidney disease (CKD).
is characterized by not only increased serum
Changes in the laboratory parameters of chronic
levels of intact parathyroid hormone (i-PTH),
kidney disease ­ bone mineral disease (CKD­
but also may cause skeletal and cardiovascular
MBD) may begin in CKD stage 3, but the
complications .(3-4) SHPT is associated with
presence of abnormal values, the rate of change,
increased mortality in end-stage kidney disease
and the severity of abnormalities are highly
as well as in earlier stages of CKD .(5,6)
variable among patients. To make the diagnosis
Deficiency of calcitriol (1, 25-hydroxy vitamin
of CKD­MBD, one or more of these laboratory
D) caused by impaired renal function, a main
abnormalities must be present however the other
factor in the pathogenesis and pathophysiology
two essential components for the diagnosis are
of secconrady hyperparathyroidism (SHPT) is
Accepted:14/5/2015 DOI: 10.12816/0018756

Full Paper (vol.61 paper# 17)

c:\work\Jor\vol61_18 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 529-534

Effects of Recovery Period and Tamoxifen on Bisphenol A Treated Female
Albino Rats
Eman G. E. Helal1, Gamal M. Elnemr2, 3, Mohamed A. Abdel-Azeiz4, Doaa I. A. Gewily1
1Department of Zoology, Faculty of Science (Girls), Al-Azhar University, Cairo, Egypt.
2Department of Medical and Radiological Researches, Nuclear Materials Authority, Egypt, and
3Department of Internal Medicine, Faculty of Medicine, Taif University, Saudi Arabia.
4Department of Physiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Bisphenol-A (BPA) is an organic synthetic polycarbonate compound [(CH3)2
C(C6H4OH)2] which is widely incorporated into many plastic industries worldwide. BPA is an endocrine
disruptor that exhibits hormone-like properties which may promote adverse effects in humans, triggering
estrogenic signals in target tissues, which raise concern about its suitability in some consumer products
and food containers. Since 2008, several governments have investigated BPA safety, which prompted
some retailers to withdraw polycarbonate products. A 2010 report from the United States (US) Food and
Drug Administration (FDA) identified possible hazards of BPA to fetuses, infants, and young children.
However, the FDA has ended its authorization of the use of BPA in baby bottles and infant formula
packaging, based on market abandonment, not safety.
Aim of the work: This study aimed to investigate the antitoxic effects of the anti-estrogen drug
Tamoxifen (Nolvadex) and the recovery period on the female albino rats which received BPA.
Materials and Methods: This study was performed on forty female albino rats with an average body
weight of 140-160 grams. The animals were divided into four groups (10 rats per cage); Group I
(Control untreated for 30 days), Group II (BPA treated for 15 days, then sacrificed), Group III (BPA
treated first for 15 days, then left to a recovery period of another 15 days), and Group IV (BPA treated
first for 15 days, then treated with the anti-estrogen drug Nolvadex for another 15 days). The following
analyses were done to all groups; ALT (alanine amino-transferase), AST (aspartate amino-transferase),
GGT (gamma glutamyl-transferase), total proteins, albumin, globulins, A/G ratio [i.e., liver function
tests], creatinine, uric acid, A/C (albumin/creatinine) ratio [i.e., renal function tests], total lipids, total
cholesterol, LDL-C (low density lipoprotein cholesterol), HDL-C (high density lipoprotein cholesterol),
and triglycerides [i.e., lipids profile].
Results: In the BPA treated group II the biochemical results showed highly significant increase (P<0.01)
in the enzymatic activities of ALT, AST, and GGT with concomitant increase in globulins (P<0.05),
creatinine, uric acid, total lipids, total cholesterol, LDL-C, and triglycerides levels when compared to the
control group. On the other hand, there was highly significant decrease (P<0.01) in total proteins,
albumin, A/G (albumin/globulin) ratio, A/C (albumin/creatinine) ratio, and HDL-C levels when
compared to the control group. These results turned back to normal control values after stopping the use
of BPA alone (Group III) or stopping BPA and treatment with the anti-estrogen drug Nolvadex in the
recovery period, except for ALT which was elevated (P<0.05) with Nolvadex (Group IV). Conclusion:
It could be concluded that BPA has dangerous toxic effects on the liver and kidney functions as well as
on the lipids profile. Moreover, the recovery period (i.e., 15 days without treatment) is better than the use
of the anti-estrogens (as Tamoxifen) which have no antitoxic effects to BPA, but caused hepatic toxicity
instead which is noted by an increase in ALT levels. So, we recommend minimizing utilization of this
compound (BPA) to protect people from its hazardous effects.
Keywords: BPA: Bisphenol-A, anti-estrogen Tamoxifen (Nolvadex), recovery period.

containers, or tableware (plates and mugs),

and epoxy resin lining food and beverage
The xeno-estrogen Bisphenol-A (BPA),
cans.(1,2) There is a global concern for human
a food contaminant with an endocrine
health as BPA binds to estrogen receptors
disruptor activity, is the monomer widely
(ERs)(3), and can interfere with normal sex
used to manufacture polycarbonate plastics
hormone balance. BPA is thought to wield its
including baby bottles, infant feeding
Received: 1/8/201
5 DOI: 10.12816/0018757
Accepted: 8/8/2015

Full Paper (vol.61 paper# 18)

c:\work\Jor\vol61_19 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 535- 547
Problematic Internet Use Among Al-Azhar University Students in Cairo

Zeinab El-Sayed Hammour 1,Heba Mohamed Abd-Elgalil 2, Hanaa Abou Elyazid Elhassan2
and Mohamed M. Abo Alabbas3
1Assistant Professor, 2Lecturer of Public Health, Community and Preventive Medicine,
Faculty of Medicine, Al-Azhar University. 3lecturer of Psychiatry, Al-Azhar University, Domiat.

Background: the Internet has become an important tool for social interaction, information, and
entertainment. Studies have shown that the percentage of students using the Internet has increased
dramatically. However, as the Internet has moved into homes, schools, Internet cafes, and businesses,
there has been a rapidly growing public awareness of the potential adverse effects arising from
excessive, maladaptive or addictive Internet usage, which are a condition also known by terms such as
problematic Internet use (PIU), Internet dependence and pathological Internet use.
Aim of the study: 1- To determine the general characteristics of Internet users among Al-Azhar under
graduate university students in Cairo. 2- To explore the problematic Internet use (PIU) among under
graduate university students based on the Internet activities . 3- To investigate the difference between
males and females regarding PIU. Materials and methods: a cross sectional study was conducted on a
sample of 600 undergraduate university students including both scientific and literary collages of Al-
Azhar Universities for girls and boys in Cairo. This sample was chosen randomly through on line
questionnaire. All participants voluntarily participated in the present study to identify the extent of
problematic Internet use among university students. On line self-administered questionnaire that
designed to include different items.
female students had significantly lower PIU levels on all dimensions (i.e., social comfort,
loneliness/depression, diminished impulse control and distraction) than those of males. Furthermore, the
results reveal that the students who use internet frequently (3-6 hours/day) and those who use it for
entertainment (e.g., game), chat, news (policy or sports news) and social networking purposes have
significantly higher PIU levels on all dimensions than the students who use it for less than 3 hours/day or
for scientific purposes. Moreover, multiple regression analyses reveal that gender and time spent online
daily are significant predictors of PIU and its all dimension except for diminished impulse control only
time spent online daily is the predictor. Conclusion: males are more at risk than females in terms of
problematic Internet use. The effect of duration of daily internet use on cognitions about PIU was found
to be significant in all analyses. Recommendation: the students should be informed about the association
between long use of internet /day and PIU to protect them from negative consequences PIU.
Problematic Internet use, Internet activities, Time spent online, Gender, Egyptian
undergraduate university students.

It seems that the Internet is widely expanded
The Internet has become the most widely and
in today communication world compared to the
frequently used media over the last two

decades. (1) The Internet is a technological tool
electronic media. About 32.7% of the world's
which makes our life easier and has become an
population has access to the internet. (6)
indispensable part of it while its number of user
The internet and mobile phone usage rates are
population increases faster each day. (2) Also,
among the highest in the developing world. In
The Internet provides healthy people the
Egypt the internet usage is growing intensively.
opportunity for a variety of benefits, including
More than 23 million Egyptians used the
social engagement, emotional support, skill
internet by the end of the year 2010, up from
development, financial gains, education, and
16.6 million in 2009, the number increased by
entertainment. (3) Furthermore the Internet, as a
28 percent during the year 2010. (7)
medium of information and communication,
By the end of the year 2014, regarding internet
has an important place in social and academic
world stats usage and population statistics,
life of university students in many societies. (4, 5)
about 46.2 millions Egyptians used the
Received:1/9/2015 DOI:10.12816/0018758

Full Paper (vol.61 paper# 19)

Is there a place for plasma Osteaopontin as key mediator in patients with diabetic nephropathy The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 548- 563

Is There A Place for Plasma Osteaopontin as Key Mediator in Patients
With Diabetic Nephropathy?
Wafaa Mohi El-Deen Abd El-Fatah* and Mona Abd El-Raof Abd El-Kader**
*Department Of Medical Biochemistry, **Department Of Internal Medicine Faculty of
Medicine for Girls Al-Azhar University

micro- and macro-vasculopathies, such as nephropathy and coronary artery disease (CAD),
respectively, are common in diabetes and constitute the major causes of death for in these patients. Pro-
inflammatory cytokines play a critical role in the pathogenesis of diabetic complications through various
biochemical and cellular pathways. Osteopontin (OPN) has been identified as a key regulator of many
metabolic and inflammatory diseases including obesity, diabete and diabetic nephropathy. The aim of
this study
was to evaluate plasma level of osteopontin in different stages of diabetic nephropathy in type
II DM, and to correlate it with the stage of nephropathy and with other measured parameters. Patients
and methods:
the study was conducted on 58 patients with diabetic nephropathy as well as 15 apparently
healthy subjects as a control group. Patients were classified into 2 main groups according to the level of
glycosylated hemoglobin (HbA1c) Group I: controlled type II DM (HbA1c 5.55%-7.6%). Group II:
uncontrolled type II DM (HbA1c
7.6 %).Each group was subdivided into two subgroups (A and B)
according to the presence of microalbuminuriaor macroalbuminuria (degree of nephropathy). In addition
to, Group III: DM type II with end stage renal disease (serum creatinine 5mg/dl) and just starting
hemodialysis (1-3 sessions Only) plasma osteopontin was measured by ELISA. Results of the study
revealed significant increase of serum osteopontin in all studied groups
Results: compared to normal control subjects (P<0.001).There was a statistically positive correlation
between serum osteopontin versus all variables in group I and II; except HBA1C in group I, and FBS in
group II. But, no statistical correlation change between serum osteopontin versus all variables in group III
(P>0.05).Cut ROC curve of osteopontin levels of all cases of diabetic nephropathy indicates high validity
of OPN to detect positive cases of diabetic nephropathy with accuracy of 100%, and OPN is considered a
high validity test in prediction of end-stage renal disease (ESRD) more than prediction of
microalbumnuria. Conclusion: plasma level of osteopontin increases with the progression of diabetic
nephropathy and osteopontin may be useful as a biomarker to trace disease progression as well as a
potential diagnostic biomarker for the prediction of diabetic ESRD.
Keywords: Osteopontin, Microalbuminuria, Macroalbuminuria, Diabetic Nephropathy, End-Stage Renal


not all patients progress to this stage, and some
approximately 30% of diabetic patients and
may regress to normoalbuminuria.(4)
leads to renal failure in most countries. It is the
DN screening must be performed when DM is
leading cause of chronic renal disease in patients
diagnosed in patients with type II DM. (5)
starting renal replacement therapy .(1)DN has
High glucose concentration can induce
been classically defined as increased protein
production of many cytokines and initiate all
excretion in urine. Early stage is characterized
kinds of pathophysiologic process .(6) Thus, the
by a small increase in urinary albumin excretion
elevated glucose concentrations observed in
(UAE), also called microalbuminuria or
patients with diabetes may directly affect the
incipient DN,(2) but doesn't cover all patients
calcification process .(7)
with renal impairment ..(3)
Pathologically, there are two patterns of
More advanced disease is defined by the
vascular calcification. Typical atherogenesis
presence of macroalbuminuria or proteinuria.
and medial calcification (also called Mo¨
Although microalbuminuria is considered a risk
nckeberg's calcification or medial calcinosis).
factor for the development of macroalbuminuria,
Medial calcification occurs initially in the
Received:9/9/2015-accepted:17/9/2015 DOI: 10.12816/0018759

Full Paper (vol.61 paper# 20)

c:\work\Jor\vol61_21 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 564- 569
Closure of the Cystic Duct Comparison Ultrasonic Harmonic Scalpel versus
Clip Application in Laparoscopic Cholecystectomy
Hazem Ahmed M. Badr
General Surgery Department, Faculty of Medicine for Girls Al-Aazhar University

Laparoscopic cholecystectomy (LC) is usually performed using titanium clips (TC) for
occlusion of the cystic duct and cystic artery. The use of Harmonic scalpel (HS) in LC has been reported.
Aim: This study aimed to compare effect of HS and clips application for closure of the cystic duct and
artery in patients undergoing LC. Patients and Methods: Totally 50 patients were operated using LC
technique from April 2010 to April 2012. Patients were retrospectively, divided into 2 groups according to
the instruments used for division of the cystic artery and duct as well as for dissection of the liver bed. On
the one hand, group 1 consisted of 30 patients who were all treated with the ultrasonic harmonic scalpel as
the sole instrument used in the whole procedure. On the other hand, group 2 comprised 20 patients in whom
dissection and coagulation were performed using monopolar coagulation, and occlusion of the artery and
duct with clips. The operative time, postoperative hospital stay, morbidity, and mortality for each group
were analyzed and compared with each other. Results: The 2 groups were comparable for age, sex,
indication for cholecystectomy, and combined procedures. Patients were randomly treated either with the
ultrasonic HS or with clips. Postoperative hospital stay of all patients in the group 1 and group2 was 2 days.
Superficial wound infection seen in one patient (2%) in group 2 which was treated by oral antibiotics.
During the follow-up period, one port-site hernia was detected in one patient (2%) in group 2. One case
(2%) of peritoneal fluid collection seen in (group 1) and treated with percutaneous drainage was found.
Conclusions: The use of harmonic scalpel was accepted as a reasonable alternative for closure of cystic
ducts < 4 mm in diameter. This Study has shown that the HS is an effective and safe tool for the closure of
both the cystic duct and artery in patients who undergo LC.
Key Words:
Cystic duct, Ultrasonic harmonic scalpel, Clip application, Laparoscopic cholecystectomy.
Abbreviations: Laparoscopic cholecystectomy (LC), American Society of Anesthesiology (ASA), Body
Mass Index (BMI), endoscopic retrograde cholangiopancreatography (ERCP), titanium clips (TC)
Harmonic scalpel (HS).



considered world wide the "gold standard" in the
Furthermore, not to be underestimated are
surgical treatment of symptomatic gall bladder
visceral and solid organ injuries caused by the
lithiasis and acute cholecystitis, because it offers
frequent instrument exchange, such as bile
well-known and more definite advantages in
leakage due to slippage of the clips. (3)
comparison with the laparotomic procedure. (1)
The ultrasonically activated scalpel (Harmonic) is
The standard laparoscopic cholecystectomy is
introduced into clinical use more than a decade
ago. Its technology relies on the application of
electrosurgical hook for dissection and clips for
ultrasound within the harmonic frequency range
occlusion of the cystic duct and cystic artery.
to tissues and allows 3 effects that act
Alternative techniques for duct ligation have
included linear stapler, endoloops, or sutures,
cavitation. (4) The temperature obtained and the
which are, however, seldom used. (2)
lateral energy spread are lower than those
Even if LC is considered a safe procedure, some
detected when the monopolar hook is used, thus
pitfalls are associated with the use of the
reducing the risk of tissue damage. (5) The
monopolar electric scalpel, such as the high
Harmonic scalpel is also an effective tool for
closure of biliary ducts and vessels whose
Of thermal injuries and significantly more
diameter is <4 mm to 5 mm. (6) .Several
common postoperative biliary complications.
studies have demonstrated the effectiveness and

110.161 01801.06 DO


Full Paper (vol.61 paper# 21)

Full Paper (vol.61 paper# 22)

c:\work\Jor\vol61_23 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 575- 590

Histological Study and DNA Changes in the Kidneys of Rat Fetuses
Maternally Treated with Clarithromycin
Asmaa M. Kandila, Gabri M. S. b, Abdel Razik H. Farragc,
Basma N. Hassanb, Doaa Ezz-Eldin I. S.b
a Pharmacology Department, National Organization for Drug Control and Research, Giza, Egypt.
b Zoology and Entomology Department, Faculty of Science, Helwan University, Cairo, Egypt.
C Pathology Department, Medical Research Division National Research Centre, Cairo, Egypt.


Introduction: macrolide antibiotics are a class of potent and well established antimicrobials that also
possess anti-inflammatory and/or immunomodulatory properties. Because of their size, lower levels of
macrolides are able to reach the developing fetuses.
Materials and method: the pregnant rats were orally administered with clarithromycin at early and
late gestational periods. The 20 day-old fetuses were dissected for excision of the kidney. Half of the
kidney was processed and stained with H & E, PAS, Masson's trichrome and Feulgen techniques then
followed by morphometric measurements and statistical study. The other half of the kidney was
preserved for DNA fragmentation assay.Results: This study revealed that clarithromycin
administration to pregnant rats showed different histopathological, histochemical and DNA changes in
the kidneys of their fetuses.
Conclusion: Administration of the antimicrobial agent; clarithromycin at early and late gestational
periods exhibits nephrotoxicity in the developing fetuses.
Key words: Clarithromycin, Antimicrobial drug, Rat fetuses, Kidney.


The correct choice of an antimicrobial
predominantly gram-positive cocci, but also
agent to treat urinary tract infections during
chlamydia, mycoplasma and legionella,
pregnancy is complex because it requires full
campylobacter as well as coxiella, bartonella,
attention to maternal and fetal safety[1].
corynebacteria and several mycobacterium
Antibiotic" earlier referred to a
species. Macrolides are suitable alternatives
compound or a substance produced by a
for patients who are allergic to penicillin[7] .
microorganism (i.e., a bacterial or a fungal

metabolite), which inhibits the growth of other
microorganisms. Today this designation
Drug and dosage:
semisynthetic or synthetic which exhibits such
agent, C38H69NO13, provided by Kahira
inhibitory effect[2] .
Pharmaceuticals and Chemical, Egypt, in
Antibiotics can be classified based on the
a commercial product called Klacid XL
cellular component or system they affect, in
as 14 film coated tablets. Each tablet
addition to whether they induce cell death
contains 500 mg of clarithromycin. The
(bactericidal drugs) or merely inhibit cell
drug was orally given once daily to
growth(bacteriostatic drugs) [3] Clarithromycin
pregnant rats at different periods of
is a semisynthetic macrolide antibiotic which
gestation by gastric tube at a dose of 45
exhibits broad-spectrum activity against gram-
mg/kg/day. The dose was equivalent to
positive and gram-negative aerobes. It is
therapeutic dose of human (500 mg/day)
known to have better oral bioavailability and
and calculated according to interspecies
tissue penetration [4] . Clarithromycin acts by
dosage conversion scheme of Paget and
binding to the peptidyl transferase region of
Barnes[8]. The tablet was crushed to
23S rRNA and inhibits bacterial protein
powder and was dissolved in distilled
synthesis[5] .
water. The given volume was adjusted so
Macrolides are bacteriostatic antibiotics
that each 100g of the animal body weight
that inhibit protein biosynthesis via reversible
received 1ml solution containing the
binding to the bacterial 50S ribosomal subunit.
required dose.
Because of their size, lower levels of
2- Experimental animals:
macrolides are able to reach the fetus [6]. The
The present experimental study was
antibacterial spectrum of macrolides includes
carried out on the adult female and male


Full Paper (vol.61 paper# 23)

c:\work\Jor\vol61_24 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 591- 614

Histological and Immunohistochemical Studies on the Kidneys of Pregnant
Rats Treated with Clarithromycin
Abdel Razik H. Farraga, Gabri MSb, Asmaa M. Kandilc,
Basma N. Hassanb, Doaa Ezz-Eldin I. S. b
a Pathology Department, Medical Research Division National Research Centre, Cairo, Egypt.
b Zoology and Entomology Department, Faculty of Science, Helwan University, Cairo, Egypt.
C Pharmacology Department, National Organization for Drug Control and Research, Giza, Egypt.

: clarithromycin is a semisynthetic macrolide antibiotic, exhibits broad-spectrum activity
against gram-positive and gram-negative aerobes. Macrolides are bacteriostatic antibiotics that inhibit
protein biosynthesis via reversible binding to the bacterial 50S ribosomal subunit. Macrolides are able
to cross placenta and reach the fetus.
Aim of the work: the present study is focused on evaluating the effects of antimicrobial drug,
clarithromycin on the kidneys of pregnant rats.
Material and methods: clarithromycin is orally given to the treated groups of the pregnant rats once
daily at different periods of gestation by gastric tube at a dose of 45 mg/kg/day. The excised kidneys
were dissected, processed and stained with H & E, PAS, Masson's trichrome, Feulgen reaction and
anti-CD68 immunohistochemical stain then followed by morphometric measurements and statistical
analysis. The kidneys were also preserved for DNA fragmentation assay.
Results: this study revealed that clarithromycin administration especially to pregnant rats showed
different histopathological and histochemical changes in kidney tissues and cellular DNA. Also
immunohistochemical anti-inflammatory marker CD68 showed positive reactivity in all treated
Conclusion: The presence of histopathological and histochemical changes revealed nephrotoxicity in
the pregnant rats after administration of the antimicrobial drug, clarithromycin.
Key words: Clarithromycin, Antimicrobial drug, pregnant rats, Kidney


Urinary tract infections are common
Clarithromycin is metabolized in the liver via
during pregnancy due to hormonal and
the cytochrome P450 isoenzymes of the
anatomo-physiological changes that facilitate
CYP3A family. Therefore, drug interactions
the growth and dissemination of bacteria in
are an important potential cause of side
the maternal urinary tract.[1]
effects. Adverse effects of this compound in
All antibiotics used in human therapy
the central nervous system (CNS) include
since the dawn of the antibiotics era in the
CNS depression (confusion and obtundation)
early 1900s can be divided into three distinct
or excitation (agitation, insomnia, delirium
categories according to how they were
and psychosis). Unfortunately, it remains
ultimately manufactured on large scale. These
unclear what mechanisms underlies the
change in mental status[5].
compounds manufactured directly by large-
The antibacterial spectrum of macrolides
scale fermentation of bacteria or fungi
includes predominantly gram-positive cocci,
chlamydia, mycoplasma and legionella,
manufactured by chemical synthesis using a
natural product as starting material, and 'Fully
corynebacteria and several mycobacterium
synthetic antibacterial compounds that are
species. Macrolides are suitable alternatives
manufactured by fully synthetic routes [2].
for patients who are allergic to penicillin [6]
Clarithromycin is a semisynthetic

macrolide antibiotic that exhibits broad-
spectrum activity against gram-positive and
Drug and dosage:
gram-negative aerobes. It is known to have
Clarithromycin C38H69NO13, provided by
better oral bioavailability and tissue
Kahira Pharmaceuticals and Chemicals,
penetration [3]. Clarithromycin acts by binding
Egypt, in a commercial product called Klacid
to the peptidyl transferase region of 23S rRNA
XL in the form of 14 film coated tablets. The
and inhibits bacterial protein synthesis. [4] t
ablet was crushed to powder and added to
Received:9/01/2015 DOI : 10.12816/0018763

Full Paper (vol.61 paper# 24)

c:\work\Jor\vol61_25 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 615- 619

Effect of Altitude on Vascular Endothelial Growth Factor Levels with
Validation of its Prognostic Significance in Patients with Non-Small Cell
Lung Carcinoma
Majed Al Mourgi
Department of Thoracic Surgery, College of Medicine, Taif University, PO Box 888, Taif 21947,
Kingdom of Saudi Arabia,Telephone:00966559956781, email:mourgi@hotmail.com

Background and aim of the work:
Recent studies revealed that hypobaric hypoxia stimulates release
of vascular endothelial growth factor (VEGF) and other studies found that high levels of this
angiogenic factor are correlated with poor prognosis in patients with non-small cell lung cancer
(NSCLC). In this study we will measure the serum levels of VEGF in both healthy individuals and in
patients with operable non small cell lung carcinoma living in hypobaric oxygen environment (Taif)
and validate the prognostic significance of its pretreatment level in those patients.
Patients and methods: Thirty one patients with operable (stage I, II and III A) non-small cell lung
cancer (the patient group) and 15 healthy volunteers with matched gender and age (control group)
were enrolled in this study from January 2010 to March 2015. The pretreatment level of VEGF was
measured in patients in addition of its level in controls. All patients had the same diagnostic and
therapeutic protocols. Mean follow up of patients was 30.4±7.8 months.
Results: The mean level of VEGF was high in control group, however, it was significantly lower than
that in patient group (P value 0.041). The median survival of stage I patients was 13 months, stage II
was 9 months, and of stage III A was 6 months. Univariate analysis showed a significant correlation
between survival and pretreatment level of VEGF in patients with small lung cancer.
Conclusions: Our results revealed that hypobaric hypoxia significantly increases the circulating levels
of VEGF in healthy individuals without remarkable effect on its level in patients with NSCLC. Our
study verified also that the pretreatment mean serum level of VEGF showed a highly significant
increase in NSCLC patients than that in control group and it was significantly correlated with patient
survival in levels above 618 pg/ml.

: vascular endothelial growth factor ­ hypobaric hypoxia ­ non small cell lung cancer

development of metastases and they found
Taif is located in the western region of Saudi
that it depends mainly on the balance between
Arabia at moderate altitude and high altitude
pro-angiogenic factors as vascular endothelial
level with mean elevation of 1,879 ±
growth factor (VEGF) and .antiangiogenic
456 meters above average sea level (range:
factors.(3) Lung cancer has a high cancer
1630- 2650 meters).(1)
specific mortality and non-small cell lung
As the altitude increases, atmospheric
cancer (NSCLC) represent more than 80%,
pressure decreases, with reduction of
however, there is a variation in prognosis of
the partial pressure of oxygen and starts to
patients even in the same stage, accordingly
affect humans at altitudes above 1,500
other factors contribute in prognosis other
meters.(2) As a consequence of the hypobaric
than the tumor stage, and a variety of factors
hypoxic environments, human would develop
have been reported as predictors for favorable
numerous physiologic responses, and recent
or unfavorable prognosis of the disease.(5-7,
studies verified that hypoxia induces the
9)Several studies found a significant
release of VEGF and other angiogenic
correlation between survival and the
factors.(2-4) The relation between these high
pretreatment levels of VEGF, but a widely
levels of angiogenic factors and pathological
accepted cut-off level is still lacking.(9)
disorders in hypobaric oxygen environment
In this study we will measure the serum levels
are still under investigations.(2, 3)
of VEGF in both healthy individuals and in
However, many investigators verified the role
patients with operable non small cell lung
of angiogenesis in tumor growth and
carcinoma living in hypobaric oxygen

environment (Taif) and validate the prognostic

Received:25/6/2015 DOI : 10.12816/0018764

Full Paper (vol.61 paper# 25)

c:\work\Jor\vol61_26 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 620- 630
Effect of Endotoxemia on Cardiac Disease in High &
Low Flux Hemodialysis Patients
Mona Hosny, Hesham Elsayed, Khaled Abo Seif, Howayda Abd Elhamid, Ashraf Elmobdy
Internal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt


Background : endotoxemia can be the missing link between ESRD and cardiac disease , the first
cause of death in hemodialysis patients .
Patients and methods : patients were recruited from Ain Shams University Hospitals , hemodialysis
units .120 patients on prevalent HD were enrolled in the study : 31 cardiac patients on high flux HD
( group A) , 29 cardiac patients on low flux HD (group B), 32 non ­ cardiac high flux HD ( group
C), and 28 non ­ cardiac low flux HD ( group D) . For all patients we measured : Hb , URR , serum
albumin , HsCRP, predialysis and postdialysisa endotoxin , endotoxin delta change, echocardiography
, and ECG . Results : we found that cardiac high flux and low flux groups had higher endotoxemia
levels than non ­ cardiac high flux and low flux groups .Conclusion : High flux hemodialysis
patients had higher accumulated endotoxin than low flux hemodialysis patients, within either cardiac
or non - cardiac groups .
Keywords : Endotoxemia - Hemodialysis - Cardiac disease - High & low flux dialysis .


The reported degree and prevalence of
Bacterial endotoxin is a lipopolysaccharide
endotoxemia in HD patients varies in the
( LPS ) which represents the major glycolipid

component of the outer membrane of gram ­
literature . May be the varied findings are due
negative bacteria and accounts for 70 % of the
to difficulties in the accurate detection of
total bacteria in the healthy human gut
endotoxin in blood with the limulus amebocyte
.Translocated endotoxin derived from intestinal
lysate assay ( LAL assay ) , the most
bacteria has a wide range of adverse effects
extensively used method in blood endotoxin
on cardiovascular ( CV ) structure and function
detection .( 6 )
, driving systemic inflammation , atherosclerosis
High serum LPS activity is strongly
, and oxidative stress .( 1 ) Also , it results in
associated with the components of the
peripheral vasodilation and reduction in cardiac
metabolic syndrome .( 7 )
contractile performance .( 2 )
Chronic kidney disease patients are
Our study was conducted on 120 patients on
characteristically exposed to significant
prevalent hemodialysis.Patients were recruited
endotoxemia . In particular , hemodialysis
from Ain Shams Hemodialysis Hospitals
induced systemic circulatory stress and
,hemodialysis units. All patients were on
recurrent regional ischemia may lead to
prevalent hemodialysis , having 3 sessions / week
increased endotoxin translocation from the gut .
, 4 hours / session , and were using bicarbonate
This represents a crucial missing link in
containing dialysate .Net fluid removal , blood
understanding the pathophysiology of the
pump speed , and Heparin dose were set on
grossly elevated CV disease risk in CKD
an individual basis according to clinical
patients .( 3 )
findings .
The precise mechanism by which HD
Patients included in the study were divided
aggravates endotoxemia in ESRD patients
into 4 groups as follows : Group A included 31
remains unknown . ( 4 )
hemodialysis cardiac patients ( patients having a
Volume overload and fluid retention being
previous and current positive cardiac disease ),
highly prevalent in HD patients , contributes in
dialyzed with high flux dialyzer , while Group
generalized and bowel edema which impairs
B included 29 hemodialysis cardiac patients
intestinal epithelial barrier function .( 5 )
dialyzed with low flux dialyzer . Group C
comprised 32 non-cardiac hemodialysis patients
Accepted:10/9/2015 DOI: 10.12816/0018765

Full Paper (vol.61 paper# 26)

c:\work\Jor\vol61_27 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 631- 642

Toxicological Effects of Generated Radiations on the Eye among Computer Users
1Nadia I. Mohammad, 2Omaima I. Abo-Elkheir, 1 Rehab A. Masoud,
3Hosny H. Mohammed, 1Neveen A. Ibrahim
1Forensic Medicine and Clinical Toxicology Department, 2Community and Occupational Medicine
Department ,3Ophthalmology Department, Faculty of Medicine - Al Azhar University, Cairo, Egypt

Nowadays computers being used in every aspect of life in both developed and
developing countries. These electronic devices generate a form of non-ionizing electromagnetic
radiation which exerts negative influence on human health. Eyes are particularly vulnerable; thus
computer vision syndrome or dry eye disease is the most frequent health problems among computer
users. This study aims to assess toxic effects of computer generated radiation on eyes among a sample
of Egyptian computer users. Subjects and Methods: this is a cross-sectional study conducted on 100
volunteers from both sexes who worked daily on a computer. All participants were subjected to a self-
filling questionnaire including questions about personal information, work and workplace related
information as well as, Ocular Surface Disease Index (OSDI) with 12 questions about symptoms of
eye and vision problems. Results: this study revealed that more than three fourths (79.0%) of the
studied computer workers suffered from symptoms of dry eye disease, 40.5% of them had severe eye
affection, 26.6 % had moderate and 32.9 % had mild eye affection. Those with severe eye affection of
participants with dry eye disease were using the computer for a mean duration of 10.3 ± 2.4 hour/day
and 70.9 % of them not taking regular rest during computer work. Wearing visual aids showed a
significant association with dry eye disease (P = 0.002).Conclusion: the majority of participants had
symptoms of dry eye disease. The most vulnerable persons were those who wearing medical glasses or
lenses and use the computer for around 10 h / day without regular rest. Occurrence of eye dryness was
relevant to the presence of fan and air conditioner in the workplace. These results indicated the
valuable role and the essential need for visual assessment of computer workers for early and proper
diagnosis of dry eye disease in order to minimize its impact on their productivity and quality of life.

Keywords: Computer users, generated radiations, eye symptoms, ocular Surface Disease Index (OSDI)

effects of non-ionizing electromagnetic
With the rapid development of information
radiation.(5) The most frequently occurring
technology, the reliance of people on
health problems among computer users are
technology is increasing; hence the dangers on
Computer Vision Syndrome (CVS), pain of
human health are also increased day by day.
wrist and shoulder, low back pain, tension
headaches and psychosocial stress.(6)
sophisticated system composed of several
A number of epidemiological studies reported
electric and radio electronic devices.(1) Sources
a relation between environmental Extremely
of Electromagnetic Field (EMF) include
Low Frequency Electromagnetic Field (ELF-
natural sources from the sun or artificial
EMF) and the onset of leukemia or
sources.(2) The level of electromagnetic
Alzheimer's disease. (7)
radiation (both ionizing and non-ionizing)
The oscillating electrons that hit the bright
from artificial sources exceeds the level from
surface of the computer screen emit an
natural sources by thousand folds.(3) Everyone
electromagnetic radiations (EMR) which
is exposed to two types of non-ionizing
continue for hours in the environment even
electromagnetic field. The extremely low
after shutting down the computer and
frequency (ELF) generated radiation from wire
negatively affects the living cells.(8)
devices such as electronic appliances and
This besides the use of high voltage electronic
electrical power lines. Plus the radiofrequency
lamps in monitors that generate an electron
(RF) radiation from wireless devices such as
beam, visible light and a small amount of UV
cell phones, cordless phones, cellular antennas
rays. Moreover, the monitor's electronic
components and the electric circuit which
Employees who working for hours on
controls the movement of electron beam create
computer or even sitting in a computer
a range of radio waves. (9)
workplaces are directly exposed to the harmful
Accepted:15/9/2015 DOI: 10.12816/0018766

Full Paper (vol.61 paper# 27)

c:\work\Jor\vol61_28 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 643- 652

Essential Hypertension among Egyptian Adults
Walaa F Elbaz*, Somaia S M Eissa*, Rehab A. Mohamed*,Naeima K Aly**,
Bassem M Abdel hady***,Taghreed M Reda
Department of Internal Medicine*, Department of Clinical Pathology**,
Department of Cardiology***Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt

: hypertensive diseases represent a major disease burden in Egypt. The prevalence of
hypertension in Egypt in 2008 among adults of age 25 was 17.6%. In 60% of patients, hypertension is
usually associated with cardiovascular risk factors. This leads to increased cardiovascular morbidity and
mortality. Management of hypertension in Egypt is not easy because of treatment costs and inefficient
primary health care system. There is a need for developing national hypertension guidelines to improve the
rates of awareness, treatment and control of hypertension with the final goal of preventing and decreasing
mortality and morbidity.
Aim of work: to assess the essential hypertension status among the Egyptian adult population of age 25
and to study the modifiable social and environmental risk factors, health consequences, and assess the
cardiovascular and non-cardiovascular complications to help disease prevention and limitation of
Patients and methods:
this study was conducted on 312 patients of age 25 with essential hypertension.
All patient were subjected to full medical history and physical examination that including measurement of
blood pressure (BP) and fundus examination. Anthropometric measurements including height, weight,
waist circumferences, and hip circumferences were also measured. Waist to hip ratio and body mass index
(BMI) were calculated. Laboratory investigations were performed including complete blood count (CBC),
fasting blood glucose, measurement of creatinine, uric acid and lipid profile. Microalbuminuria was also
assessed. Other investigations including electrocardiogram and echocardiograph were done.
Results: Male patients were 134(42.9%), while females were 178(57.1%). Their ages ranged from 30 to 85
years with a mean ±SD of 55.16±9.4years.Dyslipidemia was found in 152 (49%) patients. Left ventricular
diastolic dysfunction (LVDD) was represented in160 (51%) patients. Uncontrolled BP was represented in
(73%), (66%) and (55%) of non-educated, mild to moderate educated and high educated patients
respectively. Retinopathy was found in 121 (38.8%) patients, 76 (60%) patients were hypertensive diabetic
and 45 (24%) patients were hypertensive non-diabetic. Albumin in urine was present in 20%of patients.
Conclusion: strategies that enhance public awareness of hypertension and increase access to affordable
medications are urgently needed. Prevention of hypertension needs both a population strategy and an
intensive strategy focused on individuals at high risk. The complications of hypertension can be prevented
by adequate blood pressure control with screening programs to identify the population at risk
Key words: Essential Hypertension, Risk factors, Complications, Egyptian Adults


There are many factors contribute to raise of
Hypertension is a chronic medical condition in
blood pressure such as sedentary lifestyle, stress,
which the systemic arterial blood pressure is
potassium deficiency, obesity, elevation of renin,
elevated. Hypertension in adults is identified

when the average of two or more diastolic blood

pressure measurements on at least two
Sodium sensitivity, alcohol intake, vitamin D
subsequent visits is 90 mmHg, and / or systolic
deficiency, aging, some inherited genetic
blood pressure 140 mmHg.(1)
mutations, family history, Insulin resistance and
It is the most common condition seen in primary
sympathetic nervous system over activity. (3)
health care and leads to myocardial infarction,
In some countries, there are unusual hypertension
stroke, renal failure, and death if not detected
risk factors, such as schistosomiasis in Egypt,
early and treated appropriately.(2)
which is linked to hypertension through its effect
on the urinary tract. Environmental pollution in
the form of excessive noise, or lead pollution may
Accepted:26/9/2015 DOI: 10.12816/0018767

Full Paper (vol.61 paper# 28)

c:\work\Jor\vol61_29 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 653- 669
Prevalence and Risk Factors of Overt- and Occult Hepatitis C Virus Infection
among Chronic Kidney Disease Patients under Regular Hemodialysis in Egypt
Essam A. El-Moselhy1*, Ayman Abd El-Aziz2*, Salwa A. Atlam1**, Raed H. Mnsour3*,
Hesham H. Amin4*, Tarek H. Kabil5*, and Ayman S. El-Khateeb1***
Departments of Community and Occupational Medicine1, Internal Medicine2, Tropical Medicine3,
Clinical Pathology4, and Medical Microbiology & Immunology5
Faculty of Medicine, Al-Azhar*, Tanta**, and El-Menia*** University
Corresponding author: Prof. Dr. Essam A. El-Moselhy, e-mail: dr_elmoselhy@yahoo.com and

hepatitis C virus (HCV) infection is a major health problem. It is more prevalent among
chronic kidney disease (CKD) patients. Occult HCV infection, a new, entity has been described.
Aims: to find out prevalence of occult HCV infection among CKD patients under regular hemodialysis
(RHD) and to define epidemiology of HCV infection among them.
Patients and Methods:
a sample of 100 CKD patients under RHD was recruited. A questionnaire form
was used to collect data. HCV-RNA was tested in serum to detect overt HCV infection patients. HCV-
RNA was tested in peripheral blood mononuclear cells of undetected HCV-RNA patients' serum to
determine those with occult HCV infection. Rest of the patients was considered HCV free. Biochemical
tests were done to all patients.
Results: prevalence of overt and occult HCV infection among CKD patients under RHD was 34.0% and
27.3%, respectively. Liver and renal function tests were significantly higher among the overt and occult
HCV patients compared to negative HCV patients. Liver function tests were significantly lower among
the occult compared to overt HCV patients. Overt HCV patients had significant risk factors compared to
negative HCV patients; age group 40-59 years (OR=9.34) and rural residence (OR=3.14). Also,
significant clinical risk factors were the overweight, history of blood transfusion 5 times/year, history of
nonmedical bloody manipulations, and history of IV drug abuse (OR=3.23, 5.96, 8.28, 7.08, respectively).
Occult HCV patients had significant risk factors compared to negative HCV patients; age group 60 years
and rural residence (OR=6.25 and 6.73, respectively). Significant clinical risk factor was the history of
nonmedical bloody manipulations (OR=11.5).
Conclusions and Recommendations: prevalence of overt- and occult HCV infection is high in CKD
patients under RHD; this has important clinical and public health implications. There are many significant
socio-demographic and clinical risk factors for these infections. A close monitoring of the HD patients
and testing them for HCV-RNA in PBMCs yearly to adopted a proper management. Also, more studies
on bigger number of patients are required to understand real epidemiology of this health problem.
Keywords: CKD, hemodialysis, overt HCV, occult HCV, prevalence, HCV-RNA, PBMCs, risk factors.

HCV.(2) HCV has significant differences in their
Hepatitis C virus (HCV) is member of
global distribution and prevalence.(3) Adding to
the Flaviviridae family. Its genome of ~9.5 kb is
the problem of HCV infection is the presence of
a RNA positive strand that encodes a large poly-
occult HCV infection.(4)
protein of more than 3000 amino acid residues.
In Egypt, HCV infection is a major
HCV has great genetic variability, with 6 major
health problem. Egypt has the highest
genotypes (GTs); HCV GT-1 to 6 has been
prevalence worldwide(5) and it is estimated to be
described, each containing multiple subtypes;
14.7% among general population.(6) However,
prevalence is higher among hospitalized patients
HCV is a worldwide infection
and special clinical populations.(7) HCV
associated with an increased disease burden due
infection is prevalent among chronic kidney
to liver cirrhosis and considerable mortality. It is
disease (CKD) patients who are under
estimated that ~170 million people (~3.0% of
hemodialysis (HD). So, HD patients belong to a
the world's population) are infected with
high-risk population.(2) Also, it has detrimental
Accepted:29/9/2015 DOI: 10.12816/0018768

Full Paper (vol.61 paper# 29)

In Situ Hybridization and Light and Electron Microscopies of Cervical Squamous Cell Carcinoma Infected with Human Papillomavir The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 670- 684

Ameliorative Effect of Olive Leaf Extract on the Fetal Lung Tissue of
Diabetic Pregnant Rats
Mervat A. Abd Rabou (1) , Fawzya A. Al-Ghamdi (2)and Nehal A. Abu Elnaga(3)
(1) Biology Department, Faculty of Science, Al-Jouf University, Saudi Arabia.
(2) Zoology Department, Faculty of Science, Abdul-Aziz University, Saudi Arabia.
(3) Zoology Department, Faculty of Science, Al-Azhar University, Cairo.

Aim of the work-
Diabetes mellitus is a common metabolic disease not only affecting the individual,
but also imposes adverse effects on the offsprings. Besides increasing congenital malformations,
maternal diabetes is suggested to be associated with early pregnancy loss, altered sex ratio in the
offspring and long-term postnatal diseases. Antidiabetic plants are used as supportive therapy in the
treatment of diabetes during pregnancy, so the present study aims to investigate the protective effect of
olive leaf extract on the fetal lung of the diabetic pregnant rats.
Material and methods - Forty pregnant albino rats were used and categorized after mating into four
groups; group 1: control group(C), group 2: rats treated with olive leaf extract during the period of
pregnancy (O) (1 ml/100gm. b .wt), group 3: streptozotocin induced diabetic rats (D)(STZ 35 mg/kg
b.wt), group 4: diabetic rats treated with olive leaf extract (D+O) (as in groups 2&3). The pregnant
females of different groups were dissected during the 19 th day of pregnancy. Lung samples of fetuses
were taken for the histological and histochemical studies.
Results- Histopathological and histochemical observations of fetal lung tissue showed that the olive
leaf extract succeeded to minimize the drastic changes which were observed in the fetal lung of diabetic
rats. Conclusion- It is recommended that the use of the olive leaf extract has the ability to minimize the
adverse effects in the fetal lung tissue of diabetic rats.
Key words-Pregnant diabetic rats, olive leaf extract, fetus, lung, hyperglycemia.

complications and trauma during delivery are
Diabetic mellitus is a common metabolic
disorder characterized by hyperglycemia and
Histopathologic evidence of lung involvement
other symptoms due to impairment of insulin

production and/or insulin resistance. [1]
in subjects with diabetes mellitus has included
thickened alveolar epithelial, pulmonary
complications. Acute complications such as
microangiopathy and abnormal pulmonary
ketoacidosis and nonketotic coma can be
developed. Long term complications include
Olive tree (Oleaeuropea) leaves have
retinal, micro vascular, cardiac and neural
been widely used in traditional remedies in
damage. [2] The chronic hyperglycemia of
European and Mediterranean countries as
diabetes is associated with long-term damage,
extract herbal teas and powder. They contain
dysfunction and failure of various organs,
several potentially bioactive compounds that
especially the eyes, kidneys, nerves and
may have hypoglycemic properties. [9] Olive
arteries .[3,4] The hyperglycemic maternal
leaf extract was used by the ancient Egyptian
environment has also been associated with
and Mediterranean people to treat a variety of
neonates that are at greater risk for future
health conditions, including infections, fever
development of negative health outcomes such
and pain. [10]
as future obesity, insulin resistance, type 2
The active medical constituents find in
diabetes mellitus and metabolic syndrome. [5]
unprocessed olive leaf are oleuropein,
Islet hyperplasia and B-cell degranulation
oleuropeoside and hydroxytyrosol, as well as
were found in the fetuses of the third
several other polyphenols and flavenoids
generation from mothers (second generation)
including oleocanthal. [11] They added that
born to a diabetic mother in the first
the olive fruit, its oil and the leaves of
the olive tree have a rich history of nutritional
Perinatal morbidity and mortality,
and medicinal usesOleuropeosits (oleuropein),
congenital malformations, abnormal fetal
flavones, flavonols and substituted phenols
growth, spontaneous preterm birth, hypoxic
Accepted:22/9/2015 DOI: 10.12816/0018769

Full Paper (vol.61 paper# 30)

c:\work\Jor\vol61_31 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 685- 699

Therapeutic Effects of Olive Leaf Extract or Bone Marrow Mesenchymal
Stem Cells against Lung Damage Induced In Male Albino Rats Exposed To
Gamma Radiation
Amr Mahmoud Abd El-Hady* and Nora Abdulaziz AlJalaud**
* Faculty of Applied Medical Sciences, Misr University for Science and Technology (MUST), 6th
October, Cairo, Egypt.
** Department of Biology, Faculty of Science, University of Dammam, Saudi Arabia.
Corresponding author email: amreem2005@yahoo.com

Aim of the work
- This study aimed to investigate the histological and histochemical changes in the lung
tissue of male albino rats post exposure to gamma radiation and the possible therapeutic effect of both olive
leaf extract and bone marrow mesenchymal stem cells.
Matrerial and methods-The current study was carried out on 40 adult male albino rats (Sprague dawely
strain); they were divided equally into 5 groups (C group: control rats; O group : rats treated with olive
leaves extract( 15 mg /kg body weight/daily) ; R group: rats exposed to a single dose of gamma-radiation(3
Gy); RO group: rats of this group treated with olive extract 15 mg /kg body weight/daily one week before
and one week after irradiation; RS group: rats of this group irradiated with 3Gy then treated with bone
marrow mesenchymal stem cells ( BMSCs) 3×106 cells/ml suspension through caudal vein about 5h post
radiation exposure. Histopathological and histochemical changes were studied.
Results- Rats exposed to gamma radiation showed numerous histological and histochemical changes, these
changes were ameliorated by using either olive leaf extract or bone marrow mesenchymal stem cells.
BMSCs showed more obvious therapeutic effect than olive leaf extract.
Conclusion-The present work showed that olive leaf extract or bone marrow mesenchymal stem cells
(BMSCs) have lung tissue radiotherapeutic effects against whole body gamma radiation in male albino rats.
Key words: Gamma radiation - Albino rats - Lung - bone marrow mesenchymal stem cells (BMSCs) ­
Histology- Histochemistry.


Lung is one of the most radiosensitive
triggers for the production of reactive oxygen
organs of the body. Radiation damage to the lung
species (ROS) in cells. [3] Superoxide anions,
can be described at all levels of organization
hydrogen peroxide and hydroxyl radicals are the
from the cellular up to the organ level. Ionizing
principal types of ROS that react with
radiation is that type which contains sufficient
macromolecules, resulting in cell dysfunction
energy to displace an orbital electron around the
and tissue damage. [4] The major targets for ROS
nucleus. The most important consequence of this
include proteins, lipids and nucleic acids,
displaced electron on living tissue is the potential
generating DNA strand breakage, DNA­ protein
damage it can inflict on DNA, which may occur
cross linking and lipid peroxide production. [5,6]
directly or indirectly. [1] Direct damage occurs
These toxic products affect the balance of
when the displaced electron breaks a DNA
antioxidant systems such as glutathione and
strand. Indirect damage occurs when the electron
enzymatic antioxidant defense systems. [7,8]
reacts with a water molecule, creating a powerful
Mesenchymal stem cells are a population
hydroxyl radical which then damages the cell's
of adult stem cells and they are promising
DNA. Ionizing radiation absorption causes
sources for therapeutic applications. These cells
immediate biochemical, subcellular and cellular
can be isolated from the bone marrow and can be
damage, while its morphological expression and
easily separated from the hematopoietic stem
organ dysfunction are often considerably
cells (HSCs) due to their plastic adherence.
delayed. [2]
[9] Adult bone marrow MSCs can differentiate
Accidental exposure and the therapeutic
into several types of mesenchymal cells
application of gamma radiation are the main
Received:9/01/2015 DOI : 10.12816/0018770

Full Paper (vol.61 paper# 31)

c:\work\Jor\vol61_32 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 700-720

Evaluation of Role of Glibenclamide and Aphanizomenon flos-aquae
Extract on Lymph Node and Spleen of Diabetic Rats
Hemmat M. Abdelhafez*, Tamer M. M. Abu-Amara** and Sara M. El-debsi*
*Zoology Department, Faculty of Science, Al-Azhar University-**Histology&Cytology
Department, Faculty of Medicine, Al-Azhar University

Background:diabetes mellitus is a metabolic disorder in the endocrine system with a common
biochemical manifestation, thus hyper-glycemia is a disturbed carbohydrate metabolism. This work aimed
to evaluate the role of antidiabetic and hypoglycemic drug glibenclamide as a chemical agent and
Aphanizomenon flos- aquae extract as a natural agent on lymphoid organs such as lymph nodes and
spleen in the diabetic (type-2) white male albino rats.
Material and methods ­Fifty male albino rats were used and categorized into five groups; group 1: control
(C), group 2:Alloxan induced diabetic rats (D) (150 mg/kg b .wt); group 3:diabetic rats treated with
daonil (D+Do)(daonil 5 mg/kg b.wt/day); group 4:Aphanizomenon flos-aquae extract (AFA)(94.5mg/kg
b.wt/day) and group 5:diabetic rats treated with Aphanizomenon flos -aquae extract(94.5mg/kg b.wt/day)
(AFA+D). All groups were dissected after 30 days of treatment. Lymph nodes and spleen samples were
taken for histological and histochemical studies. Blood samples were taken for measurement of serum
glucose and serum insulin level. Results- Diabetic male rats showed very highly significant increase in
the serum glucose level, while non significant increase was recorded in the other treated groups in
comparison with the control group.Diabetic male rats showed highly significant decrease in the serum
insulin level as compared to the control group. Conversely, treatment of diabetic rats with daonil showed
a significant increase in the levels of serum insulin. On the other hand non significant increase in the
serum insulin was observed in AFA or AFA+D groups in comparison with the control group. Many
histopathological and histochemical changes were observed in the lymph nodes and spleen of the diabetic
rats, but using AFA extract succeeded to minimize the drastic changes which were observed in the lymph
nodes and spleen of the diabetic rats more than that observed with glibenclamide. Conclusion-
glibenclamide (daonil) as asynthetic drug and Aphanizomenon flos-aquae extract as a natural product
ameliorated biochemical, histopathological and histochemical changes in the lymph nodes and splenic
tissues of the diabetic rats.Aphanizomenon flos-aquae extract proved to be antidiabetic agent better than
daonil drug and its antidiabetic action may be due to its anti-inflammatory, antioxidant and hypoglycemic
Keywords:Diabetic rats, Aphanizomenon flos-aquae extract, lymph node, spleen and hyperglycemia.

anti-insulin serum.[3]Diabetes mellitus remains a
About 347 million people worldwide have
major global health problem impacted
diabetes according to the world health

organization.[1}. Diabetes Mellitus (DM) consists
by genetic risk propensity. However this makes
of a group of syndromes characterized by
it largely unpreventable, there exist preventive
hyperglycemia, altered metabolism of lipids,
measures which reduce the onset of the disease
carbohydrates and proteins and an increased risk
and the extent of progression was associated
of complications of the vascular diseases.
with complications in patients with Type -2
Clinically diabetic patients can be classified
diabetes and this was accompanied with
clinically as having either type-1(insulin
elevation of blood glucose level, abnormal
dependent diabetes mellitus) or type-2 DM (Non
abdominal fat deposition, insulin resistance and
­insulin dependent diabetes mellitus). [2]
This disease remains incurable and can only
be controlled with drugs. Several animal models
nephropathy, neuropathy, microangiopathy and
have been used for studying diabetes mellitus or
retinopathy. [4] Aging, obesity, insufficient
testing antidiabetic agents. Manipulations were
energy consumption, alcohol drinking, smoking,
done in several animal speciesto induce diabetes
etc., are independent risk factors of pathogenesis
mellitus by several agents such as:alloxan
of Type- 2 diabetes. Obesity (particularly
monohydrate, streptozotocin with or without
visceral fat obesity) due to a lack of exercise is
nicotinamide, ferric nitilotriacetate, ditizona and
accompanied by a decrease in muscle mass,
insulin resistance and is closely associated with
Received:9/01/2015 DOI : 10.12816/0018771

Full Paper (vol.61 paper# 32)

c:\work\Jor\vol61_33 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 721-744

Histological, Histochemical and Immunohistological Comparative Study
between Ranitidine and Rebamipide in Gastric Mucosal Protection after
Dexamethasone Induced Injury in Adult Male Albino Rats
Ayman F.Elsharawy1, Wagih M. Abdelhay 1 , Mohammed A. Eisa 1 , Al-Sayed A. Abd-
Elrahman 2 , Wail M. Gad Elrab 2 and Adel I. Abd Elaziz 3
1Histology& Cell Biology Department, Faculty of Medicine, Al-Azhar University, Egypt.
2 Human Anatomy Department, Faculty of Medicine, Al-Azhar University, Egypt.
3 Pharmacology Department, Faculty of Medicine, Al-Azhar University, Egypt.

Gastritis can be caused by many factors, one of them is drugs, and among these drugs is
dexamethasone that has many uses in medicine. Dexamethasone prevent synthesis of gastric mucous barrier
by surface epithelial cells, so the stomach wall will be injured by digestive enzymes and stomach HCl.
Treatment of gastritis can be done by antisecretory drugs like H2 receptors blocker as ranitidine or by drugs
that stimulate prostaglandins synthesize by surface epithelial cells of gastric mucosa to form the mucous
barrier like rebamipide.
Aim of the work: Comparison between ranitidine and rebamipide to detect which mechanism is better in
gastric mucosal protection after dexamethasone administration.
Material and methods: Twenty male albino rats were included in this study, they were divided into four
groups, control group, dexamethasone administrated group, dexamethasone and ranitidine administrated
group, dexamethasone and rebamipide administrated group, each group contained five rats.
The examined samples were stained with hematoxylin & eosin stain, PAS & Alcian blue stains and TdT
reaction, all of the results were statistically analyzed.
Results: The result showed improvement of the gastric mucosa by using both of ranitidine and rebamipide
as protective agents against injury induced by dexamethasone but the improvement was better in the group
that was administrated rebamipide as indicated by better number of healthy cells, low numbers of damaged
cells and better formed mucous barrier.Conclusion: The drug that stimulates mucous barrier formation is
better than antisecretory drug in gastric mucosa protection.
Keywords: Ranitidine , Rebamipide, Gastric Mucosal Protection, Dexamethasone.


Many injurious factors can cause gastritis
deficiency anaemia and osteoporosis respectively
followed with complication like ulcers bleeding
in addition to decreased ability of stomach in
and cancers (1, 2, 3). Among these factors is
food sterilization so the liability in GIT infection
corticosteroid like dexamethasone which has
increase(9,10,11). Another line of treatment is
wide range in medical use as anti allergic and anti
building up of the mucous barrier through using
inflammatory agent (4, 5). Corticosteroids inhibit
prostaglandin stimulators like rebamipide. This
synthesis of prostaglandins essential for mucous
drug has no effect on pH so hypochlorhydria does
barrier building up so the stomach wall will be
not occur with that drug (12, 13,14).
susceptible to injury by digestive enzyme and
The aim of this work was to compare between
stomach HCl (6, 7). Many drugs are used in the
ranitidine and rebamipide to evaluate which
treatment of gastritis such as H2 receptor blocker
mechanism is better in protection of the gastric
like ranitidine decrease HCl secretion by
mucosa after administration of dexamethasone by
blocking histamine receptors on the parietal cells
so it prevent the activation of the pepsinogen
computerized image analysis and statistical
enzyme to pepsin(8). The use of ranitidine leads to
analysis of the results.
increased pH of the stomach. This condition is

known as hypochlorhydria which results in many
side effects including interference with normal
Twenty males of adult albino rat were raised up
absorption of iron and calcium leading to iron
in faculty of medicine Al-Azhar University in the
Received: 15/09/2015 DOI: 10.12816/0018772
Accepted: 30/09/2015

Full Paper (vol.61 paper# 33)

c:\work\Jor\vol61_34 The Egyptian Journal of Hospital Medicine (Oct. 2015) Vol. 61, Page 745-753

Relation between IL-1 and IL1-ra in Pathogenesis of Febrile Convulsions
Seham Elsaid, Manal Hafez, Eman Saif Eldeen
Neurology department, Faculty of Medicine for Girls, AL-Azhar University

febrile seizures are the most common form of childhood seizures. Fever is induced by
proinflammatory cytokines during infection. The cytokine network may contribute to the generation of
febrile seizures in children. Interleukin beta (IL-1 ) and Interleukin receptor antagonist (IL-1ra) have
been implicated in the pathogenesis of febrile seizures.
Aim of the work:
was to estimate the role of IL-1 and IL-Ra in febrile convulsions and their relation to
pathogenesis of febrile convulsions.
Methods: serum interleukin I beta (IL-1 ) and interleukin 1 receptor antagonist (IL 1ra) were measured
by ELISA technique in twenty five children with febrile seizure and twenty five age matched controls
children with febrile illness without convulsion within 24 hours from onset of fever .
Results: serum IL-1 and IL 1ra levels were significantly higher in febrile seizure patients than in fever
in controls. Serum IL-1 and IL 1ra levels were highly significant higher in complex febrile seizures
than in simple febrile seizures. Serum levels of IL-1 and IL 1ra were significantly positive correlated
with duration of seizure in patients group.
Conclusions: serum levels of IL-1 and IL 1ra were significantly higher in febrile seizure children. Our
study suggest that the inflammatory cytokine may play role in the generation of febrile seizures in
children. These information may allow the development of anti- inflammatory therapy targeting these
cytokines to prevent febrile seizures or subsequent epileptogenesis
Key words: febrile seizures, proinflammatory cytokines, Interleukin 1- , Interleukin receptor 1


Febrile seizures (FSs), associated with the
this polymorphism results in an increase in IL-1
rapid rise of body temperature, are the most
production (5,6)

common convulsions in childhood, occurring in
Pro-inflammatory cytokines may trigger
2%-5% of children before the age of 5 years.(1)
seizures. (7) IL-1 increases
While simple FSs (duration <15 min) are
glutamatergic neurotransmission and lowers the
generally regarded as benign and have little
peak magnitude of GABA-mediated currents (8),
influence on neurological activity, both complex
supporting the role of pro-inflammatory
FSs (duration 15-30 min) and febrile status
cytokine contribution to the generation of fever-
epilepticus (SE, duration >30 min) are regarded
induced seizures. (7Also, IL-1 prolongs the
as seizures that may predispose to later
duration of electroencephalographic seizure. (9)
epilepsies including temporal lobe epilepsy
IL-1 down-regulates AMPA receptor
(TLE) .(2) Thus, FSs are important and should
expression and phosphorylation in a Ca2+- and
be conquered. Both clinical and experimental
NMDA-dependent manner in hippocampal
studies have revealed that the components of the
neurons (10)
It reduces the frequency of AMPA-
immune response involved in FSs may play a
dependent spontaneous excitatory postsynaptic
role in their pathogenesis (3)

currents and miniature excitatory postsynaptic
Several genes have been implicated in the
currents (11), but enhances NMDA receptor-
susceptibility to febrile seizures, including those
mediated currents .(10, 11) Viviani et al. found that
coding sodium channels, GABAA receptors,
IL-1 increases NMDA receptor function by
and interleukins. (4) IL-1 allelic polymorphism
activating tyrosine kinases and subsequent
in the promoter region at the -511 position is
NR2A/B subunit phosphorylation .(12) IL-1
significantly higher in febrile seizure patients
increases the excitability of hippocampal CA1
than in fever only children, and
neurons in the p38-dependent inhibition of the

outward NMDA current .(13) These results
Received: 15/09/2015 DOI : 10.12816/0018773
Accepted: 30/09/2015

Full Paper (vol.61 paper# 34)