c:\work\Jor\vol64_1 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 258- 266
Evaluation of Preservative Capacity for Some Selected Cosmetic
Products Found in the Market
El-Bazza Z. E.; Abdulall A. K. *; Afifi S. S. * and Shafik M.A
Drug and Radiation Research Dept., National Center for Radiation Research and Technology, Atomic
Energy Authority, Egypt; * Department of Microbiology and Immunology,
Faculty of pharmacy (girls), AL Azhar University, Egypt.

Aim of the study:
To determine the preservative capacity of different cosmetic preparations
commonly found in the Egyptian markets.
Microbiological evaluation of 74 cosmetic sample and preservative capacity test for
cosmetic samples showing no microbial contamination using rejecting microorganisms by cup plate
It was found that 29 samples were contaminated at levels >103 or >500 (for baby care
products) or contaminated with rejecting microorganisms or both. The preservative capacity was
variable between the different types and brands of the tested cosmetics against bacteria (P<0.05), while
for Candida albicans all samples of the different cosmetic types were of nearly the same effect
The detection of microbial counts greater than the microbial limits standards and
isolation of rejecting microorganisms are clear evidences of non-adherence to good Manufacturing
Practices. Variable preservative capacity in some cosmetics may indicate its ability to withstand
microbial contamination which leads to spoilage of these cosmetics.
cosmetics, contamination, rejecting microorganisms, preservative capacity.


All Preservatives incorporated into cosmetics
cosmetic products is of concern worldwide due
have limitations on some microorganisms they
to possible negative consequences on the health
are active against, regarding the physical
of users and on product integrity1. Cosmetic
characteristics of the products and also the
industries are not obliged to produce sterile
cosmetics. Nevertheless, they are liable to assure
production of the finished product. So, it is
safety of the product to the potential consumer.
critical to ensure that the preservatives selected
Their microbiological load is strictly controlled
for a particular product are matched to the
at various manufacture stages and during shelf-
physical and chemical requirements of the
product and will provide protection against the
full spectrum of microorganisms likely to be
cosmetics may cause spoilage of the product and
when rejecting microorganisms are present, they

represent a serious health risk for consumers
worldwide3. Most cosmetics contain a lot of
ingredients that are good for microbial growth
Seventy four commercially available
also the production of cosmetics is not a sterile
cosmetic products samples, from sixteen
process, and at least the storage temperature is
different brands were purchased from the
nearly optimal for microbial growth2.
Egyptian market and employed in this study,
Preservatives are intended to be added
and they are represented in Table 1. The
to prevent microbial spoilage during production,
samples were analyzed as soon as possible upon
to prevent contamination by consumers while in
their arrival.
use, to kill low levels of contamination
introduced during storage and repeated use, and
The rejecting microorganisms that were
hence prolong the shelf life of products and
protect consumer from potential infections1,4.
Staphylococcus aureus, Escherichia coli,
Preservatives are not used to mask
contaminated raw materials and should not be
pneumoniae, Enterobacter cloacae and Candida
used to treat contaminated products5,6.
albicans. Some of these isolates were reused in

Received: 11/07/2016 DOI : 10.12816/0029018
Accepted: 17/07/2016


Full Paper (vol.64 paper# 1)

M The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 267-276
Prevalence of Helicobacter Pylori Infection in Anemic and Non-anemic
Children in Helwan, Egypt: Impact on Blood Cell Parameters
Gamal M. Elnemr1,2
1Medical and Radiological Researches Department, Researches Sector, Nuclear Materials Authority,
Egypt; 2Internal Medicine Department, College of Medicine, Taif University, KSA

Helicobacter (H.) pylori is the most common chronic bacterial infection of humans;
affecting ~50% of the world's population. It is the cause of disease states of varying degrees of severity.
Anemia is a widespread public health problem; ~50% of cases are diagnosed as iron deficiency anemia
(IDA). Recent studies have suggested an association between H. pylori infection and IDA in children.
Aims of the work: this study was conducted to evaluate the prevalence of H. pylori infection in
children with and without IDA diagnosis and also to determine effects of the bacterium on complete
blood count parameters of those children. Subjects and Methods: a case-control (retrospective) study
design was chosen to conduct this research. The prevalence of H. pylori antibody (Ab) seropositivity
was compared between 50 children diagnosed with IDA vs. 50 non-anemic control children matching in
age and sex. Results: a total of 18 (36%) anemic and 10 (20%) non-anemic children were found
positive to H. pylori Ab (P=0.0013). Also, comparison of the anemic to the control group revealed
statistically significant lowering of ferritin, and red blood cell (RBC) parameters (i.e., hemoglobin,
packed cell volume, mean corpuscular volume, and mean corpuscular hemoglobin), and also platelet
count in the anemic group. Moreover, comparison of H. pylori positive and negative anemic children
revealed statistically significant lowering of RBC parameters in the H. pylori positive anemic children.
Also, comparison of H. pylori positive and negative children revealed statistically significant lowering
of RBC parameters in H. pylori positive children. In addition, correlation of H. pylori with all other
parameters revealed negative significant correlation between H. pylori and RBC parameters.
Conclusions: H. pylori infection had a higher prevalence among preschool children with IDA and the
hematological impact was more on H. pylori positive anemic children. Recommendations: both IDA
and H. pylori are treatable diseases, so children having IDA must be investigated for H. pylori infection
for early treatment to avoid serious complications of both diseases.
Keywords: Egypt, Helwan, H. pylori, IDA, Preschool aged children.

Iron deficiency (ID) is the most widespread
Helicobacter (H.) pylori is a microaerophilic,
cause of anemia worldwide 6. The WHO
estimated that about two billion people in the
organism. It is the most common chronic
world are suffering from anemia, with
bacterial infection of humans as it is present in
approximately fifty percent of them are
almost half of the world's population 1. The
diagnosed as IDA 7. It develop in three stages;
pathogen has been shown to be the causative
iron depletion, iron deficient erythropoiesis, and
agent of disease states of varying degrees of
IDA 8. It is estimated to be the most common
severity, including; chronic gastritis, peptic ulcer
nutritional deficiency in both developing and
disease, gastric adenocarcinoma, and gastric
developed countries 9. ID results in impairment
mucosa-associated lymphoid tissue lymphoma 2.
of the immune, cognitive, and reproductive
The prevalence of H. pylori infection varies in
functions, as well as lowered work performance.
different populations, even within the same
It is also suggested to be related to DNA
geographic regions. It has been found that the
damage. IDA in children is still considered as a
highest rate of infection is associated with low
major health problem all over the world. This is
socioeconomic status during childhood 3. The
because of the long term effects on mental and
rates of infection range from more than 80% in
cognitive skills, immunity, and general physical
the developing world to less than 40% among
well being 10.
industrial countries 4. In developed countries,
It was reported that H. pylori may influence
widespread use of treatment against H. pylori
some extra-gastrointestinal diseases such as
infection has led to dramatic decrease in the
idiopathic thrombocytopenic purpura (ITP),
prevalence of infection 5.
anemia, and allergic diseases 5. The role of H.
infection in the development of extra-
Received: 14/10/2015
Accepted: 28/10/2015

Full Paper (vol.64 paper# 2)

ž’,'E9) The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 277- 286

Assessment of the Potential role of Hesperidin as an Antioxidant on the
Carbon Tetrachloride -Induced Kidney Damage in Rats

1Ali Abd Alsalam , 2Fathy M. Elshaer , 3Hamdi Abdou Mansour
1Department of Pharmacology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt,
2Zoology Department, Faculty of Science, Al-Azhar University, Cairo, Egypt
3Department of Pharmacology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt,
Corresponding Authour:Dr.Ali4@yahoo.com

Aim of the work
-The present work aimed to investigate the ability of Hesperidine (HDN) as an
antioxidant to retard development of renal toxicity induced by CCL4 in rat. Hesperidin (HDN), a
citrus bioflavonoid, decreases the oxidative stress produced by carbon tetrachloride in rat kidney.
Exposure to CCl4 induces acute and chronic renal injuries. The present study was designed to
evaluate the protective effect of hesperidin, on rat kidney damaged by CCl4. Material and methods-
Animals were divided into five groups pretreated with hesperidin (HDN) (100 and 200 mg/kg orally)
for 10 days and then challenged with CCl4 (2 ml/kg/s.c.) of in olive oil subcutaneously. Rats were
sacrificed by carotid bleeding under ether anesthesia. Results: The present results showed that the
antioxidant properties of hesperidine might be the main factor responsible for its strong protective
action on CCl4-induced nephrotoxicity. Conclusion- This study proved that hesperidin has a
protective effect on the renal tissue of rat and the degree of improvement varies in intensity according
the dose of Hesperidin
Key words: Hesperidin, carbon tetrachloride, kidney, albino rat

Humans are constantly exposed to hazardous
made towards the possible kidney protective
pollutants in the environment for example, in
properties of medicinal plants and hence
the air, water, soil, rocks, diet or work places.
Flavonoids now have been great attention as
Kidney failure is nowadays increasing at an
they found to have protective effect on kidney
alarming rate. It is therefore a matter of concern
to know if kidney can be protected especially in
Carbon tetrachloride is a colorless liquid, non-
conditions like diabetes mellitus and persons
flammable and is heavier than air (7).
under long drug therapy (1).
Consequently, it has been widely used as a fire
The kidneys serve the body as a natural filter of
extinguisher being useful for fighting fires near
the blood which removes wastes, which are
electrical equipment because it does not
diverted to the urinary bladder. In producing
conduct electricity .(8) Carbon tetrachloride is
urine, the kidneys excrete wastes such as urea
very toxic and because of this, most of its uses
and ammonia (2).
in households and industries have been
Oxidative stress, resulting from an imbalance in
suspended (7) .
generation of free radicals and antioxidant
Hesperidin is a flavanone glycoside named after
the term 'hesperidium', referring to citrus fruits
which are the main source of hesperidin.
alterations that lead to cell damage and its death
Hesperidin and its aglycone are common
(3). This phenomenon is considered to be a major
dietary flavonoids due to being large
factor in pathogenesis of a variety of renal
compounds of citrus fruits (Alongside
diseases. In this regard, reduction of oxidative
naringenin) and especially the peels and
stress may be a good target for prevention and
pericarp (9).
treatment of renal toxicity (4). Considering
Hesperidin is a flavonoid diglycoside (two
hazards of treatment failure, drug resistance and
sugars) and flavonoid monoglucosides can be
heavy costs associated with renal therapy, there
absorbed in the small intestine following
is strong interest in study of natural compounds
hydrolysis by lactase phloridzin hydrolases, or
with free radicals scavenging capacity (5).
cytosolic -glucosidases. Rutinoside glycosides
Nephrotoxicity is mostly related to oxidative
(Rhamnose bound to glucose and then bound to
stress and nowadays much attention has been
the flavonoid) cannot be absorbed in this
Received: 6/1/2016
Accepted: 15/1/2016 DOI: 10.12816/0029020

Full Paper (vol.64 paper# 3)

c:\work\Jor\vol64_4 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 287- 303

The Role of Vitamin D during Therapy in Chronic Hepatitis C Virus
Infection and Its Relation to CYP 27 B1-1260 Promoter Polymorphism
1Saadia Farid, 2Laila Rashed, and 3Samya Sweilam
Department Of Tropical Medicine, Biochemistry, and Medical Biochemistry
National Hepatology and Tropical Medicine Research Institute and
Faculty of Medicine, Cairo University

Objective: v
itamin D is a potent immunomodulator. A number of genetic polymorphisms in the
vitamin D pathway have been shown to affect vitamin D signaling, and stratification according to such
polymorphisms has already being implemented in randomized controlled clinical intervention studies.
Aim of the work: the study was attempted to examine whether vitamin D improved viral response and
predicted treatment outcome in patients with chronic hepatitis C virus (CHCV) infection.
Patients and methods: ninety two patients with CHCV, whose age ranged between 20 and 56 years,
were selected from the National Hepatology and Tropical Medicine Research Institute were included
in this study, before and after the treatment with pegylated interferon (PEG-IFN), ribavirin (RBV) and
vitamin D supplementation drops; 2000 IU/day, 10 drops/day, six patients whom received identical
therapy without vitamin D were included to serve as controls. All the patients had body mass index
(BMI) 30, were subjected to the following: history, clinical examination, abdominal ultrasonography
and collection of blood samples for routine laboratory investigations. CBCs and analysis of the
expression of CYP 27 B1-1260 gene, vitamin D receptor (VDR), and the levels of serum 25-
hydroxyvitamin D before and after chronic hepatitis C virus treatment.
Results: the treatment group with vitamin D had BMI 30 and high viral load 90900004.00 IU/ML,
(P= 0.098). Sixty three percent of treated patients were HCV RNA negative at 48 weeks after
treatment (SVR). Baseline serum vitamin D level was 8.5 minimum, mean level (32.9 ± 27 ng/mL). It
increased after 48 wk vit D treatment, to a mean level of (54.9 ± 38 ng/mL). VDR show highly
significant difference between patients and controls as regarding Ff=55.4% for patients (P=0.01), and
66.7% ff for the controls (P=0.006) alleles. CYP27B1 show non significant relation between
patients and controls, with CYP27B1 genotype frequencies of the promoter polymorphism CC =
51.1% for patients, 66.7% for the control group, C allele frequency 69% for the patients, 83.3% for the
controls, AC 35.9% for the patients, 33.3% for the controls. The majority of cases had A1F1 and A1F2
biopsy results.
Conclusion: our study suggests a role of vitamin D in the response to treatment of chronic HCV
patients. However, serum concentration is not a suitable predictor of treatment outcome. VDR had a
predictive positive treatment outcome. CYP27B1-1260 was found to be an independent predictor of
sustained virologic response (SVR).
Recommendations: The level of recommended supplementation of vitamin D depends on the
patient's individual deficiency, although 2000 IU daily is a common dose. Patients taking vitamin D
supplements should have serum measurements made after starting therapy to determine whether they
are reaching target levels.
Key words: Hepatitis C virus, vitamin D, genotype 4, VDR, SVR, CYP27B1, fibrosis.


Vitamin D plays a role on the degree of liver
functions, dealing with both innate and adaptive
damage in patients with chronic hepatitis C
(CHC): low vitamin D levels have been
Calcitriol mediates its biological effects by
associated with high hepatic necroinflammatory
binding to the vitamin D receptor (VDR), which
activity and progression of liver fibrosis.
is expressed not only by intestine, bone and
Vitamin D is known to have pleiotropic
kidney but also on cell membranes of T

lymphocytes, B lymphocytes, dendritic cells and
Received: 01/07/2016 DOI : 10.12816/0029021
Accepted: 10/07/2016

Full Paper (vol.64 paper# 4)

c:\work\Jor\vol64_5 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 304- 310

Diagnosis of Echinococcosis (Hydatidosis) Using Dot-ELISA
Ramadan M. M.1, El-Ameer A. M.2, Shalash I. R.3, Taki-El-Deen F. M. A.1, Abdeen G. S. 1
1Biological and Geological Sinces Department, Faculty of Education, Ain Shams
University,2Zoology Department, Faculty of Science, Cairo University,3Theodore Bilharz
Research Institute, Giza, Egypt

Background:cystic echinococcosis (CE) is a complex, chronic and neglected disease caused by
the larval stage of Echinococcus granulosus. The effects of this neglection have a powerful impact
in remote rural areas whose population has no chances of being diagnosed and treated correctly
without leaving their works and travelling long distances, sometimes taking days to reach the
closest medical center. The present study was designed to evaluate the diagnostic efficacy of
purified polyclonal antibody (PAbs) raised against Echinococcus granulosus 50 and 31 kD
proteins for detection of circulating hydatid antigen using dot ELISA. Materials and methods:
the previous proteins from sheep and camel lungs was purified by ammonium sulfate and caprylic
acid.The purified protein injected in Newzealand rabbits to raise specific polyclonal antibodies
(pAb) against E. granulosus. Detection of 50 and 31 kD proteins in serum by dot-ELISA gave a
sensitivity of 92.9%, a specificity of 95%. Conclusion: dot-ELISA techniques emerge to be
adequately sensitive assays for the diagnosis of human echinococcosis using cathepsin B antigen.
Key words: Echinococcosis­ 50 and 31 kd proteins ­ dot-ELISA technique.


Human echinococcosis is a parasitic
such as ultrasonography or radiology easily
disease caused by tapeworms of the genus
detect CE in clinical settings, the primary
Echinococcus (1).Echinococcosis, a severe
diagnosis needs be confirmed by serological
zoonotic disease that may be fatal if untreated
tests since the clinical signs of the disease are
non-specific (8). A great number of
immunological assays have been developed
Echinococcus granulosus (3). Human cystic
for detection of anti-hydatid cyst antibodies
echinococcosis (CE) is a zoonosis caused by
and recently, hydatid antigens in the serum (9).
Therefore, immunodiagnosis remains an
Echinococcusgranulosus and the most
important tool in the diagnosis of the disease.
common sites affected are the liver and lung
Chordi and Kagan(10) were the first to use
in approximately 80­90% of cases. The
immunoelectrophoresis to identify
hydatid bone represents the 0.5­2.5% of all
antigenic components of sheep hydatid cyst
cases (4).
fluid (HCF) and subsequently determined
Hydatid cyst disease, accounting for
which antigenic components were active in
over 95% of human echinococcosis,
detecting antibodies in the sera of patients
predominates in poor, pastoral communities
that raise sheep and other livestock, and keep
immunodiagnostic test depends on the use of
dogs for guarding and herding because of the
highly specific and sensitive antigens, as well
complex two-host lifecycle (5).
as the detection of the appropriate antibody
Clinical diagnosis of CE is frequently
class or subclass (11), (12).
difficult, hence always supported by imaging
However, ELISA results showed highly
variable sensitivities, and no cross-reactivity
immunodiagnostic methods detecting the
with other parasite species has been
antibodies have the disadvantages of low
frequently reported (13).
specificity and sensitivity and the inability to
The presence of a cyst-like mass in a
differentiate between recent and past
person with a history of exposure to
infections (5).
sheepdogs in areas where E. granulosus is
The diagnosis of hydatidosis is based on
endemic supports the diagnosis of cystic
immunodiagnostic methods along with
echinococcosis. However, echinococcal cysts
radiological and ultrasound examinations (6,7).
must be differentiated from benign cysts,
Although various imaging techniques
cavitary tuberculosis, mycoses, abscesses,
Received:12/4/2016 DOI: 10.12816/0029022

Full Paper (vol.64 paper# 5)

c:\work\Jor\vol64_6 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 311- 318

Role of Quercetin against 2-Butoxyethanol Induced Micronucleus and
Chromosome Aberrations in Mice
Zeinab Eid Madboly Hanafy 1, Hassan Abd El sattar Eldawy 2,
Karima Fathi Mahrous, 3 Asmaa Kutb Mohamed1
1 Zoology Department, Faculty of Science, Al­Azhar University (Girls), 2 Radiation biology Department, National
Center for Radiation Research and Technology, 3 Cell biology Department,National research center.

EGBE is also known as 2-butoxyethanol (2BE). EGBE is widely used as a solvent in various
applications, such as in surface coatings, spray lacquer, quick-dry lacquers, enamels, varnishes, varnish
removers, latex paint, metal cleaners, and in commercially available cleaning products. 2-Butoxyethanol
causes cellular damage via formation of reactive oxygen species. Quercetin, a flavonol group of plant
flavonoid, has generated interest because of its potential antioxidant, anti-proliferative, chemoprotective
and anti-inflammatory properties. Quercetin exhibited significant antimutagenic and DNA-protective
effects against oxidative damage due to the presence of hydroxyl groups in the molecule; it is considered
an excellent free radical scavenging antioxidant owing to the high number of hydroxyl groups.
Materials and Methods: 2BE was given orally to male mice for seven days at two doses (450µl
&900µl/kg b.w.). Quercetin was dissolved in corn oil. The animals in positive control group were treated
with only corn oil. Quercetin (20 mg/kg b.w.) was administered orally for 7 days prior to 7 days treatment
of 2BE for the two doses. Quercetin (20 mg/kg b.w.) was also administered for 14 days (7 days before
and 7 days during the period of treatment with two doses of 2BE).
Result: the two doses of 2BE induced both micronuclei (2.88% and 12.77%) and chromosomal aberration
in (50% & 72.8%, respectively) of cells. Quercetin administration lowered the frequency of micronuclei
and chromosome aberration.
Conclusion: These effects of quercetin are to be taken into consideration while evaluating the possible
use of quercetin as a protective agent.
Key words: Chromosome aberration, Micronucleus, 2-Butoxyethanol, Quercetin

biological membranes 4.
About 50% of synthesized organic
Quercetin (QUR) is a polyphenol (3, 3',
solvents (OSs) are employed for the production
4', 5, 7-pentahydroxyflavone). QUR found in
of paints and thinners. 2-Butoxyethanol, Xylene,
vegetables and fruits in the form of a glycoside
toleune, styrene, ethylbenzne , acetone and
(with an exceptionally high concentration in
methyl ethylketone are some of most frequently
onions, apples, tea and broccoli) 5.Several studies
and quantitatively represented solvents in the
indicate that QUR has multiple beneficial effects
composition of paints 1. It is well documented that
6. Among the many attributes of QUR are its
several OSs are potent carcinogens among
antioxidative7; anti-inflammation 8and anti-
population at risk. Their genetic effects have
apoptosis 9; properties. Furthermore, there is
important implications for cancer induction2.
reason to believe that QUR can shield the liver
EGBE is also known as 2-butoxyethanol. EGBE
from damage brought about by hepatotoxins 10.
is widely used as a solvent in various

applications, such as in surface coatings, spray
lacquer, quick-dry lacquers, enamels, varnishes,
1. Chemicals
varnish removers, latex paint, metal cleaners, and
in commercially available cleaning products 3.
The toxic effect of 2-butoxyethanol is caused by
purchased from Alpha Aesar, Germany.
the formation of reactive oxygen species (ROS).
Colchicine and Giemsa stain were purchased
There are several studies reporting that 2-
from Sigma Chemicals Co.
butoxyethanol causes cellular damage via
The chemical solutions were freshly prepared
formation of ROS. ROS are believed to cause
prior to experimentation as followes:
lipid peroxidation resulting in damage to
Quercetin: 26 mg was dissolved in 5ml corn
Received: 02/05/2016 DOI : 10.12816/0029023
Accepted: 10/05/2016

Full Paper (vol.64 paper# 6)

c:\work\Jor\vol64_7 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 319- 327
Impact of Circulating Soluble CD40 Concentration Levels in Patients with
Hematologic Malignancies
Mohamed Hamed Bahnasawy,Salah el ShahatAref,
Nahed Ahmed Mohamed Omar, Shaimaa Mohamed Ebrahim el Sayed
Zoology Department,Faculty of Science Damietta University ,faculty of Medicine,Mansoura
University, Zoology Department,Faculty of Science Damietta University

The present study was carried on forty (40) diagnosed ALL (Acute lymphoblastic leukemia), CML
(Chronic myeloid leukemia), AML(Acute myeloid leukemia)patients who attended Oncology Centre,
Mansoura University. Their ages ranged from 3 to 77 years. They were 27 males and 13 female. Patients
were followed up throughout the period of the study. All patients were subjected to the following: Detailed
history, clinical examination and Laboratory investigations.
CD04 expression was not associated with any of the studied demographic ,clinical or laboratory
variables. No statistically significant associations were elicited between CD 04expression and any of the
studied prognostic factors of patients. However ,a significant positive association was detected between
patients who responded to chemotherapy and positive CD04L.
Conclusion: CD04L is an independent prognostic factor for relapse free survival ,and also an independent
prognostic factor for the prediction of good response to chemotherapy ,since CD04L positive patients are
more liable to achieve complete remission ,while CD 04negative ones are more susceptible to death
chemotherapeutic resistance.
Key words: CD40, AML,CML,ALL,Hematological Malignancies.


Leukemia are clonal , neoplastic proliferation
different clinical and laboratory data as well as
of immature cells of the hematopoietic system,
its relation to disease outcome and prognosis
which are characterized by aberrant or arrested
during the period of the study.
differentiation to increase in the number of

blast cells that have common characteristics
which induce poor responsiveness to regulatory

The present study included serum samples
mechanisms (apoptosis) and tendency to have
from 40 patients, 14 (35%) with ALL, 20
diminished capacity for normal differentiation
(50%) with AML and 6 (15%) with CML.This
and expansion at the expense of normal
cohort comprised 12 males and 28 females
with a mean (±SD) age of 34.7 (±22.1) years.

CD40 is a 50-kDa cell surface protein,
In addition, 10 healthy individuals were
CD40 is best appreciated as a critical regulator
included as controls.
of cellular and humoral immunity via its
All patients were subjected to:
expression on B lymphocytes, dendritic cells,
a) Detailed history
and monocytes2.
b) Thorough clinical examination
Aim of the work:
c) Laboratory investigations:
The aim of this work is to assess CD40L in
1- Complete blood count (CBC).
patients with acute lymphoblastic leukemia ,
2- Bone marrow (BM) aspiration and
acute myeloid leukemia and chronic myeloid
examination the percentage of BM blast
leukemia to evaluate its correlation with the

3- Evaluate of CD40L by ELISA.

Received: 02/06/2016 DOI: 10.12816/0029024
Accepted: 12/06/2016

Full Paper (vol.64 paper# 7)

c:\work\Jor\vol64_8 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 328- 336
Comparative Study of the Use of Multifocal Electroretinogram versus Visual
Field Testing in Evaluating Cases of Primary Open Angle Glaucoma
Noha Mohsen, Amany Elshazly, Hazem Noah, Hoda Saber
Ophthalmology department, Faculty of medicine, Ain Shams University, Cairo, Egypt.
Corresponding author: Noha Mohsen, e-mail: nahnosh85@hotmail.com

to compare between results of multifocal ERG and visual field in cases of primary open angle
Methods: 30 eyes with primary open angle glaucoma and 30 eyes of normal subjects were included in this
study. Humpheray visual (SITA standard 24-2 strategy) and multifocal electroretinography were
performed to all included patients and normal subjects.
Results: the patients group showed increased latency of the N and P wave of the multifocal ERG when
compared to the normal subjects. No difference in amplitude of waves was found between the two studied
groups. when comparing different stages of glaucoma (mild, moderate, and severe) according to the mean
deviation of the visual field no difference was found in amplitude or latency of the waves produced by the
multifocal ERG.
Conclusion: multifocal ERG was able to differentiate between patients with POAG and normal subjects in
the form of prolonged latency of waves produced, but it was not able to differentiate between different
grades of glaucoma. This makes it a good prognostic tool but not a diagnostic tool, where the automated
visual field analyzer remains superior in diagnosing POAG.
Key words: multifocal ERG, Primary open angle glaucoma, visual field, lateny, amplitude, P wave, N


Primary open-angle glaucoma (POAG) is defined
Visual field. Usually, the diagnostic findings are
as a chronic slowly progressive optic neuropathy
not so obvious. In these cases, the patient is
with characteristic forms of optic nerve damage
called a glaucoma suspect. Such patients require
and visual field loss. POAG lacks the identifiable
repeated assessments of the optic nerve, the IOP
contributing factors of the secondary open-angle
and the visual field at regular intervals with the
glaucomas. Elevated intraocular pressure (lOP) is
frequency of visits depending on the index of
the most important risk factor for POAG. The
elevation of intraocular pressure mainly is due to
Visual field is used to assess the individual's
resistance of aqueous outflow through the
functional vision. Perimetry helps clinicians to
trabecular meshwork (TM), which is the main
identify glaucomatous loss as well as to stage the
drainage pathway of aqueous humor. The
disease according to the severity of field loss. The
biological changes in the cells and the
24-2 program with a size III stimulus is
extracellular matrix (ECM) of that drainage
considered the most commonly used testing
pathway cause an increase in IOP and the
pattern and target size with the Humphrey Field
pathogenesis of POAG1.
Conventional diagnostic approaches of POAG
Advantages of automated perimetry include
depend on the following: 1. Elevated intraocular
providing more sensitive and reproducible
pressure, 2. Angle of the anterior chamber, 3.
results, giving quantitative information, very easy
Signs of optic disc damage, 4. Signs of affected
to be used, and it can detect early glaucomatous
Received: 02/07/2016 DOI: 10.12816/0029025
Accepted: 12/07/2016

Full Paper (vol.64 paper# 8)

c:\work\Jor\vol64_9 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 337- 349
Serum sP-Selectin Level and Brachial Artery Flow Mediated Dilation as
Predictors of No Reflow in Patients with ST Segment Elevation Myocardial
Infarction Undergoing Primary PCI
Ayman Saleh, Hany Awadallah, Hamdy Soliman , Eman Hasan , *Mohamed Omar
Department of Cardiology, Faculty of Medicine, Ain Shams University
*Corresponding author: Mohamed Omar,e-mail:m.omar84@yahoo.com Phone: 01006190508

: no reflow phenomenon is associated with major adverse cardiac events, prediction of no
reflow using laboratory and noninvasive imaging techniques can help in early prevention and
management of this phenomenon.
Objectives: to investigate the predictive value of serum sP-selectin and endothelial dysfunction
assessed by using brachial artery flow mediated dilation (FMD) in patients with STEMI undergoing
primary PCI to address patients with high incidence of no reflow.
Methods: the prognostic performance, clinical and angiographic correlates of sP-selectin and FMD
was assessed in 96 patients admitted in National Heart Institute and Ain Shams University Hospitals
by STEMI and underwent primary PCI as a reperfusion strategy. Each patient was subjected to
(history taking, clinical examination, laboratory investigations including withdrawal of serum samples
for detection of sP-selectin levels, echocardio-graphy, assessment of endothelial dysfunction by
measuring the FMD, assessment of the angiographic results using TIMI flow grade and myocardial
blush grade. Follow up of the patients during hospital stay and after one month for the incidence of
Results: a significant correlation between patients with high serum sP-selectin and TIMI flow II was
found (P=0.038) and between the serum levels of the sP-selectin and the MBG score (P=0.009), also a
significant correlation between the FMD and the MBG score among the study cases (P=0.029) as well
as a significant correlation between the FMD and the serum P-selectin level among study cases
(P=0.016). There were no statistical significance between TIMI flow grade and brachial artery FMD
(P=0.075). Also no significant correlation was found between the patients' serum levels of sP-selectin,
brachial artery FMD and the incidence of MACE during the hospital stay or during one month of
follow up after discharge (P=0.127 and P=0.693, respectively).
Conclusions: serum sP-selectin level in patients with STEMI treated by primary PCI can predict the
patients who will develop no reflow phenomenon after PCI, FMD could not predict the incidence of no
reflow among those patients.
Key words: No reflow, sP-slectin, Flow mediated dilation

adverse cardiac events following primary PCI
No-reflow has been variably defined.
(2,3,4). Several trails tried to address the
In the setting of percutaneous coronary
clinical and procedural predictors of no reflow
intervention (PCI) it is best defined as
(5), others tried to find correlation between the
inadequate myocardial perfusion in the infarct
different biomarkers and no reflow; thus
related artery without evidence of mechanical
epicardial vessel obstruction. Angiographic no-
procedures could be applied to prevent the
reflow is defined as less than Thrombolysis in
occurrence of no reflow (6) .
Myocardial Infarction (TIMI) 3 flow and it
P-selectin is an adhesion molecule
occurs in around 2% of all PCI cases (1).
located in the platelet alpha granule and
Studies showed that no reflow was
Weibel-Palade body of endothelial cells.
associated with high incidence of major
P-selectin plays a key role in diseases

associated with injury and arterial thrombosis.

Increased expression of P-selectin is observed
Received: 02/07/2016 DOI : 10.12816/0029026
Accepted: 12/07/2016

Full Paper (vol.64 paper# 9)

c:\work\Jor\vol64_10 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 350- 363

Genotoxic Effect of Methotrexate on Bone Marrow Chromosomes and DNA
of Male Albino Mice (Mus musculus)
Nagla Zaky Ibrahim El ­Alfy1, Mahmoud Fathy Mahmoud1,
Amany Ibrahim Alqosaibi2 and Sally Ramadan Gabr El-Ashry1
1Biological and Geological Sciences Department, Faculty of Education, Ain Shams University, Cairo,
Egypt, 2Biology Department, Science College, University of Dammam, Dammam, Saudi Arabia
* Corresponding Author: Mahmoud Fathy Mahmoud, Biological and Geological Sciences Department,
Faculty of Education, Ain Shams University, Egypt Mahmoudfathy76@yahoo.com

Aim of the work-Methotrexate (MTX), a structural analogue of folic acid, is an antineoplastic and
antirheumatic agent which is used in a variety of clinical schedules and combination therapy regimens in
man. Material and methods- Sixty mice of nearly the same age were randomly categorized into four
groups (one control and three treated groups with different doses of methotrexate). Mice of the treated
groups 1, 2 and 3 were intraperitoneally injected with a single dose of methotrexate (2.5, 5 or 10 mg/kg b.
wt. respectively) at the first day of the experiment. All the control and the treated animals were sacrificed
after 24, 48 or 72 hour by cervical dislocation post treatment. Results-Methotrexate treatment induced
structural and numerical chromosomal aberrations in male mice bone marrow cells which were
significantly increased (P< 0.001) by dose and time. Structural aberrations were chromosomal gap,
fragment, break, centromeric attenuation, deletion, centric fusion, ring formation, end to end association
and beaded chromosomes. Numerical aberration was polyploidy. Also, methotrexate treatment decreased
the mitotic index in bone marrow cells of all the treated mice in comparison with the control group by
increasing dose and time of treatment. Comet assay results indicated that treatment with methotrexate
significantly increased (P< 0.001) DNA damage in the blood leukocytes in dose and time dependent
manner. Conclusion- It can be concluded that methotrexate induced genetic damage on the chromosomes
and DNA content of male albino mice even after single treatment with low doses .
Keywords: Methotrexate, Mice, Chromosomes, DNA, Comet assay.


Cancers are a group of diseases
lymphomas as well as liver cholestatic disorders
characterized by uncontrolled cell growth and
[6]. The basic principle of therapeutic efficacy of
spread [1]. Methotrexate (MTX), is one of the
MTX is due to the inhibition of dihydrofolate
widely used antineoplastic drug and a well
reductase, a key enzyme in the folic acid
known immunosuppressant introduced for
metabolism, which converts dihydrofolic acid to
therapeutic use since 1950s [2]. It is used against
tetrahydrofolic acid. The perturbation in the
a broad range of neoplastic disorders including
folic acid metabolism leads to depletion of
acute lymphoblastic leukaemia, non-Hodgkin's
nucleotide precursors like thymidylates and
lymphoma, breast cancer and testicular tumors
purines, which in turn inhibits DNA, RNA and
[3]. Further, it is effective for the treatment of
psoriasis, rheumatoid arthritis and different
thymidylate synthase and the transport of
immune suppressive conditions [4]. It is also one
reduced folates into the cell [7]. MTX was found
of the drugs of choice in the new regimen
to be a clastogenic agent in tumor cells and in
combination treatment against rheumatoid
9]. The
arthritis and for several tumors [5]. It was proved
carcinogenicity, mutagenicity, teratogenicity and
that high dose of MTX regimens can be used
embryo lethality of MTX in different test
against primary central nervous system
systems have been studied and reviewed and the

data have been listed in the genetic activity

Received: 02/07/2016 DOI : 10.12816/0029027
Accepted: 12/07/2016

Full Paper (vol.64 paper# 10)

c:\work\Jor\vol64_11 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 364- 372
Radioprotective Role of Some Bacteria Belonging to Actinomycetales against
Gamma Irradiation-Induced Oxidative Stress in Male Albino Rats
Seham Abdel-Shafi1, Tamer M. M. Saad2 *, Abdel-Haliem M. E. F.1, Abdel-Rahman M. A.
Ghonemey2, and Gamal Enan1
1 Department of Botany and Microbiology, Faculty of Science, Zagazig University,
2 Nuclear Materials Authority, Egypt.


Background: radiation protection concepts and philosophy have been evolving over the past several
decades. The inadvertent exposure of human from various source of radiation causes ionization of
molecules, setting off potentially damaging reactions via free radicals production. Development of
radioprotectants and mitigators is the therapeutic approach to ameliorate the negative health impact
of radiation exposure. The majority of substances with biological activity used in medicine are
produced by actinomycetes and fungi. Aim: the aim of the present study is to evaluate the
radioprotective role of the antimicrobial active metabolite of Streptomyces atrovirens Rahman as
antioxidant against gamma irradiation that induced some biochemical alterations in rats.
Material and Methods: animals were pretreated with antimicrobial active metabolite of Streptomyces
Ab1 using suitable stomach tube for two weeks prior to radiation exposure. The levels of
malondialdhyde (MDA), glutathione content (GSH), superoxide dismutase (SOD), catalase (CAT),
glutathione peroxidase (GPx), glutamic oxaloacetic transaminase (ALT), glutamic aspartate transaminase
(AST), alkaline phosphatase (ALP) and gamma glutamyl transferase (GGT) activities, also total
cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), and low density
lipoprotein cholesterol (LDL- C) were estimated. Results: the results revealed that exposure to
ionizing radiation resulted in significant elevation in the levels of MDA content, ALT, AST, ALP
and GGT activities and concentration of TC, TG and LDL-C, meanwhile, showed significant
depletion in GSH content and SOD, CAT and GPx activities and HDL-C concentration. Conclusion:
it could be concluded that, the administration of the antimicrobial active metabolite of Streptomyces
Ab1 pre-whole body gamma irradiation resulted in sufficient amelioration against radiation
effects on the biochemical aspects examined in the present study.
Key words: Ionizing Radiation, Actinomycetes, Streptomyces and Antioxidants.


Free radicals are believed to play a role in
Radiation is known to produce various
more than sixty different health conditions,
reactive oxygen species (ROS) in biological
including the ageing process, cancer, radiation
systems such as superoxide, hydrogen peroxide
damage, atherosclerosis1. Antioxidants work in
and hydroxyl radical reaction6. The range of
several ways by reducing the energy of the free
antioxidant defense available within the cell and
radicals, stop the free radical from forming in the
in the extracellular fluid should be adequate to
first place, or interrupt an oxidizing chain reaction
protect oxidative damage7.
to minimize the damage of free radicals2.
Radiation therapy (RT) is considered to be
The development of radioprotective agents
one of the most popular and important tools to
has been the subject of intense research in view of
care cancer8. The radio-sensitivity of normal
their potential for use within a radiation
tissues particularly organs away from the tumor
environment; however, no ideal, safe synthetic
sites are suggested to limit the therapeutic gain9.
radioprotectors are available to date, so the search
Detrimental effect of ionizing radiation
for alternative sources has been ongoing for
occurs mainly due to free radicals generated
several decades3,4.
through the decomposition of cellular water10.
People are exposed to natural radiation
However, organisms have protective systems
sources as well as human-made sources on a
against free radical reaction, for example,
daily basis. Natural radiations come from
endogenous antioxidants and antioxidative
many sources due to naturally occurring
radioactive materials in soil, water, air and
Exposure to radiation can be classified
cosmic rays. Human-made sources range
into three types based on exposure situation;
from nuclear power generation to medical
planned exposure, resulted from intended
uses of radiation for diagnosis or treatment5.
introduction and operation of radiation
Received: 09/07/2016 DOI: 10.12816/0029028
Accepted: 18/07/2016

Full Paper (vol.64 paper# 11)

c:\work\Jor\vol64_12 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 373- 388

Gender Difference in Self-Reported Preparedness for Clinical Practice
among House Officer Junior Doctors of Al Azhar University in Cairo
Thoraya Abd El-fatah1, Monira Gad 2, Zeinab Hammour1,
Hanaa Abouelyazid 1 and Heba Abd-elgalil 1
Community Medicine1, Gynecology and Obstetrics Department2 Faculty of Medicine (Girls),
Al-Azhar University.

the successful completion of medical school education should provide students with a
level of knowledge and skills necessary to fulfill a junior doctor's daily duties at hospital. As regard
gender some researchers concluded that women outperform men in academic and clinical assessment
at medical schools. There are no reasons to suppose that female students leave medical school less
prepared than men for work. Aim of the work: this study aimed to clarify whether there are gender
difference in house officers' view for preparedness for work or not, and to demonstrate strength and
weakness points regarding their undergraduate medical education. Subjects and Methods: the current
study is a cross sectional comparative one. It was conducted on 51 house officers' (HOs) females from
Al Zahraa University Hospital compared to 100 male HOs recruited from Al Hussien and Sayed Galal
University Hospitals about how much they feel prepared to medical practice. All the questionarable
items were arranged in 8 domains of educational goals adopted according to NARS , requirements and
from ' preparedness for Hospital Practice' survey. Results: the results showed that 96.1% of females
felt sufficient preparedness for clinical work compared to 79.0% of males, 72.5% and 35.3% of
females felt somewhat adequate preparedness in understanding the disease process and carrying out
arterial blood gases respectively versus 40.0% and 28.0% of males while males felt adequate
preparedness in all elements of interpersonal skills than females. In addition, it was found that
understanding the interaction of social factors with disease, approach confidently senior staff for help
in interpreting investigations, manage time effectively; score of patient management and prevention
were significant predictor of preparedness for clinical work; while gender was not significant in the
regression model. Conclusion: female house officers felt more sufficient well prepared than male
ones. However gender was not a significant predictor of performance. More emphasis on weakness
points recorded by the two groups as defect in some medical skills as write prescription, gap between
knowledge and practice, bad communication with the teaching staff and dealing with patient to
improve feeling of preparedness .
Key words: medical education, gender, preparedness for work, Al Azhar


Medical education is an education
extent to which their medical school prepared
related to the practice of being a medical
them for their work in clinical practice is
practitioner1. An important task for medical
important2. Numerous studies however have
schools is to ensure that graduating doctors
shown that medical graduate often feel ill-
feel prepared, as best they realistically can, for
prepared for their demands of their new jobs5.
their first medical job2.
Moreover some researchers concluded that
The successful completion of a
women outperform men in academic and
medical school education should provide
clinical assessments at medical school. There
students with a level of knowledge and skills
are no reasons to suppose that female students
necessary to fulfill a junior doctor's daily
leave medical school less prepared for work
duties at hospital3. The importance of
than men6.
adequately preparing medical students to cope

with the tasks and roles they have as junior
doctors is apparent to all medical schools4.
- To clarify whether there are gender
Reporting junior doctors' views about the
differences in house officers' view for

preparedness for work or not.
Received: 09/07/2016 DOI : 10.12816/0029029
Accepted: 18/07/2016

Full Paper (vol.64 paper# 12)

c:\work\Jor\vol64_13 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 389- 394
Effect of Bisphenol A on the First Generation of Female Rats from Both
Parents Treated with the Same Xenoestrogen
Eman G. E. Helal1, Mohamed A. Mustafa2, Neama M. Taha3
1Zoology Department, Faculty of Science, Al-Azhar University, Egypt
2Basic Centre of Science, Misr University for Science and Technology, Egypt
3 Physiology Department, College of Medicine, Umm Al-Qura University, KSA

bisphenol A (BPA) is a worldwide used endocrine disruptor that is incorporated in
many plastic industries. The exposure of human 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 such substances. The aim of the present work was to evaluate the extent to which
BPA can affect the first generation (of parents treated with the same compound, during pregnancy and
lactation), which treated with the same compound during their life time.
Materials and Methods:
group 1: 15 control female rats. Group 2: 15 female rats of the first
generation treated with BPA (20mg/kg b.wt) for one month. Sexual hormones, liver and kidney
functions were measured.
Results: BPA induced increase in breast and ovarian tumor markers. It also showed significant
increase in estrogen, FSH, prolactin, and progesterone. It is also increased liver function, kidney
function, lipid profile. In the same time it leads to decrease in LH, HDL, and protein levels.
BPA induced toxicity, which is mediated by oxidative stress. This study ringing the bells
of danger for using such compounds.
Key words: BPA, female, rats, liver, kidney, tumour marker, generation, lipids.


Bisphenol A (BPA) is a high
Natural estrogens bind estrogens
molecular polymer organic compound widely
receptors and they in turn bind to estrogens
used all over the world. It used as a component
responsive elements and induce the expression
of many industrial products, such as
of genes in their target cells. These cells
plasticizers, the epoxy resin liners of
include those in the reproductive organs
aluminium cans, and thermal receipts, thermal
(vagina, uterus, oviduct, ovary, cervix, testis
stabilizers, pesticides, paints and dental
and epididymis), the mammary gland, the
materials. In addition, it used in the production
brain and pituitary, the thyroid gland, the
of polycarbonate and epoxy resins. Because of
skeletal and cardiovascular systems, among
the use of BPA in the production of materials
others. As a synthetic estrogen with the
used for food and potable water, it has been
capability of binding to estrogens receptors,
detected in food and water consumed by
BPA also has the potential to alter
humans as well as animals1.
development at various levels of organization.
It is possible that humans may gain
High doses of BPA may mediate its effects
exposure to BPA through the air and by
through mechanism other than those regulated
absorption through the skin. Additional studies
by estrogens receptors (ERs)4.
have quantified BPA levels in various aqueous
It also acts as a xenoestrogen
media, including fresh and marine surface
modulating the endocrine pathways via a
waters and groundwater2.
BPA is absorbed from gastrointestinal
mechanism of action similar to that of the sex
tract into the blood and redistributed to other
hormone at the receptor. Therefore, numerous
tissues. It is highly conjugated in the liver to
studies have investigated the effects of BPA in
form bisphenol A glucuronide, a major
male and female reproductive systems.
metabolite, which is excreted in urine8. BPA
However, few studies have concern the toxic
has been demonstrated in both in vivo and in
effect of BPA on other tissues and its potential
vitro experiments to act as an endocrine
to increase the risk of metabolic disorders.
disrupting chemical3.
Indeed, the endocrine disrupting chemicals not

only act as hormone-mimics or antagonists

Received: 13/08/2016 DOI : 10.12816/0029030
Accepted: 21/08/2016

Full Paper (vol.64 paper# 13)

c:\work\Jor\vol64_14 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 395- 404

The Protective Role of Vitamin C against Histological Changes and Some
Biochemical Indices in Liver of Rats Chronically Exposed to Diazinon
Walid Ali Abu-Sheir
Zoology Department, Faculty of Science, Al-Azhar University, Nasr City, Cairo, Egypt.

Background: Diazinon is one of the most toxic organophosphrous pesticides. It is used widely in
agriculture and affects the general health and the economy of the human. Toxic effect of Diazinon is due to
inhibition of acetylcholine esterase, an enzyme needed for proper nervous system function. This study was
designed to investigate the effects of Diazinon on the liver tissue and the expected protective role of
vitamin C. Aim of this study: is to evaluate effect of Diazinon and vitamin C on liver of albino rats.
Results: data showed a significant increase in liver enzymes AST, ALT in addition to GGT and decreased
total proteins and albumin as well as different histological changes caused by the pesticide Diazinon.
Using vitamin C caused amelioration in liver structure and function tests, although, all these tests did not
return to the normal level. Conclusion: the present study proved that Diazinon has adverse effects on some
biochemical parameters and liver functions leading to histological impairment and these effects increase
with the increased time of exposure. Meanwhile, supplementation with vitamin C could ameliorate the
adverse effects of Diazinon.
Keywords: Diazinon, Vitamin C, Serum enzymes, Liver histology, Rats


Diazinon is an organophosphate insecticides
Research Institute of Ophthalmology, Giza,
Egypt. Animals were housed in metal cages for
1950s.Handy et al.1reported that Diazinon caused
one week, as an acclimatization period, under the
toxic effects on blood cells, spleen, thymus and
laboratory conditions. The rats were fed a
lymph nodes of rats.
commercial balanced ration and allowed free to
Diazinon is a non-systemic insecticide used
excess of water. Abnormally noticed animals
in agriculture to control soil and foliage insects
were eliminated. Thereafter, the animals were
and pests on a variety of fruits, vegetables and
categorized into six groups in separated cages
field crops. Diazinon is also used on non-lactating
(40×60×30 cm), each group contained 6
cattle in an insecticidal ear tag. Prior to the
cancellation of all residential uses by 2004,
- Experimental Groups:
Diazinon was used outdoors on lawns and
1- The Control group (C1): without any
gardens, indoors for fly control and in pet collars
treatment or additives for the ration or water for
designed to control fleas and ticks2.
Diazinon caused changes in liver enzymes
2- Diazinon group (D): received Diazinon (64
and biochemical indices and swelling of
mg/kg b. w. Half of LD50) twice weekly for the
mitochondria in hepatocytes and it also has been
whole period of the experiment (5weeks).
linked to the development of serious
3- Diazinon + Vitamin C group (D+C): rats
histopathological lesions in the kidneys and the
given Diazinon (64 mg/kg b. w. Half of LD50
twice weekly) and supplemented with Vitamin C,
Some authors demonstrated that vitamins
daily, (5 mg/kg) for all the experiment period (5
such as C and E can be used to counteract
pesticide toxicity in the experimental animals6-8.
4- The Control group (C2): without any
Vitamin C is an important water-soluble chain-
treatment or additives for the ration or water for
breaking antioxidant and enzyme cofactor 9.
(10 weeks).
5- Diazinon group (D): received Diazinon (64
mg/kg b. w. Half of LD50) twice weekly for the
Experimental design and used animals:
Thirty six adult male albino rats (Rattus
whole period of the experiment (10 weeks).
norvegicus) about 90 ±10gm weight were
6- Diazinon + Vitamin C group (D+C): rats
obtained from the Animal Breeding House of the
given Diazinon (64 mg/kg b. w. Half of LD50
Received: 15/08/2015 DOI : 10.12816/0029031
Accepted: 23/08/2015

Full Paper (vol.64 paper# 14)

c:\work\Jor\vol64_15 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 405- 410

The Relationship between Serum Ferritin and Glycosylated Hemoglobin in
Adults with Type 2 Diabetes Mellitus
Shawkia S. Abd El-Halim1 and Lobna M. El-Hadidy2
1Nutritional Biochemistry Department and 2Nutrition Requirements & Growth Department
National Nutrition Institute, Cairo, Egypt
Corresponding authors: Shawkia S. Abd El-Halim. E-mail address: drshawkia2013@gmail.com.
Now: working in the Faculty of Art and Science- Qilwa- El-Baha University. Saudi Arabia

serum ferritin, an acute phase reactant is a marker of iron stores in the body. Several
studies concluded that, serum ferritin was found to be high in uncontrolled type 2 diabetic patients. This
study was carried out to investigate serum ferritin levels in poor controlled type 2 diabetes (PCD) and
well controlled type 2 diabetes (WCD). Subjects and Methods: the study comprised of 42 apparently
healthy controls and 84 type 2 diabetic patients. They were recruited from the Governmental and NGO's
Hospital at Cairo, Egypt. Anthropometric measurements including: weight and height were measured
and body mass index (BMI) was calculated. Fasting blood glucose (FBG); Glycosylated hemoglobin
(HbAIc) and serum ferritin were determined. Patients were subdivided into PCD and WDC according
to HbAIc levels. Results: BMI; FBG; HbAIc and serum ferritin were significantly higher in in type 2
diabetics compared with apparently healthy controls. Based on glycemic control; the levels of FBG and
serum ferritin were elevated in patients with HbA1c >7. Moreover, there was a positive significant
correlation between serum ferritin, HbA1c and FBG that was more pronounced in PCD patients.
Conclusion: the present study showed positive association of serum ferritin levels with glycemic
control in Type 2 diabetic patients.
Keywords: Type 2 diabetes- Fasting blood glucose- Glycosylated haemoglobin- Serum ferritin-
glycemic control

secretion (6).Ferritin is a specialized iron storage
Diabetes mellitus is one of the most
protein, which reflects iron stores in the body (7).
common problems caused by a combination of
It has been used as a surrogate variable
insulin resistance and impaired insulin secretion
to reflect body iron stores in healthy individuals.
by pancreatic cells (1). Type 2 diabetes has a
Previous studies have demonstrated an
rising attitude globally. The worldwide spread
association between increased SF levels and
of diabetes among general population is
higher risks of diabetes (8, 9).
estimated to increase to 300 million in 2025 (2,3).
Glycosylated hemoglobin (HbA1c) is a
Elevated iron stores may increase the
stable, irreversible product of non-enzymatic
risk of developing diabetes. Emerging scientific
glycosylation of the hemoglobin -chain by
evidence has revealed unsuspecting influences
serum glucose. HbA1c is used as an indicator
between iron metabolism and type 2diabetes.
for the state of glycemic control, progression of
The relationship is bidirectional, iron affects
the disease and development of complications in
glucose metabolism, and glucose metabolism
diabetic patients (10, 11).
impinges on several iron metabolic pathways. It
The present study is undertaken to
is increasingly recognized that iron influences
estimate the association between serum ferritin,
glucose metabolism, even in the absence of
FBG and glycemic control in type 2 adult
significant iron overload (4).
diabetes mellitus.
Although a mechanism linking iron

concentrations and diabetes is not established, it
is known that iron is a catalyst in the formation
of hydroxyl radicals, which may contribute
This study comprises eighty four adult
initially to insulin resistance, subsequently to
patients with type 2 diabetes mellitus (treated
decreased insulin secretion, and ultimately to
with hypoglycemic drugs) as well as forty two
the development of type 2 diabetes (5). Animal
ages and sex matched apparently healthy adults
models suggest that iron excess may result in
serve as a control group. They were recruited
beta-cells oxidative stress and decreased insulin
from the Governmental and NGO's Hospital at
Cairo, Egypt. Diabetic patients met the criteria
Received: 17/08/2016 DOI: 10.12816/0029032
Accepted: 25/08/2016

Full Paper (vol.64 paper# 15)

c:\work\Jor\vol64_16 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 411- 421

The Protective Role of Transplanted Bone Marrow Cells against Injuries
Induced by a Chemical Carcinogen and / or -Rays in Kidney tissue of Rats.
Fatma A Eid[1] ,Neamat H Ahmed [2],Somia Z Mansour [2] and Manal A Ahmed[3]
1-Zoology Department, Faculty of Science, Al-Azhar Univ.2-National Center for Radiation Research
and Technology 3- Umm-El-Atebaa-Hospital, Dokki, Giza


Aim of the work:this work aimed to study the biochemical and histopathological changes in the
kidney of male albino rats post exposure to 6Gy of gamma radiation and the protective role of
transplanted bone marrow cells against damage induced in rat's kidney by a chemical carcinogen.
Materials and Methods: in this study, forty eight healthy and active male albino rats about 120
grams in body weight were used. The animals were housed in plastic cages under normal temperature,
pressure, humidity and good ventilation conditions during the whole period of experimentation. The
animals were fed on a standard pellet diet and water.
Results:exposure of rats to -radiation caused a significant increase in kidney function tests,
decreased significantly the antioxidants with numerous histopathological changes in the rat kidney
tissue. These changes were ameliorated by bone marrow transplantation either after whole body gamma-
irradiation and/or Fe-NTA treatment.
Conclusion: bone marrow transplantation either after whole body gamma-irradiation and/or Fe-NTA
treatment restored the kidney functions and ameliorated the oxidative stress and antioxidants markers.
The histopathological observations showed amelioration in the structure of the kidney cortex. So, BM
transplantation exerts some curative effects on the function and histological structure of kidney cortex of
rats exposed to gamma-irradiation and/or Fe-NTA treatment.
Keywords: Gamma radiation, Ferric-nitrilotriacetic acid (Fe-NTA), Bone marrow transplantation,


Due to the progressive development in all areas

of science and technology in the world there are
potent strategy to protect human or ameliorates
a growing number of various sources of
the deleterious effect of ionizing radiation [3].
Eid et al.[4] reported that radiation induced
communications, development of new methods
reactive oxygen species(ROS) and free radicals
of medical diagnostics, space exploration,
which react with the molecules of cell
creation of nuclear weapons and the
membranes and induce lipid peroxidation
development of the nuclear industry and power
products which play an important role in the
that led to a serious threat to the environment
biological damage such as mutagenic and
and human health [1]. Ionizing radiations cause
carcinogenic damage. They also demonstrated
similar damage at the cellular level. Gamma
many histopathological and biochemical
rays and neutrons are more penetrating, causing
changes in the kidney tissue post exposure of
diffuse damage throughout the body (e.g.
rats to gamma rays. Ferric-nitrilotriacetic acid
radiation sickness, cell's DNA damage, cell
(Fe-NTA) is a potent nephrotoxic agent and
death due to damaged DNA, increasing
induced acute and sub acute renal proximal
incidence of cancer) rather than burns. The most
tubular necrosis by catalyzing the decomposion
biological damaging forms of gamma radiation
of H2O2-derived production of hydroxyl radicals,
occur in the gamma ray window, between 3 and
which are known to cause lipid peroxidation and
10 MeV [2]. Whole body gamma-irradiation of
DNA damage [5].
animals at the sub lethal and lethal dose levels

alters the metabolism of various organs and
causes a series of biochemical and physiological
Experimental animals
disturbances in the different biological tissues.
In this study, 48 healthy and active male albino
Ionizing radiation produces harmful effects on
rats about 120 grams in body weight were used.
the organisms and due to the wide spread use of
The animals were housed in plastic cages under
normal temperature, pressure, humidity and
industry,therefore, pharmacological intervention
good ventilation condition during the whole
could be most
Received: 20/08/2016 DOI : 10.12816/0029033
Accepted: 28/08/2016

Full Paper (vol.64 paper# 16)

c:\work\Jor\vol64_17 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 422- 429
Antiviral Activities and Phytochemical Constituents of Egyptian Marine
Seaweeds (CystoseiraMyrica(S.G. Gmelin) C. Agardh and Ulva Lactuca
Linnaeus) Aqueous Extract
Shaimaa Ashour Abdel-Latif Zaid1, Nermine Nasr El-Din Hamed2, Kouka Saad El-Din
Abdel-Wahab3, Enas Kamal Abo El-Magd3, Rawheya Abdel-Latif Salah El-Din2
1Microbiologist at Chemistry Administration,Ministry of Commerce and Industry
2Botany and Microbiology Department, Faculty of Science for Girls, Al-Azhar University
3Microbiology Department, Faculty of Medicine for Girls, Al-Azhar University


Background: some natural and synthetic compounds can prevent, suppress, or reverse the
progression of virus infection. Natural products have proven to be the most effective in terms of their
ability to act as an antiviral. In the present study, the antiviral potentiality of the bioactive compounds
derived from aqueous extract of two Egyptian marine seaweed species (Cystoseiramyrica and Ulva
)were assessed on different viruses. Materials and methods:these two species were collected
from Hurghada at the Red Sea and Al-Agami area in Alexandria Mediterranean Sea, Egypt.The assay
of cytotoxicity and antiviral activity by MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenlytetrezolium
bromide] and by neutralization methods were conducted. Results:these two species have a bioactive
compound affected hepatitis A virus (HAV-H10), Coxsackie B4 virus,herpes simplex virus types-1
(HSV-1) and type2 (HSV-2), grow and cytopathic effect (CPE) in Vero cells.
Keywords: Antivirus, Marine seaweed, Cystoseiramyrica, Ulva lactuca, Hurghada, Red Sea, Al-
Agami, Alexandria, Egypt.

syncytial and influenza viruses have been
For thousands of years,algae resources
have been sought ability to prevent disease and

prolong life was a belief.Seaweeds are
potentially excellent sources of bioactive
macroalgae from Mediterraneancoasts remains
metabolites that could represent useful leads in
partially unexplored. Many chemically unique
the development of new functional ingredients
compounds ofmarine algae with antimicrobial
in cosmetic andpharmaceutical industries.
activity have been isolated and a number of
Their derived chemical compounds have a
them are underinvestigation and/or are being
developed as new pharmaceuticals such as
activities.Already, they are used as herbal
medicine, fertilizer, fungicides, herbicides and
polysaccharides, peptides, proteins, acrylic
direct sources in human nutrition too1,2.
acid, terpenes, chlorophyllides,phenols and
Traditional and modern medicines
heterocyclic carbons etc.8,9. The present
have relatively exhausted most of their
investigation was per-formed with the
resources in land plants. However, the marine
following objectives: To evaluate the antiviral
environment by its biological and chemical
activity of the two seaweeds as well as to
diversitycan be a source of new types of agents
reveal the chemical constituents in the two
against cancer and infectious diseases3,4.
seaweeds using GC-MS, IR and NMR)
novelcompounds have been isolated from

marine organisms and many of these
substances havebeen demonstrated to possess

interesting biological activities5,6.
Collection and identification of seaweeds:
In particular, antiviral effects of
The studied algal species were
sulfated polysaccharides and terpenes from
collected from the coastal areas of Hurghada
marine seaweeds against a variety of enveloped
viruses, such as Herpes Simplex Virus type 1
Mediterranean Sea Egypt. Algal samples were
cleaned of epiphytes, and necrotic parts were
Immunodeficiency Virus (HIV), human
removed. Then, cleaned samples were rinsed
cytomegalovirus, dengue viruses, respiratory
with sterile water to remove any associated
Received: 20/08/2016 DOI : 10.12816/0029034
Accepted: 28/08/2016

Full Paper (vol.64 paper# 17)

Abstract The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 430- 435

Screening For Antiviral Activities of Aqueous Extracts of
Some Egyptian Seaweeds
Shaimaa Ashour Abdel-Latif Zaid1, Kouka Saad El-Din Abdel-Wahab2, Nermine N. Abed3,
Enas Kamal Abo El-Magd 2, Rawheya Abdel-Latif Salah El-Din3
1Microbiologist at Chemistry Administration, Ministry of Trade and Industry
2Microbiology Department, Faculty of Medicine for Girls, Al-Azhar University
3Botany and Microbiology Department, Faculty of Science for Girls, Al-Azhar University

Background: aqueous extracts of six species of marine seaweed were studied as antiviral activity
on different viruses. Materials and methods: these collected from two sites Hurghada at the Red Sea
and Al-Agami area in Alexandria Mediterranean Sea Egypt and belonging to the classes Chlorophyta,
Phaeophyta and Rhodophyta were assayed for the cytotoxicity and antiviral activity by MTT [3-(4,5-
dimethylthiazol-2-yl)-2,5-diphenlytetrezolium bromide] and by neutralization methods.
Results: these extracts have antiviral activity to herpes simplex virus types-1 (HSV-1) and type-2
(HSV-2), hepatitis A virus (HAV-H10), and Coxsackie B4 virus in Vero cells with very low
cytotoxicity to the host cells.
Keywords: Antivirus, Marine seaweed, Hurghada, Red Sea, Al-Agami, Alexandria, Egypt.


Seaweeds are the most interesting
containing sea water to prevent evaporation,
algal groups because they are considered as a
sorted and carefully cleaned from associated
unique source of antimicrobial1,2, antiviral3,4,
biota, then dried at room temperature and
antifungal5, anti-allergic6, anticoagulant7,
ground to a fine powder before performing
antitumer8,9,10,11, antifouling12 and antioxidant
extraction. Samples were identified according
to Nasr and Aleem14,15. Samples were stored
The present study was aimed to
in dry cold place until performing extraction.
examine the antiviral activity of aqueous
Crude extract preparations from seaweed
extracts of six seaweed species that were
Sixty gm of each dried seaweed
collected from two locations: Alexandria on
sample were weighed, crushed by an electric
the Mediterranean Sea and Hurghada on Red
blender jar to get the fine powder, and then
sea shores. The chosen viruses in Vero cell
the powder of dried seaweeds was extracted
cultures and had cytopathic effects. They
with 100ml of water in one liter flask for 24h
were grew herpes simplex virus types 1
at 45°C with ground stopper. Then the water
(HSV-1), herpes simplex virus types 2 (HSV-
was filtered through a filter paper. The
2), hepatitis A virus (HAV-H10), and
aqueous extract was evaporated by rotary
Coxsackie B4 virus.
evaporator and the residues were completely

dried to constant weight by placing it in a
porcelain dishes inside desiccators with
Seaweed collection and identification
calcium carbonate. Then the powder was
Six seaweeds species belonging to
stored at -12°C till further uses. Five grams of
the residue was dissolved in 100ml of sterile
Phaeophyta and Rhodophyta), including
distilled water to make 5% seaweed
Sargassum latifolium, Cystoseira myrica,
suspension. They were filtered and then, the
Turbinaria ornate, Jania rubens, were
filtrate was used for the antimicrobial test as
collected from Hurghada Red Sea, while,
described by Meisner et al.16.
Ulva lactuca and Codium tomentosum were
Determination of extract cytotoxicity
collected seasonally from two sites Hurghada
For cytotoxicity assay, aqueous crude
at the Red Sea and Al-Agami area in
extracts were prepared individually from the
Alexandria Mediterranean Sea, Egypt from
collected algae. The procedure described by
on November 2009 to January 2011 with
Van den Berghe et al. was applied17.
temperature average from 25°C to 37°C.
Antiviral activity test
Samples were washed in seawater
The first step to determine each virus
and delivered to the laboratory in plastic bags
titre and to prepare a dilution that contains
Received: 22/08/2016 DOI : 10.12816/0029035
Accepted: 30/08/2016

Full Paper (vol.64 paper# 18)

c:\work\Jor\vol64_19 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 436- 449

The Protective Effect of BM Transplantation on Liver Tissue by a
Chemical Carcinogen or - Radiation in Rats.
Fatma A. Eid 1,Neamat H. Ahmed 2,Somia Z. Mansour 2 and Manal A. Ahmed3
1Zoology Department, Faculty of Science, Al-Azhar Univ.2National Center for Radiation Research
and Technology 3Umm-El-Atebaa-Hospital, Dokki, Giza


Aim of work: this work aimed to study the biochemical and histopathological changes in
the liver of male albino rats post exposure to 6Gy of gamma radiation and the possible protective
effect of bone marrow(BM) transplantation on the liver tissues by a chemical carcinogen ferric
nitrilotriacetate (Fe-NTA) or - radiation in rats.
Materials and methods:in this study, thirty six healthy and active male albino rats about 120 grams
in body weight were used. The animals were housed in plastic cages under normal temperature,
pressure, humidity and good ventilation conditions during the whole period of the experiment . The
animals were fed on a standard pellet diet and water.Animals were categorized into six groups and
served as the following groups: control, gamma irradiated(R), Fe-NTA, BM+R, BM + Fe-NTA and
Results: the present results suggested that exposure to -radiation or Fe-NTA induced a
significantly disturbance in the liver functions and structure. They increased significantly the
oxidative stress and decreased significantly the antioxidants tissues and they also increased necrotic
and apoptotic cells in rat's liver tissue.
Bone marrow transplantation either after whole body gamma-irradiation or Fe-NTA treatment
restored the liver functions and structure.BT also
ameliorated the oxidative stress and antioxidative markers.
The histopathological observations recorded some amelioration in the apoptotic and necrotic
evaluation in liver tissue.
Keywords: - Radiation, ferric nitrilotriacetate, bone marrow,rats.


Ionizing radiations cause similar damage at
nitrilotriacetate (Fe-NTA), a free radical
the cellular level. Gamma rays and neutrons
generating compound, is formed by the
are more penetrating, causing diffuse damage
interaction of iron and nitrilotriaceticacid [4]. It
throughout the body (e.g. radiation sickness,
is asynthetic chelating agent used in various
cell's DNA damage, cell death due to
countries as a constituent in detergents and it
damaged DNA, increasing incidence of
is known to catalyzes in vitro hydroxylradical
cancer) rather than burns. The most biological
production from H2O2 more efficiently than
damaging forms of gamma radiation occur in
does Fe(III) [5].
the gamma ray window, between 3 and 10
Fe-NTA has been shown to induce hepatic
Megaelectron-volts (MeV) [1].
oxidative damage in HepG2 cells [6].Fe-NTA
When male Wistar rats were exposed to a
induced hepatotoxicity in rats and increased
single dose of 6 Gy whole body gamma
values of
alanine transaminase
radiation, the results showed a highly

significant increase in the levels of plasma
[7].The prevention of Fe-NTA induced
ASTand ALT during three weeks post-
hepatotoxicity by vitamin E has also been
irradiation [2].Exposure of rats to both doses (1
reported by Agarwal et al. [8].
& 6Gy) of gamma radiation induced a
Vossen [9]and El-Ganzuri et al.[10].reported
significant increase in plasma AST and
that autologous or syngeneic and allogeneic
ALTlevels as a dose dependent manner after 2
bone marrow transplantation (BMT) is
hours, 2 days till 2 weeks postirradiation.
increasingly used in the therapy of lympho-
Similar results were reported by Ramadan et
hematopoietic and solid malignancies, as well
al.[3]after 1 and 6 days post irradiation at dose
as in non-malignant disorders such as
levels of 2 and 6 Gy in male rat. Ferric
thalassemia and immunodeficiency .Also, the

preclinical and clinical study demonstrated
Received: 23/08/2016 DOI : 10.12816/0029036
Accepted: 31/08/2016

Full Paper (vol.64 paper# 19)

c:\work\Jor\vol64_20 The Egyptian Journal of Hospital Medicine (Jul. 2016) Vol. 64, Page 450- 453
Autonomic Cardiac Changes in Temporal Lobe Epilepsy
Samia Ashour Mohammad1 , Ahmed Abdul Monem Gaber2 , Lobna Mohammad Elnabil3 ,
Walid AbdElAziem Elhammady4 ,Maha Aly Mohamad Nada5
1 Professor of Neurology -Faculty of Medicine, Ain Shams University.2 Professor of Neurology
-Faculty of Medicine,Ain Shams University.3 Professor of Neurology -Faculty of Medicine, Ain Shams
University. 4Professor of Cardiology -Faculty of Medicine, Ain Shams University.
5 Assistant professor of Neurology -Faculty of Medicine,Ain Shams University.
Correspondence: Raymond SalehShehata. Specialist of neurology , eltalaba hospital , Ain Shams university.
Raymondsaleh@yahoo.com. 6532223210

Background: e
pileptic patients suffer from many autonomic symptoms either during the seizure or in between
seizures. Interictal autonomic cardiac changes may cause arrhythmia which may be life threatening.
Aim of the work: to recognize the presence of cardiac autonomic changes in patients with temporal lobe
epilepsy and to find the relation between autonomic cardiac changes and different variables.
Patients and methods: Twenty patients with well controlled TLE and twenty patients with uncontrolled TLE
were subjected to standard 12-lead ECG and 24 hour holter ECG.
Results: QTc was significantly shorter in patients with uncontrolled TLE than in patients with well
controlled TLE. Patients with uncontrolled TLE had a faster heart rate than patients with well controlled
TLE. Patients with uncontrolled TLE showed significant less SDNN, rMSSD and PNN50 than those with
well controlled seizures.On the other hand, LF and LF/HF ratio was significantly more in uncontrolled
group than the controlled group.
Conclusion: There is an interictal alteration in autonomic control of the heart in TLE. This alteration is
corrected with proper control of seizures
Keywords: -epilepsy, QT interval, Autonomic, ECG.
Abbreviations:- TLE temporal lobe epilepsy, ECG electrocardiogram, SDNN Standard deviation of all
normal RR intervals in the entire 24 hr ECG recording,PNN50Percent of difference between adjacent
normal RR intervals that are greater than 50 msec,rMSSDRoot mean square successive difference,LF
low-frequency , HF high frequency.SUDEP sudden unexpected death in epilepsy.


Approximately 1% of the population
Periictal and interictal ECG changes in
has epilepsy, the second most common
different types of epilepsy were found in up to
neurological disorder. Different autonomic
60% of epileptic patients and these findings are
symptoms can be observed during seizures or
variable including QT, QTc and PR
precede epileptic seizure 1.
abnormalities of various degrees. This finding
Epilepsy has widespread effects on the
suggests that the effect of epilepsy on the heart
heart. These effects range from subtle
is not only at the time of seizure but also in
decrease in heart rate variability that is
between seizures4.
detected only with 24 hours ECG monitoring
Clinical evaluation of autonomic
to life threatening tachyarrhythmia or heart
nervous system in patients with epilepsy is so
block. Sudden unexplained death in epilepsy
important because it may help in distinguishing
(SUDEP) is suggested to be due to the effect of
a group of people at greater risk of SUDEP5,6.
epilepsy on autonomic control on the heart2.
Normal heart rate variation depends on
Assessment of interictal heart rate and
blood pressure suggest that the function of the
sympathetic and parasympathetic effects on the
parasympathetic and sympathetic nervous
heart which induces heart rate oscillations at
systems are diminished among patients with
different rhythms. Analysis of HRV is a non-
epilepsy, as compared with a control
invasive method for the assessment of
population 3.
autonomic cardiac control7,8.

Received: 23/08/2016 DOI : 10.12816/0029037
Accepted: 31/08/2016

Full Paper (vol.64 paper# 20)