c:\work\Jor\vol65_1 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 454- 467

Role of Vitamin D in the Induction of Regulatory T Cells Producing
Interleukin 10 in Children with Cow Milk Allergy
Randa Reda Mabrouk1, Han2a Ahmed Amer1,Dina Ahmed Soliman2,Nesrine Aly
Mohamed4,Dalia Helmy El-Ghoneimy3,Sara Mohammad Atef
1Chemical Pathology, 3 Clinical and Chemical Pathology, 3Pediatric, Faculty of Medicine ­ Ain
Shams University
Corresponding author: Sara Mohammad Atef mostafa.e-mail:drsara15181@yahoo.com.

Various populations of regulatory T cells play a central role in the development of
peripheral tolerance to allergens. Culturing of CD4+ T cells isolated from peripheral blood of allergic
patients with vitamin D induces the generation of stable IL-10 producing CD4+CD25+ Treg cells
suppressing the proliferation of T helper cells obtained from the same patients. The immune
regulatory role of vitamin D in allergic patients has been controversial and obviously needs a more
clarifying research work. Aim of the work: to determine the percentage of induced T regulatory cells
producing interleukin 10 after stimulation of T regulatory cells with cow milk allergen in the presence
of vitamin D in culture. This aims to further in-vitro study the immune regulatory role of vitamin D in
cow milk allergic patients. Results: there is association between decreased level of vitamin D and
milk-allergy, as serum level of 25(OH) D3 was insufficient in 16 (80 %) patients (10- 29.9 ng/ml)
while 4 (20%) patients were sufficient (30-100 ng/ml). Addition of vitamin D, in culture, induces the
production of CD4+ CD25hi Foxp3+ IL10+ .
Treg cells within peripheral blood mononuclear cells (PMNCs) isolated from allergic children who
had insufficient vitamin D, but not in allergic children who had normal level of vitamin D.
Conclusion: this work provides further evidence for an important role of 1,25(OH)2D3 as an
immune-modulatory molecule and suggests that supplementation of vitamin-D-deficient individuals,
who are reported to have reduced numbers of circulating and Foxp3+ IL10+ Treg cells, may represent
an attractive therapy for enhancing endogenous populations of Treg cells in allergy.
Keywords: Regulatory T cells, calcitriol, food allergy.


Various populations of regulatory T cells play a
allergen-specific immunoglobulin-E 3. Cow milk
central role in the development of peripheral
allergy is believed to be either IgE-mediated in
tolerance to allergens and also in successful
which activation of milk-specific Th cells leads
to the production of milk-specific IgE, or non
immunotherapy which represents the single
IgE-mediated that may include T cell/mast cell
curative treatment in allergic diseases1. T
interaction with secretion of inflammatory
regulatory cells are classified to natural T
cytokines including IL-4 and IL-5. Decreased
regulatory cells and induced T regulatory cells.
Treg activity has been identified as a factor in
The natural T regulatory cells (nTreg) are self
both allergy mechanisms 4. Shreffler and
antigen specific CD4+ T cells that express
colleagues (2009) 5 showed that children, who
CD25+ in high levels and forkhead box protein
were allergic to cow milk and become tolerated,
(FOX) that are selected in the thymus, and
had high percentage of milk-specific CD4+
become regulatory T cells in the periphery. The
CD25+ Treg cells in their peripheral blood with
induced-T reg cells (Treg-1) are converted from
high in-vitro proliferation activity when
naļve T cells after encountering specific antigen
stimulated with cow milk protein. Xystrakis et
in the periphery and are characterized by
al. 6 previously reported that culturing of CD4+ T
cells isolated from peripheral blood of atopic
Regulatory T cells inhibit the activation of T-
patients with vitamin D induces the generation of
helper cells (Th), mast cells, basophils and
stable IL-10 producing CD4+CD25+ Treg cells
eosinophils thus minimizing the production of
suppressing the proliferation of T helper cells
interlukin-4 (IL-4) and IL-5 which are essential
obtained from the same patients. They confirmed
cytokines during the allergic reactions. In
the immune regulatory role of vitamin D in
addition, Treg also act on B lymphocytes to
atopic patients. However the role of vitamin D in
suppress the production of
Received: 1/7/2016 DOI : 10.12816/0033753


Full Paper (vol.65 paper# 1)

c:\work\Jor\vol65_2 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 468- 473
Use of Onion and Curcumin as Radioprotectors against Ionizing Radiation
Induced Hepato-Testicular Alterations in Rats
Amal A. A. Ammar
Medical and Radiation Research Department,Nuclear Materials Authority, Cairo, Egypt

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. Onion, Allium cepa linn, is a major source of
dietary flavonoids and has used since ancient times as a food plants. Curcumin is a yellow pigment from
curcuma longa, is a major component of turmeric and has commonly used as a spice and food coloring
materials. Aim: the aim of the present study is to evaluate the radioprotective role of both onion and curcumin
extracted as antioxidant against gamma irradiation that induced some biochemical alterations in rats.
Materials and Methods:
animals were pretreated with onion or curcumin by orally administration using
suitable stomach tube for two weeks prior to radiation exposure. The levels of malondialdhyde (MDA),
glutathione content (GSH), superoxide dismutase (SOD), glutamic oxaloacetic transaminase (GOT), glutamic
pyruvic transaminase (GPT) and testosterone were estimated in both serum and tissues. Results: the results
revealed that exposure to ionizing radiation resulted in significant elevation in the levels of MDA, GOT
and GPT activities, meanwhile, showed significant depletion in GSH content and SOD activity and
testosterone concentration. Conclusion: administration of onion or curcumin by using suitable stomach
tube pre-irradiation has significantly ameliorated the radiation induced disturbances in all of the
investigated parameters.
Ionizing Radiation, Onion, Curcumin and Antioxidants.


Ionizing radiation has a diversity of
attention in identifying novel, nontoxic,
effective and convenient compound to protect
radiotherapy as an important treatment modality
humans against radiation-induced normal tissue
for a wide variety of tumors, radiographs for
screening, diagnosis and staging of diseases and
The development of radioprotective agents
malignancies, but its acute side effects on the
has been the subject of intense research in view of
normal tissues limit the effectiveness of therapy1.
their potential for use within a radiation
Scientific and technological advancements
environment; however, no ideal, safe synthetic
have further increased the radiation burden in
radioprotectors are available to date, so the search
humans, because exposure to low levels of
for alternative sources, including plants, has been
radiation has become common during space or air
ongoing for several decades5.
travel, cosmic radiation and using certain
Fortunately, there are many plants derived
electronic gadgets. Other sources of radiation
natural antioxidants that interfere with free radicals
include radon in houses, contamination from
before they can damage the body. Antioxidants
weapons testing sites and nuclear accidents2.
work in several ways by reducing the energy of the
It is well known that ionizing radiation
free radicals, stop the free radical from forming in
induce oxidative stress on target tissues, mainly
the first place, or interrupt an oxidizing chain
through the generation of reactive oxygen species
reaction to minimize the damage of free radicals6.
(ROS) resulting in imbalance of the pro-oxidant
The fresh flavors of onions and other
and antioxidant in the cells, attack diverse
members of the Allium genus are produced by
cellular macromolecules such as DNA, lipids and
enzymatic decomposition of Salkyl and
proteins, eventually inducing cell death3.The
SalkenylLcysteine Soxides from which the
range of antioxidant defense available within the cell
primary products are thiolsulfinates containing
and in the extracellular fluid should be adequate to
alkyl and alkenyl substituents (alkyl and
protect oxidative damage. Free radicals are believed
to play a role in more than sixty different health
precursors of the onion are (+)Smethyl,
conditions, including the ageing process, cancer,
(+)Spropyl, and (+)S(lpropenyl)Lcysteine
radiation damage, atherosclerosis4.
Soxide, with the last amino acid predominant.
Owing to the harmful effects of ionizing
Enzymatic decomposition of the propenyl
radiation, radiobiologists have long been paying
derivative yields the characteristic transitory
Received: 3/7/2016 DOI : 10.12816/0033754
Accepted: 7/7/2016

Full Paper (vol.65 paper# 2)

c:\work\Jor\vol65_3 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 474- 478

Ameliorative Effect of Vitamin E on Oxidative Stress Induced by
Bisphenol A in Female Albino Rats
Eman G.E Helal1, Neama M. Taha2, Ahmed M. mohamed3, Hoda M. Abu-Taleb4
1Zoology Department, Faculty of Science, Al-Azhar University, 2Physiology Department, College of Medicine, 3Umm
Al-Qura University, KSA, 3Clinical Pharmacology Department, Faculty Of Medicine, Zagazig University,4Department
of Environmental Research, Theodor Bilharz Research Institute, Cairo, Egypt.
*Corresponding authors: Eman G.E. Helal,email:emanhelal@hotmail.com

Objective: O
xidative stress is induced by bisphenol A (BPA) and affects many organs. Vitamin E is an effective
antioxidant which prevents the activity of free radicals. This study was aimed to clarify the effect of vitamin E on the
oxidative stress induced by chronic administration of BPA.
Materials and methods: 30 female albino rats were divided into 3 groups (10/each); group1: control rats, group 2: rats
treated with bisphenol A (20 mg/ kg.B.wt) for three months, and group 3: rats treated with bisphenol A (20 mg/kg.B.wt) for
three months, then treated with BPA and vitamin E (0.57/100 g B.wt) for other 15 days. Results: BPA induced hormonal
disrupt in liver and kidney dysfunctions and hyperlipidemia. Vitamin E ameliorated all these parameters. Conclusion: since
we exposed to many harmful disruptions and oxidative stress compounds, we must take vitamin E as a protective agent.
Key words: BPA, vitamin E, sexual hormone, liver, kidney, lipids.


Bisphenol A is one of the environmental contaminants
conditions (12 hour light/dark cycle, the temperature was
widely used in the manufacture of polycarbonate plastic
23±3°C, and compressed food and water was available ad-
(e.g.water and baby bottles), inside coating in metallic food
libitum) for about 15 days before the onset of the
experiment for adaptation.
Hence, it becomes an integrated part of the food chain. It
Drug and dose:
also found in polymers that are used in dental materials.
(a) Bisphenol-A
Human exposure mainly occurs through diet as polymers
containing BPA can be hydrolyze under high temperature
dissolved in sesame oil and orally administered. BPA was
and acidic or basic conditions. Exposure may occur
purchased from Sigma Chemical Co. (St Louis, MO,
through dermal contact with thermal papers used widely in
USA). The dose of BPA was calculated according to
cash register receipts1.
Takahashi and Oishi4.
BPA is a chemical switch in endocrine process,

reproduction and development. It acts like a hormone,
Experimental design:
altering cellular function. It is absorbed in the
Experimental animals were divided into three groups
gastrointestinal tract after ingesting products packed in
(10/each) as follows:
plastic containers. It causes liver damage, thyroid disorder,
Group I (Control group): Normal female albino rats
diabetes mellitus type 2 and pancreatic damage2.
(without any treatment) for 105 ± 2 days. Group II
Vitamin E is a potent scavenger of free radicals and is able
(Bisphenol-A group): Female albino rats were orally
to prevent the membrane damage caused by free radicals3.
administered with 20 mg BPA /kg. B.wt/day for 105 ± 2
The present study was performed to evaluate the effect of
days. Group III (Stem cell Enhancer treated group):
vitamin E on the hazardous damage of BPA on some
Female albino rats were administered with 20 mg BPA /kg.
physiological parameters.
B. wt/day for 105 days with concomitant orally

administered by Vitamin E (0.57mg /100g B. wt /day) at
the last 15 ± 2 days.
Experimental animals
Blood samples collection: At the end of the experimental
Thirty female albino rats of Sprague Dawley strain,
periods (105±2 days, those rats that had reached the stage
weighing 100-120 g, at the age of 6-8 weeks were
of diestrus), the overnight fasted animals (14 h) were
purchased from Theodore Bilharz Research Institute, Giza,
anesthetized by ether, and blood samples were collected
Egypt. Animals were kept under observation at control
from retro-orbital sinus in a clean centrifuge tubes and left
Received: 11/7/2016 DOI : 10.12816/0033755
Accepted: 17/7/2016

Full Paper (vol.65 paper# 3)

c:\work\Jor\vol65_4 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 479- 490

Clinical Utility of Procalcitonin in The Prediction of Cardiovascular
Complications in Patients with Type 2 Diabetes Mellitus
Hanaa Hamdy1,Wafaa Ghoneim2, Hatem Abdelmonem2,Ibrahim Ali3 ,Marwa Emam3
1 Hormones Department,National Research Center,2Biochemistry Departments, Faculty of Science,
Helwan University, 3Biochemistry Department, National Institute of Diabetes and Endocrinology

this study was initiated to assess procalcitoninas prognostic marker forcardiovascular
complication in type2 diabetic patients.
Subjects and methods:
forty type 2 diabetic patients without cardiovascular disease, forty type 2
diabetic patients with cardiovascular disease and twenty healthy control counterparts were included in
the present study. Serum procalcitoninlevels were assayed and correlated with metabolic
parameters.ROC curve analysis was also done for this biochemical marker.
the mean level of procalcitonin was 707.17± 99.19ng/l in diabetic subjects versus 881.30±
123.56ng/l for the cardio-diabetic subjects (P < 0.0001).Procalcitonin levels were significantly
amplified in the cardio-diabetic patients with increasing C-reactive protein (CRP), triglycerides (TG),
fasting blood glucose (FBG),and cholesterol (P = 0.004, 0.0005, 0.002 and 0.01 respectively). From
ROC curve analysis, it was observed that the area under curve for procalcitoninwas 0.878. This finding
indicates the good validity of the above biomarker as aprognostic factor for cardiovascular
complication in type 2 diabetic patients.
this study evidences the usefulness of measuring serum levels of procalcitoninin diagnosis
of cardiovascular complication in type 2 diabetic patients.
Keywords:procalcitonin, diabetes mellitus, cardiovascular complications,prognosis.


cardiovascular (CV) disease especially coronary
Diabetes mellitus is a chronic disease that
artery disease7.
affects 415 million people worldwide and 5
CRP and procalcitonin (PCT) are well known
million people died from diabetes-related
acute inflammatory markers that have been used
as markersof infection8.These two indicators are
(T2DM) is characterized by hyperglycemia,that
easy to be detected, reliable and inexpensive,
results from lack of endogenous insulin or
and they are used for the diagnosis and follow-
resistance to the action of insulin in muscle, fat
up of several diseases8,9.
and liver in addition to an inadequate response
PCT is produced during bacterial infections,
by the pancreatic beta cells2.
sepsis and cardiogenic shock, major surgery,
T2DM isconsiderd as a risk factor for
burns, multiple trauma, and after cardiac
cardiovascular disease (CVD). This is due to a
surgery10,11. It is a 116-amino acid hormone that
complex group of risk factors associated with
is implicated in calcium metabolism, firstly
identified as prohormone of calcitonin, and is
synthesized by the medullary C-cells of the
thyroid gland12,13,14. Even thyroidectomized
inflammation and adipose tissue-derived factors
subjects have a PCT response during acute
3, 4, 5. Worthmentioning , the changes in the mass
inflammation15indicating that there are other
and metabolism of adipose tissue may be
probable origins of PCT production.
accompaniedwith insulin resistance and visceral
Some researches have suggested that PCT may
obesity commonly associated with T2DM6.
be produced by other tissues like liver and
Inflammatory mediators play an important role
inflammatory cells 16,17. The inflammatory
in the pathogenesis of cardiovascular (CV)
response is a key feature of acute coronary
disease.In particular, acute coronary syndrome
syndrome (ACS) and myocardial infarction
(ACS), is an inflammatory disease and the
(MI). In acute myocardial infarction(MI), signs
serum levels of inflammatory factors, such as
of inflammation are well identified and
interleukin (IL)-6, IL-18 and C-reactive protein
enhanced levels of acute phase reactants have
(CRP) are used to identify patients with
been found to be paralleled by a worse short-
and long-term prognosis18. Signs of a systemic
Received: 10/7/2016 DOI : 10.12816/0033756
Accepted: 17/7/2016

Full Paper (vol.65 paper# 4)

c:\work\Jor\vol65_5 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 491- 497
Chemerin Novel Biomarker As a Prognostic Factor for Cardiovascular
Complications in Type 2 Diabetic Patients
Hanaa Hamdy1,Wafaa Ghoneim2, Hatem Abdelmonem2, Ibrahim Ali3, Marwa Emam3
1 Hormones Department, National Research Center, Giza (Egypt), 2Biochemistry Departments, Faculty
of Science, Helwan University, Cairo (Egypt),3Biochemistry Department, National Institute of Diabetes
andEndocrinology, Cairo (Egypt).

the present study was aimed to assess chemerin as prognostic factor forcardiovascular
complications in type2 diabetic patients.
Patients and methods:
forty type 2 diabetic patients without cardiovascular disease, forty type 2
diabetic patients with cardiovascular disease and twenty healthy control counterparts were included in
thepresent study.Chemerinlevels were assayed and correlated with clinical pathological
parameters.ROC curve analysis was also done for this biochemical marker.
the mean level of chemerinwas 57.65± 15.69 ng/l in diabetic subjects versus 93.97 ± 26.62 ng/l
for the cardio-diabetic subjects (P < 0.0001).The chemerin levels were significantly elevated in the
cardio-diabetic patients with increasing-reactive protein(CRP), triglycerides(TG), fasting blood glucose
(FBG), glycated hemoglbin(HbA1C), micro-albumin and cholesterol (P < 0.0001, P < 0.0001, P =
0.005, P=0.04, P=0.011andP=0.0001 respectively). From the ROC curve analysis, it was observed that
the area under curve for chemerin was 0.877. This finding indicates the good validity of the above
biomarker as aprognostic factor for cardiovascular complication in type 2 diabetic patients.
it could be concluded that chemerin can be used as prognostic biomarker for
cardiovascular complications in type 2 diabetic patients.
Keywords:chemerin , diabetes mellitus,cardiovascular complication,prognosis


Diabetes mellitus is a chronic disease that
link between obesity, insulin resistance and
affects 415 million people worldwide and 5
cardiovascular diseases 10, 11.
million people died from diabetes-related
Chemerin is considered a proinflammatory
complications1.Type 2 diabetes mellitus(T2DM)
cytokine that activates immune cells and
is characterized by hyperglycemia,that results
contributes to inflammation by activating
from lack of endogenous insulin or resistance to
macrophage adhesion to vascular cell adhesion
the action of insulin in fat, muscle, and liver in
molecule-1(VCAM-1) and fibronectin12. It is
addition to an insufficient pancreatic beta cell
not only a marker of vascular damage13, 14 but
response 2.
T2DM is considered as a risk factor for
addition,chemerin is related to glucose, and lipid
cardiovascular disease (CVD). This is due to a
metabolism, inflammation, and adipogenesis.
complex group of risk factors associated
All of these lead to the development of cardio-
resistance, hyperglycemia, hyperinsulinemia,
patients,especially atherosclerosis 11,16,17.
diabetic dyslipidemia, systemic inflammation

3,4,5.Worthmentioning,the Changes in the mass
and metabolism of adipose tissue may be
cardiovascular disease (cardio-diabetic group)
accompanied with visceral obesity and insulin
and forty type 2 diabetic patients without
resistance commonly associated with T2DM6.
evidence of CVD (diabetic group) were
Adipocyte is considered as an active endocrine
included in the current studyand collected from
organ and secretes a large number of bioactive
clinic,s national institute of diabetes and
mediators (adipokines)that signal to the brain,
endocrinology. In addition, , twenty apparently
liver, skeletal muscle, and the immune system,
healthy subjects with no history of type 2 DM,
the important metabolic organs in the body 7,8.
other endocrine dysfunctions, hyperlipidemia,
These adipokines include omentin-1, visfatin,
hypertension, or coronary heart diseases were
and chemerin8, 9. Dysregulation of pro-
enrolled in the study and served as controls.
inflammatory and antiinflammatory adipokines
Patients in the group without vascular disease
secretion in obesity may serve as a pathogenic
were T2DM patients who had no history of
Received: 12/7/2016 DOI: 10.12816/0033757
Accepted:1 9/7/2016

Full Paper (vol.65 paper# 5)

c:\work\Jor\vol65_6 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 498- 503

Facial Dimploplasty: Open Surgical Access Case series
Muhammad Helal, Khalid Al-Shareef, Mohamed Abdelaaty, Shatha ALqahtani

Plastic Surgery Department, King Faisal Medical Complex, Taif, KSA


Background: Facial dimples are common findings in the human face and always have been considered
a sign of facial beauty.
With the increased awareness of plastic surgery ,there are also an increased in the willingness to
have surgically created dimples. Multiple surgical techniques have been described for creating facial
The open surgical technique for facial diploplasty gives proper visual access for mimicking the
natural dimples rather than the blind coring of the tissues or the transcutaneous sutures as both are
associated with more risk of unwanted complications or side effects.
Key words: Dimple, dimple surgery, sutures


Dimples are frequent dents in the human

face, as they usually show up on the more
mobile areas about the cheeks and lower lips,
Figure 1 shows one of the old non-invasive
also it sometimes appears as a constant dent in
methods of creating facial dimples.
the middle of the chin prominence (1). Cheek
Multiple surgical techniques have been
dimples is always considered as an attractive
proposed for dimple creation such as blind
facial feature in both males and females with no
coring of the tissue from the buccal mucosa to
specific predominance (1, 2), they may occur
the dermis (6), placement of non-absorbable
unilateral or bilateral and usually are genetically
suture sling between the buccinators and the
inherited as a dominant trait (3).
dermis (7), removal of punch of tissues (1) and the
The size and shape of dimples varies from
open surgical access that mimics the anatomical
one person to another and sometimes its shape
basis of the natural dimple (2).
can differ in the same individual with the change
Blind coring of the soft tissue from the
of his body weight or with the aging process,
buccal mucosa to the dermis carries the risk of
these variations can be due to the elasticity of
injury to the buccal branch of facial nerves
the soft tissues, the facial muscle tone and their
(1).Further, transcutaneous sutures can cause
cutaneous insertions (1).
puncture scars and have been reported to cause
Dimples are dynamic facial features, this
foreign body granulomas (7).
means that they show up with facial animations
In this topic, we discuss the open
and disappear upon rest. This is attributed
technique that replicates the anatomical basis of
anatomically to an abnormal insertion of the
the natural dimple.
facial muscles to the skin (2). Anatomical studies

of the cadaveric faces showed that there is a
variation of the zygomaticus major muscle that
Actually, our subjects are not considered
has bifid insertion, the inferior slip was found to
patients as dimple creation is an elective surgery
be inserted into the dermis of the buccal chin
with no underlying illness that mandates surgical
and was attributed to the occurrence of the facial
intervention, so there is no special characteristics
dimples as the skin is tethered to the contracting
for patient selection.
muscle (4). That's why all dimple creation
Our subjects were all females, with the
surgeries relay on securing myodermal
age ranging between 25 to 30 years, some were
attachment between the buccinator muscle and
married while others were not, and none of them
the dermis (2).
complained of any chronic illnesses or
Having a dimple is a frequent request by
associated co-morbidities.
many people all over the world specially the
The operation is done on a day case
females with both surgical and non-surgical
surgery basis under local anaesthia, the patient is
Received: 7/9/2016 DOI : 10.12816/0033758
Accepted: 17/9/2016

Full Paper (vol.65 paper# 6)

c:\work\Jor\vol65_7 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 504- 514
An Analysis of Micronuclei and DNA Damage Induced by Methotrexate
Treatment of Male Albino Mice
Nagla Zaky Ibrahim El-Alfy1, Amany Ibrahim Alqosaibi2, Mahmoud Fathy Mahmoud1and
Sally Ramadan Gabr El-Ashry1
1Biological and Geological Sciences Department,Faculty of Education, Ain Shams University, Cairo,
Egypt, 2 Biology Department, Science College, University of Dammam, Dammam, Saudi Arabia
* Corresponding Author: Nagla Zaky Ibrahim El-Alfy, Biological and Geological Sciences Department, Faculty of
Education, Ain Shams University, Egypt naglaelalfy@hotmail.com


Background: Methotrexate is an antineoplastic, antipsoriatic and antirheumatic agent belongs to the
group of antimetabolites and inhibits folic acid metabolism. Materials and methods: To investigate its
possible effect, sixty male mice were randomly assigned to one of four groups (one control and three
treated groups with different doses of methotrexate). Mice of groups 1, 2 and 3 were intraperitoneally
injected with 2.5, 5 and 10 mg /kg b.wt. methotrexate respectively. All the control and treated animals
were sacrificed at 24, 48 and 72 hour by cervical dislocation post treatment. Results: Micronucleus assay
results showed that methotrexate treatment induced genotoxicity in bone marrow cells, the number of
micronucleated polychromatic erythrocytes (MNPCEs) and the ratio of polychromatic erythrocytes /
normochromatic erythrocytes was gradually increased significantly (P < 0.001) by increasing dose and
time of treatment in methotrexate treated groups in comparison with the control group. An analysis of
randomly amplified polymorphism DNA-polymerase chain reaction (RAPD-PCR) showed different
ranges of DNA modifications in the treated groups after 24, 48 and 72 hour of treatment in comparison
with the control group. Results of this study indicate that methotrexate treatment induced cytotoxic and
genotoxic effect on bone marrow cells and DNA content of male albino mice even after a low dose and
single treatment. Conclusion: Therefore, the therapeutic uses of methotrexate should be restricted to a
very narrow range border.
Keywords: DNA, Mice, Methotrexate, Micronuclei, RAPD-PCR.


Chemotherapy is one of the most effective

methods for cancer treatment, but it is often
20 mg / kg b.wt.) indicated it's highly clastogenic
associated with several short and long term
effect [7]. Other in vivo
toxicities [1]. Methotrexate (MTX), is one of the
studies indicated that micronuclei induction was
widely used antineoplastic drug and it is a well
known immunosuppressant introduced for
methotrexate compared to a single treatment in
therapeutic use in the 1950s [2]. It is used against
male mice [8, 9].
a broad range of neoplastic disorders including
Goodman and Polisson[10] demonstrated that
acute lymphoblastic leukaemia, non-Hodgkin's
methotrexate caused damage to the small
lymphoma, breast cancer and testicular tumors
intestine leading to nausea, vomiting, diarrhea,
[3]. The basic principle of therapeutic efficacy of
methotrexate is due to the inhibition of
gastrointestinal ulceration in patients. Dadhania
dihydrofolate reductase (DHER), a key enzyme
et al. [11] reported that it increased the intestinal
in the folic acid (FA) metabolism, which
toxicity in rat that assessed by evaluating
converts dihydrofolic acid to tetrahydrofolic acid
different parameters of oxidative stress and DNA
[4]. The perturbation in the folic acid metabolism
leads to depletion of nucleotide precursors like
Padmanabhan et al. [12] investigated that
thymidylates and purines, which in turn inhibits
methotrexate decreased the sperm count and
DNA, RNA and protein synthesis. Methotrexate
increased the frequency of sperms with abnormal
also inhibits thymidylate synthase and the
head. Del Campo et al [13] proved that
transport of reduced folates into the cell [5, 6].
methotrexate is also a potent teratogen [13]. Belur
The induction of statistically significant number
of chromosomal aberrations and micronuclei
myleosuppressive effects of methotrexate [14].
(MN) in mice by a single intraperitoneal
This study aimed to detect the genotoxic effects
treatment with three different doses of
of MTX on mouse bone marrow cells using
methtrexate (2, 10 &
analysis of micronuclei and on DNA using
Received: 7/7/2016 DOI : 10.12816/0033759
Accepted: 17/7/2016

Full Paper (vol.65 paper# 7)

Some Pharmacodynamics of Gabapentin in Experimental Animals and in Patients Undergoing Spinal Surgeries (Pharmacological and Clinical Study) The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 515- 525

Interactions between Gabapentin and Cisatracurium in Experimental
Animals and in Patients Undergoing Spinal Surgeries
(Pharmacological and Clinical Study)
Zeinab Bayomy 1 *, Enas Abdel Aty 2 * and Mahmoud Farid 3 *
1. Professor (A) in the department of Anesthesiology & Intensive Care,2. Professor (A) in the
department of Pharmacology, 3. Professor (A) in the department of Neuro surgery, *. Faculty of
Medicine, Alazhar University.

Background: gabapentin was originally discovered over 40 years ago by the Japanese, who
initially were looking for an antispasmodic or muscle relaxant, but, later it was used as an antiepileptic and
multimodal perioperative drug. Objective of this randomized study is to assess the some cardiovascular
effects of gabapentin as well as its effect on the neuromuscular blockade induced by Cisatracurium. The
interactions between both of them was also done in cats and rats & in patients undergoing elective spinal
surgeries. Materials & Methods: The pharmacological study was carried out at the pharmacological lab
of Al-Azhar University. The effect of different doses of cisatracurium (0.25 -4 µg/ml) and Gabapentin (6-
96 µg/ml) & interactions between gabapentin (24µg/mL) and cisatracurium (0.25-4 µg/mL) were also
done to test the effect on the amplitude of contraction of isolated Rat phrenic nerve -diaphragm
preparation. Effect of intravenous (IV) injection of cisatracurium (1-16 mg/kg) and Gabapentin (15-240
mg/kg) and interactions between gabapentin (60mg/kg) and cisatracurium (1-16 mg/kg) on mean arterial
blood pressure (MAP) and electrocardiogram (ECG) were also studied on anesthetized cats. Each
experiment was done on six preparations. The clinical Study was carried out at Al-Zahraa University
Hospital on 90 patients (ASA I or II) of both sexes undergoing spinal operations were randomized into
three equal groups (30 patients) for each; one hour preoperatively they received oral capsules, group I;
gabapentin (1200mg), group II gabapentin (800mg) and group III; placebo capsules. After induction of
anesthesia with (IV) fentanyl, thiopental and cisatracurium & tracheal intubation, anesthesia was
maintained by isoflurane (0.5-2%), Patients were assessed for heart rate (HR), MAP, neuromuscular
blockade. Isoflurane concentration, fentanyl needed and cisatracurium consumption were recorded.
Results: Experimentally: In-vitro study: Cisatracurium besylate (0.25-4µg/ml) produced dose-dependent
significant reductions on the amplitude of muscle contractions. Gabapentin (6-96µg/ml) produced dose-
dependent significant reductions on the amplitude of muscle contractions at 24-96 µg/mL while the first two
doses 6-12 µg/mL have no effect. On interactions Gabapentin (24 µg/ml) produced synergistic effect on
neuromuscular blocker effect of cisatracurium (0.25-4 µg/mL). In-vivo study cisatracurium, IV, (1-16
mg/kg) produced no effect on both mean arterial blood pressure (MAP) and heart rate (HR) of
anesthetized cats. Gabapentin (15- 240 mg/kg) caused dose-dependent significant reductions on the MAP
and the HR of the anesthetized cats except the first two doses (15-30 mg/kg). On interactions Gabapentin
(60 mg/kg) potantiated the effect of cisatracurium (1-16mg/kg) and caused significant reduction on mean
arterial blood pressure and heart rate. Clinically: Gabapentin 1200mg produced highly significant
reduction in MAP&HR at pre-induction and immediately after intubation which extended for 120min. It
also prolonged the duration of neuromuscular blockade of cisatracurium 0.15 mg/kg for 100min. While
Gabapentin 800mg produced significant reduction in MAP &HR at pre-induction, immediately after
intubation which extended for 45min. It also prolonged the duration of neuromuscular blockade of
cisatracurium 0.15mg/kg up to for70min.
Conclusion: Gabapentin has a neuromuscular blocking effect on interactions Gabapentin produced
synergeistic effect on the neuromuscular blocker effect of cisatracurium. It also has considerable
hypotensive as well as negative chronotropic effect. On interactions, gabapentin potantiated the effect
cisatracurium on MAP&HR and caused significant decrease in MAP & HR on experimental animals and
on patients undergoing elective spinal surgeries.
Keywords: Cisatracurium, Gabapantin, Isolated rat phernic-nerve, Anaesthetized cats.


Spinal fusion & lumber discectomy are the
performed for patients with back and leg
most common spinal surgical procedures
symptoms associated with perioperative severe
Received: 07/8/2016 DOI : 10.12816/0033760
Accepted: 17/8/2016

Full Paper (vol.65 paper# 8)

c:\work\Jor\vol65_9 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 526- 535

Comparison of Arteriovenous Fistulae Having Blood Flow Equalto and
Higher Than 800 Ml / Min as Regards Clinical and Laboratory
Mona Hosny Abdel-Salam*, Tamer El-Said*, Ahmed Abdallah**
( * ) Internal Medicine Department , Faculty of Medicine , Ain Shams University , Cairo , Egypt
and (**) Ministry of Health , Cairo , Egypt
Corresponding author: Salamhosnymona2015@gmail.com

: According to KDOQI guidelines, the lower limit of arteriovenous fistula blood flow
accounting for 600 ml / min. We have observed that this limit was not enough, at least for our
patients. The aim of this work was to prove the hypothesis that this limit must be higher for performing
adequate dialysis.
Patiemts and methods : Fifty patients on prevalent hemodialysis were included in this study. They
were divided into 3 groups; group I: 12 patients formed low flow group, group II: 18 patients formed
moderate flow group , and group III: 20 patients formed high flow group . Complete physical
examination including clinical fistula examination for patency , were performed for all patients .
Laboratory tests performed for all patients included :urea reduction ratio (URR %) , serum calcium
,serum phosphorus , calcium ­ phosphorus product , serum albumin , hemoglobin , serum Iron ,
serum ferritin ,TIBC , Transferrin saturation (TSAT %) , Kt / V (number used to quantify hemodialysis
treatment adequacy), serum creatinine , together with blood urea before and after session . Fistula
blood flow and static venous pressure were determined by Doppler ultrasound . Fistulogram was
performed to confirm the fistula stenosis site , whenever detected by Doppler .
Results: Mineral bone profile markers , Iron profile markers , together with malnutrition ­
inflammation complex indicators , were all in favour of moderate and high flow groups ,
mainly the moderate flow group II due to the presence of much less complications than the other
groups . Conclusion: We have to try to perform arteriovenous fistulae for ESRD patients needing
regular dialysis , in such a way that fistula blood flow is above 800 ml / min , and it is better to
be within the range of 801 ­ 1600 ml / min .
Keywords : Hemodialysis ­ Arteriovenous Fistula - Stenosis - Doppler- Fistulogram


Vascular access problems are a daily occurrence
and limb ischemia . Working fistula must
in hemodialysis units. Loss of patency of the
have a blood flow adequate to support
vascular access limits hemodialysis delivery and
dialysis which equates to a blood flow
may result in underdialysis that leads to
greater than 600 ml / min 2.
increased morbidity and mortality. Despite the
Vascular access guidelines recommend routine
known superiority of autogenous fistulae over
screening for the timely detection of stenosis
grafts, autogenous fistulae also suffer from
using noninvasive methods, including clinical
frequent development of stenosis and subsequent
assessment (monitoring) and device-based
thrombosis 1 .
surveillance relying on access blood flow (Qa)
Dialysis delivery should be adequate not
and static intra-access pressure (sVPR, static
only to improve quality of life , but also to
venous pressure ratio) measurements and duplex
prolong survival . Quality of life when
ultrasound (DU) 3.
adjusted for life expectancy has defined a
The medical management of maintenance
Kt / V of 1.3 as the optimal cost ­ effective
hemodialysis patients by clinicians is usually
dialysis .An ideal access delivers a blood
based on repeated measurements of blood tests4.
flow rate to the dialyzer that is adequate for

the dialysis prescription , has a long ­life use
and a low rate of complications including :
This is a cross ­ sectional study . It was
infection , stenosis , thrombosis , aneurysm
conducted at dialysis units , Ain Shams
Received: 7/7/2016 DOI : 10.12816/0033761
Accepted: 17/7/2016

Full Paper (vol.65 paper# 9)

c:\work\Jor\vol65_10 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 536- 546

Efficiency of Hyaluronic Acid Binding Ability to Improve Sperm Selection in
Intracytoplasmic Sperm Injection (ICSI)
*Amira B.M. , *Aziza M.A. , * Ahmed K.G., ** Osama A.S., ** Bakery S.A.
* Assisted Reproduction Unit, International Islamic Center for Population Studies and Research Al-Azhar
University. **Zoology Department, Faculty of Science, Al-Azhar University.

Background: intra Cytoplasmic Sperm Injection (ICSI) is a reliable method for single sperm selection
and injection to a large number of infertile patients. Human oocytes are naturally surrounded by cumulus
cells embedded in the intracellular matrix made primarily of hyaluronic acid (HA), which plays a role as
physiological selector for Intra-Cytoplasmic Sperm Injection (PICSI). Mature spermatozoa are able to
bind to and digest HA for the best chance of reaching the oocyte and to maintain fertilization. The intact
human spermatozoa are bound to immobilize HA surrounding oocyte in vitro and this leads to reduced
risk of chromosomal imbalance or chromatin diseases.
Selection of spermatozoa by HA before ICSI may help to optimize the outcomes of the treatment; thus,
our study aimed to compare ICSI results, based on the hyaluronic acid or traditional method for sperm
selection. Setting: this study conducted at International Islamic Center for Population Studies and
Research, Assisted Reproduction Unit, Al-Azhar University from January to October 2015.
Patients and Methods: 120 couples with male factor infertility and normal wives conducted at the
Assisted Reproduction Unit in the International Islamic Center for Population Studies and Research
(IICPSR), Al-Azhar University, Egypt, during the period from January to October 2015. All cases were
clinically evaluated and eligible for analysis by using inclusion and exclusion criteria. All studied men
subjected to ejaculated sperm prepared by traditional method and another prepared by PICSI method.
ICSI performed simultaneously for different oocytes from the same woman using an ejaculated sperm by
two methods from the same husband. ICSI outcomes compared to the two sequential attempts performed,
respectively. Number and quality of oocytes, fertilization rates, rate of embryo cleavage and pregnancy
outcomes were recorded. The collected data were tabulated and statistically analyzed.
Results: the present study showed a significant increase in the incidence of fertilization rate, the
percentage of embryos with top grade in teratozoospermia and thawed semen groups with PICSI
technique compared to the traditional method of ICSI groups. Finally, the percentage of pregnancy rate an
increase in all groups manipulated with PICSI technique and this increase was statistically significant.
Conclusion: this study shed more light on the physiological sperm selection method (PICSI) which may
improve fertilization and pregnancy rates compared to the traditional selected sperm in ICSI. It is
concluded that PICSI technique in Assisted Reproductive Technology (ART) is one of the very important
technique that improve fertilization in case of low fertilization rate after ICSI.
Keywords: ICSI, PICSI, Infertility, Physiological Selector, Fertilization rate, Pregnancy rate.


ICSI has been successfully applied worldwide for
problems [1] .It should be considered that ICSI
several years, nevertheless we have no real
may increase the risk of injecting spermatozoa
knowledge regarding the hypothetical long-term
with genetic or functional anomalies [2]. For these
side effects of ICSI; since the embryologist just
reasons and to minimize any risk related to ICSI,
select a single sperm blindly and inject it into the
any new advance in this procedure that can help
oocyte. In fact, some doubts about the safety of
the operator to restore some of the basic
this technique can arise due to the fact that with
physiological checkpoints and to stimulate the
ICSI some check points of natural fertilization are
natural fertilization process should be welcome
bypassed and some steps differ considerably from
the physiological process; For instance, the
Hyaluronic acid (HA) is the main component of
introduction of the sperm tail into the ooplasm
the extracellular matrix (ECM) of the cumulus
may cause sperm nuclear decompensation
oophorous. In the fertilization process, human
Received: 8/7/2016 DOI : 10.12816/0033762
Accepted: 15/7/2016

Full Paper (vol.65 paper# 10)

c:\work\Jor\vol65_11 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 547- 552

Amelioration of Insulin Resistance in Rats Treated with Rice Bran Oil
Sohaier, A. Abd Elbast1, Laila, A. Rashed2, Mona, A. Mohamed3, Mervat, A. Ahmed1,
Elham, A. Ahmed1
1Zoology Department, Faculty of Science, Al-Azhar University (Girls), Cairo, Egypt
2Biochemistry Department, Faculty of Medicine, Cairo University, Cairo, Egypt
3Biochemistry Unit, Chemistry Department, Faculty of Science, Al-Azhar University (Girls), Cairo,

insulin resistance (IR) is a pathological condition characterized by inadequate
peripheral tissue metabolic response to circulating insulin. It plays pathophysiological role in type 2
diabetes mellitus (T2DM). High dosage of fructose in the diet (60 g/100 g diet) may induce insulin
resistance accompanied by deleterious metabolic consequences including hyperglycemia and
hyperinsulinemia. Rice bran oil (RBO), is a rich source of antioxidants especially -oryzanol, -
tocopherols and tocotrienols which contribute to high oxidative stability, longer shelf life than other
edible oils and high antioxidant property against free radicals. The present work was undertaken to
study if the addition of rice bran oil in rat's diets ameliorate the insulin resistance.
Materials and methods: to achieve this target, plasma fasting glucose, serum insulin and calculated
HOMA-IR, which assesse the presence of insulin resistance, was evaluated. Serum lipid profile
(cholesterol, triglycerides, high-density lipoprotein- cholesterol (HDL) and low-density lipoprotein-
cholesterol (LDL) was also evaluated. In addition, the oxidative stress was assessed through hepatic
malondialdehyd (MDA) as an oxidative biomarker and the antioxidant enzyme superoxide dismutase
(SOD) was also estimated.
Results: RBO ameliorated HOMA-IR, oxidative biomarker (MDA) and increased SOD activity.
Conclusion: high fructose diet induced oxidative stress which lead to insulin resistance, this was
ameliorated by addition of RBO.
Keywords: Insulin resistance, Oxidative stress, Rice Bran Oil


and oleic fatty acids and bioactive compounds
Insulin resistance (IR) is a major underlying
such as -oryzanol, phytosterols, tocopherols,
mechanism responsible for the `metabolic
and tocotrienols(4). Many studies have shown
syndrome' which is also known insulin
that, bioactive compounds in RBO have
resistance syndrome. The incidence of metabolic
therapeutic effects against diabetes mellitus by
syndrome is increasing at an alarming rate, due
reducing oxidative stress(5). The present work
to increase in the consumption of high-fructose
was undertaken to study if the addition of rice
corn syrup (HFCS). Consumption of fructose, in
bran oil in rat's diets ameliorate the insulin
the form of added sugars such as high fructose
corn syrup or sucrose, has increased markedly in

the last few years, which is strongly correlated
with the prevalence of metabolic syndrome(1).
Experimental Animal Design
High dosage of fructose in the diet (60g/100g
A total 50 adult female albino rats weighting
diet) may induce insulin resistance accompanied
140-220 g were used throughout this study. The
by deleterious metabolic consequences including
animals were purchased from the breeding unit
hyperglycemia and hyperinsulinemia(2). Rice
of the Egyptian Organization for Biological
bran oil (RBO) is an important product of rice
Products and Vaccines (Helwan, Egypt). Rats
bran extracted during rice processing industry. It
were divided into five groups (10 rats each),
is widely popular edible oil in east Asia
housed in steel cages (5/cage) at constant
countries such as China, Korea, Japan,
environmental temperature (25°C±5) and
Taiwan and Thailand(3). RBO has mild flavor,
humidity (50%±10) with dark and light cycle
high smoke point, good stability and no adverse
(12hrs). Animals were maintained for a week on
effect, that make it a suitable alternative for
a standard diet, before starting the experiment as
other used oils for industrial and culinary
an acclimatization period. Food and water were
purposes(3). Crude rice bran oil is rich in
provided ad libitum. Animals were allocated to
unsaturated linoleic
their groups according to the following scheme:
Group I
: Normal Control (NC), this group fed
Received: 17/09/2016 DOI : 10.12816/0033763
Accepted: 30/09/2016

Full Paper (vol.65 paper# 11)

c:\work\Jor\vol65_12 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 553- 567

Comparison of Immediate and Intermediate-Term Outcomes of
Intravascular Ultrasound-Guided Versus Angiography-Guided Intervention
for Type C Coronary Lesions
Ahmed Essam EL-Din Mohamed Ammar*, Mohamed Khairy Abdel Dayem,
Nabil Mahmoud Farag, Khaled Elsayed Elarabi Darahim,
Ahmed Shawky Elserafy, Haitham Galal Mohammed
Department of Cardiology, Faculty of Medicine, Ain Shams University
*Corresponding author, Ahmed Essam EL-Din Mohamed Ammar, e-mail: ahmed_ammar@med.asu.edu.eg.,
Phone: 01001500138

the intravascular ultrasound (IVUS) is an invasive access technique that allows analysis
of characteristics (qualitative and quantitative) of coronary atherosclerosis. Percutaneous coronary
intervention (PCI) of complex lesions (i.e., American College of Cardiology/ American Heart
Association class type C) remains challenging and the outcome may be compromised. The use of
intravascular ultrasound (IVUS) to guide PCI was suggested to improve outcome.
The Objectives: aim of this study was to compare intravascular ultrasound-guided and angiography-
guided Intervention for Type C coronary lesions regarding major adverse cardiac events (MACE).
Patients and Methods:
Our study was conducted on patients undergoing elective PCI for type C
coronary lesions in Cardiology Department in Ain Shams University hospitals. The study included 50
patients who underwent IVUS guidance PCI for Type C lesions and 50 patients who underwent only
angiographic guidance PCI for Type C lesions. We evaluated the impact of IVUS guidance on clinical
outcomes of patients undergoing PCI for complex lesions defined as ACC/AHA type C. Major adverse
cardiovascular events (MACE), a composite end-point of all-cause mortality, Q-wave myocardial
infarction and target lesion revascularization, were compared between the 2 groups. Mean follow-up
duration was 12 months. Results: baseline clinical characteristics were similar in both patient groups.
Adding IVUS to the procedure lengthened the procedure time. On the other hand, lower amount of
radiographic contrast was required in the IVUS guided group during the procedure. Regarding the target
coronary vessel in our study was similar in both groups with no significant difference. In addition, the
number of ostial, proximal, mid and distal lesions was similar between the two studied groups. Patients
with IVUS-guided PCI underwent more direct stenting, more postdilatation, larger maximal stent
diameter and greater number of implanted stents. Consequently, the final diameter stenosis was
significantly better in IVUS guided group. A strategy of routine IVUS for drug-eluting stent
implantation in complex coronary lesions did not improve the 1-year MACE rates.
Conclusion: use of intravascular ultrasound (IVUS) is associated with lower amount of radiographic
contrast used during the procedure, more procedural time, more post dilatation and less postintervention
final diameter stenosis. In addition, use of intravascular ultrasound (IVUS) in complex lesions allows
proper assessment of minimal lumen area, optimizing PCI procedures and confirming stent well
Keywords: intravascular ultrasound, major adverse cardiac events.


The intravascular ultrasound (IVUS) is an
(qualitative and quantitative) of coronary
invasive access technique that allows the
dynamic acquisition of tomographic imaging in
In theory, the use of IVUS could improve the
vivo of the vascular lumen and wall, being
long-term results of angioplasty with stent
considered one of the best invasive imaging
implantation. These better results derive from
methods for the analysis of characteristics
at least three factors: the confirmation that there

is no significant residual stenosis or that artery
Received: 15/7/2016 DOI : 10.12816/0033764
Accepted: 20/7/2016

Full Paper (vol.65 paper# 12)

c:\work\Jor\vol65_13 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 568- 572

Hematological and Biochemical Changes Associated with Ectopic
Pregnancy in Jazan Area Saudi Arabia
Saleh M. Abdullah1, Ahmed A. Jerrah1,Hala Mowafy2and Ahmed F. Elshaieb1
Department of Medical Laboratory Technology, Fac. Applied Medical Sciences, Jazan University.
Department of Obstetric and Gynecology, Fac. Medicine, Zagazig University.

Ectopic pregnancy (EP) is an implantation of fertilized ovum outside the intrauterine
cavity. Many cases of EP are not associated with a clinical signs at early stages that makes its
diagnosis is difficult. The confirmation of EP needs several investigations as ultrasonography and
repeated measurements of serum -hCG levels every 48 hours that make it very expensive and take a
long time so, rupture may be occurred that leads to increased maternal morbidity and mortality rates.
Thus, the aim of this study was to investigate the alterations of some hematological and biochemical
parameters associated with normal and ectopic pregnancy in addition to evaluate their efficacy in
early diagnosis of tubal ectopic pregnancy (TEP) among women living in Jazan area, Kingdom of
Saudi Arabia.
Subjects and methods:
this retrospective study was carried out on 200 women with their ages ranged
from 25­37 years old at the Obstetric and Gynecology Department of King Fahd Central Hospital and
Sabiya General Hospital during the period between March 2010 and March 2014. The subjects were
divided into three groups. Group (1) consists of 69 cases ruptured EP; Group (2) consists of 61 cases
non-ruptured by visual examination during surgery and subsequently histopathological examination,
where as group (3) consists of 70 women representing the control group having a normal intrauterine
pregnancy. Hematological and biochemical measurements were done on all groups.
: the hematological findings revealed a significant increase in mean platelet volume (MPV),
total leukocytic count (WBC) and erythrocyte sedimentation rate (ESR) among TEP patients
especially in ruptured cases in comparison with those of normal pregnancy control. A significant
decrease in hemoglobin (Hb) and packed cell volume (PCV) in TEP cases either ruptured or non-
ruptured and a non-significant changes in total erythrocytic count (RBC). The biochemical findings
revealed a significant increase in serum creatine kinase ( CK) but a significant decrease in serum -
hCG in both ruptured and non-ruptured TEP.
Conclusion: it could be concluded that theWBCs,MPV count and ESR were significantly increased
in TEP especially in ruptured cases. The MPV can differentiate between TEP and normal pregnancy
but has less clinical significance to differentiate between ruptured and non-ruptured cases. On the
other hand, the level of -hCG is an important indicator of TEP. Moreover, serum CK cannot be used
as a tool for diagnosis of TEP but may differentiate between ruptured and non-ruptured cases.

Ectopic pregnancy, Hematology, Biochemistry.

histopathological changes like endothelial
Tubal ectopic pregnancy (TEP) is
damage, inflammation and tissue hypoxia
considered one of the most important causes
[7].Spontaneous bilateral EP may be recorded
of maternal morbidity and mortality in the first
trimester all over the world, particularly when
Diagnosis of EP can be done by routine
rupture and hemorrhage occur[1]. It is a result
blood tests in addition to ultrasonography
of implantation of fertilized ovum outside the
when pain or bleeding occurs in early
intrauterine cavity[2]. The fallopian tube is the
pregnancy[9]. Such tools for diagnosis are still
most common site for EP, but abdominal and
not sufficient to predict ruptured TEP[10].
ovarian implantation were also may be
Serum -hCGis produced by trophoblasts[11].
occurred[3]. The main cause of EP is still
Moreover, the level of -hCG increased when
unknown. The incidence of EP among normal
pregnancy occurred and its estimation may
women is 1-2% of all pregnancies [4]. The
help the diagnosis of EP[12]. The increased -
incidence may reach 35- 50% among women
hCG in serum, bile, vitreous, pericardial and
cereprospinal fluid may help in diagnosis of
inflammatory disease[6]. The TEP leads to
EP postmortem [13]. Creatine kinase (CK) is an
Received: 20/9/2016 DOI : 10.12816/0033765
Accepted: 25/9/2016

Full Paper (vol.65 paper# 13)

c:\work\Jor\vol65_14 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 573- 582

Antiapototic Effect of Captopril in Cisplatin-Induced Kidney
Injury in Rats
Amany M. Gad a*; Ola M. Abd El-Raouf a; Bahia M. El-Sayeh b;
Hala M. Fawzy a; Dalaal M. Abdallah b
a Department of Pharmacology, National Organization for Drug Control and Research (NODCAR),
Giza, b Department of Pharmacology and Toxicology,
Faculty of Pharmacy, Cairo University, Cairo, Egypt
*Corresponding author: e-mail: amanygd@yahoo.com

Aim of the work:
captopril protects against cisplatin induced nephrotoxicitity; however its
potential modulatory effect on hemeoxygenase (HO)-1, antioxidants, as well as inflammatory and
apoptotic markers has not yet been verified.
Materials and methods: male Sprague-Dawley rats were divided into control (saline), cisplatin (5
mg/kg; i.p), and captopril (60 and 100 mg/kg) given 5 days before and after cisplatin (5 mg/kg; i.p)
treatment. Results:five-day pre- and post-treatment with captopril (60 and 100 mg/kg; i.p), for a total
of 10 days, dose dependently, reduced blood urea nitrogen, as well as serum creatinine and gamma
glutamyl transferase, but serum albumin and total protein levels were increased. Captopril restored
renal pro-oxidant/antioxidant balance by activating glutathione peroxidase, catalase and superoxide
dismutase, and boosting the renal glutathione content. These effects were accompanied by the
reduction in serum and/or renal HO-1, tumor necrosis factor-, monocyte chemoattractant protein-1,
nitric oxide, endothelin-1 and caspase-3. Microscopically, captopril especially at 100 mg/kg dose
level, prevented cisplatin-induced degenerative changes and inflammatory cell infiltration in the
kidney. Conclusion: captopril protects against cisplatin nephrotoxicity by its antioxidant, anti-
inflammatory and antiapoptotic potentials.
Captopril; Cisplatin; Renoprotection; Apoptosis; Inflammation.


Captopril, an angiotensin-converting enzyme
activity. El-Sayed et al. [13] showed that
inhibitor (ACEI), is widely used for the
captopril renoprotection reside, in part, in its
treatment of hypertension, congestive heart
antioxidant potential and endothelin (ET)-
failure, and diabetic nephropathy[1]. ACEIs
reduce angiotensin (Ang) II and aldosterone
that play key roles in their renoprotection [2].
multifactorial actions of captopril remain to be
In the clinical settings, captopril protects
revealed. Therefore, in the present study, the
against contrast-induced nephrotoxicity [3]and
possible modulatory effect of captopril on
improves the abnormal renal hemodynamics in
hemeoxygenase (HO)-1, some antioxidant
cyclosporine-treated patients [4]. Meanwhile, in
enzymes and inflammatory mediators, as well
the experimental studies captopril ameliorated
as the apoptotic marker caspase (Casp)-3 were
radiation, doxorubicin, adriamycin, and
cisplatin-induced nephropathy, as well as

cisplatin cardio- and cadmium testicular
toxicity [5-9].
Adult male Sprague-Dawley rats (150-200g)
captopril restored kidney functions via an
were obtained from the breeding colony and
antioxidant character linked to the sulfhydryl
maintained at the animal house of the National
(-SH) structural moiety and its ability to
Organization for Drug Control and Research
conjugate with copper , as well as the
(NODCAR; Giza, Egypt). Animals had free
preservation of the mitochondria and
access to food and water ad libitum. They
enhancement of ATP production [10&11]. Jones
were kept under controlled temperature
et al.[12]reported that captopril reduced
(23±2°C), relative air humidity (60±10 %),
cisplatin devastating effects on the rat kidney
and 12 hours of light daily. Animals were
without interfering with its antineoplastic
subjected to one week adaptation period in the

animal house before the beginning of the
Received: 11/9/2016 DOI : 10.12816/0033767
Accepted: 23/9/2016

Full Paper (vol.65 paper# 14)

c:\work\Jor\vol65_15 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 583- 591
Histopathological And Immunohistochemical Evaluation of Antifibrogenic
Effect of Grape Seed Extract on CCl4-Induced Model of Hepatic Fibrosis
Ahmed A. Tantawy1,2 , Abd El Ghany A. Moustafa1, 3 and Hussein M. Ibrahim 1,4
1 Clinical Laboratory Sciences Department, College of Applied Medical Sciences, Aljouf University, Aljouf, KSA,
2 Pathology Department, Faculty of Veterinary Medicine, Benha University, Benha, Egypt, aatantawi@ju.edu.sa,
3 Histology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt ,aamalsanaferi@ju.edu.sa,
4 Anatomy and Embryology Department, Faculty of Medicine, Ain Shams University, Egypt, hmibrahim@ju.edu.sa

Liver fibrosis represent a worldwide challenge of clinical importance, results from chronic
damage of liver, and evidenced by build up of excessive extracellular matrix proteins.. The present study
was carried out to evaluate the antifibrogenic effect of grape seed extract (GSE) against hepatic fibrosis
induced by CCl4 in mice.
Experimental Design:
forty adult male albino mice were divided into four equal groups; first (control) in
which mice were injected IP with olive oil as vehicle. In the second group (GSE) mice were received
GSE orally at a dose of 200mg/kg/day for 8 weeks while in the third group (CCl4) mice were injected IP
with CCl4 (0.4ml/kg / twice weekly) for 8 weeks . In the fourth (GSE+ CCl4) group mice were injected
IP with CCl4 and co-treated with GSE orally as in previous treated-groups. At the end of the experiment,
animals were sacrificed and blood samples and liver tissue specimens were collected.
Results: the examined liver of CCl4-intoxicated group revealed marked hepatic fibrotic lesions confirmed
by Masson's trichrome stain and associated with the presence of intensely stained -SMA-positive
hepatic stellate cells (HSCs) in entire of the hepatic lobules and in the vicinity of bridging fibrotic septa.
Hepatic degeneration and necrosis were also seen. This hepatic damage was associated with significant
increases in AST and ALT activities with low albumin levels and hypoproteinemia. Co-administration of
GSE with CCl4 improved the microscopic picture of liver where scanty fibrotic lesions and mild
degeneration of some hepatic cells were recorded. Less intensely stain
ed -SMA-immunopositive cells were observed. Serum AST , ALT, albumin and total protein values
were more or less within the ranges of these parameters in the control non-intoxicated group.
GSE has potent antifibrogenic effect on CCl4-induced hepatic fibrosis by inhibiting HSCs
activation, decreasing collagen synthesis and improving hepatic regenerative capability through its
powerful antioxidant and anti-inflammatory properties.
Liver fibrosis, Grape seed extract, Histopathology, immunohistochemistry, serum Biochemical


of these ECM are hepatic stellate cells[4].
Hepatic fibrosis is a public health
Therefore, activation of hepatic stellate cells
(HSCs) considered as an important step in liver
significant morbidity and mortality rates [1].
Liver fibrosis arises from improper tissue repair
accumulation of ECM, which finally leads to
through connective tissue deposition that occurs
liver fibrosis [5]. In addition, activated HSCs
in chronic liver injuries such as chronic viral
increase the production of alpha-smooth muscle
hepatitis, autoimmune diseases and metabolic
actin (-SMA) and collagen [6].
disorders [2]. Pathogenesis of liver fibrosis is
Liver fibrosis frequently progresses to
complex process, as hepatic injury persists,
cirrhosis, hepatic failure, portal hypertension,
regenerative response of parenchymal cells fails
and hepatocellular carcinoma [7]. In advanced
and then hepatocytes are replaced by abundant
stages of hepatic fibrosis, liver transplantation is
extracellular matrix (ECM) [3]. The main sources
the only treatment for patients. Therefore, new

strategies for anti-fibrotic therapy are essential

and using of natural by products including
medicinal plants is one of these strategies.
Received: 11/8/2016 DOI : 10.12816/0033768
Accepted: 23/8/2016

Full Paper (vol.65 paper# 15)

c:\work\Jor\vol65_16 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 592- 597

Natural Killer Cells And Their Interaction With Dendritic
Cells in Hepatitis C Infection
Aisha Yassin Abdel Ghaffar, Manal Zaghloul Mahran, Hossam Mostafa Fahmy, Dina
Elsayed Elshennawy, Dalia Youssef Samaha, Sara Ibrahim abdel Fattah Taha
Clinical pathology department-Faculty of medicine - Ain shams University

Background: Hepatitis C is a viral infection of the liver that has affected around 200 million
people globally. The immune response against HCV infection includes both the innate and adaptive arms
of immunity, with crosstalk between liver inhabitant and infiltrating cells. In the current study, we aimed
to investigate the natural killer cells activation and inhibition status, and their role in interaction with DCs
utilizing different combinations between NK cells and DCs in the presence of HCV peptides in a ratio of
5 NK: 1DC.Results: HCV NK cells upregulated both activation and inhibition markers. This could be
attributed to HCV infection and their interaction with DCs especially healthy DCs. Moreover, apoptosis
of DCs and NK cells occurred more in HCV NK cultures due to their higher frequency of NKp30 and
KLRG1. The death of NK cells was more than DCs despite DCs maturation defect due to HCV infection,
suggesting that the inhibitory marker KLRG1 took the upper hand over the upregulated activation
markers leading to impaired cytotoxic activity and apoptosis of NK cells.
Conclusion: The bidirectional crosstalk between NK cells and DCs is important in both
potentiating mechanisms of the innate immune responses and the subsequent adaptive immune responses
in the immune surveillance of cancer and infections. HCV infection impairs this crosstalk which may be a
leading cause in viral persistence and chronicity.
Keywords: natural killer cells and dendritic cells crosstalk, natural killer cells and dendritic cells
in HCV, natural killer cells and dendritic cells co-culture


It was found that NK / DC cell
taking, the presence of HCV antibodies by
interaction is bi-directional and complex, as it
could result not only in NK cell activation but
1- Twenty Blood bags from HCV Infected
also in DC maturation or apoptosis, depending
donors (double positive PCR and ELISA HCV
on the activation status of both players (1). The
antibody) (Group I).
NK cell activating receptor NKp30 appears to
2- Twenty Blood Bags from HCV negative
play a central role in DC maturation or apoptosis
healthy donors (double negative PCR and
induced by NK cells (2).
ELISA HCV antibody) (Group II).
Viruses have developed mechanisms to
The study groups were subjected to the
escape from the antiviral response of NK cells
and to establish persistent infection (3).During
1) Peripheral
chronic viral infections, an aberrant DC
(PBMCs) separation and isolation by
susceptibility to NK cell-mediated lysis resulted
density gradient centrifugation method.
in an accumulation of poorly immunogenic DCs
2) Immature DCs generation and pulsing by
in lymph nodes, causing progressive immune
core, NS3/NS4 and NS5 HCV peptides.
dysfunction (4).On the other hand, DC lysis by
3) Isolation of NK cells by NK Cell Isolation
NK cells could also negatively regulate the
Kit (Miltenyi Biotec, Germany).
duration of virus specific T cell responses in
4) Co-culture of the NK cells with DCs
vivo by limiting exposure of T cells to infected
pulsed with HCV peptides.
antigen presenting cells (5).
5) Flowcytometric characterization of cellular

surface markers (CD16, CD69, NKG2D,
NKP46, NKp30 and KLRG1) expression
Two groups of blood bags were selected
on peripheral blood NK cells (CD3-CD56+)
from the blood bank according to: history
Received: 14/08/2016 DOI : 10.12816/0033769
Accepted: 25/08/2016

Full Paper (vol.65 paper# 16)

Seasonal variation of biochemical composition of Penaeus kerathurus (Decapoda : Penaeidae) with study effect of shell extract The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 598- 610
Seasonal Variation of Biochemical Composition of Penaeus Semisulcatus
(Decapoda: Penaeidae) and the Effect of Its Shell Extract on
Bacteria, Fungi and Cancer
Amr. M. Nasef
Marine Biology Section, Zoology Department, Faculty of Science, Al-Azhar University,
Nasr City ­ Cairo ­ Egypt. dramrnasef@yahoo.com

shrimps are extremely good source of high nutritive value making them a very healthy choice
for human food. Aim of the work: to examine the changes induced by seasonal variation in Peanuts
biochemical composition and nutritive value. The present work aimed also to screening of
crude shell extract for bioactivity and economic importance. Materials and methods: The proximate
composition and biochemical constituents were analyzed seasonally in the muscle tissue of Penaeus
The Crude protein, lipid, carbohydrate, calorific value, moisture and ash were quantified in the
Penaeid Prawn. Extraction, isolation, and identification of some bioactive marine natural products were done
for study its effect on bacteria, fungi and Larynx cancer. Results: there is seasonal variation of the
nutritional status of edible Portion of prawn. Statistical analysis for the measured results of the correlation
values for each of measurements with the seasons of the year. The correlation was a positive weak. The
results of Antimicrobial activity of Penaeus semisulcatus shell extract indicated a significant effect
differences between the groups treated with shell extract (1.5, 2.5, and 5 mg/mL) compared to the control
group. Also, evaluation of viability of Hep -2 cell line post treatment with shell extract of Penaeus
using Sufranin uptake assay as (M T T) uptake and Microscopic examination indicated a
significant difference between the groups treated with shell extract compared to the control group. Cell
viability decreased depending on dose or concentration. The shell extract inhibited the proliferation of a
Larynx cancer cell line in a dose dependent manner.
Conclusion: the results of the present study reported that, the nutritional values of shrimp muscle
constituents were different from season to the other, with positive weak correlation. Also, Shell extract can
be used as antibacterial, antifungal and anticancer.
Keywords: Seasonal variation - edible Portion - Proximate composition -seafood ­ Marine biotechnology-
Marine ecology - biochemical composition - Penaeus semisulcatus - Decapoda ­Benthos - Shell - extract ­
Bacteria- Fungi ­ Cancer.


Marine food constitutes an important part of
collection and isolation (4,5,6). Also the
the diet and health of the world's population (1).
identification of new therapies is still required for
Various indigenous allergenic or toxic nitrogen
treating cancer
compounds can be found. The occurrence of these
So that the aim of this work is: to identify the
compounds is not only species characteristic but is
changes induced by seasonal variation in Penaeus
also affected by environmental and seasonal
semisulcatus biochemical composition and
factors. Both aspects have been extensively
nutritive value.The present work aimed also to
investigated during the recent two decades(2).
study extraction, isolation, and identification of
Marine invertebrates are an important part of our
some bioactive marine natural products and
diet as they contribute to the intake of health(3) .
screening of crude extracts for bioactivity to
Marine natural products have also been submitted
determine its effects on bacteria, fungi and Larynx
to general screening assays, as exemplified by the
cancer (HepII CelL line).
search for anticancer compounds, anti-AIDS

inhibitors.Despite the current interest in bioactive
Sampling :
marine compounds, our knowledge is limited
For the present work, seasonally sampling was
because of the short history of this area of research
carried out for Penaeus semisulcatus, during a
Moreover, the difficulties associated with the
period of one year, from January 2012 to January
Received: 11/09/2016 DOI : 10.12816/0033770
Accepted: 20/09/2016

Full Paper (vol.65 paper# 17)

Electromagnetic Field Effect on Skeletal Muscles and Skin of Albino Rat Embryos The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 611- 626
The Protective Effect of Olive leaves Extract or Bone Marrow Mesenchymal
Stem Cells on Skin Tissue Damage Induced in Gamma Irradiated Rats
Nahed Mohamed Mansour Emam*and Khadija Abdul jalil Fadladdeen**
* Faculty of Sciences, Al- Arish University, Egypt
** Faculty of Science, University of King Abdel-Aziz University, Saudi Arabia
Corresponding author email: mansour.nahed@yahoo.com & k_jalil1@yahoo.com

Aim of the work: this study aimed to examine the histological and histochemical changes in the skin
tissue of male rats after exposure to gamma radiation and the possible therapeutic effect of either olive leaf
extract or bone marrow mesenchymal stem cells.
Material and methods: the present study was applied on forty adult male albino rats (Sprague Dawely
strain). The rats were categorized equally into five groups (1-C group: control rats; 2- O group: rats treated
with plant leaves extract (15 mg/kg b. wt. /daily); 3-R group: rats exposed to a single dose of gamma-
radiation (3 Gy); 4-RO group: rats of this group treated with olive leaf extract 15 mg /kg b.wt./daily one
week prior to irradiation and one week post irradiation; 5- RS group: rats of this group were irradiated with
3Gy then treated with bone marrow mesenchymal stem cells (3×106 cells / ml suspension) through the
caudal vein about 5 hours post radiation exposure. Histopathological and some common histochemical
changes were studied.
Results: rats exposed to gamma radiation showed several histological and histochemical changes, these
changes were improved by using either olive extract or bone marrow mesenchymal stem cells. The bone
marrow mesenchymal stem cells (BMSCs) showed more obvious curative effect than olive leaf extract.
the present work showed that both olive leaf extract and bone marrow mesenchymal stem
cells have skin tissue radiotherapeutic effects against gamma radiation in male albino rats.
Keywords: -
radiation - Albino rats - skin - bone marrow mesenchymal stem cells (BMSCs)­
Histopathology- Histochemistry.

occurs when the displaced electron breaks a DNA
The skin is the largest organ of the body,
strand. Indirect damage occurs when electron
comprising between 15 and 20% of the total body
reacts with water molecule, creating a powerful
weight and performs numerous functions,
hydroxyl radical which then damages the cell's
including thermo regulation, sensory perception,
DNA. Ionizing radiation absorption causes
excretion and absorption, as well as protection
immediate biochemical, sub cellular and cellular
from insults, dehydration and infection. It consists
damage, while its morphological expression and
of two tissue types; the epidermis (an external
organ dysfunction are often considerably delayed
stratified, non-vascularised epithelium) and dermis
[3]. Accidental exposure and the therapeutic
(underlying connective tissue, consisting largely of
application of gamma radiation are the main
triggers for the production of reactive oxygen
fibroblasts). Radiation damage to the skin can be
species (ROS) in cells [4]. Superoxide anions,
described at all levels of organization from the
hydrogen peroxide and hydroxyl radicals are the
cellular up to the organ level. The damaging
most important types of ROS that react with
effects of ionizing radiation lead to cell death and
macromolecules, resulting in cell dysfunction and
increased risk for diseases. Ionizing radiations
tissue damage [5]. The major targets for ROS
cause formation of free radicals which in turn
include proteins, lipids and nucleic acids,
destroy DNA and other cellular components [1].
generating DNA strand breakage, DNA­ protein
Ionizing radiation is that type which
cross linking and lipid peroxide production [6].
contains sufficient energy to displace an orbital
These toxic products affect the balance of
electron around the nucleus. The most important
antioxidant systems such as glutathione and
effect of this displaced electron on living tissue is
enzymatic antioxidant defense systems [7]. Skin
the potential damage of cell's DNA, which may
damage post-irradiation was detected in rats
occur directly or indirectly [2]. Direct damage
exposed to a single dose of radiation (45Gy) and
Received: 13/09/2016 DOI : 10.12816/0033773
Accepted: 22/09/2016

Full Paper (vol.65 paper# 18)

c:\work\Jor\vol65_19 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 627- 633
Sex Hormone-Binding Globulin in Obese Type 2 Diabetics
Eman M Abd EL Salam1, Nagwa A Mohamed2,
Hend M Maghraby1,Rehab A Mohamed1
1Internal Medicine Departments, Faculty of medicine, Al Azhar University, Cairo, Egypt.
2Department of Clinical and Chemical Pathology, National Research Center, Cairo, Egypt

Obesity is one of risk factors for type 2 diabetes because of its association with insulin
resistance and poor glycemic control. Sex hormone­binding globulin (SHBG) and adipose tissue
hormones have a role in development of insulin resistance, hyperlipidemia and type 2 diabetes. Serum
SHBG has a role in glucose homeostasis and low levels are associated with development of diabetes,
cardiovascular diseases, insulin resistance and hyperinsulinemia. Aim of work: to study the relationship
between serum SHBG, obesity, and metabolic parameters in type 2 diabetes in both sex.
Patients and Methods: forty obese type 2 diabetic patients and ten obese non-diabetic as controls were
included in this study. Blood was taking from all subjects for estimation of glucose, Lipid profile, insulin
and SHBG. Results: there was highly significant decrease in mean serum SHBG concentration in diabetic
group compared with control non diabetic group. There were significant negative associations between
serum SHBG and age, disease duration, BMI and glucose. On the other hand, there were non significant
correlations between SHBG and waist circumference, fasting insulin, HOMA-IR, cholesterol and
triglyceride levels.
Conclusion: Low serum SHBG is associated with hyperglycemia in both sexes, independent of
Key Words: SHBG, type 2 diabetes, insulin, obesity.


Hyperglycemia characterizes diabetes mellitus is
identified as a contributing factor in the
due to insulin defects (either secretion or action
pathophysiology of T2DM. Many studies
or both). It is associated with organ failure 1.
showed a relation between decreased serum
World Health Organization (WHO) recorded in
SHBG and T2DM, and genetic studies revealed
2014 that among adults aged 18 years and
that transmission of specific SHBG gene
above, the diabetes world prevalence was near to
polymorphisms influence the risk of T2DM5.
10%2. The prevalence of diabetes in Egypt
There are multiple interactions between SHBG
according to WHO survey was 6.0% and Egypt
and its receptors in many target tissues
will have about 8.6 million adults with diabetes
suggesting physiologic roles for SHBG that are
in year 2030. Among the most important causes
more complex than transport of sex hormones in
of premature mortality in Egypt is diabetes
serum6. The involvement of SHBG in
mellitus3. Early diagnosis of diabetes mellitus is
impairment of glucose metabolism may occur
limited to blood glucose and glycated
hemoglobin (HbA1c) but blood glucose test is
bioavailability and activation of SHBG specific
affected by sample processing and of lower
receptor7. Plasma membranes of different cell
reproducibility. HbA1c use for screening and
types can bind specifically with high affinity to
diagnosing diabetes mellitus can reflect
SHBG. These data support the role of SHBG in
glycemic control in retrospect manner and are
the pathophysiology of T2DM and insulin
affected by haemolytic anemia4. Many factors
resistance. The concentrations of SHBG tend to
contribute to physiologic changes responsible
be more reliably determined than those of sex
for T2DM as polycystic ovarian syndrome in
steroids8. Previous studies identified the
women and hypoandrogenism in men. They are
influence of hormone genes and lifestyle-related
related to insulin resistance, suggesting that
factors on circulating SHBG levels. The main
modulations in normal sex steroids may play a
factor in regulation of SHBG synthesis is
role in the pathogenesis of diabetes. SHBG is
estrogen/ androgen balance7,8.
Received: 1/10/2016 DOI : 10.12816/0033774
Accepted: 11/10/2016

Full Paper (vol.65 paper# 19)

c:\work\Jor\vol65_20 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 634- 642

The Fibrinogen/CRP Ratio as a New Parameter for the Prediction of
Disseminated Intravascular Coagulation in Patients with HELLP Syndrome
Tarek Fathy Tamara, Ihab Fouad Serag El-Din Allam, Tamer El-Sayed Mohamed El-
Ghazaly, Mohammed Adel Ali Ahmed
Faculty of Medicine ­ Ain-Shams University

The syndrome of Hemolysis, elevated Liver enzymes, and Low Platelet count
(HELLP) is a life-threatening variant of preeclampsia, and may be accompanied by disseminated
intravascular coagulation (DIC). Recently the fibrinogen/C-reactive protein (CRP) ratio has been
suggested as a measurement that predicts onset of DIC. The authors sought to analyze the
fibrinogen/CRP ratio among obstetric patients who developed DIC due to HELLP syndrome. Aim:
the aim of this study is to determine if the fibrinogen/C-reactive protein (CRP) ratio could be used as
a predictor for disseminated intravascular coagulation in obstetrics patients with the HELLP
syndrome. Patients and Methods: this study was conducted as a prospective observational study at
Ain Shams Maternity Hospital from November 2014 to November 2016 .The study included Patients
diagnosed to have Severe Pre Eclamptic Toxemia SPET according to ACOG (2013).Patients was
diagnosed with the HELLP syndrome according to the Martin classification of HELLP syndrome.
Results: the results of our study suggest that replacing the use of fibrinogen levels alone with the
fibrinogen/CRP ratio would enhance the diagnostic and prognostic power for DIC in patients with
HELLP syndrome. Conclusion: in light of the physiologic changes of the coagulation cascade during
gestation, the International Society on Thrombosis and Hemostasis ISTH score could not be
implemented in pregnant women alone for the diagnosis and prediction of DIC. Recommendations:
further evaluation of the fibrinogen/ CRP ratio is required to determine the generalizability of this
marker's use in DIC because of causes such as placental abruption, septic abortion, and failed
abortion. Furthermore, prospective studies should be performed to determine the best method to
predict if there any new method to predict DIC in patients with the HEELP syndrome.
Keywords: HELLP syndrome, fibrinogen, C-reactive protein, pre-eclampsia, DIC


Preeclampsia is a human-pregnancy-
cascade triggered by combination of abnormal
specific disease defined as the occurrence of
maternal inflammatory response, endothelial
hypertension and significant proteinuria in a
previously healthy woman on or after the 20th
hemodynamic milieu, and deranged immunity
week of gestation. It occurs in about 2­8% of
(1). The HELLP syndrome is a serious
pregnancies (1).
complication in pregnancy characterized by
It is the most common medical
haemolysis (H), elevated liver enzymes (EL)
complication of pregnancy whose incidence has
and low platelet count (LP) occurring in 0.5 to
continued to increase worldwide. It is associated
0.9% of all pregnancies and in 10­20% of
with significant maternal morbidity and
cases with severe preeclampsia (4).
mortality, accounting for about 50,000 deaths
This syndrome usually develops
worldwide annually (2).
suddenly between 28-36 weeks gestation. Its
The etiology of preeclampsia is poorly
etiology and pathogenesis are not well
understood, a leading theory is that insufficient
understood. Generally, the disorder is
spiral artery remodeling in the placenta may
considered a placenta-instigated, liver-targeted
result in a hypoxic environment with reperfusion
acute inflammatory condition, with elements
injury and up-regulation of oxidative stress, the
of disordered immunological processes the
pre-eclamptic placenta secretes factors such as
hemolysis which characterizes the syndrome is
inflammatory cytokines and reactive oxygen
of microangiopathic origin. Red cells become
species into maternal circulation to induce
fragmented as they pass through small vessels
hypertension through local production of
with pathological fibrin deposits and damaged
vasoconstrictors, notably endothelin-1 (3).
endothelium. Obstruction of hepatic blood flow
Most theories on the etiology of
by the same fibrin deposits in hepatic sinusoids
preeclampsia suggest that the disease is a
results in elevated liver enzymes, and peri portal
Received: 20/8/2016 DOI : 10.12816/0033775
Accepted: 29/8/2016

Full Paper (vol.65 paper# 20)

c:\work\Jor\vol65_21 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 643- 647

Risk of Osteoporosis and Osteopenia in Patients with Prolonged
Use of Proton Pump Inhibitors
*Abdullah Ali Al-Zahrany and **Majed AL Mourgi
*Department of Orthopedics, Taif University, Saudi Arabia
**Department of Thoracic Surgery, Taif University, Saudi Arabia

Background and aim of the work:
several studies suggest that proton pump inhibitors (PPIs) use
may be involved in development and acceleration of osteoporosis. The aim of this study is to
investigate the relationships between prolonged uses of PPIs in patients with gastro-esophageal reflux
disease (GERD) and to reveal their possible role in development of osteopenia or osteoporosis with
evaluation of different diagnostic tools which help in follow up of those patients.
Patient and methods:
This prospective controlled study which was conducted at King Abdul Aziz
Specialist Hospital in Taif, Saudi Arabia, from January 2013 to June 2016. We compared the
prevalence of osteoporosis or osteopenia in 2 groups of individuals, the first group; of 30 patients
using PPIs as treatment of GERD for more than 2 years. The second group included thirty healthy
control subjects .In both groups we measured the bone mineral density using the dual energy X-ray
absorptiometry (DEXA), calcium (Ca), inorganic phosphorus (P), serum alkaline phosphatase, and
deoxypyridinoline (DPD) in urine. Results: there were no significant differences between the 2 groups
as regards, age, gender, and their clinical history (P > 0.05), however, the history of fragility fracture
was significantly higher in PPIs group of patients (P< 0.05). The means of antroposterior spine and left
femur BMD-T scores were lower than normal in both groups; however, it was significantly lower in
PPIs group than in control group (P< 0.05). Serum calcium was slightly lower than the reference range
with normal phosphorus level without significant difference between both groups (P> 0.05). The
serum alkaline phosphatase and urinary DPD were higher than normal reference levels, but,
significantly higher in patients receiving PPIs (P< 0.05). The number of osteopenic/osteoporotic
patients was significantly higher in PPIs group than in control group (P< 0.05). Osteopenia and
osteoporosis were significantly correlated in PPIs group with male gender, younger age group of
patients (P< 0.05), and the correlation was highly significant with the duration of use of the drug
(P<0.001). In control group the decrease in bone density was significantly correlated with the female
gender and to older group of patients (P< 0.05).
Conclusion: in GERD patient using PPIs, the osteopenic/osteoporotic effect with increased possibility
of fragility fractures must be discussed with the patient if prolonged use of these drugs is expected,
taking in consideration the potential safety and reliability of laparoscopic or thoracoscopic surgical
options as alternative therapy.
Keywords: GERD, PPIs, Osteopenia, Osteoporosis, Fragility fractures


with multiple prospective studies in different
GERD is one of the most common diseases in
populations not only in western society.4-8The
the world and the incidence to experience the
aim of this study is to investigate the
disease at some time reached up to 40% in
relationships between prolonged uses of PPIs in
some studies.1The actual incidence is expected
patients with gastro-esophageal reflux disease
to be higher as most of patients control their
(GERD) and to reveal their possible role in
symptoms with over the counter medications
development of osteopenia or osteoporosis with
without medical consultation.2The disease
evaluation of different diagnostic tools which
affects any age with higher incidence above
help in follow up of those patients.
forty years with equal male to female incidence;

This prospective controlled study was
esophagus and esophageal adenocarcinoma.3
conducted at King Abdul Aziz Specialist
PPIs are the gold standards for treatment of
Hospital in Taif, Saudi Arabia, from January
gastro-esophageal reflux disease, however,
2013 to June 2016. The study was approved by
controversial data about the rule of these drugs
the Hospital Ethics Board and all patients gave
in calcium metabolism and increase the process
informed consent. We compared the prevalence
of osteopenia/osteoporosis must be validated
of osteoporosis in 2 groups of patients, the first
Received: 20/9/2016 DOI : 10.12816/0033776
Accepted: 30/9/2016

Full Paper (vol.65 paper# 21)

c:\work\Jor\vol65_22 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 648- 651

The Effectiveness of Three Layers Foam Dressing as an Offloading
Technique in Treating Diabetic Foot Ulcer ­ Comparative Study
1Amal Safar Al Thebati, 2Nora Mohammed AL-Ouda, 1Sahar Masri Al khaldi,
Asmaa Doghether Al sofyani, 4Mohamed Al Saeed
1King Faisal Hospital,2Taif, Prince Sultan Military Medical City ­ Riyadh, 3Ministry of Health, Taif,
4Department of surgery, Taif University
Background and aim of the work
: and aim of the work: More than 25% of Saudi Arabia population are
diabetics, about 20% of the will develop ulcer in their feet. Offloading is the cornerstone in prevention or
healing of plantar neuropathic foot ulcers. This study aimed to investigate the effectiveness of use of
three layers elastic foam as an off-loading modality in patients with diabetic non infected neuropathic
ulcers in term of the speed of healing progress and comparing that with removable walking boat off-
loading techniques.
Patients and methods: this prospective double-blind, randomized, controlled clinical trialwas done in
diabetic foot care clinics at King Abdul Aziz specialist Hospital, King Faisal general Hospital and Prince
Mansour military Hospital, Taif, Saudi Arabia from January 2014 to October 2016.Diabetic patients with
non infected neuropathic plantar ulcers after debridement of at least 2 weeks were included in the study.
Ischemic ulcers are excluded from the study. Patients who met the inclusion criteria of this study
weresubdevided randomized into 2 groups, the felted foam dressings group; in which the three layers
felted foam was applied around the ulcer. Control group the removable walking boat was used. In both
groups the ulcer was covered with saline soaked dressing to be changed daily.
Results:47 patients were enrolled in the study (23 in felted foam group and 24 in the removable walking
boat group). There was no significant difference in the demographics, ulcer size, duration of diabetes,
and clinical and laboratory data between both groups (P > 0.05). The mean duration of complete healing
of the ulcer was highly significantly shorter in felted foam group than in the removable walking boat
group (P < 0.001). In both groups the duration of healing was negatively correlated with the patient age,
the level of HbA1c,andthe ulcer size (P < 0.05).
Conclusions: the three layers felted foam is effective, simple, and less expensive offloading technique
and it superior to removable walking boat in promoting the complete healing of neuropathic diabetic foot
Keywords: neuropathic plantar ulcer, three layer felted foam, removable walking boat.

Hospital, King Faisal general Hospital and
It is generally accepted that (besides infection
Prince Mansour military Hospital, Taif, Saudi
control and revascularization, when necessary)

pressure relief is the most important measure in
Arabia from January 2014 to October 2016
the treatment of diabetic foot ulcers(1,2).The use
after approval of the ethical committee. Diabetic
of felted foam dressings is a promising but not
patients with non infected neuropathic plantar
yet well-standardized technique for the
ulcers after debridement of at least 2 weeks
treatment of neuropathic diabetic foot ulcers and
were included in the study. Ischemic, neuro-
may have some advantage over total contact
ischemic ulcers or infected ulcers were excluded
casting or removable walking boat techniques (1-
from the study. Patients who met the inclusion
4).This study aimed to investigate the
criteria of this study were randomized and
effectiveness of use of three layers elastic foam
subdevided into 2 groups without interference
as an off-loading modality in patients with
from the treating team, one group to receive the
diabetic non infected neuropathic ulcers in term
felted foam off loading treatment and in the
of the speed of healing progress and comparing
other group the removable walking boat was
that with removable walking boat off-loading
used. Complete clinical history and physical
examination was done included the inspection

of the foot and the palpation of the peripheral
pulses. Peripheral diabetic neuropathy was
This prospective double-blind, randomized,
evaluated by measuring the vibration perception
controlled clinical trial was done in diabetic foot
threshold with the calibrated tuning fork, fundus
care clinics at King Abdul Aziz specialist
examination, and complete organ profile were
performed. Patients with neuroischemic or
Received: 21/9/2016 DOI : 10.12816/0033777
Accepted: 30/9/2016

Full Paper (vol.65 paper# 22)

c:\work\Jor\vol65_23 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 652- 661

Prevalence of Generalized Anxiety Disorder in Patients with Rheumatoid
Arthritis and its Relationship with Disease Activity
Asmaa B Ahmed (1), Abdulah MA Radwan (1), Hameed M Baddary (2)
(1) Physical Medicine, Rheumatology and Rehabilitation Department, (2) psychiatry, Head of
Neuropsychiatry Department,Faculty of Medicine, Sohag University

rheumatoid arthritis (RA) is a lifelong disease with a progressive disabling course and
individuals with RA experience higher levels of psychological distress than general population.
Objective: the objective of the present study was to assess the prevalence of generalized anxiety
disorder (GAD) in RA patients and determine its relationship with disease activity.
Patients and Methods: the study included 200 RA cases. Psychiatry examinations of all cases were
performed according to Hamilton scale. Patients who suspected to have GAD were further assessed by
the most recent diagnostic criteria for GAD in diagnostic and statistical manual of mental disorders
fifth edition (DSM-5) and psychiatry assessment sheet (PAS).
Results: the prevalence of GAD in RA cases was 38.5% (n=77) assessed by psychiatry assessment
sheet (PAS). RA patients with GAD significantly showed higher disease activity measures than those
without GAD (P value <0.001). It was found that GAD did not related to disease duration (r=0.617; p
value >0.05) or RF positivity (r=0.058; p value >0.05). Conclusion: generalized anxiety disorder
(GAD) is common to occur in RA cases. Disease activity was significantly higher in RA cases with
GAD than RA cases without GAD. GAD was found to be not related to disease duration.
Keywords: Rheumatoid arthritis, generalized anxiety disorder.


disability lead to social stress and contribute to
Rheumatoid arthritis (RA) is a systemic,
the development of psychiatric disorders in RA
chronic, and inflammatory disease with

patients (7), also multiple lines of investigations
suggest that stress plays a significant role in
characterized by symmetrical peripheral
shaping the cause of inflammatory diseases
polyarthritis, resulting in joint deformity (1). In
such as RA; stress activates a cascade of neuro-
addition to producing a chronic inflammatory
humoral events many of which may be dys-
state, the disease generally causes many
regulated in RA patients, including aspects of
harmful psychosocial consequences for patient
the hypothalamic-pituitary-adrenal axis (HPA),
(2); also the patient with this chronic disease
the autonomic nervous system, and pro-
faces the course of which cannot be predicted
inflammatory processes (8), so this implies that
and a painful progression marked with attacks
the endocrine stress response system could be
a target for stress management interventions in
patients with immune-mediated diseases such
tiredness, incapacity to work, economic
as RA (9).
limitations, and side effects of therapeutic
People with RA tend to experience more
drugs, which RA may bring about, can end up
anxiety and other emotional problems than
reducing these patients's quality of life (4). In
other people in the general population,
addition, psychiatric symptoms in RA patients
moreover, it is found that anxiety has a direct
increase the perception of pain, use of
effect on pain and that effect was significantly
analgesics and work disability and lead to
higher than that of depression. Previous
reduction in drug compliance (5).
research has revealed that a frequent temporal
One of the factors believed to play a role in the
sequence is anxiety first and then subsequently
initiation, maintenance and exacerbation of RA
depression. Therefore, screening for symptoms
is psychological stress. The diagnosis of RA
of anxiety in persons with RA might facilitate
may cause stress and uncertainty in patients
early identification of depression and help to
and their relatives, also higher stress at the
prevent future depressive episodes (10).
onset of the disease predicts worse disease
One of the most common types of anxiety
prognosis (6).
disorders in RA is the generalized anxiety
It is hypothesized that chronic pain, joint
disorder (GAD) (11). GAD is characterized by
deformities, loss of function and work
excessive anxiety and worry about a variety of
Received: 22/10/2016 DOI : 10.12816/0033778
Accepted: 30/10/2016

Full Paper (vol.65 paper# 23)

c:\work\Jor\vol65_24 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 662- 669

Determinant Analysis of Obesity among Adult Females in Egypt
Raouf Alebshehy1, Nura Musa Shuaib2, Jato Denis Mbako3, Dina Barffo4 and
Roland KuuzagrNuotol5
1Department of Preventive Medicine, Ministry of Health, Egypt, 2 TB and Leprosy, Ministry of
Health, Nigeria, 3Integrated Health for All Foundation, Cameroon, 4Ghana Health Service, Ghana, and
5Kintampo College of Health, Ministry of Health, Ghana
Corresponding author: Raouf Alebshehy,dr.ebsh@yahoo.com,+21221253003


Background: obesity is a major and growing health problem that affects developed, and developing
countries. It has many health, financial, and social consequences. Therefore, addressing obesity tops
the World Health Organization's public health agenda. In Egypt, there is a remarkable increase in
obesity with more than one third of the whole population being obese. A particular issue in Egypt is
that prevalence of obesity is more than double among females (46%) as compared to males (22%).
Moreover, there is no national program to address the problem, and 95% of females are not taking any
measures to change their weight. Despite the major gender gap in obesity prevalence, little research
has examined gender differences in its determinants. Therefore, this study aims to analyse
determinants of adult Egyptian female obesity.
Methods: this study is an in-depth review based on secondary data collection. A conceptual
framework was developed to analyse the determinants. Data is obtained from different resources such
as key health databases such as PubMed, Global health, and websites of relevant institutions such as
World Health Organization, and Egypt's Ministry of Health. Findings: the study has revealed the
huge burden of obesity among women in Egypt. It shows that obesity among Egyptian females
increases with age, wealth, urban residency, unhealthy diet, and physical inactivity. It revealed the
growing trend of obesity among poor and rural people. It also discussed other sectors of influence that
lead to higher obesity rates such as urbanization, and levels of education.
Key words: Obesity, female, Egypt

compared to 22% in men in last STEPs survey
Obesity is dramatically growing in Eastern
[3]. Moreover, a study of 1,502 adolescents
Mediterranean Region including Egypt. The
attending public schools in Egypt revealed that
prevalence of overweight and obesity, in this
26% of girls and 13% of boys are overweight
region, ranges from 74% to 86% among
or obese [7].
females and 69% to 77% among males [1].
Furthermore, Egyptian adult females' obesity
Egypt underwent a process of epidemiologic
(BMI 30 kg/m²) and severe obesity (BMI 35
transition with a remarkable increase of non-
kg/m²) raised from the twelfth and the tenth
communicable diseases [2]. Therefore, non-
highest in the world in 1975 to the seventh and
communicable diseases are the leading causes
the sixth highest in 2014 respectively [8]. In a
of Egypt's Disability Adjusted Life Years and
study based on Egyptian Demographic and
Years of Life Lost [2]. The last STEPS survey
Health Surveys, it was found that between
conducted in Egypt was in 2011-2012, a
1995 and 2005, the mean BMI of reproductive
multistage cluster sample study, and showed
aged females increased from 26.31 to 28.52 [9].
that approximately 30% of adult Egyptians
Moreover, it reached 29.2 in 2008 [10].
aged 25 to 64 years are obese [3]. Many chronic
Additionally, the Egyptian Demographic and
diseases have increased in parallel with
Health Survey of 2008 showed that about 66%
obesity such as cardiovascular diseases, and
of married females aged 25-29 suffered
diabetes mellitus [4, 5].
overweight or obesity [11]. Additionally,
A particular problem in Egypt is that obesity
according to World Health Organization,
prevalence is more than double among females
Egypt has the fifth highest percentage of obese
as compared to males [3, 6, 7]. For example, 46%
women in the world over the age of fifteen [12].
of females as compared to 22% of males [in a
It is estimated that 75% of Egyptian females,
representative survey of 10,000aged 15-65
over the age of 30, are overweight or obese [13].
years] are obese [6]. Similarly, women aged 25-
The Survey of Young People in Egypt, which
64 years had a 41% prevalence of obesity as
covers a nationally representative sample of
Received: 24/9/2016 DOI : 10.12816/0033779
Accepted: 30/9/2016

Full Paper (vol.65 paper# 24)

c:\work\Jor\vol65_25 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 670- 671

Threats to Egypt's Plan to Eliminate Hepatitis C Virus Infection: Injection
Drug Users and Sex Workers are Unaddressed Reservoir That Cannot Be
Ignored; A Short Communication
Raouf Alebshehy
Egyptian Ministry of Health
Corresponding author: Raouf Alebshehy,dr.ebsh@yahoo.com,+21221253003


Background: Hepatitis C virus (HCV) is a huge health problem in Egypt with 15% prevalence,
165,000 annual new cases, and 40,000 annual deaths. Egypt has developed a five years plan to
eliminate HCV, however this plan does not fully address the problem of HCV among vulnerable
groups such as injection drug users and sex workers. This article is to shed the light on this
unaddressed reservoir that threatens the fully elimination of HCV in Egypt. It also provides an
overview about proposed strategies to tackle HCV problem among that sensitive population.
Key words: hepatitis C, injection drug users, sex workers, peer health education

History of Hepatitis C virus (HCV) in Egypt
shed some light on the unaddressed reservoir
dates back to the 60s, when unsterilized glass
of HCV among sex workers and IDUs, in
syringes were used to deliver Schistosomiasis
addition to proposing possible strategies to
tackle the problem.
campaigns leading to spread of infection
The absence of interventions targeting high
among scores of Egyptians (1). Ironically,
risk groups of having HCV such as IDUs, and
public health campaign has started HCV
sex workers is either due to the fact that 8 out
spread and health facilities are maintaining
of 10 new cases are infected in health facilities
that role; 80% of new infections are occurring
(2), consequently infection control tops list of
in health facilities as HCV's main mode of
priorities of the Egyptian Ministry of Health,
transmission is blood borne, therefore it
or due to continuous denial among Egypt's
transmits through blood transfusions and
conservative people about existence of IDUs,
invasive procedures (2).
and sex workers. Therefore, it is a huge burden
According to the World Health Organization
to any government to address these groups.
(2), HCV is a highly infectious disease that
It is indeed a very sensitive issue to address
annually infects about 165,000 individuals,
this problem, however there are effective
and kills about 40,000 patients in Egypt. Its
strategies recommended by international
prevalence is 15% (3) and it is the main cause
organizations that could be adapted, and
of cirrhosis (4), which leads to 9% of
implemented in Egypt's context such as
Egyptians' mortality (5).
reducing the incidence of HCV by raising
Egypt's political leaders are supporting a five
awareness among IDUs about risks of same
years plan to tackle viral hepatitis (6). The
needle usage, and among sex workers about
plan includes goals, objectives, and actions
hazards of unprotected sex and the importance
that cover six areas; surveillance, infection
of using condoms (8).
control, blood safety, vaccination, treatment,
Buying new syringes or condoms in Egypt is
and educating providers and communities (7).
not difficult because private pharmacies are
Although the main cause of HCV infections in
everywhere in Egypt selling these supplies.
Egypt is health facilities, there are other causes
Therefore, the problem is not availability of
of infection such as injection drug users
syringes or condoms but it could be lack of
(IDUs) and unprotected sex (8). However,
knowledge among IDUs, and sex workers
Egypt's plan does not target sex workers
about their usage and importance. Therefore,
except for hepatitis B vaccination, and does
this article suggests that health education
not target IDUs except in the objective of
interventions among these groups about the
establishing a viral hepatitis serologic
importance of following preventive measures
surveillance (8). Therefore, this article aims to
such as using new syringes in case of IDUs,
DOI: 10.12816/0033780

Full Paper (vol.65 paper# 25)

c:\work\Jor\vol65_26 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 672- 673
Relationship between Warfarin and Thrompocytosis (A Case Report Study)
Ghormmallah Al-Ghamdi1, Hamdan Al-Ghamdi2, Mansour AL-Ghamdi3,
Mohanad al-nofeei3, Shog Hamoud Al-Otibi4
Cardiology department1, Critical Care unit2,Pediatric department3,
Internal Medicine department,4Taif Children Hospital, Taif, Saudi Arabia

This report is point to patient admitted to our hospital as case of G6PD and dilated cardiomyopathy,
with congestive heart failure started on anti-failure and aspirin and need to be admitted on ICU for
inotropic support, then on the 2nd day the patient developed thrombocytopenia then we stopped aspirin
and warfarin started after using of warfarin by one-day patient developed sever thrombocytosis so we
consider to start low molecular heparin which improved the platelets count then started to decreased to
normal range in 5 days duration after LMH started.
Keywords: Warfarin, Thrompocytosis.


Thrombocytosis, defined as a platelet count
Prenatal And Neonatal History:
(PC) of more than 450,000/L,
Normal pregnancy. Normal spontaneous full
Aspirin consider on patient with dilated
term vaginal delivery (NSVD). After
cardiomyopathy to prevent the thrombosis that
delivery, the newborn was not admitted to
may present due to weak cardiac contractility
neonatal intensive care unit (NICU).
and stasis,
Past medical history:
Is there any relationship between Warfarin and
The patient was diagnosed 2 months back with
G6PD in alkhormah hospital after attack of
acute haemolytic anaemia. He was known to
2 years old yamani male living in alkormah.
have no other chronic illnesses or history of
He was diagnosed as glucose-6-phosphate
previous hospitalization.
dehydrogenase deficiency (G6PD) and referred
Nutritional history: Breast feeding. Weaning
from alkhormah Hospital with:
had been started with cereals liquid diet at age
Abdominal destination, pallor, sweating,
of 6 months. Then with same family diet. He
and shortness of breath (SOB) FOR 3
was fully vaccinated with no extra vaccines.
Developmentally he was up to age.
The patient was in good condition until 3 days
Family history: 2nd grade consanguinity. The
back of referral, when he started to have
mother was 38 years old and well educated.
abdominal distension started gradually with
The father was 39 years old, positive for G6PD
mild pain progressive associated with pallor.
from maternal side. There was history of
On the day of referral, the patient developed
ischaemic heart disease (IHD) in older relative
SOB, sweating , decreased activity, poor oral
of parent. No history of sudden death of
intake, decrease appetite. Other signs and
chronic heart disease (CHD) and the patient
was the only child for the family.
syncopal attacks, jaundice, dark urine, skin
Social history: Live in alkhorma in 3
rash and joint involvement were absent.
bedrooms apartment with good socioeconomic

status with income of 2000 real per months.

Physical Examination:
Patient looked ill, lethargy, dehydrated with signs of respiratory distress (RD), intercostal and
subcostal retractions. Cyanosis or jaundice were not present.
Vital signs (V/S):
Growth parameter:
Temperature: 36,1. Hear rate: 160.
Weight: 6 Kg below 3rd percentile.
Respiratory rate: 55 .
Hight: 75 cm below 3rd percentile.
blood oxygen saturation,or SpO2: 91%
Head Circumference: 40 cm 50th percentile.
on RA

Received:15/9/2016 Accepted:22/9/2016 DOI: 10.12816/0033781

Full Paper (vol.65 paper# 26)

c:\work\Jor\vol65_27 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 674- 682

Perception of Knowledge, Attitude, Practice of Safety, Effectiveness,
Consequences and Management of Bariatric Surgery among Community
in Jeddah City
Ayman Sayed Abouhamda, Yousef Ehab Gan, Fahad Mohammed Altowairqi,
RadwanYousef Badr, Abdulghani Abdulaziz Alzamzami , Khalid Ahmed Sherian,
Feher Mohammed Alturkistani, Mohannad Talal Tolah, Abdulrahman Ghazi
Alqurashi , Wail Omar AlGorashi , Sultanah Sameer Saeedi, Marwa Thani Hawsawi,
Zina Abdulkareem Al Zahidy.
Department of General Suergery, King Abdulaziz University Hospital, Saudi Arabia

obesity is associated with increased mortality and morbidity. The use of bariatric
surgery has recently increased dramatically in order to lose weight fast; however, the heavy
consequences and the long-term weight loss induced by bariatric surgery has favorable effects on life
span remains unclear. Aim of Study: this study was aimed to explore knowledge and beliefs about
safety, effectiveness and consequences of bariatric surgeries among community population in Jeddah
city and to evaluate the role of demographic factors in shaping those beliefs, and assess possible
associations between demographic characteristics with lose weight preventive behavior.
Patients and methods: this study was done in 2016 and carried out among a sample of 474 citizens,
of them 70.1% women and 29.9% men. The mean age of citizens was 35.77. To assess citizens'
demographic factors, risk factors of obesity and beliefs about bariatric surgeries, consenting citizens
responded to an anonymous online questionnaire. The data was entered and analyzed using SPSS
version 20. Data were entered into the Statistical Package for Social Sciences (SPSS, version 20) and
descriptive analysis conducted.
Results: the results of the current study show that among the respondents, (24.5%) were obese,
(13.7%) severely obese and (9.3%) were morbid obese. The majority of them believed that the lack
of exercise is the cause of their obesity (45.7%), (71% ) of the respondents think that genetics play a
role in obesity, (69.3%) of respondents have someone in their family who suffers from obesity and
(61.6%) were not keen to exercise. The majority of respondents (77.4%) think that weight loss
procedures contribute to weight loss, however (69.8%) are not of favor towards weight loss
procedures to get rid of obesity, (63.4%) of them have not undergone any surgery, and (86.6%) of
the respondents do not think of surgeries as their first choice to lose weight without exercise or diet,
also (71.0%) think that weight loss procedures and its complications may lead to death.The majority
of the respondents (74%) have inadequate beliefs about bariatric surgery and (50.8%) of the
respondents have good knowledge on prevention behavior of obesity.
Keywords: Bariatric surgery, Obesity prevention, weight loss.


Overweight and obesity are defined as
has become a serious epidemic health
abnormal or excessive fat accumulation that
problem, estimated to be the fifth
may impair health. Obesity represents a
leading cause of mortality at global level[2].
rapidly growing threat to the health of
Obesity is not a single disease but is instead a
populations in an increasing number of
syndrome with multifactorial etiology that
countries. At least 2.8 million adults die each
includes metabolic, genetic, environmental,
year as a result of being overweight or obese.
social, and cultural interaction [3]. Obesity is a
In addition, 44% of the diabetes burden, 23%
complex condition in which excess of body fat
of the ischemic heart disease burden, and
may put the person at risk of hypertension,
between 7% and 41% of certain cancer
diabetes, metabolic syndrome, stroke, certain
burdens are attributable to overweight and
types of cancer (endometrial, breast, prostate
obesity[1] .The prevalence of obesity is
and colon), dyslipidemia, gall bladder disease,
increasing worldwide at an alarming rate in
sleep apnea, osteoarthritis, increase in all
both developing and developed countries. It
causes of mortality, emotional distress,

discrimination, and social stigmatization[4].
Received: 24/9/2016 DOI : 10.12816/0033782
Accepted: 30/9/2016

Full Paper (vol.65 paper# 27)

c:\work\Jor\vol65_28 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 683- 692

The Potential Anticancer Action of Lectin Extracted from Pisum sativum
Against Human Hepatocellular Carcinoma Cell Lines
Hafez E.E1 and Shati A.A2
1Genetic Engineering Department, New Borg El-Arab City, Alexandria, Egypt.
2Biology department, Science College, King Khalid University, Abha, Saudi Arabia
Corresponding author: Dr. Ali A. Shati, Biology Department, College of Science, King Khalid
University, Abha, Saudi Arabia; Tel.: +966172419892; E-mail address: aaalshati@kku.edu.sa

plant lectins, carbohydrate binding proteins, are distributed in many species of medicinal
plants mainly those belong to legumonase family. This study aimed to investigate the anticancer
activity of the lectin extracted from Pisum sativum on Human Hepatocellular carcinoma (HepG2).
Materials and Methods:the morphological signs of apoptosis were examined and the ability of lectin
to induce alteration in both pro-apoptotic and anti-apoptotic such as Bax, IB, P53 and Bcl2 genes
were analyzed using RT-QPCR method. The safety usage pattern of P. sativum lectin was evaluated on
human HepG2 cell lines. Results: lectin displayed high antioxidant activity on the Hep2 cells when
compared with 5FU (anti-cancer drug as a control). Lectin dilution that exhibits LC50 on HepG2 cells
was found to touch 25% from the original concentration (100%). The extracted lectin was found with
inhibition percentage in cellular viability touching 80.5% with 67.6% inhibits the integration of BrdU
in the HepG2 proliferated cells. HepG2 treated cells showed apparent nuclear condensation after 16 h
of treatment as lectin had the ability to upregulate the gene expression of P53 and IB and down
regulates Bax and Bcl2. Conclusion: lectin may have a vigorous role in achievement of
hepatocarcinoma therapy plan.
Keywords: Lectin, hepatocarcinoma, real time PCR, antioxidants, anticancer activity.


The pharmacological importance of plant
Furthermore, Lectins are capable to adapt the
lectins has been provoked since 100 years ago
cell cycle by encouraging both cell cycle
[1]. Lectin is a non-immune carbohydrate-
seizure and caspase cascade, and stimulation of
binding protein. Although glycoproteins are
the genes that play the main role in apoptotic
present in fungi, bacteria, invertebrates and
cell death. Lectins have been shown to have a
vertebrates [2], they are mainly existing in
positive action on the interleukins and down-
plants i.e. in leaves, barks, seeds [3,4,5]. Plant
regulate telomerase activity [1]. Other studies
concluded that lectins have several applications
contributed in cancer therapy studies since they
such as therapeutic mediators by binding these
have vital roles in many processes of the cell
compounds to cancer cell membranes and/or
biology [6]. Lectins were classified based on
their receptors, which regulate tumor growth,
their carbohydrate types into: mannose binding
anticancer agents and potential cancer markers
[7], glucose binding [8], galactose binding [9] but
[1]. Pea (Pissum sativum) lectin has been shown
a new taxonomy systems was introduced
to induce apoptosis in Ehrlich ascites
depending on the lectins sources (animals or
carcinoma (EAC) cells in mice. The inhibition
plants) and on their structures [10,11,12]. Plant
of cancer growth in mice was shown to involve
lectins were classified into 12 different types
apoptosis by cell cycle seizure at G2 /M phase
according to their structural and evolutionary
by enhanced expression of proapoptotic Bax
relations when compared with legume lectins,
and reduced expression of anti-apoptotic Bcl-2
jacalins and amaranthins [2,13].
and Bcl-XL [15]. To our knowledge, there are
Lectins have been extensively used in many
no studies have investigated the anti-cancer
purposes [1]. They are widely involved in many
effect of lectin extracted from the seeds of the
cellular progressions such as cell immune
wild medicinal plant P. sativum (non-edible
plant which belong to legumonase plant
interaction, in addition to their positive actions
family). Therefore, the current study will
on tumor growth and metastatic extent [14].
address this issue and investigate the response

of human hepatocarcinoma cell line (HepG2)
Received: 10/9/2016 DOI : 10.12816/0033783
Accepted: 20/9/2016

Full Paper (vol.65 paper# 28)

c:\work\Jor\vol65_29 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 693- 695

Assessing the Knowledge, Attitudes and Practice of Diabetic Complications
among Physicians in Taif Saudi Arabia
1Marah Mohammed Alzaidi, 1Haifa saeedAlmalki,
1Ghada Mohammed Alghamdi, 1, 2Hala El Nashar
1College of Medicine, 2Department of Pathology, Taif University, Saudi Arabia


Background and aim of the work: The aim of this study is to assess the Knowledge, Attitude, and
Practices (KAP) towards diabetes and its complications among physicians in Taif.
Subjects and Methods: this survey was done by interviewing the physicians to fill the questionnaire
focusing on their awareness about screening, diagnosis, and preventive measures of diabetic
Results: A total of 101 physicians (72% females), 88% of them were practicing in urban areas and
78% of them practiced > 5 years. 90% of the physicians had postgraduate qualifications and 49% of
them had special training on diabetes management. Eighty one percent follow guidelines for care for
diabetes. In 72% of practioners diabetic patients constituted 18-50% of patients in their daily practice
and in 28% of practioners diabetic patient were > 50% of daily practice. Over 80% of the participants
were aware about the correct answers. Comparing the percentages of awareness among practioners in
tertiary hospitals and primary health care centers it was significantly higher in the formers (P< 0.05).
The question which had the highest percentages of correct answer was about the value of periodic
examination of diabetic patient (correct in94%) The effect of lipid profile on diabetic complications
was the least to be answered correctly.
Conclusion: The study revealed a good to excellent awareness of Taif practioners about early
detection, diagnosis and management of diabetic complications especially those practicing in tertiary
hospitals, reflecting the values of continuous medical education programs applied in such hospitals.
Keywords: Taif physicians, diabetic complications, KAP

2016. The study was approved by the Ethics
The incidence of diabetes is rising throughout
Board of the hospitals and centers. The
the world, by 2025 it is anticipated that there
survey was done by interviewing the
will be 300 million diabetics all over the globe
physicians to fill the questionnaire which
and more than 75 percent of the diabetics will
focused on physician
be in the developing countries (1, 2). In Saudi
demographics and training in addition to
Arabia the incidence is about 30% of the
screening, diagnosis, and preventive measures
population (3, 4).Physicians can play an
of diabetic complications. Statistical analysis:
important role with the care and education of
Data were gathered, tabulated. SPSS program,
people with diabetes(5).This study was
version 20.0(SPSS Inc., Chicago, IL, USA)
designed to carry out a survey on Physicians
was used. The data were expressed in number
working in the urban and rural areas of Taif,
and percentage (qualitative) whereas, the
to assess Knowledge, Attitude and Practices
quantitative data were expressed as means
±SD. The significance between 2 means was
complications. The outcome will provide
tested by Student's t test. The chi-square and
appropriate guidelines to the physicians,
Fisher exact (FE) tests were used to
resulting in better care to the people with
differentiate between two groups. P<0.05 was
diabetes, ultimately leading to a reduction in
considered as statistically significant. Pearson
morbidity and mortality among a large
and Spearman's correlation tests were used to
segment of the population.
correlate between each parameter and

different variants in the same group to find
significant differences.
In this prospective controlled study which

was conducted at tertiary hospital, primary
health care centers, and private centers in Taif,
A total of 101 physicians (72% females and
Saudi Arabia, from January 2016 to June
28% males) participated in the study, with

Received: 03/9/2016 DOI : 10.12816/0033784
Accepted: 10/9/2016

Full Paper (vol.65 paper# 29)

c:\work\Jor\vol65_30 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 696- 698
Impact of Sleeve Gastrectomy on Weight Loss, Comorbidities of Obesity,
and Quality of Life in Saudi Arabia
Mohammad E. Mahfouz, Abdulrahman Altowairqi, Haitham Altowairqi,
Saif Altalhi, FahadAlotaibi, Fahad Alhazmi, Almutairi, Abdulmajeed Muteb,
Maha Aljumaie, Hala El Nashar
Taif University College of Medicine, Saudi Arabia

Background and aim of the work:
laparoscopic sleeve gastrectomy (LSG) proved to be an effective
operation for control of obesity and associated comorbidities. The aim of this study was to evaluate the
impact of this operation on weight reduction, improvement of obesity comorbid diseases, and the
quality of life (QoL).Patients and method: A cross sectional web-based survey was conducted
between June and October 2016. A total of 660 patients who was subjected to LSG volunteered in the
survey and answered the online questionnaire which consisted of 30 items (multiple choice and short
answered questions). Results: the study involved 425male patients (64.4%) and 235 female patients
(35.6%). The mean preoperative BMI was significantly reduced from 38.6±9.1 kg/m2 to 28.4±6.9kg/m2
after a mean duration of 24±5.6 months following LSG. There was highly significant improvement (P<
0.001) in obesity comorbid diseases; however, the improvement was significant (P< 0.05) for
improvement in sexual performance. The patient satisfaction from the weight reduction after LSG was
rated as excellent by 68.2% of participants, as very good to good by 24.2% of participants, and as just
accepted by 1.8%. 5.8% of patients had no changes or even gain weight after LSA (P>0.05). 92.4%
considered that their quality of life became better and would recommend the sleeve gastrectomy for
other obese people who suffer from the obesity.
laparoscopic sleeve gastrectomy is a good option for those with morbid obese patients as
regard weight reduction, improvement of obesity comorbid diseases, and their quality of life.
Sleeve gastrectomy, obesity comorbid diseases, quality of life, Saudi patients

items (multiple choice and short answered
More than 1.7 billion people are suffering from
questions), in addition to the socio-demographic
obesity around the world and in Saudi Arabia
information. All patients have been underwent
sleeve gastrectomy. The study was conducted
socioeconomic problem (1). There is an
after approval of the college ethical board. Non
increasing of incidence of obese patient who are
Saudi patients were excluded from the study and
being referred for surgical treatment due to
failure of conservative methods in reducing
questionnaires. The survey is divided into two
weight and improving the functional ability ,
sections; the first section is socio-demographic
comorbidities, and patient quality of life as
information that consists of 4 items including
whole(2-4).Numerous surgical options are
sex, age, marital status and nationality. The
practicized and sleeve gastrectomy was initially
second section is the 30 items including BMI
offered to super obese patients with as the first
before and after the LSG, effect of the operation
part of a two part surgical procedure, which was
of different obesity comorbid diseases if found
later followed by a gastric bypass or a duodenal
and patient satisfaction from weight reduction.
switch. However, recent studies verified that the
Statistical analysis: Data were gathered,
weight loss after sleeve gastrectomy is enough
tabulated. SPSS program, version 20.0(SPSS
for most of the individuals (5-8).The aim of this
Inc., Chicago, IL, USA) was used. The data
study was to evaluate the impact of this
were expressed in number and percentage
operation on weight reduction, improvement of
(qualitative) whereas, the quantitative data were
obesity comorbid diseases, and the quality of
expressed as means ±SD. The significance
life (QoL).
between 2 means was tested by Student's t test.
Non-parametric methods were used when data
A cross sectional web-based survey was
a ranking but
conducted between June and October 2016. A
clear numerical interpretation
total of 660 patients who was subjected to LSG
participitated in the survey and answered the
The study involved 425male patients (64.4%)
online questionnaire which consisted of 30
and 235 female patients (35.6%) of mean age of
Received: 01/9/2016 DOI : 10.12816/0033785
Accepted: 07/9/2016

Full Paper (vol.65 paper# 30)

c:\work\Jor\vol65_31 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 699- 708

Histological Effect of Bisphosphonate, Vitamin D and Olive Oil on
Glucocorticoid Induced Osteoporosis (Gio) in Albino Rat
Mohammad Ahmad Kasem1, El-Sayed Galal Khedr2,
Ahmad Mohammad Abdel-Aleem1 and Abdallah Shehatah Said1
Histology department at Al-Azhar Faculty of Medicine in Assiut1 and in Cairo2

Previous studies demonstrated that the prevalence of osteoporosis was 4% in women
aged 50 to 59 years compared to 44% in women aged 80 years and older. Osteoporosis may be primary
or secondary. Glucocorticoid induced osteoporosis (GIO) is considered among the most common
causes of secondary osteoporosis. The present study aimed to assess if vitamin D and olive oil could be
useful in the treatment of GIO as bisphosphonate.
Materials and Methods: Fifty adult female albino rats weighing 180-220 grams and aged 16-19
weeks were divided into five groups (each consists of ten rats): the control group, osteoporotic group,
bisphosphonate group, vitamin D group and olive oil group. The first group served as a negative control
group. The other four groups were injected subcutaneously by methyl-prednisolone (0.5 mg/kg/day -
three times a week) for 60 days to induce osteoporosis (glucocorticoid induced osteoporosis "GIO").
One of the four groups served as a positive control group while other three groups were treated with
oral bisphosphonate (0.84 mg/kg/day - five days a week), oral Vitamin D3 (0.1 ug/kg/day - five days a
week) and oral Olive oil (0.1 ug/kg/day - five times a week) respectively for additional 60 days. At the
end of the experiment, the right femur was removed from each rat and examined histologically after
staining by hematoxylin and eosin stain as well as Masson's trichrome stain. The stained sections were
photographed and analyzed to assess cortical bone thickness, osteocyte number and osteocyte lacunae.
Results: By comparing the cortical thickness in all groups we detected a significant difference between
bisphosphonate group and the control group, as well as between the GIO group and the control group.
We also found a significant decrease in osteocyte number by comparing the GIO group to the control
group. There was as a significant difference between vitamin D group and control group when we
compared the number of osteocyte lacunae in all groups.
Conclusion: GIO affects mainly the cortical bone thickness as well as the osteocyte number.
Bisphosphonate is possibly the drug of choice in the treatment of osteoporosis especially by increasing
the cortical bone thickness. Although olive oil acts also on increasing cortical bone thickness as well as
bisphosphonates but it was less effective. On the other hand, vitamin D increases both; the cortical
thickness and the osteocyte number moderately and may be used as a prophylactic agent against
Keywords: Osteoporosis ­ GIO ­ Bisphosphonates ­ Vitamin D ­ Olive oil.


Osteoporosis is a systemic skeletal disorder
x-ray absorptiometry measurement of bone-
characterized by low bone mass and micro-
mineral density is 2.5 standard deviations
architectural deterioration of bone tissue with a
below the typical peak bone mass of young
consequent compromised bone strength and
healthy women 2. Often patients who have not
increased susceptibility to fracture. In the
sustained a fracture do not report symptoms
developed countries 12.6% of the population is
that would alert the clinician to suspect a
elderly compared with 4.6% in the developing
diagnosis of osteoporosis thus this disease is a
countries 1. According to the national health
"silent thief" that generally does not become
and nutrition examination survey (NHANES)
clinically apparent until a fracture occurs 4.
data, the prevalence of osteoporosis based on
The overall incidence of osteoporosis has a
reduced hip bone density was 4% in women 50
female-to-male ratio of 4:1 5. It occurs in both
to 59 years of age compared to 44% in women
genders, at all ages and can be classified into
80 years of age and older 2.
three types: (1) Primary osteoporosis in which
Ninety percent of hip fractures occur in persons
no underlying cause can be clearly identified,
aged 50 years or older, occurring most often in
but often follows menopause in women and
the eighth decade of life. A patient is
occurs later in life in men. (2) Secondary
considered osteoporotic when the dual-energy
osteoporosis in which the underlying cause is

Received: 03/6/2016 DOI : 10.12816/0033786
Accepted: 10/6/2016

Full Paper (vol.65 paper# 31)

c:\work\Jor\vol65_32 The Egyptian Journal of Hospital Medicine (October 2016) Vol. 65, Page 709- 723

Study of Smoking among Females Students in Ibn Sina
National Medical College
Amoutazbillah Abdurahman Khedrawi1, Maha Ali Alshammari2 , Saleha Hamed
Mabrouk3, Tarnim Muhsen Alghamdi2 , Alaa Ahmed Mohamed Elmorsy Elsayed2 ,
Lujain Osama Rayes2, Banan Mohammad Ali Majrashi2, Sefa Mehmet Emin Altun2,
Abdulmajeed Abdullah Al-Gh amdi4, Abdullah Labib Almanzalawi2, Nedaa Hassan Alshihri2
,Ahmed Yousef Atiah2,Qamar Omar Betrah5 ,Alaa Hassan Mousli
5 , Nawaf Faiq Alsarraj5,
Mohamed Awad Alqarni5, Sultan Mohammad Srougi5, Ahmed Abdulrahman Alharbi5,
Ahmed Fahad Alzahrani5, Zaher Saleh Alshehri5
1 Jeddah Maternity and Children's Hospital, 2 Battarjee Medical College For Science And
Technology, 3 Ibn Sina National Medical College, 4 King Abdul-Aziz Hospital & Oncology
Center, 5 Kings Abdul-Aziz University

prevention of smoking is a key strategy to improve general health. However, survey data
from Jeddah, Saudi Arabia have indicated that a large number of female medical students are addicted to
smoking despite the knowledge of its harmful effects. This article comparatively explores the impact of
smoking on health among female medical students in Jeddah, Saudi Arabia. Data were collected as part
of a program of qualitative and quantitative research investigating the prevalence of smoking among
female medical students. Objectives:to study the prevalence of smoking among females in the college of
ibn Sina and it is impact on their health in relation to personal and family character, CAP knowledge
attitude and practice, and association of medical condition as chronic bronchitis and bronchial asthma.
Methods:the study was conducted among female's students attending college of ibn Sina-Jeddah-Saudi
Arabia. An open-ended questionnaire was developed to cover the objectives.
Conclusion: this study indicated that across the targeted sites, the descriptions made by female smokers
about the harmful impact of smoking on their health were often vague. After assessment of the risk
factor and variables that may increase prevalence of smoking among medical students, the prevalence of
smoking was only 7.95% and used to practice smoking habit despite the knowledge of its side effects.
Keywords: Smoking cessation; awareness spreading.


Tobacco has been growing wild in the Americas
smoking cessation as a crucial preventive
for nearly 8000 years. Around 2,000 years ago
medical measure: they are generally accessible
tobacco began to be chewed and smoked during
to the whole community; are frequently visited;
cultural or religious ceremonies and events [1].
are the preferred source of information on health
Smoking is the leading single cause of
and lifestyle matters; and have been
preventable disease [2] and death in the western
demonstrated to be effective agents of change
world. Smoking-related mortality is estimated to
[6]. Assuming that physicians' personal attitude
increase from 3 million annually (1995
towards the issue of smoking cessation
estimate) to 10 million annually by 2030, with
counselling is to a great extent formed during
70% of these deaths occurring in developing
their medical education, any successful tobacco
countries [3]. The vast majority of these smokers
control measures within the medical profession
wish to quit, but find it difficult to do so, in
will need to begin prior to graduation from
large part because of the addictive effects of
medical school. Teaching modules should focus
on the responsibility of physicians in disease
represents one of the most cost effective
prevention and training in specific smoking
healthcare interventions [4].
cessation techniques early in undergraduate
Effective behavioral and pharmacological
curricula [7].
Smoking is one of the most prevalent addictive
counselling and advice, are required to improve
habits, and has deteriorating effects on
smoking cessation rates [5]. Since smoking
numerous diseases, such as cardiovascular,
duration is the principal risk factor for smoking-
respiratory and malignant diseases[8­10].The
related morbidity, the treatment goals should be
epidemic of smoking use among young people
early cessation and prevention of relapse
is defined as a major public health problem in
[5]. Physicians are uniquely placed to assist in
developed and developing countries. The
Received: 03/9/2016 DOI : 10.12816/0033787
Accepted: 10/9/2016

Full Paper (vol.65 paper# 32)