Evaluation of the Role of Apoptosis in Vitiligo: Immunohistochemical Expression of P53, Bcl-2 and MART-1 Antigens The Egyptian Journal of Hospital Medicine Vol., 8 : 1 11 September 2002


Evaluation of the Role of Apoptosis in Vitiligo: Immunohistochemical
Expression of P53, Bcl-2 and MART-1 Antigens

Ahmed M. Abdel-Aal*; Mohammad A. Kasem**and Ahmed H. Abdel-Rahman***

From the Department of Dermatology, Venereology & Andrology, Al-Azhar University in
Cairo*; Departments of Histology *
* and Pathology***, Al-Azhar University, Assuit

It is clear that melanocytes are absent from the vitiliginous skin. However, the mechanism
of melanocyte disappearance has never been clearly understood. It is not clear whether
melanocyte loss in vitiligo results from apoptosis or other causes of cell death. A very few data
were published about the role of apoptosis in vitiligo.
To investigate the role of apoptosis in vitiligo, ten biopsies from patients and ten normal
control biopsies were taken from the skin of the thigh by the scalped biopsy technique. Each
biopsy included adjacent areas of the lesional, peri-lesional and non-lesional skin. All subjects
were males selected at Al-Housein University Hospital and ranged between 25 to 43 years in
The expression of MART-1 protein as a melanocyte marker, Bcl-2 as an antiapoptotic
molecule and P53 as a proapoptotic molecule were evaluated by the immunoperoxidase
technique and computerized image analysis. The study revealed complete absence of MART-1
positive melanocytes in the lesional skin, gradual appearance in the peri-lesional areas and
showed no significant difference between the non-lesional areas and the normal skin (P=0.43).
The melanocytic Bcl-2 expression was higher in normal skin than the non-lesional area, lower
in the peri-lesional areas and lowest in the lesional areas (p<0.05). Conversely, more expression
of melanocytic P53 was seen in the lesional than the peri-lesional areas, lower in the non-
lesional skin and lowest in the normal skin (p<0.05). Accordingly, the study revealed more
susceptibility to apoptosis in the vitiliginous skin than in normal skin. We hope that these data
can help in understanding the pathogenesis and the progression of this disease as well as
providing better lines of its treatment.

Key words: Apoptosis, Bcl-2, P53, Immunohistochemistry, Melanocytes, Vitiligo.

Vitiligo is an acquired progressive
morphology, representing 10-15% of the
skin disorder characterized by depigmen-
total cell population; these include
tation caused by selective destruction of
Langerhans cells, melanocytes and Merkel
melanocytes which are highly specialized
cells. Melanocytes are cells with a dendritic
cells responsible for skin pigmentation (Le
morphology, of neural crest origin located
Poole et al., 1993). Clinically, vitiligo is
within the basal cell layer. The ratio of
manifested as white macuoles on the skin
melanocytes to basal keratinocytes along
that can be localized or generalized. The
the dermoepidermal junction is site depen-
course of the disease is unpredictable but is
dent and ranges from approximately 1:4 in
often progressive with phases of stabilized
the cheek to 1:11 in the thigh ( Breathnach,
depigmentation (Castanet and Ortonne,
1971). They label on routinely-processed
tissue sections with antibodies to MART-1
Normally, the epidermis has a strati-
protein (Kanitakis, 1998, Palermo et al,
fied, keratinizing epithelium consisting of
2001 and Carlson et al., 2002).
Melanocytes also constitutively express
keratinocyte cells usually with a dendritic
bcl-2 oncoprotein; a 25 kDa cytoplasmic


Full Paper (vol.8 paper# 1)

Conventional TENS Efficacy on Autonomic Function and MCV of the Neuropathic The Egyptian Journal of Hospital Medicine Vol., 8 : 12 17 September 2002


Conventional TENS Efficacy on Autonomic Function and MCV of the
Neuropathic Tibial Nerve.

Z. Mowafy Emam Mowafy*, Wafaa H. Borhan * and Akef A. Khowailed**

* Physical Therapy Department for Surgery , Faculty of Physical Therapy, Cairo
University. Egypt.
** Physiology Department Faculty of Medicine , Cairo University, Egypt.


This study has been conducted to determine efficacy of conventional TENS on the
autonomic function by assessing the big toe skin temperature (TST) and the motor conduction
velocity (MCV) of the neuropathic tibial nerve. Thirty neuropathic patients (20 males, and 10
females) ranging in age from 30 to 50 years (X= 45.411.16) who were divided into 3 groups
of equal number (two study and one control) and consented to receive 40 Hz and 80 Hz
conventional TENS along the tibial nerve course for the first and second study groups
respectively, while the third (control group) received placebo TENS. Both TST and MCV were
recorded before and immediately after treatment (one session for 25 minutes). Treatment and
data collection procedures were done in air conditioned room with the ambient room
temperature was adjusted within the comfortable zone between 24C to 28C. Data collected
showed a significant differences in both TST and MCV in meter/ second, in the first study
group (P<0.05) and in the second study group (p<0.001). While there was no significant
differences in the control group (p>0.05). There was a correlation between the TST and MCV in
both study and control groups. The 80 Hz conventional TENS was more fruitful in enhancing
the autonomic and electrophysiological functions of the neuropathic tibial nerve as manifested
by the increased TST and MCV than 40Hz conventional TENS.


tone in many neurological disturbances as
toward the end of the eighteenth century
polyneuropathy lead to increased systemic
with Galvani's discovery of animal
vascular resistance, decreased cutaneous,
muscular, and endoneurial blood flow
Electrophysiological assessments of
muscle and nerve are now considered
indispensable in the practice of neurology,
Certain patients are more susceptible
physical therapy, and other related clinical
to a peripheral neuropathies as alcoholics,
diabetics and others, as well as the old aged
The clinical measurement of nerve
because they are less mobile, and their
nerves do not tolerate pressure well,
increasingly popular since the late articles
by Hodes et al. (1940 and 1948), which
stimulation is an effective, noninvasive, non
contained the first clinically relevant
-aversive , non-addictive method of
discussion of conduction velocity testing
managing pain, muscle guarding and
and created great interest in the subject of
dysfunction of the pain cycle as well as the
electrophysiological testing,
internal changes that accompanied the pain
Skin temperature assessment is one of
cycle can be managed or at least reduced by
the most important autonomic nerve
TENS application. As pain produces a state
functions as dominance of the sympathetic
of muscle tension that results in a

Full Paper (vol.8 paper# 2)

On The Interaction between Induced Diabetes Mellitus and Schistosomiasis: Mechanism and Protection The Egyptian Journal of Hospital Medicine Vol., 8 :18 31 September 2002


On The Interaction between Induced Diabetes Mellitus and Schistosomiasis:
Mechanism and Protection

Nahla S. El-Shenawy and Maha F. M. Soliman

Zoology Department, Faculty of Science, Suez Canal University, Ismailia, Egypt.

In this study mice were percutaneously exposed to 50 S. mansoni cercariae. Seven weeks
post infection (pi), infected mice were either injected i.p. a single dose of alloxan (200 mg kg-1)
or treated with a single dose of alloxan followed, three days later, with daily i.p. treatment of
ethanolic extract of Cleome droserifolia (0.31 g kg-1) for 18 days. Diabetes mellitus (DM)
affected characteristics of Schistosoma infection as shown in alteration of oogram pattern,
impairing of egg maturation and lowering of faecal egg output. However, extract treatment
(EXT) affected the previously mentioned aspects in addition to its remarkable effect on worm
load, diminishing of hepatic granulomas and suppressing the formation of involutional
granulomas. Results indicated that DM increased the complications of schistosomiasis that was
manifested by the augmented increase of serum glucose level, the severe decrease of serum
thyroid hormones (tri-iodothyronine; T3 and tetra-iodo-thyronin; T4), insulin levels, liver
glycogen content and hepatic DNA. In addition, a decrease in hepatic GSH that was
accompanied by an increase in serum uric acid were observed in infected-DM mice. Serum total
proteins concentrations were obviously decreased and some of protein fractions were also
decreased or absent in both infected and infected-DM mice except for gamma globulin that was
increased in both groups. EXT succeeded efficiently to alleviate these alterations in infected-
diabetic mice, to various extents. The beneficial effects of EXT on thyroid and pancreatic
hormones status seem to be contradictory to its beneficial anti-schistosomiasis effects. This
contradiction may suggest that EXT exerts its beneficial effects through its direct effects on the
parasite, not secondary to its effect on the host. The current results showing differential effects
of both diabetes and extract on schistosomiasis, though both are beneficial, serve to corroborate
this hypothesis.

Key words: Schistosoma masoni, diabetes mellitus, parasite load, biochemistry, granuloma, nuclear

The physiological relationship betw-
metabolic pathways of mammalian hosts
een S. mansoni and its host is complex
should affect schistosomiasis, as metabolic
moreover, the details of several bioche-
mical processes affecting this relationship
are still to be determined (Neves et al.,
(Turchetti-Maia et al., 1983), administrat-
2002). Host provides a nutrient-rich enviro-
ion of enzyme inhibitor or hormonal
nment from which the parasite benefits by
therapy (Chen et al., 1991) and insulin-
taking up copious amounts of glucose and
dependent diabetes mellitus (Hulstijn et al.,
other metabolites needed for its develo-
2001 & 2002).
pment and reproduction. Since the host
The importance of several hormones
environment is crucial for the biology of the
(insulin, steroids and thyroid hormone) on
parasite, therefore, changes in the host
worm development, egg production and the
metabolism due to other illnesses, or
way schistosomes might exploit host
physiological complications could alter the
signaling molecules to evade the hosts'
normal course of schistosomiasis (Hulstijn
et al., 2002). Doubtless, changes in the
(Mendonca et al., 2000 and Salzet et al.,

Full Paper (vol.8 paper# 3)

Effect of Ankle Joint Inversion Trauma on Common Peroneal Nerve MCV The Egyptian Journal of Hospital Medicine Vol., 8 :32 36 September 2002


Effect of Ankle Joint Inversion Trauma on Common
Peroneal Nerve MCV.

Z. Mowafy Emam Mowafy* , Wafaa H. Borhan* And Akef A Khowailed**

* Physical Therapy department for surgery, Faculty of Physical Therapy, Cairo University, Egypt.
** Physiology department, Faculty of Medicine, Cairo University, Egypt.


This study has been conducted to determine effect of ankle joint inversion trauma on
common peroneal nerve motor conduction velocity (MCV). Twenty patients (8 males and 12
females) who were 30 to 45 years of age (X=33.75+1.15) participated in this study. They
received the same medical care and manual tests for the inversion trauma. The involved lower
limbs were considered the experimental group, while the normal contralateral lower limbs were
considered the control group for all the twenty patients. Measurements of the MCV were carried
out 10 days post trauma as a first record and one month post trauma as a second record for the
both groups. Data collected for the first record showed that averages of MCV (m/sec), were
29.50+2.14 and 42.45+3.08 for the experimental and control groups respectively. While data
collected for the second record showed that averages of MCV (m/sec), were 31.02+2.25 and
42.80+3.11 for the experimental and control groups respectively. Results showed a highly
significant reduction in MCV for the first record in the experimental group, and in the second
record for the experimental group, MCV was still significantly reduced. Results of this study
support the hypothesis that inversion ankle trauma is frequently accompanied by peroneal nerve
lesions. Also suggest that MCV measurements can be a valuable tool in evaluating more
objectively the functional instability of the ankle joint.


The most common painful injury to
exceed a critical level, lateral capsular and
the ankle joint is sprain, this injury may
ligamentous structures are injured,
vary from a simple strain in which the
Various degrees of sprain-may occur,
ligaments are merely elongated with
the ligament may be over-stretched
Minimal microtrauma to serious
(strained) without disruption of the integrity
tearing of the ligamentous fibres with or
of the fibres, usually this is minor and
without avulsion of the bones to which they
recovery is rapid and complete. Fibres may
be torn constituting a sprain, which is more
The severity of a sprain is so
severe and requires a longer healing period,
frequently unrecognized that the statement
fiber tearing may be partial or complete
of Watson Jones must be heeded "It is
tear, the simple strain does not impair joint
worse to sprain an ankle than to break it."
stability, all difficult sprains must be
This implies that fracture receives adequate
considered to have ligamentous damage
treatment and sprain is neglected or receive
impairing joint stability and thus must be
inappropriate care,
probably treated,6.21.22..
The most common ligamentous injury

With the steady improvement of
occurs to the ankle lateral ligaments from
recording apparatus, nerve conduction
inversion stress, most epidemiological
studies have become a simple and reliable
studies report that approximately 95% of all
test of peripheral nerve function, the
ankle sprains are lateral and occur when
foot is a plantar flexed and inverted position
standardized and widely used as a means of
at the time of injury, when forces applied
not only objectifying the lesion but also


Full Paper (vol.8 paper# 4)

INTERLEUKINS & FETAL FIBRONECTIN LEVELS IN PRETERM DELIVERY The Egyptian Journal of Hospital Medicine Vol., 8 : 37 49 September 2002


Interleukins & Fetal Fibronectin Levels In Preterm Delivery

Ragab H. EL-Yamani* and Maha G. Soliman**
* Obstetric and Gynecology Dept. Faculty of Medicine, Al-Margab University, Great Socialist
People's Libyan Jamahiriya and ** Pharmacology Dept (Medical microbiology and
immunology unit) Notional Organization for Drug Control and Research

Although the prevention of preterm birth remains the most important challenge in
obstetrics, the mechanism for the onset of preterm labor has not been fully explained. The
purpose of the present study is to investigate the usefulness of cervicovaginal fetal fibronectin
and certain cytokines (interleukin-1B and interleukin-8) levels during pregnancy as markers of
preterm and term delivery. This study was performed on 130 pregnant women at 24 to 29 years
old age. The women were classified into group I (women not in labor, n=65) and group II
(women with spontaneous labor, n=65). Each group was classified into two subgroups [preterm
delivery (<37 weeks gestation, n=40) and full term delivery (>37 weeks gestation, n=25)]. We
obtained cervicovaginal swabs for fetal fibronectin and cervicovaginal fluids for cytokines
The present study revealed that fetal fibronectin, IL- lB and IL-8 levels were significantly
higher in patients in preterm labor than in patients at preterm not in labor. They were
significantly higher in women at full term in labor than in women at full term not in labor.
Interleukin- lB and IL-8 obtained from women not in labor increased exponentially as
gestational age increased, and the cytokines levels were significantly correlated. This study
revealed that cervicovaginal measurement of fetal fibronectin, IL-lB and IL-8 in combination
with clinical findings may be useful for the evaluation of patients with threatened premature

Preterm birth is probably the most
hazardous treatment for thousands of
challenge problem in modern medicine
women annually (Gibbs et al., 1992 and
(Malak et al., 1996). Although preterm
Iams et al., 1995). Part of the clinical
delivery (prior to 37 completed weeks of
problem arises from the absence of
gestation) occurs only in 7% to 11% of
objective criteria for the prediction or early
births, they account for about 85% of
neonatal deaths of normally formed infants
Unfortunately, the initial promise shown by
(Creasy, 1993; Copper et al., 1993). In
risk scoring systems including a history of
addition to the increased risk of neonatal
previous preterm delivery or abortion,
morbidity, many of survivors will be per-
uterine anomalies, heavy work, low socio-
manently handicapped or disabled (Taylor,
economic status and cervical incompetence
1984). Despite significant advances in
has been limited by its poor predictive
prenatal medicine, the incidence of preterm
value and its populations specific analysis
delivery has remained unchanged and stills
and predicts at best 50% of preterm
a serious obstetric problem (Chien et al.,
deliveries (Creasy and Merkatz 1990;
Keirse, 1995). Cervical examination,
The diagnosis of early preterm labor
screening for reduced breathing movements
is difficult and is accompanied by a high
on ultrasound scanning or screening for
false positive rate. These false diagnosis
recurrent uterine contractions provides little
result in unnecessary and potentially
additional predictive power (Lockwood,

Full Paper (vol.8 paper# 5)

Response of Intestinal Mucosa to Trichinosis in immunized and non-immunized Albino Rat The Egyptian Journal of Hospital Medicine Vol., 8 : 50 61 September 2002


Response of Intestinal Mucosa to Trichinosis in immunized and non-
immunized Albino Rat

Azza A. Elnokaly and Abdel-Mawgoud A. Ismaeil
Departments of Parasitology and Histology, Boys and Girls Faculties of Medicine,
AlAzhar University

The intestinal mucosa is reported to be greatly affected by infestation by Trichinella
The infestation by the worm is also controlled by intestinal tissue factors including
cytokines and immune response. Vaccination with larval muscle antigen was reported to be of
limited effect. However, vaccination with adult worm crude antigen may infer better protection.
The aim of this work is to relate the histological, morphometric and immunological response of
the intestinal mucosa of T.spiralis infested rat to worm burden, female fecundity and worm
expulsion before and after immunization with crude antigen of the adult worm. This relationship
is expected to give better evaluation of immunization by this antigen.
45 adult albino rats were allotted among three equal groups: control, T.spiralis infested
and immunized infested group. Infection was done by 300 freshly isolated infective T.spiralis
larvae. Five rats from each group were sacrificed at the end of the first, second and third week
of infestation. The efficacy of immunization was assessed weekly by measuring adult worm
burden and female fecundity, in relation to changes in the histological appearance, relative
villus length, number of goblet, and mast cells and the amount of histamine in the intestine.
The results indicated that the worm burden was at its peak by the end of the first week
after infestation. The mean protection value due to immunization in this parameter was 67%.
Immunization resulted in a protection value relative to larval emergence of 38%. Maximum
changes in the host tissue parameters were detected a week after that of worm burden.
Measurement of the host intestinal response represented 78% change in villus/crypt ratio, 13.3%
in number of goblet cells in the villus and 16.22 in the crypts, 22.5% in mast cell number and
16.8% in histamine content. The results indicate that immunization by crude antigen of the adult
T.spiralis has a protective effect of the intestinal mucosa of the host due to inhibition of worm
vitality and larval emergence. Mast cell production of histamine and goblet cell secretion of
mucins could also play a role in protection.

Trichinosis remains an important
presence of Trichinella in these animals
zoonotic food-born parasitic disease of
followed the use of proteins of animal
world wide distribution (Murrell, 2001).
origin in breeding herbivorous animals,
Trichinella spiralis parasitizes many mam-
which is now a common practice in many
mals including man. The pig is considered
countries(Pozio et al., 2001) including
the main component of the epidemo-
epizootologic chain (Leiby et al., 1990).
The relationship between parasites
Although in Egypt pork meat is not a
and hosts can be considered according to
common dish due to religious instructions,
the concept that the host is an environment
yet the risk of infection is still there, since
providing microhabitats for parasites to
sheep proved to be a source for human
exploit (Rollinson and Anderson, 1985).
trichinosis (Rosa et al., 1992; Kim, 1993;
Parasites divert resources from the host to
and Theodoropoulos et al., 2000). Recently,
their own use. So, the host is under strong
Trichonella larvae have been also detected
selection pressure to stop, or at least, reduce
in ostriches (Piergilli-Foretti et al., 2001)
this drain of his resources. One result of
and horses (Viveros et al., 2001). The
these pressures has been the evolution of

Full Paper (vol.8 paper# 6)

Protective effect of deoxynucleotide triphosphates on DNA damage in different mammalian cells exposed to g-radiation The Egyptian Journal of Hospital Medicine Vol., 8 : 62 69 September 2002


Protective effect of deoxynucleotide triphosphates on DNA damage in
different mammalian cells exposed to -radiation

Elmaghraby, T

National Center for Radiation Research and Technology,Egypt.


DNA is generally considered to be the most critical cellular target when considering the
lethal, carcinogenic and mutagenic effects of drugs, radiation and environmental chemicals. So
the study aim to the determination the damaging effect of -radiation on DNA and the
protective effect of deoxynucleotide triphosphates (dNTPs). The study includes three cell types,
lymphocytes, kidney cells of African gree monkey (Vero) and hepatocellular carcinoma of
human (HePG2) exposed to 1-5 Gy of -radiation and by using fluorometric analysis of DNA
unwinding (FADU) method, DNA damage was measured after radiation. The cells were divided
into two groups:
The first received 5x10-5 dNTPs from 0-30 minutes after radiation, while the second
group was not supplemented with deoxynucleotides. Clonogenic survival for vero and HePG2
cell lines was measured. The results revealed that the increase of irradiation dose precipitates an
increase of DNA strand breaks. The slope curve of initial DNA damage and mean inactivation
dose (D ) differ between vero and HepG2 cell line by a factor of up 3.5 and 2, respectively.
dNTPs have clear ameliorating effect on DNA damage. FADU method can play an
important role in the choice of a suitable treatment (radiation or drugs) and its dosage according
to measurement of DNA damages in selective malignant tissues. Moreover, using dNTPs
mixture can reduce the side effect of these treatment especially after experimentally on live
mammals (mice) .


DNA is generally considered to be the
Although base damage may have
serious consequence for a cell, low levels of
considering the lethal, carcinogenic and
base damage are difficult to measure by
mutagenic efects of drugs radiation and
physical or chemical means (Paterson,
environmental chemicals. These agents may
1978), by contrast, DNA strand breaks can
damage DNA by altering bases or
be detected with great sensitivity by many
disrupting the sugar-phosphate backbone. It
methods. Pulsed field gel electrophoresis
is generally accepted that cell death induced
(PFGE) Whitaker, et al., (1995), constant
by ionizing irradiation is due to DNA
field gel electrophoresis. (CFGE) Dikomey
double strand breaks (Steel et al., 1989).
et al., 1997) and neutral filter elution
The molecular mechanisms that control
(Zaffaroni et al., 1994) have shown a
variations in radiation induced DNA
correlation between radiosensitivity and
damage between cell types are not
residual unrepaired DNA double-strand
understood. Both the initial DNA damage
and the residual unrepaired DNA damage
A common thing in these methods is
may be critical determinants in the
that they measure DNA double strand
processes leading to cell death.
breaks and hence are sensitive for

Full Paper (vol.8 paper# 7)

Physiological Changes Induced by Long Term Administration of Saccharin Compared With Aspartame to Male Albino Rats The Egyptian Journal of Hospital Medicine Vol., 8: 70-81 September 2002


Physiological Changes Induced by Long Term Administration of Saccharin
Compared with Aspartame to Male Albino Rats

Inas Z.A. Abdallah
Nutrition and Food Science Dept., Faculty of Home Economics
Helwan University


Artificial sweeteners have been in use by food industries for a long time. Safety concerns raised
about artificial sweeteners since they are widely used nowadays. The present work aims to study the
possible changes in body weight, blood picture, liver functions, blood glucose and liver glycogen content
as wel as histopathological changes induced in liver and urinary bladder of male albino rats after
administration of two artificial sweeteners (saccharin or aspartame). Male rats were administered
saccharin (50 mg/kg b.w.) or aspartame (100 mg/kg b.w.) daily by intragastric gavage for 14 weeks. The
results revealed that both saccharin and aspartame provoked highly significant reduction in body weight
gain %. Saccharin exerted highly significant reduction in haemoglobin (Hb) level, haematocrit (Hct%)
and red blood cel s (RBCs) count, while aspartame induced insignificant changes in al haematological
parameters. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity levels were
significantly increased with saccharin and aspartame. Alkaline phosphatase (ALP) levels in serum
showed slightly insignificant increase by saccharim administration, while aspartame caused a significant
rise in ALP. Blood glucose level of rats given saccharin significantly dropped, while aspartame caused a
significant elevation in blood glucose level. Liver glycogen content of rats given saccharin significantly
increased, while aspartame caused a significant reduction in liver glycogen content. Microscopic
examination of liver sections showed lymphocytic and macrophages infiltration of the portal traid in rats
administered saccharin, while aspartame group showed no histopathological changes except slight
hydropic degeneration of hepatocytes. Urinary bladder sections of rats administered saccharin revealed
proliferation of the mucosal epithelial cel s into papil ary invaginated projections with highly vascularized
connective tissue core and mononuclear inflammatory cel s infiltration, while aspartame group showed
no histopahtological alterations. It could be recommended that the use of saccharin as an artificial
sweetener should be restricted, while aspartame should not be administered to diabetic. When it
is necessary to use artificial sweeteners, fresh fruits and vegetables should be ingested as they
act as scavengers for the liberated free radicals and help to delay the postprandial rise in blood
glucose level.

Food additives are substances not
and xylitol are just some of the many nutritive
normally found in foods which are added to
sweeteners used in foods (Wardlaw, 2000).
extend shelf life, and improve flavour, colour
Non-nutritive sweeteners are also referred to
and texture or stweeten food. Most highly
as intense sweeteners, very low caloric or
processed foods cannot be made without
alternative sweeteners. These were discovered
them. Additives include antioxidants, prese-
in the last century, beginning with saccharin
rvatives, sweeteners, colourants, flavors,
which was discovered in 1879, later, this was
emulsifiers and stabilizers (Duyff, 2002).
followed by many other artificial sweeteners
Sweeteners could be classified as natural
including, sucralase, alitame, cyclamate,
nutritive and artificial non-nutritive sweeten-
acesulfame-k and aspartame (Marion and
ers. Nutritive sweeteners include monosac-
Franz, 1993).
charides, disaccharides and sugar alcohols
There are various reasons why
from either natural or refined sources. White
sweeteners are used. In previous times, there
sugar, brown sugar, honey, corn syrup,
was a medical need and purpose for
glucose, fructose, lactose, maltose, sorbitol
developing artificial sweeteners, but today

Full Paper (vol.8 paper# 8)

The Egyptian Journal of Hospital Medicine Vol., 8 : 82 87 September 2002


Study of Interleukin-1 in Essential Hypertension

Hoda A. Hassan ,Amal Ahmed Mokhar,Adila M.Gad, Amal Abdel Aleem*
Department of General Medicine & Clinical Pathology*
Al Azhar University (Girls)
The observation of increased blood interleukin 1 levels in subjects with hypertension is a
finding that raises the hypothesis that the immune mechanisms may be involved in the
atherogenic cascade . Our aim in this study was to investigate the possible interrelations
between blood pressure, lipid profile and IL-1 to clarify the possible participation of this
cytokine in the cascade phenomena presented during the process of essential hypertension (EH)
such as atherogenesis.
28 hypertensive patients and 10 healthy volunteers served as control matched for age and
sex were included. IL-1 (enzyme immunoassay), total cholesterol , triglycerides, high and low
density lipoprotein cholesterol were estimated. Significant elevation of IL- 1 in hypertensive
patients in comparison to the control was found with positive correlation between IL- 1 and
diastolic. Systolic and the mean Blood pressure r=0.16, 0.046 and 0.28 respectively . Also the
study showed positive correlation between IL-1 and body mass index (r=0.42), serum
cholesterol and LDL cholesterol and negative one with TG while no correlation was found with
HDL cholesterol TG. Elevated IL-1 levels in subjects with EH may be related causally to the
role of immunologic mechanisms in the development of EH and even to the atherogenic
cascade.Thus we can suggest that the presence of high levels of IL-1 may be an additional risk
factor for atherogenesis in patients with EH


The dysfunction of the immune
cellular matrix proteins by endothelium
system has been implicated recently in the
Montensano et al ., (1984) and promotion
pathogenesis of essential hypertension (EH)
of vascular permeability Martin et
(Dalekas et al.,1997) ,On the other hand
al.,(1989). In 2002 Vito et al observed that
alteration in renal handling of salt and
nitric oxide and IL-1 exert a tonic inhib-
water, the rennin angiotensin system, the
itory action on central sympathetic nervous
vascular structure , systemic haemody-
system activity. IL-1 also suppresses
namics, the sympathetic activity, environ-
vascular contractility and has procoagulant
mental or genetic factor, the hyperins-
activity Bevilacqua et al., (1986). In 1989
ulinaemia and the tissue resistance to
Wang et al detected increased levels of IL-
insulin have been involved to varying
1 and IL- IB m RNAs in human atherosc-
degree in the pathog-enesis of essential
lerotic plaque, however, increasing evide-
hypertension. IL-I forms part of a complete
nce has accumulated in the last years
integrated group of cytokines that has been
supporting the speculation that alterations
shown to mediate the inflammatory host
in the function of the immune system could
response to infection Dinarello,1998 , it has
significantly contribute to the cause of
also been implicated in the pathophysiology
many forms of experimental and human
of endotoxin and immune mediated shock.
essential hypertension. Alteration in both
In vitro evidence suggests that this cytokine
humoral and cellular immunity (khraibi,
may act as a regulatory protein in the ather-
1991), inherited abnormalities of the compl-
osclerotic process. Several mechanisms
ement system and immunogenetic correl-
have been suggested including stimulation
ations between histocompatibility antigens
of leukocyte adherence to the endothelium,
with either borderline hypertension have
modulation of LDL metabolism Rasmuss
been found (Titkov, et al .,1993). It has
en &Seljehid ,( 1989) , induction of extra
recently been shown that antihypertensive

Full Paper (vol.8 paper# 9)

Comparative study of Ropivacaine versus Bupivacaine for pediatric caudal block The Egyptian Journal of Hospital Medicine Vol., 8: 88 93 September 2002


Comparative study of Ropivacaine versus Bupivacaine for pediatric
caudal block

Omar Elsafty MD, Ahmed M.S. Hamed MD, Sherif Wadie MD
&Maged M.Kamel
Departement of anesthesia Ain shams university


Ropivacaine is a long acting amino-amide local anesthetic, it is less cardiotoxic and less
likely to cause motor blockade than bupivacaine.
In our study we compared the effectiveness, degree of motor block produced by either
ropivacaine or bupivacaine as well as the onset and duration of both drugs.
Fourty children ASA I scheduled for elective minor lower abdominal surgery were
randomly allocated to receive a single caudal extradural injection of 1ml/ kg of either
ropivacaine 0.375% r group (n=20) or bupivacaine 0.375 % b group (n=20) after induction of
general anesthesia.
Heart rate and arterial blood pressure were measured every 5 minutes from the beginning
of G. A. until the child is transferred to the ward. The extent of motor block in the recovery
room was scored according to modified Bromage scale , time to first analgesic requirement
were recorded.
Both groups were similar in age, weight, and there were no difference in heart rate or
arterial blood pressure. Yet the degree of motor block was significantly different between the
two groups.
Ropivacaine group showed a shorter duration of motor block than bupivacaine group,
postoperative analgesia was required at almost equal time in both groups. These findings
suggest that there is no great difference between ropivacaine compared with bupivacaine as
regard the hemodynamics or sensory block, yet ropivacaine is superior for it s safety and less
motor block.


Ropivacaine is the s-enantiomer of
Caudal analgesia is a relatively simple
amide local anesthetic, which has been
technique with a predictable level of
extensively evaluated in adults and older
blockade, provides excellent postoperative
children. Recently it has been used in
analgesia. It is the most popular regional
younger children and several studies have
anesthetic used in pediatric surgery for
reported its clinical efficacy and safety
various surgical procedures, such as lower
when administered for caudal epidural
abdominal, urologic and lower limb
analgesia, for lumber epidural, for
operations. This long-acting regional
peripheral nerve block and as a continuous
technique provide analgesia beyond the
epidural infusion (1).
duration of surgery, with a smooth recovery
Ropivacaine has several properties
period and good postoperative pain control,
which may be useful in pediatric practice,
and therefore reduces analgesic requirement
namely the potential to produce differential
and facilitates early discharge.
neural blockade with less motor block and
Long acting anesthetics, such as
reduced cardiovascular and neurological
bupivacaine, have had a well-defined role
toxicity. (2) These features are particularly
in regional anesthesia and analgesia for
attractive for day case surgery in children,
many years. Since the report of several
which is increasing in frequency.
cases of systemic toxic reactions after

Full Paper (vol.8 paper# 10)

Clinical importance of P53 and P21 determination as a biomarkers in bladder cancer and bilharzial patients The Egyptian Journal of Hospital Medicine Vol., 8: 94 103 September 2002


Clinical importance of P53 and P21 determination as a biomarkers in
bladder cancer and bilharzial patients

Wafaa Abd-Allah* Sohair A Hassan**, Faten E Hafez and***
Hafez Faruk*.

* Cancer Biology Department, National Cancer Institute, Cairo, Egypt.
** Medicinal Chemistry Department, National Research Center , Cairo, Egypt.
***Clinical Pathology Department, National Cancer Institute, Cairo, Egypt.

The present study was made to shed more light on the clinical importance of early
detection of bladder cancer using p53 and p21 mutant proteins as a biomarkers using simple,
applicable ELISA techniques. Serum samples were collected from 70 patients , the first group
included 50 bladder cancer patients, the second included 20 bilharzial patients ,while the third
group consisted of 20 healthy individuals used as control. P53 wild and mutant types showed
significant changes (p<0.02 and <0.007,respectively ) in bilharzial patients. Also they showed
significant changes in bladder cancer patients with (+ve) lymph node (p<0.02 and p<0.01,
respectively) when compared to control as well as it showed great differences between low and
high grade ( p< 0.01 and p<0.001) for wild and mutant type. Moreover p53 showed higher
sensitivity levels for mutant and wild type in both bilharzial 19.5, 31.2 compared to 23.9 and
35.9%, respectively in bladder cancer one . P21 mutated amino acids were proved to be of
significant values in bladder cancer group (p<0.001) compared to bilharzial group. The p21
mutated amino acids showed a correlation with different histological grades for bladder patients,
while ARG12 and ASP13 were highly related to bladder cancer with bilharzial history with the
notion that ASP13 achieved high sensitivity level to bladder cancer group 91% and 83% for
those of bladder cancer with bilharzial history .In conclusion the results of the present study
revealed that determination of both p53 and p21 are of great value in the early detection and
follow up of bladder cancer patients and screening for risky bilharzial ones .


Bladder cancer represents a main
is not entirely explained by differences in
health problem in Egypt . Its a major
cigarette smoking or occupatio-nal exposure
urological disease and accounted for 30.3 %
( Hartge et al., 1990).
of total malignancies according to the
In Egypt, the male incidence of bladder
registry of National Cancer Institute ( NCI )
cancer is higher (Mokhtar, 1991) due to
Cairo University in 1990 (Mokhtar, 1991).
frequent field exposure and bilharzial
In fact bladder cancer is uncommon below
infestation among men. Considerable evide-
the age of 40 years ( Samuel and Sonny,
nce suggests that schistosomiasis plays an
1992). In younger ages as they exposed to
important role in the development of
bilhazial infection the incidence of
bladder cancer in Egypt and other countries
bilharzial bladder cancer is remarkably
where infection with the parasite is
higher when compared to non-bilharzial
epidemic (El-Bolkainy, 1998). Several
series (Payne, 1959). The incidence of
hypothesis have been proposed to explain
bladder cancer increases with age reaching a
the etiological roles of schistosomal
peak between 50 to 60 years old ( El-Bolkainy
infection in the development of bladder
et al., 1972, Fitzpatrick and Reda, 1986).
cancer. Among these roles only two are
Bladder cancer is five times more frequent in
strongly contributing in the development of
men than in women, a different causes that
the tumor. The first one is increasement of

Full Paper (vol.8 paper# 11)

The minimum effective intravenous dose of ondansetron for prevention of postoperative nausea and vomiting after adenotonsillec The Egyptian Journal of Hospital Medicine Vol., 8: 104 115 September 2002


The minimum effective intravenous dose of ondansetron for prevention
of postoperative nausea and vomiting after adenotonsillectomy in
dexamethasone pretreated children

Asharf Mahmood A. Swellam and Tarek Ali Helal*
Assistant Professor - Anesthesia Department, Ain-Shams University, Cairo, Egypt
* Assistant Professor - E.N.T Department, Cairo University, Egypt

Postoperative nausea and vomiting (PONV) remains a distressing and common problem
after tonsillectomy with an incidence ranging from 40-73% in those who did not receive
prophylactic antiemetic. This study was done to identify the minimum effective IV dose of
ondansetron to decrease the incidence and severity of PONV in the dexamethasone (150ug/kg)
pretreated children undergoing adenotonsillectomy. In this prospective, randomized, double-
blinded, placebo-controlled study, 150 children (3-12 years old) received dexamethasone
150g/kg IV (maximum 8mg) premedication were randomly assigned to receive either placebo
(saline) or ondansetron in a dose of 25, 50, 75 or 150g/kg IV immediately after induction of
anesthesia. All children received standardized perioperative care, including surgical and
anesthetic techniques, IV fluid, postoperative analgesic and rescue antiemetic (RAE). The
incidence and severity of PONV were recorded in a standardized fashion at the intervals 0-2, 2-
12 and 12-24h postoperatively. The time to first postoperative analgesic, total analgesic
consumptions, the need for rescue antiemetic (RAE), the fast tracking time (FTT), the time to
first oral intake and parent's satisfaction score were recorded as clinically true outcome
measures. The five treatment groups were similar with respect to patients's characteristics and
operative data. There was no significant difference with respect to the incidence (P>0.05) or
severity (P>0.05) of PONV between the placebo and 25g/kg ondansetron group during the
study period (0-24h). The incidence of early (0-2h), delayed (2-12h), and late (12-24) PONV
were significantly less in the 50 (P<0.05), 75 (P<0.05) and 150 (P<0.05) g/kg ondansetron
groups compared with placebo. The incidence of 24h PONV was 43, 37, 13, 10 and 7% in
placebo, 25, 50, 75 and 150g/kg ondansetron groups, respectively. The PONV severity scores
(0-3) were significantly less (p<0.05) in children who received ondansetron in a dose of
50g/kg or more compared with the placebo. There was no statistically significant difference
with respect to the incidence (P>0.05) or the severity (P>0.05) of PONV between the 50, 75 and
150g/kg ondansetron groups. The time to first postoperative analgesic, the total postoperative
analgesic consumptions, the need for RAE, the time to first oral intake and the fast tracking time
(FTT) were significantly less (P<0.05) in children who received 50, 75 and 150 g/kg
ondansetron in comparison with placebo. The parent's satisfaction scores were significantly
high (P<0.05) for those children who received ondansetron in a doses of 50g/kg or more
compared with placebo. There was no significant difference with respect to the clinically true
outcome measures in children who received ondansetron in dose of 50g/kg or more. In
conclusion, ondansetron 50g/kg IV was the minimum effective IV dose to decrease the
incidence and severity of PONV in dexamethasone (150g/kg IV) pretreated children
undergoing adenotonsillectomy. This dose was associated with a significant reduction in the
time to first postoperative analgesic, total analgesic consumptions, the need for rescue
antiemetic (RAE), the time to first oral intake, the fast tracking time (FTT) and a high parent's
satisfaction scores. Increasing the dose of ondansetron to 150g/kg provided no significant
benefits in reducing the incidence or severity of PONV in dexamethasone (150g/kg IV)
pretreated children undergoing adenotonsillectomy.


Full Paper (vol.8 paper# 12)