c:\work\Jor\vol63_1 The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 127 - 132

Is Suturless and GluelessLimbal Conjunctival Autograft for Primary
Pterygium Surgery Efficient and Safe?
Hoda Saeed Mohamed Hassan Arab
Ophthalmology Department, Faculty of Medicine for Girls, Al-Azhar University

Aim of the study:evaluate the safety and efficacy of sutureless glue free limbal conjunctival autograft
for the management of primary pterygium surgery.
Material and method:This prospective,interventional randomized,non comparative study was held at
AlZahraaUniversity Hospital between May, 2013 and June, 2015. It included 20 eyes of 17 patients, 12
males(70.6%), and 5 females(29.4%). Their mean age±SD was 52.50±18.31 years (Range:30-75 years).
They were presented to the outpatient clinic of Al Zahraa University Hospital with primary pterygium.
Inclusion criteria included primary pterygium,non atrophic, with healthy conjunctiva. Exclusion criteria
included atrophic pterygium, pseudopterygium, ocular surface pathology, infection, previous limbal
surgery or double head pterygium. Surgeries were done under local anesthesia. Simple pterygium excision
was done leaving a bare sclera. The size of bare sclera was measured. A conjunctival graft 2 mm larger in
width and length than the recipient bed was created from the superior temporal quadrantand was
extended to the limbus to include limbal stem cells. The graft was gently moved to the recipient bed with
the epithelial side up and keeping the limbal edge toward the limbus.Hemostasis was allowed to occur
spontaneously without use of cautery to provide autologous fibrin to glue the conjunctival autograft
naturally in position without tension.All patients were followed up after 48 hours, weekly for one month
then monthly for 12 months. Results:Pterygia were located nasally in all cases. Pterygia were presented
right eye in10(50%) and left eye 10(50%). Mean graft size±SD was 5.5±1.5 millimeter (Range: 5-7
mm). Mean duration of graft fixation ±SD was 10±2.82 minutes (Range:10­12minutes).Mean operative
time±SD was 25±1.41 minutes(Range: 24-26 minutes) with good cosmetic outcome in all cases. There
was minimal postoperative pain and discomfort, without graft dislocation or dehiscence and without
recurrence of pterygia during the follow up period.
Conclusion:Sutureless and gluelessconjunctivallimbalautograft following primary pterygium excision
is safe,easy,effective and economic technique in primary pterygium surgery.
Pterygium,Fibringlue,Limbalautograft,graft retraction, conjunctival edema.


Pterygium (derived from pterygion, ancient
reduce the recurrence rate to an acceptable level
Greek for wing) is a common ocular disease seen
with minimal complications and without the use
mostly in tropical and subtropical areas. It is an
of potentially toxic drugs or radiotherapy would
abnormal overgrowth of fibrovascular tissue
be ideal for the management of pterygium. Some
arising from the subconjunctiva toward the
reports favor the use of fibrin glue above
cornea, almostalways in the palpebral fissure and
sutures.[7-8]The use of fibrin gluehas been
thought to be caused by increased light exposure,
reported to improve comfort, decrease surgical
dust, dryness, heat and wind.[1] Although it can be
time, reduce complications and recurrence
easily excised, it has a high rate of recurrence
rates.[9-10] Suture-related complications include
ranging between 24% and 89%.[2]With the
infection, prolonged operating time, postoperative
popularity of conjunctivalautograft and use of
discomfort, suture abscesses, buttonholes, and
antimetabolites such as mitomycin C and 5-
pyogenic granuloma which usually require a
Fluorouracil the incidence of recurrence has been
second surgery for removal[11]. Plasma-derived
greatly reduced up to 12%.[3­5] The role of carbon
fibrin glue has the potential risk ofdisease
dioxide and excimer lasers in pterygium surgery
transmission and anaphylaxis in susceptible
remains uncertain. Additionally, the relative
Sutureless grafting has been used successfully in
physiochemical methods to prevent recurrence.
gingival graftsand represents a similar mucosal
membrane tissue environment to the conjunctiva
mitomycin C and beta-irradiation include aseptic
of the eye.[14]
necrosis of the sclera and cornea, cataract,
In this study, weevaluate the safety and efficacy
persistent epithelial defects and visual loss.[6]
Therefore, a simple surgical procedure that can
Received: 1/1/2016
Accepted: 25/1/2016 DOI: 10.128



Full Paper (vol.63 paper# 1)

c:\work\Jor\vol63_2 The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 133- 137
Incremental Value of 2-Dimensional Longitudinal Radial and Circumferential
Speckle Tracking Strain Imaging to Wall Motion Analysis for Detection of
Coronary Artery Disease in Patients Undergoing Dobutamine Stress
Adel Etriby, Alaa Roshdy, Bassem Wadeaa, Mohamed Abdel Rahman,
Zeinab Abdel Salam, Yomna Omar.
Ain Shams University, Cardiology department Cairo, Egypt

DSE is considered one of the good options in clinical practice but due to some limitations
new promising modalities like speckle tracking echocardiography (STE) was introduced. STE is a new
imaging technique that allows evaluation of global and regional myocardial function independently from
the angle of acquisition and from cardiac translational movements.
Objectives: Determine optimal cutoff values for longitudinal, radial and circumferential strains at peak
DSE for detection of significant stenosis on CA. Also investigate incremental value of combining strain
measurements to wall motion analysis. Methods: The study population comprised 100 patients (age 50
±9 years) underwent high dose DSE, STE followed by CA. DSE and STE results were compared and
added to each other and finally compared to CA result.
Results: GLS cutoff points (-16.75%) showed significantly higher accuracy when compared to GCS and
GRS, with highest balanced sensitivity and specificity to predict CAD. GLS, GRS and GCS reduced the
DSE false positivity by 83%, 72.2% and 66.6% respectively. STE also showed better Agreement with CA
than DSE in detecting coronary territorial affection especially LAD (Kappa= 0.775).
Conclusions: STE is feasible during DSE, it helps increasing the diagnostic accuracy of DSE and
decreasing its false positivity. Both global and segmental longitudinal strain can offer accurate, feasible
and non invasive assessment of CAD.
Keywords: Coronary angiography (CA), Coronary artery disease (CAD), Dobutamine stress
echocardiography (DSE), Global circumferential strain (GCS), Global longitudinal strain (GLS), Global
radial strain (GRS), Left anterior descending (LAD), Left circumflex artery (LCX), Left ventricle (LV),
Speckle tracking echocardiography (STE), Right coronary artery (RCA), Wall motion score index


STE is considered one of the good
independent.4 Although the use of WMSI during
options assessing the presence, localization and
DSE relies on visual assessment of myocardial
extent of CAD.1 But wall motion analysis during
radial thickening, 2D speckle tracking not only
DSE is subjective, and an expert observer is
allows quantification of LV radial strain but also
required to achieve the published levels of
LV circumferential and longitudinal strains that
accuracy.2 STE is a new technique based on pure
are not visually apparent. However, the
2D grayscale ultrasound acquisition allowing
comparative diagnostic accuracies of these 3
calculation of segmental strains markers that can
orthogonal myocardial strains during DSE for
be tracked from frame to frame throughout the
the detection of CAD have not been previously
cardiac cycle.3 It has been integrated into the
most recent echocardiographic systems for
quick, automated or manual evaluation of LV
function. It is commercially available software
longitudinal, radial and circumferential strains at
that automatically or manually tracks myocardial
peak DSE for detection of significant stenosis on
motion throughout the cardiac cycle and allows
CA. Also investigate incremental value of
rapid generation of regional myocardial strain
combining strain measurements to wall motion
curves that are site specific and angle
DOI: 10.12816/0023839

Full Paper (vol.63 paper# 2)

c:\work\Jor\vol63_3 The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 138- 142

Electronic Prescribing with a Quick Look for Its Application in
Al-Husein Hospital/ Jordanian Royal Medical Services (Jrms)
Rehab.K Salah 1, Jelnar .Z Alkalaldeh 2, Nadia Ahmad AL-Omari 3
Sahar AL-Niemat 4, Rasha Baninasur 5,Toleen.I Bisharat 3
Supply Pharmacy, Queen Alia Heart Institute1, Supply Pharmacy, King Hussein Medical Center2
Clinical Pharmacy, Queen Alia Heart Institute3, Supply Pharmacy, Dirocterate of Royal Medical
Services4, Clinical Pharmacy, King Hussein Medical Center5
Correspondaning author: Rehab.K Salah .E-mail:Rehabsalahat@yahoo.com.Phone Number: 00962795178447.

Aim of the study :
electronic prescribing is the computer­based electronic generation; it allows a
physician to electronically transmit a new prescription to the community or health facility pharmacy. The
aim of this study was to evaluate an electronic prescribing patient and physician satisfaction at AL-
Hussein Hospital/(JRMS).
Patients and Methods:An electronic prescribing patient satisfaction survey was conducted a sample of
100 patient were randomly chosen.An electronic prescribing physician satisfaction survey was
conducted a sample of 50 physician in the specialty clinics of AL- Hussein Hospital were randomly
chosen .
Results:Around 77% of patient was satisfied that the clinic had adopted electronic prescribing, and
around 80% of physician were satisfied that the clinic had adopted electronic prescribing. The feedbacks
of patients and physicians were great.
Conclusion:This study approved that electronic medical record system improve the quality of patient
care and decrease medical errors. Periodic assessment is needed to evaluate many aspect and
consequences of e-prescribing and to measure the enhancement in patients and community in addition
to achieve a good resource management .
Keywords: Electronic prescribing, patient, physician, pharmacist, satisfaction, computer, medication.


Hippocrates, the father of medicine, already
drug therapy. However, there is quite little co-
realized that "the physician must not only be
operation between the partners. The physician
prepared to do what is right himself, but also
prescribes the drug, the pharmacist delivers the
make the patient cooperate".(1) On a worldwide
drug, and medication compliance depends on
basis, the World Health Organization (WHO)
quite many things, e.g. the drug information the
projects that only about 50 percent of patients
patient has received.
typically take their medicines as prescribed.(2)
The implementation of a well-designed
computerized prescription system is a viable
persistence are old age problems.(3)
policy option that can be done at a relatively
Medical compliance is commonly defined as
small cost, and can bring substantial long-range
the extent to which a patient conforms to
benefits for monitoring and improving quality
medical advice about lifestyle and dietary
of care for public-sector clients.
changes as well as taking medication as
For the hospital budget, the quality
prescribed.(1,4) It remains a challenge more than
management of drugs, in terms of checking
expirations of drugs in stock, is essential. The
Furthermore, lack of medication adherence
presence of professional and technological
leads to unnecessary disease progression,
resources means that pharmacists are expected
disease complications, reduced functional
to do things ``better, faster and cheaper' , as
abilities, a lower quality of life, and even
well as ``smarter.'' Technology would help and
premature death. (2,3)
enable a pharmacist to be a healthy care
Three partners, the patient, the physician
provider under limited professional personnel
and the pharmacist are needed for carrying out
Accepted:8/3/2016 DOI: 10.12816/0023841

Full Paper (vol.63 paper# 3)

c:\work\Jor\vol63_4 The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 143- 156

Early Detection of Left Atrial Dysfunction by Speckle Tracking
Echocardiography in Hypertensive Patients with Normal Left Atrial Size
Bassam Sobhy Kamal ,Osama Mohamed Hassan, Wael Mahmoud El Kilany, Haitham
Galal Mohamed, Ahmed Mohamed Mamdouh
Department of Cardiology, Faculty of Medicine, Ain shams University
Corresponding author: Bassam Sobhy Kamal e-mail: bassam.sobhy@hotmail.com, Phone: 01227141744

Arterial hypertension adversely affects LA size and function, effect on function may
precede effect on size. This effect is reflected on patient's morbidity and mortality risks. Many techniques
were used to assess LA function but with many pitfalls.
The objectives: early detection of left atrial dysfunction with speckle tracking echocardiography in
hypertensive patients with normal left atrial size.
Patients And Methods:
The study was conducted on 50 hypertensive patients and 50 age matched
normotensive controls , all with normal LA size and free from any other cardiovascular disease that may
affect the LA size or function. They were all subjected to history taking, clinical examination and
echocardiographic study, both the conventional measures and speckle tracking then both groups were
compared regarding LA strain representing LA function.
Results: Our study found that hypertensive patients had significantly reduced LA function as
measured by speckle tracking when compared to normotensive controls (P-value < 0.001). Also, many
factors were associated with worse LA function in hypertensive patients as old age, high BMI, DM, LV
diastolic dysfunction, high LV mass index, larger LA size, lower LA expansion index and higher systolic
Conclusion: Speckle tracking echocardiography is a useful novel technique in detecting LA
dysfunction in hypertension even before LA enlargement occurs.
Keywords: hypertension, left atrium, speckle tracking.


Arterial hypertension is associated with
limitations of Doppler-derived strain measures. (4)
morphologic and functional left atrial (LA)
The assessment of LA strain dynamics by STE in
abnormalities. An increase in LA size in patients
hypertensive patients may be of particular interest
with hypertension is a common finding in clinical
in those with no evidence of LA enlargement,
practice, and the mechanisms underlying this
because it may provide additional information for
enlargement have been extensively analyzed. (1)
the early detection of LA abnormalities. (5)
Most of studies included patients regardless of

LA size. This raises the question of whether LA
dysfunction in patients with hypertension may be
Study subjects: This study included 50 patients
detected in the absence of LA enlargement. This
with arterial hypertension and 50 age matched
question may be of clinical interest, because LA
non hypertensive control subjects.
size is often used as a surrogate marker of LA

function in clinical practice. (2)
Inclusion criteria for patients group:
Also, LA enlargement and dysfunction are
1- Patients with systemic arterial hypertension
considered risk factors for development of atrial
fibrillation and cerebrovascular strokes in
Systolic BP 140 mmHg and/or diastolic BP
hypertensive patients. (3)
90 mmHg or Antihypertensive treatment with a
Speckle-tracking echocardiography (STE) allows
documented history of hypertension.
direct and angle-independent analysis of
2- All patients should have an echocardiographic
myocardial deformation, thus providing sensitive
evidence of normal LA size; defined as: LA
and reproducible indices of myocardial fiber
volume index < 28 ml / m2.
dysfunction that overcome most of the

Accepted:30/12/2015 DOI: 10.12816/0023841

Full Paper (vol.63 paper# 4)

c:\work\Jor\vol63_5 The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 157- 171
Assessment of the Role of Speckle Tracking Echocardiography in Targeting
the Left Ventricular Lead Position in Patients Undergoing Cardiac
Resynchronization Therapy
Azza Abdallah El Fiky, Hayam El Damanhoury, Walaa Adel Abdel Halim, Sameh Samir
Raafat Naguib, Ahmed Mohamed Abou Bakr El Missiri, *Ahmed Yehia Ramadan Salama
Department of Cardiology, Faculty of Medicine, Ain shams University
*Corresponding author: Ahmed Yehia Ramadan Salama;
e-mail:ahmed.yehia.ramadan@gmail.com Phone: 01005643801

: Cardiac Resynchronization Therapy (CRT) is now a well-established treatment for patients
with advanced heart failure through biventricular pacing. Optimizing the left ventricular (LV) lead position
via echocardiographic speckle tracking guidance could reduce the rate of non-responders to CRT.
Objectives: to assess the role of speckle tracking echocardiography in determining the proper position of
the left ventricular lead in patients undergoing CRT.
Methods: the study population comprised 50 patients who were indicated for CRT according to the ESC
2012 guidelines. Speckle tracking echocardiography was done to all patients before CRT implantation or
shortly after implantation while switching off pacing to determine the latest activated myocardial wall of
the LV. The patients were classified after CRT implantation into two groups; the first group (group A)
included 20 patients and represented those with concordance between the most mechanically delayed
myocardial wall derived from speckle tracking echocardiography and the coronary sinus lead position, and
the second group (group B) included 30 patients that showed discordance between them. Both groups were
recruited for follow-up after a period of 6 months to assess clinical response, echocardiographic response
and mortality
Results: Significant correlation was observed between echocardiographic response and the LV lead
concordance (p value=0.041), and between combined clinical and echocardiographic response and LV lead
concordance. There was a nearly significant difference between clinical response and the LV lead
concordance (p value=0.057), and there was a trend towards less mortality in the group with concordant
LV lead (10.5% in the concordant group versus 24.1% in the discordant group) with no statistical
significance (p value=0.286).
Conclusions: we demonstrated an increased benefit with an echocardiographically optimized LV lead
position targeting the most delayed myocardial wall by 2D speckle tracking echocardiography.
Key words: resynchronization, speckle tracking, strain, dyssynchrony


Heart failure is a complex clinical

syndrome characterized by impaired myocardial
the most important causes of morbidity and
performance and progressive activation of
mortality in the industrialized world.(2)
neuroendocrine system leading to circulatory
Cardiac resynchronization therapy (CRT)
insufficiency and congestion. With the increasing
is now an established therapy for patients with
age of the population, improved survival of
advanced heart failure with prolonged QRS
patients with myocardial infarction and reduced
mortality from other diseases, incidence of heart
improvement of left ventricular (LV) systolic
failure and the cost of managing patients with
function and associated LV reverse remodeling
heart failure continue to increase. Data suggest
has been reported. (3) Recently, improvement of
that the lifetime risk of developing heart failure is
right ventricular function also has been reported.
about 20%.(1)
Heart failure is an urgent public health need
So far, better characterization of patients
with national and global implications. It is one of
who will respond to CRT has been the main focus
Accepted:28/12/2015 DOI: 10.12816/0023842

Full Paper (vol.63 paper# 5)

c:\work\Jor\vol63_6 The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 172- 184

Effect of Stiffness of Single Implant Supported Crowns on the Resultant
Stresses. A Finite Element Analysis
Sara Ahmed Sayed Ahmed 1, Mohamed A. A. Eldosoky1, Mohamed Tarek El- Wakad1,
Emad MTM Agamy2
1Department of Biomedical Engineering, Faculty of Engineering, Helwan University, 2Department of
Prosthetic Dentistry, Faculty of Oral and Dental Medicine, Minia University, Egypt


Objective: In the present study, the 3D finite element method was used to investigate the effect of crown
material on stress distribution in the bone surrounding immediately loaded single dental.
Materials & Methods: A 3D Finite Element model of mandibular first premolar was constructed to
evaluate the performance of seven crown materials with different degree of stiffness (Porcelain, zirconium,
Porcelain fused to gold, pure titanium, titanium alloy, Poly methyl methacrylate, and Polyether ether ketone
PEEK). The model was constructed using Solid Works version 2010 software. The model simulated also a
cement layer between the implant abutment and the crown (Virolink II, Vivadent). An axial static occlusal
force of 200 N was applied to eight points in each functional cusp. The three-dimensional (3D) FE model
was analyzed by ABAQUS/CAE version 6.10 software.
Results: The results of this study indicated that among all crown materials the maximum von Mises stress
values was observed in porcelain crown design (345.390 MPa).The highest von Mises stresses were found
in the abutments for all models. In implants, the greatest stress was concentrated on the cervical region.
PMMA and PEEK crown designs transferred less stress to abutment and screw. In all models, von Mises
stresses increased in the coronal third of cortical bone in which the maximum von Mises stresses observed
in the implant ­ cortical interface.
Conclusions: Using more rigid material for the superstructure of an implant supports prosthesis did not
have any effect on the stress values and stress distribution at the bone tissue surrounding implant. However,
in the abutment, cement and crown structure, stress distributions and localizations were affected by the
material's rigidity. More clinical studies are needed to evaluate the survival rate of these materials.
Keywords: Dental implant, finite element analysis, prosthetic materials, immediate loading.


Dental implants have become a significant aspect
affects morphology of the surrounding bone is the
of prosthodontic treatment. Despite of high
type of prosthetic material.
success rates; complications and failures still
In this regard, however, the results of various in
occur. One factor that is increasingly being
vitro and in vivo studies appear to be somewhat
implicated with dental implant failure is occlusal
controversial. Skalak proposed that the use of
overloading as the support of teeth and implants
acrylic resin for construction of the prostheses
is inherently different. The natural teeth are
would contribute to dissipate a significant portion
visco- elastically supported in the bone by the
of the impact forces during mastication, due to
periodontal ligament which acts as a shock
the low stiffness of this material.3 However, the
absorber between a root and surrounding bone.
results of an in vivo study by Bassit et al. showed
In contrast to natural teeth; there is no periodontal
that the resilience of an acrylic resin veneer is
ligament between dental implants and their
insufficient to cause significant change in the
surrounding bone. The occlusal loads are
force transmission through the prosthesis as
transmitted directly to surrounding bone which
compared to a ceramic veneer.4 Also
could cause micro fracture in the interface
Eskitascioglu et al investigated the influence of
between bone and implant, fracture of implant.1, 2
porcelain- and acrylic based material on stress
One of the factors that affect load transfer at
distribution when dynamic forces were applied in
the bone implant interface, influences stress
vertical and lateral directions on metal-supported
distribution in dental implants and consequently
crowns over implants. Porcelains were found to

absorb and distribute the stress in itself and
Received: 01/01/2016 DOI : 10.12816/0023843
Accepted: 15/01/2016

Full Paper (vol.63 paper# 6)

þÿ(1H*HCHD The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 185- 194

The Association between Hypoalbuminemia and
Intradialytic Hypotension in Heamodialysis Patients

Ezzat A. Al-Etreby, Ayaman Abd El-Aziz,Osama El-Waseef, and Essam A. El-Moselhy1
Internal Medicine & Nephrology and Community Medicine1
Faculty of Medicine, Al-Azhar University, Egypt

: hypoalbuminemia is an important risk factor of hypotension during hemodialysis and
progressive left ventricular hypertrophy in patients with chronic kidney disease (CKD). Aim of the
: this study was done to evaluate the relationship between serum albumin and intradialytic
hypotension (IDH) and cardiac functions. Patients and Methods: forty patients on regular hemodialysis
(HD) were included in the present study. They have been divided into two groups; Group 1: Patients of
this group developed recurrent attacks of IDH and Group 2: Patients of this group not developed IDH.
The patients have been classified again according to serum albumin level into two groups; Group A:
Hypoalbuminemic patients and Group B: Non-hypoalbuminemic patients. Data collected from each
patient included: (1) Demographic features (age, gender) and clinical features (blood pressure changes
during session, ultrafiltration rate, cardiothoracic ratio, duration of dialysis and Kt/V); (2) Blood
chemistry (creatinine, urea, hemoglobin, hematocrit value, total proteins, albumin, triglycerides,
cholesterol, AST, ALT, Kt/V, and fasting blood sugar); and (3) Echocardiographic assessment of left
ventricular geometry. Results: there was a significant negative correlation between serum albumin and
Delta BP in HD patients. Also we found no significant changes in cardiac functions among different
studied groups. Conclusion: We concluded that there was a relationship between low serum albumin and
intradialytic hypotention and cardiac functions in CKD patients undergoing HD. Recommendations:
Regular assessment of serum albumin is mandatory for all HD patients.
Key words: Heamodialysis, Hypoalbuminemia, Risk factor, Intradialytic hypotension.

relationship between serum albumin and
The association between blood pressure
intradialytic hypotention and cardiac functions
changes and death rate is higher in hemodialysis
in patients with chronic kidney disease (CKD)
patients than in general population.(1) Intra-
on regular hemodialysis.
dialytic hypotension (IDH) was found to be an

independent and negative predictor of long-term
fistula outcome.(2)
Study groups:
Intradialytic hypotension continues to
This study was done in the nephrology
be a leading problem, especially in elderly and
and dialysis unit at Bab-Eshearea University
cardiovascular compromised patients.(3) The
Hospital on 40 patients with CKD on regular
sensitivity of patients for IDH may not be a
hemodialysis (HD). They were divided into 2
stable condition. Many patients were found to
groups according to BP changes during HD:
have large differences in the incidence of IDH
Group 1: This group included 20
over a 24-month period.(4)
patients with CKD on regular HD for at least 6
Rapid ultrafiltration especially in elderly
months, 3 times /week, duration of each session
patients may cause a premature drop in blood
was 4 hours, 11 of them were males, 9 were
pressure during hemodialysis before they reach
females, their age ranged between 17 and 63
dry weight.(3) Hypoalbuminemia is an important
years with a mean of 47.1±2.72. Also, their
risk factor of hypotension during hemo-
serum albumin ranged between 2.4 and 4.7 g/dl
dialysis.(5) Also, hypoalbuminemia was an
with a mean of 3.55±0.15. Blood access was
important risk factor for progressive left
through arteriovenous fistula. The duration of
ventricular hypertrophy in patients with end
HD ranged between 1 and 12 years with a mean
stage renal disease (ESRD).(6)
of 5.8±0.89. The criteria for inclusion in the

study were that patients had recurrent episodes
of intradialytic hypotension (IDH) and
The aim of the study is to identify the
interdialytic normal BP. Among these twenty

Received: 01/51/2016 DOI : 10.12816/0023844
Accepted: 15/51/2016

Full Paper (vol.63 paper# 7)

c:\work\Jor\vol63_8 The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 195- 205

Relation of Body Mass Index and Waist Circumference to Some Fertility
Markers among Male Partner of Infertile Couples
Hodeeb Y. M.*; Amal M. Al Dinary**; Ibrahim H. S.***; Heba M. Abd El-galil**
Zeinab El-sayed Hammour**
Departments of Dermatology & Veneriology*; Community Medicine** Al-Azhar Faculty of Medicine;
International Islamic Centre for Population Studies and Researches***

Global estimates of infertility range between 8% and 12% of couples with women of
childbearing age, affecting 50­80 million people. Excess weight is not only linked to increased risk of
chronic disease but has also been shown to increase risk of reproductive problems. The consequences of
obesity in female fertility have been widely studied, but studies in the male population are less frequent.
Aim of the study:
The aim of this study to clarify the role of body mass Index and waist circumference
on some male-fertility laboratory markers among Egyptian males of infertile couples.
Subjects and methods: A descriptive cross sectional study was carried out on a total sample of 59 males
of infertile couples for at least one year after regular unprotected reproductive activity. BMI and WC
were assessed, and a morning blood sample was taken assessing serum levels of testosterone, sex
hormone-binding globulin, prolactin, luteinizing hormone (LH), follicle-stimulating hormone, and
estradiol. Semen-analysis parameters were also measured.
Results: In the present study, it was found that there was no statistical significant difference in relation
of BMI or WC and sperm count. The likelihood of athenospermia was increased at higher BMI and WC
values. BMI was not found to be associated with mean numeric values of the semen-analysis parameters,
including sperm count, sperm morphology, and sperm motility. BMI was not significantly correlated
with some hormone levels, such as LH and prolactin. However, a statistically significant inverse
correlations was observed between WC and testosterone (r=-0.3&p=0.04). A different pattern of
associations in this study was observed when the associations between BMI &WC and sexual hormone
levels were compared between (fertile and subfertile) from infertile men.
Conclusion: The association explored between WC and testosterone as well as different patterns of this
association between (fertile and subfertile) from infertile men.
Keywords: Male infertility, body mass index, waist circumference, sperm analysis, sexual hormones


A person's weight can have a profound impact
Involved in the decreased semen quality in men
on fertility, men who are either under or over
with BMI < 20 kg/m² or > 25 kg/m², although
their ideal weight have a higher risk of
the mechanisms behind the decreased semen
experiencing infertility. (1) WHO defined
quality in the slim and overweight men may not
infertility as the failure of a couple to conceive
be the same. (4)
after regular unprotected intercourse for at least
The distribution of body fat specifically in the
one full year. It has a high worldwide
central abdominal region has also been used to
psychosocial burden. Male infertility has a
diagnose a patient as obese and currently waist
substantial share of the total infertility burden. (2)
circumference is believed to be a more accurate
Body Mass Index (BMI) is a simple and widely
marker of obesity. (5) The interaction between
used method for estimating body fat. (3)The
obesity and fertility has received increased
pattern in reproductive hormones differed
attention owing to the rapid increase in the
between the different BMI groups, and it could
prevalence of obesity. (6) Indeed, the American
be speculated that hormonal imbalance may be
Medical Association recently classified obesity

as a disease. (7)
Received: 01/01/2016 DOI : 10.12816/0023845
Accepted: 15/01/2016

Full Paper (vol.63 paper# 8)

c:\work\Jor\vol63_9 The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 206- 209

Prognostic Roles of Endostatin, Matrix Metalloproteinase-2 & 9 and Tissue
Inhibitors of Metalloproteinase-1in Advanced Non-Small Cell Lung Cancer
Majed Al Mourgi, Nesriene El Margoushy, Hala El Nashar, Manal El Nashar,
Nihad El Nashar, Mohamed Hatem
College of Medicine, Taif University PO Box 888, Taif 21947, Kingdom of Saudi Arabia
Corresponding author: Dr Majed Al Mourgi, Telephone: 00966559956781, email: mourgi@hotmail.com

Background and aim of the work:
Previous studies verified that Endostatin, matrix metalloproteinase
(MMP) -2 and -9, in addition to tissue inhibitors of metalloproteinase (TIMP) -1 may play a crucial role
in prognosis of non-small cell lung cancer (NSCLC). In this study we will investigate the changes in the
pretreatment serum levels of these factors and to evaluate their clinical implication in patients with
advanced non-small cell lung cancer (NSCLC).
Patients and methods: Pretreatment serum samples were collected from 25 patients and 10 control
healthy individuals. The levels of Endostatin, MMP-2, MMP-9, and TIMP-1 were measured using a
sandwich enzyme immunoassay kit.
Results: The pretreatment serum levels of Endostatin and TIMP1 were significantly elevated and
correlated with their stages and survival (P< 0.05), where, the serum level of Endostatin in healthy
subjects was 81.20±23.99 ng/ml and in patients with NSCLC was 354.40 ± 164.01 ng/ml. The serum
level of TIMP1 in healthy subjects was 1.49±0.29 ng/ml and in patients with NSCLC was 2.96±0.58
ng/ml. The serum level of MMP2 and 9 were non-significantly decreased in serum of NSCLC patients (P
> 0.05), where the serum activity of MMP2 in healthy subjects was 0.14±0.03 ng/ml and in patients with
NSCLC was 0.09±0.03 % and the serum activity of MMP9 in healthy subjects was 0.13±0.019 ng/ml and
in patients with NSCLC was 0.10±0.03 %.
Conclusions: Our results indicated that the circulating levels of Endostatin, and TIMP-1 in patients with
NSCLC may be valuable future tools for treatment planning and monitoring of treatment, however, these
blood tests need to be standardized and validated in large-scale prospective clinical trials.
Keywords: Endostatin, matrix metalloproteinase, tissue inhibitors of metalloproteinase, non small cell
lung cancer.


The incidence of lung cancer in Saudi Arabia is
normal physiological processes such as
dramatically increasing and it is expected to
embryogenesis and tissue remodeling and may
become the leading cause of cancer deaths in the
be implicated in creating an environment that
near future. (1) Tumor angiogenesis is essential
supports the initiation and maintenance of tumor
for primary tumor growth, spread, and growth of
growth.(5) They are believed to play a crucial role
tumor cell metastasis.(2)Endostatin is an
in tumor invasion and metastasis, and they
angiogenesis inhibitor that is an endogenously
correlate with advanced clinical stage and
produced proteolytic fragment of type XVIII
considered by some investigators as a negative
collagen. It is a specific inhibitor of endothelial
prognostic factor for survival.(6)
cell proliferation, migration, and angiogenesis.(3)
The Tissue Inhibitors of Metalloproteinase
(TIMP) family is a natural inhibitor of several
Endostatin to tumor-bearing animals increases
matrix metalloproteinase (MMPS) enzymes and
the apoptotic index of the tumor cells without
are known to inhibit invasion and metastasis in
affecting their proliferation index.(4)Biologically
animal models.(7) Binding of the TIMPS to their
active Endostatin was able to inhibit systemic
specific MMPS result in an efficient inhibition
angiogenesis, inhibit primary tumor growth, and
of enzymatic activity of MMPS and it was
prevent the development of primary metastatic
suggested by some researchers that a broad
spectrum MMP inhibitor might be considered as
therapeutic method of reducing tumor invasion
proteolytic enzymes which are involved in
and metastasis in NSCLC.(8)
206 DOI: 10.12816/0023846

Full Paper (vol.63 paper# 9)

c:\work\Jor\vol63_10 The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 210-212

Uniportal Therapeutic Video-Assisted Thoracoscopic Surgery: A Single
Hospital Experience, Taif Saudi Arabia
Majed Al Mourgi1, Ahmad Haj Hussein2, Tamer Abdel-Rahman1, 3, Samir Badr1, 4
Reem Alsayali5, Samah Al-Sawat5, Rana Alsayali5
1Department of Surgery, Taif University, Saudi Arabia, 2 King Abdul-Aziz Specialist Hospital Taif Saudi
Arabia,3Banha Teaching Hospital, Banha, Egypt ,4GOTHI, Egypt,5College of Medicine, Taif, University
Corresponding author: Dr. Majed Al Mourgi, FRCS, FCCP, FACS, Email: mourgi@hotmail.com

Background and aim of the work:
Therapeutic uniportal video-assisted thoracic surgery (VATS) has
less postoperative pain, shorter hospital stay, and less operative time. In this study we will present our
experience in therapeutic VATS at King Abdul Aziz Specialist Hospital, Taif Saudi Arabia.
Patients and methods: This retrospective study was conducted in King Abdul Aziz Specialist Hospital,
Taif, Saudi Arabia, from July 2012 to January 2016 and included 162 patients who were admitted to the
hospital in this period and therapeutic uniportal VATS was conducted for them.
Results: The 162 patients were 102 males (63%) and 60 females with mean age of 45.1±6.8years.
Bilateral sympathectomy was performed for palmar hyperhidrosis in 36% of cases, VATS stapled
blebectomy with apical pleurectomy were performed for primary spontaneous pneumothorax in 32% of
cases, wedge resections in 23.5%, adhesiolysis was performed in 5%, and in3.7% anatomical segment
resections was done. Mean operative time was 25.5±5.5 minutes. The mean hospital stay was 5.3±1.2
days. No operative or early postoperative mortality was recorded.
Conclusion: Uniportal VATS was proved to be safe and effective and can replace the multiportal
approach in the management of various disorders which require thoracic surgery.
Keywords: Video-assisted thoracic surgery (VATS), uniportal VATS, uniportal sympathectomy,
uniportal blebectomy, uniportal pleurodesis, Taif, Saudi Arabia

Specialist Hospital, Taif, Saudi Arabia, from
Over the past two decades, video-assisted
July 2012 to January 2016 and therapeutic
thoracic surgery (VATS) has revolutionized the
uniportal VATS was conducted for them. After
management of intrathoracic disorders. (1-3)
approval of ethical board of the hospital and
VATS is associated with less pain, decreased
taking informed consents we revised the patients
general complications and shorter hospital stay
records. Records which could not be properly
which in turn decreases the hospital cost.(4) The
evaluated were excluded from the study.
technique has the same principles of tumor
Outcomes were; the surgical indications,
management if compared with traditional open
operative findings, mean operative duration, rate
procedures. (5-7) VATS leads to a fast
of conversion to open procedure, postoperative
postoperative recovery which allows the earlier
pain, and mean hospital stay. Statistical
administration of adjuvant therapy when
analysis was done using SPSS program version
necessary. (7) The implementation of uniportal
18.0. Qualitative data were expressed as number,
technique into the clinical practice is spreading
percentage and mean ± standard deviation. Mc
globally and the initial clinical outcomes and
Nemar test was used to compare paired
short-term results are encouraging, and more
categorical data.
long term data are awaited.(1-7) In this study we

will present our experience in therapeutic VATS
at King Abdul Aziz Specialist Hospital, Taif
The 162 patients were 102 males (63%) and 60
Saudi Arabia.
females with mean age of 45.1±6.8 years. The
cases included 58 (36%) where sympathectomy
was performed for palmar hyperhidrosis, 52
In this retrospective study which involved 162
cases (32%), where VATS stapled blebectomy
patients, we revised the records of all patient
with apical pleurectomy were performed for
who were admitted to King Abdul Aziz
primary spontaneous pneumothorax, wedge
Received: 01/04/2016 DOI : 10.12816/0023847
Accepted: 07/04/2016

Full Paper (vol.63 paper# 10)

c:\work\Jor\vol63_11 The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 213- 2

Routine Early Coronary Angioplasty versus Ischaemia-Guided Coronary
Angioplasty after Successful Thrombolysis in Patients with Acute Anterior
*Ahmed Ibrahim Nassar, *Hany Fouad Hanna, *Haytham Galal Mohamed,**Hany
Ibrahim Ragy,*Amir Wadie Andrawes.
Author's affiliation:*Cardiology department, Ain Shams university.**National heart institute.
Corresponding Author:Amir W. Andrawes.Email: amir-wadie@hotmail.comTel: 01008880048

the potential benefits of routine early intervention after thrombolysis include prevention of
re-infarction, recurrent ischemia, and reduction of the infarct size and mortality.
Aim of the work: the purpose of this study is to compare routine early coronary angioplasty in patients
with acute anterior STEMI after successful thrombolysis versus ischaemia-guided coronary angioplastyas
regards the occurrence of MACCE.
Study design: a total number of 100 patients with acute anterior STEMI received thrombolytic therapy
and then were randomly assigned to either routine invasive strategy or ischemia based strategy based on
risk stratification by stress myocardial perfusion scan done within 30 days of the onset of AMI with
subsequent CA after demonstration of residual myocardial ischemia and or good viability.
Results: the cumulative incidence of MACCE including recurrent ischemia, stroke, MI, HF or mortality
was significantly lower in theroutine early invasive strategy.
Conclusion: STEMI patients who cannot undergo timely primary PCI should receive prompt fibrinolysis
followed by early routine invasive strategy.
Keywords: Pharmaco-invasive PCI.

viability. Patients with poor myocardial viability
Mechanical recanalization by primary PCI is an
(<50% radiotracer uptake in >40% of vessel
extremely effective reperfusion treatment for
territory) continued on their optimal medical
STEMI and has been demonstrated to be superior
treatment.(4) Patients with recurrent ischemiaor
to fibrinolytic therapy in reducing mortality when
who developed hemodynamic instability during
it can be performed rapidly.(1)
hospital stay underwent urgent intervention.
However, many hospitals lack PCI facilities and
Follow up for 3 months from the onset of AMI
few provide around-the-clock staffing for these
implied special emphasis on occurrence of
procedures. Since reperfusion is a key strategy to
MACCE and echocardiographic examination
decrease mortality and major cardiovascular
repeated after 3 months of the onset of AMI.
events in STEMI care, and the benefit is time-
STATISTICAL ANALYSIS: Data were analyzed
dependent; therefore thrombolytic therapy is
using IBM© SPSS© Statistics version 22 (IBM©
administered to eligible patients if primary PCI
Corp., Armonk, NY, USA) and MedCalc©
cannot be performed in a timely fashion.(2)
version 14 (MedCalc© Software bvba, Ostend,
Current guidelines recommend an early routine
Belgium). Continuous numerical data were
coronary angiogram 3-24 hours after successful
presented as mean ± standard deviation (SD).
Categorical Data were presented as ratio or as

number (%) and between-group differences were
compared using the chi-squared test or Fisher's
This study enrolled 100 patients presented with
exact test, when appropriate. To detect the risk
acute anterior STEMI and received thrombolytic
relative risk (RR) was used. A two-sided p-value
therapy. Patients were randomly assigned to
<0.05 was considered statistically significant.
either routine invasive strategy (Group A):

scheduled for CA within 24 hours after successful
thrombolysis or ischemia based strategy (Group
CA and mechanical revascularization: In group
B): scheduled for risk stratification based on
A, patients underwent pharmaco-invasive PCI of
stress myocardial perfusion scan done within 30
the IRA (LAD). Patients in group B were assigned
days of the onset of AMI with subsequent CA and
to ischemia based strategy (spontaneous or
intended revascularization after demonstration of
induced ischaemia), 34 patients underwent stress
residual myocardial ischemia and or good
gated SPECT study done within one month of the
Received: 01/04/2016 DOI:10.12816/0023849

Accepted: 07/04/2016

Full Paper (vol.63 paper# 11)

c:\work\Jor\vol63_12 The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 217- 228

Role of Astaxanthin in Improving the Physiological and Teratolgical Changes
of Aspartame in the Pregnant Albino rats and Their Fetuses
Abu Gabal, H*and Al Waely, M**
* College of Science and Humanities, Prince Sattam Bin Abdul Aziz University, KSA.
**College of Science, Princess Nora Bent Abdul Rahman University, KSA.

Aim of the work:
the present work was done to investigate the role of astaxanthin in ameliorating the
physiological and teratological effects of aspartame on the pregnant rats and their fetuses.
Materials and methods:
in this study 70 virgin mature female albino rats (Wistar wistar) were used and 35
males (for mating); pregnancy was ascertained by vaginal smearing. The pregnant rats were injected on
days7, 9, 11 and 13 of gestation (organogenesis period). The animals were divided into the following
groups: animals of the first group which were intraperitoneally injected with 0.5ml saline (solvent of
aspartame); animals of the second were intraperitoneally injected with 0.5 ml olive oil (solvent of
astaxanthin). The third group was divided into 2 subgroups, the pregnant rats of the first subgroup were
intraperitoneally injected with aspartame (20mg./kg. body weight), the pregnant rats of the second subgroup
were intraperitoneally injected with aspartame (40 mg./kg. body weight). Pregnant rats of the 4th group were
intraperitoneally injected with astaxanthin (50mg.\kg. body weight) 2 hours after aspartame injection by its
2 doses.
Results: aspartame at the dose of 40 mg./kg.body weight induced pre- term ( early delivery); however the
2 doses of aspartame resulted in very highly significant decrease in the mean maternal body weight ,
unequal horns of the uteri and unequal distribution of the fetuses between them , abnormal amount of fats
surrounding the 2 horns of the uterus, regions of hemorrhage were present on the external membrane of the
uteri ,very highly significant uterine weight decrease , cases of abortion were noticed as well as highly
significant increased resorption of the fetuses. Intraperitoneal injection with aspartame at the 2 doses
resulted in fetal mortality, very highly significant fetal body weight and length decrease with a significant
decrease in fetal tail length. Moreover, aspartame induced fetal morphological changes such as body
diminution, exencephaly, cognition of the blood vessels in the head region and cleft lips. The skin seemed
thin and fragile in the head region as well as the fore and hind regions; hematoma was obvious beside
edema, clubbed fore and hind limbs, kyphosis was obvious beside hernias on some regions of the skin with
hypertrophy of some fetuses and protrusion of the viscera outside the body. Aspartame exposure at the 2
doses induced highly significant increase in mean of maternal serum AST activity, very highly significant
increase in mean serum GGT and serum creatinine activity.
Conclusion-Treatment with astaxanthin induced obvious improvement in all of the physiological and
morphological changes caused by aspartame in the pregnant rats and their fetuses.
Key words: Aspartame- Astaxanthin - Pregnant albino rats - Fetuses -Physiology -Teratology.


Aspartame (APM) is an artificial sweetener
discovered by James Schlatter during his attempts
widespread in the world; its brand name is
to obtain a gastric ulcer drug in 1965.[3]This white,
NutraSweet. Millions of people use aspartame;
crystalline and odorless powder is 180-200 times
which is used in many food products like chewing
sweeter than sucrose. The intense sensation of
gum, desserts, yoghurts, vitamins, medicines and
sweetness allows the use of such small doses so
particularly in diet beverages as well as people
that the product is almost non-caloric although its
trying to lose weight or patients with diabetes,
energy value is 4 kcal/g of aspartame. The
including children, frequently use these products.
sweetener is a chemical agent, N-L-Alpha-
[1]It was found that aspartame is present in 68% of
comestible assortment among sugar-free products
(C14H18N2O5).[4] This substance is hydrolyzed
in Poland.[2] It is applied by diabetics as tablets
completely in the intestinal lumen during
instead of sugar (NutraSweet, Equal, Sugar Free,
metabolism of the body to the three main
breakdown products: phenylalanine (50%),
Received: 04/02/2016 DOI : 10.12816/0023850
Accepted: 22/02/2016

Full Paper (vol.63 paper# 12)

Immunomodulatory Factor of Lactobacillus acidophilus in Pathogenesis of Chronic HCV The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 229- 237
Immunomodulatory Factor of Lactobacillus acidophilus
in Pathogenesis of Chronic HCV
Sonya Ahmed El-Gaaly, Hesham Hamdy Radwan, and Mohamed YousefAttiha
Department of Internal Medicine Faculty of Medicine,AinShams University.


Background: Hepatitis C virus (HCV) infection is gaining an increasing attention as a global health
crisis. Egypt reports the highest prevalence of HCV worldwide, ranging from 6% to more than 40%
among some regions and demographic groups. Gut microbiota serve as antigens to prime hepatic innate
immune cells to produce important antiviral cytokines including IFN while also promoting hepatic T
cell function . Objective: is to evaluate the role of lactobacillus acidophilus in the immunopathogenesis
of HCV. Methods: This study was conducted on 40 patients (group I) with established chronic liver
disease due to hepatitis C virus infection and 10 healthy controls (group II). All patients and controls
were subjected to: Full history taking and clinical examination, Abdominal U/S, Liver function tests
,serum transaminases, Quantitative HCV PCR using Real Time PCR and, Fibroscan (Transient
Elastography) for noninvasive measurement of liver fibrosis, Stool analysis and culture for total lactic
acid bacteria and lactobacillus acidophilus, PCR for Lactobacillus acidophilus, serum IL2 (Th1
cytokine), IL4 (Th2 cytokine), IL10 ( Th3 ,T- regulatory anti- inflammatory cytokine) by ELISA.
Results: There was highly statistically significant difference between patients and control group as
regards comparison of IL 2, IL 4 and IL10 with IL-2, IL-10 values being higher in patient group while
IL-4 was higher in healthy control. We found highly statistically significant difference between both
groups as regards total lactic acid count being higher in control group (Z= -4.565 and P value <0.001 )
and lactobacillus acidophilus count being higher in control group (with Z=-4.619, p<0.001).There was
significant correlation between Lactobacillus acidophilus and serum transaminases (ALT, AST) with
r=0.462, 0.538 and P=0.003,<0.001 respectively in patient group compared with control . There was
non-significant negative correlation between Lactobacillus acidophilus with Th1 cytokine (IL-2), T
regulatory cytokine (IL-10) but positive correlation with Th2 cytokine(IL-4) with r=-0.027,-
0.016,0.193 respectively in patients group compared with healthy control group who had the reverse
correlation with r=0.228,0.063,-0.236 respectively. Negative correlation between stool Lactobacillus
acidophilus with fibrosis score was noticed but it was statistically insignificant (Z=-1.160, P=0.246).
Conclusion: Gut lactobacillus acidophilus has an influence on Th1, Th2, and T regulatory cells that
may attenuate chronic inflammatory states and infection mediated injury in HCV patients.
Keywords: Hepatitis C Virus (HCV);Lactobacillus acidophilus ;Th1 Cells; Th2 Cells; Cytokines; T-reg

Viral clearance is associated with a vigorous,
Worldwide, an estimated 130-170
multi-specific CD4+ and CD8+ T cell response
million people have HCV infection. HCV
with Th1 responses dominating. Regulatory T
prevalence is highest in Egypt at >10% of the
cells (Treg) are found in the HCV infected liver
general.population and China has the most
where they have a dualistic effect; on one hand
people with HCV (29.8 million).(1)Epidemic
they suppress HCV-specific CD8 T cells and
hepatitis C virus infection in Egyptmay lead to
promote viral replication on the other they
a substantial health and, consequently,
suppress collateral inflammatory damage to
economic burden over the next 10-20 years. (2)
reduce liver injury in chronic .(5)
In the majority of cases of infection with the
Emerging evidence suggests a strong
hepatitis C virus (HCV) neither the early innate
interaction between the gut microbiota and
nor the later adaptive immune response
health and disease. (6) The interactions of the
succeeds in clearing the virus and infection
gut microbiota and the liver have only recently
becomes chronic. Furthermore, in many
been investigated in detail. HCV infection is
patients the infection remains undiagnosed (3)
associated with a number of hepatic diseases
and the ineffective inflammatory response
from hepatocellular lipid accumulation to
drives fibrogenesis and the development of
cirrhosis. It is critical to understand this
recruitment, and cancer development. Indeed, it
immune pathology if preventative and curative
could be that gut-derived antigens serve to
therapies are to be developed.(4)
prime hepatic innate immune cells to produce

important antiviral cytokines including IFN
Received: 01/03/2016
Accepted: 15/03/2016 DOI:

Full Paper (vol.63 paper# 13)

c:\work\Jor\vol63_14 The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 238- 247

Effects of Recovery Period and Stem Cell Enhancer on Bisphenol A Treated
Female Albino Rats
Eman G. E. Helal1, Nora Abdulaziz Al Jalaud2, Gamal M. Elnemr 3,4, Doaa I. Gewily1
1Department of Zoology, Faculty of Science (Girls), Al-Azhar University, Cairo, Egypt, 2Department of
Biology, Faculty of Science, University of Dammam, Saudi Arabia, 3Department of Medical and
Radiological Researches, Nuclear Materials Authority, Egypt, and 4Department of Internal Medicine,
Faculty of Medicine, Taif University, Saudi Arabia.

Bisphenol A (BPA) is a worldwide used endocrine disruptor that is incorporated in many
plastic industries. Exposure of humans to such substance starts early during the fetal life, postnatal life,
and extends throughout the life of the individual. Many agencies raised warnings against excessive use
of such substance.
Aim of the work: This study aimed to investigate effects of the recovery period (RP) and stem cell
enhancer (SCE) 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. Animals were divided into four groups (10 rats per cage); group I (control
untreated for 30 days), group II (BPA treated for 15 days, and then sacrificed), group III (BPA treated
first for 15 days, then left for another 15 days without any treatment "RP"), and group IV (BPA treated
first for 15 days, then treated with SCE for another 15 days). The following biochemical 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,
A/C (albumin/creatinine) ratio, uric acid [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 rats (group II) the biochemical results showed highly significant increases
(P<0.01) in the enzymatic activities of ALT, AST, GGT, creatinine, uric acid, total lipids, total
cholesterol, LDL-C, and triglycerides levels, with only a significant increase (P<0.05) in globulins
levels when compared to the control group. On the other hand, there was highly significant decreases
(P<0.01) in total proteins, albumin, A/G ratio, A/C ratio, and HDL-C levels when compared to the
control group. These results turned back to about the normal control values after stopping the use of
BPA and either taking a RP (group III) or receiving the SCE (group IV).
Conclusions and Recommendations: It could be concluded that BPA has dangerous toxic effects on
the liver and kidney functions as well as on the lipids profile. So, we recommend minimizing utilization
of this compound (BPA) as possible to protect people from these hazardous effects. Moreover, the RP
(i.e., 15 days without treatment) is better than the use of SCE which has no more benefit against the
antitoxic effects of BPA.
Keywords: BPA; bisphenol A, RP; recovery period, SCE; stem cell enhancer.


release, and oxidative stress. When first
Bisphenol A (BPA, 2,2-bis 4-hydroxy
discovered, BPA was investigated for its
phenyl propane) is one of the environmental
estrogenic properties, as it is thought to alter the
contaminants widely used in the manufacture of
synthesis of estradiol and testosterone and
polycarbonate plastic (e.g., water and baby
interfere with receptor binding.(5) There is a
bottles), epoxy resin (e.g., inside coating in
metallic food cans), and is a non-polymer
concentration of BPA and cardiovascular
additive to other plastics.(1, 2) Hence, it became
disorders, type 2 diabetes, and liver enzyme
an integrated part of the food chain.(3) There is a
abnormalities in a representative sample of US
global concern for human health as BPA binds
population.(6) Moreover, two studies on the
to estrogen receptors (ERs),(4) and can interfere
laboratory animals have shown adverse effects
with normal sex hormone balance. BPA is
of BPA on brain, reproductive system, and
thought to wield its effects through endocrine
metabolic processes, including alterations in
disruption, epigenetic modification, cytokine
insulin homeostasis and liver enzymes.(7)
Received: 01/04/2016 DOI : 10.12816/0023852
Accepted: 15/04/2016

Full Paper (vol.63 paper# 14)

c:\work\Jor\vol63_15 The Egyptian Journal of Hospital Medicine (Apr. 2016) Vol. 63, Page 248- 257

The Potential Protective Effect of Stem Cell Enhancer on Chronic Bisphenol-
A Treated Female Albino Rats
Eman G. E. Helal1, Rasha A. A. El sayed1, Hoda M.Abu-Taleb2
1Department of Zoology, Faculty of Science, Al-Azhar University (Girls), Cairo, Egypt.
2 Department of Environmental Research, Theodor Bilharz Research Institute, Cairo, Egypt.
*Corresponding authors: Eman G.E. Helal - Rasha A. A. El sayed,
E-mail: emanhelal@hotmail.com - rs.elsayed@gmail.com


Background: The xenoestrogen, bisphenol-A (BPA), is a worldwide food contaminant with
endocrine disruptor activity that is incorporated in many plastic industries. The exposure of humans to
such substances starts early during the fetal life, postnatal life and extends throughout the life of the
individual. Many agencies raised warnings against the excessive use of these substances. Aim of the
The present study was designed to determine if the usage of stem cell enhancer (SE) moderates the
physiological changes occasioned by exposure to BPA in the female albino rats. Materials and
This study was performed on thirty female albino rats with an average 100-120 g body weight.
The animals were divided into three groups; Group I (Control untreated-group), Group II (bisphenol­A
treated group) and Group III (treated group orally supplied with bisphenol ­A then treated with stem cell
Enhancer (SE)). Serum was separated and used for estimation of hormonal levels [estradiol, progesterone,
prolactin (PRL), follicle-stimulating hormone (FSH) and luteinizing hormone (LH)], some biochemical
parameters (liver enzymes, kidney function, glucose and lipid profile) and CA-125 and CA 15-3 tumor
markers. Results: The biochemical results showed marked significant increase (P<0.01) in the enzyme
activities [aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT) and alkaline
phosphatase (ALP)],urea and creatinine in bisphenol­A treated group when compared to the control
group. These parameters were significantly reduced in the group treated with stem cell enhancer as
compared to bisphenol ­A treated group . Decline in the concentration of lipid profile with increase in
high density lipoprotein cholesterol (HDL- C) levels in the stem cell treated group as compared to
bisphenol-A group were observed. There was a significant elevation in prolactin, FSH and tumor marker
levels concomitant with a significant reduction in LH levels in bisphenol-A treated group compared to the
control group. These results were changed to values very close to control by using the stem cell enhancer.
Conclusion: It could be concluded that bisphenol-A has dangerous effects on liver and kidney functions
as well as on lipid profile, female hormones and tumor markers level. So, we recommended minimizing
the utililizing of this compound and the use of some protective materials as stem cell enhancer to protect
people from its hazardous effects.
Keywords: BPA ( bisphenol- A), stem cell enhancer, tumor markers, kidney and liver function tests.


Xenoestrogens are nonsteroidal, man-made
monomer used to manufacture polycarbonate
chemicals that can enter the body by ingestion or
plastics including baby bottles, infant feeding
containers or tableware, and a constituent of
exposure to xenoestrogens stem from their
epoxy and polystyrene resin that are extensively
potential actions as endocrine disruptors. These
used in the food-packaging industry and in
chemicals share no structural homology with
dentistry, lining food and beverage cans.(3)
estradiol and include substances such as
Bisphenol­A has adverse effects on humans
pesticides and industrial by-products. Phenols
because of its ubiquitous presence in the
are one of the most common classes of
environment, resistance to degradation, and
xenoestrogens found in foods and consumer
potential for accumulation in fat tissues.(4)
products that made of polycarbonate plastics.(2)
BPA binds to estrogen receptors (ERs), and
Bisphenol-A (BPA), a food contaminant
can interfere with normal sex hormone balance.
with endocrine disruptor activity, is the widely
Bisphenol-A is thought to wield its effects
Received: 02/04/2016 DOI : 10.12816/0023853
Accepted: 17/04/2016

Full Paper (vol.63 paper# 15)