Correlation Of Plsma C The Egyptian Journal of Hospital Medicine Vol., 12 : 1 ­11 September 2003


Correlation of Serum Concentrations of Soluble
Thrombomodulin, Soluble Vascular Cell Adhesion Molecule-1,
Intracellular Adhesion Molecule -1 And E-Selectin In Patients With
Systemic Lupus Erythematosus

Malak., A. Mohsen*, Magda.A.Gamil*,Maha. I.Shehata*
Boshra.H,El Zawahry **and Salwa.S.I.Afifi***

Clinical Biochemistry,*Microbiology and**Physiology Departments.
Faculty of Medicine for Girls and *** Microbiology Department Faculty of Pharmacy,
Al- Azhar University, Cairo, Egypt.

To date no specific serological parameters are available to assess disease activity in
systemic lupus erythematosus (SLE). The objective of this study was to correlate serum levels
of thrombomodulin (TM), intracellular adhesion molecule-1 sICAM-1, vascular cell adhesion
molecule-1 sVCAM-1, and E-selectin with standard laboratory tests and clinical indices of
disease activity in 40 patients with SLE and 20 apparently healthy persons as controls.
According to British Isles Lupus Assessment Group (BILAG) disease activity index, the 40
patients were divided into two groups, the first consisted of 22 with active disease, and the
second consisted of 18 patients with inactive SLE. Serum sTM, sICAM-1, sVCAM-I, and E-
selectin were measured in their sera, using enzyme linked immuonosorbent assay (ELISA)
technique.C-reactiv protein (CRP), Erythrocyte sedimentation rates (ESR) and serum
creatinines were measured by standard laboratory tests. Total leukocytic count and hemoglobin
concentration were detected by coulter counter. Levels of sTM and sVCAM were highly
elevated in the group of patients with active SLE as compared to the inactive one (P<0.0005)
while sICAM-1 levels were moderately elevated (P<0.005). E-selectin was poorly correlated
with disease activity in SLE (P>0.05). In SLE, the BILAG disease activity index, ESR and
serum creatinine correlated best with sTM, sVCAM-1 and E-selectin levels while there was a
weak association between CRP levels and the adhesion molecules, and no correlation between
CRP level and disease activity.
In conclusion, sTM and sVCAM were the most important serological indices of disease
activity in SLE and might be valuable serological parameters for monitoring therapy.


Systemic lupus erythematosus (SLE)
to blood vessel destruction and organ injury
is an autoimmune disease of unknown
(e.g. glomerulonephritis and vasculitis).It
aetiology affecting multiple organ systems
has been suggested that expression of
.The role of vascular injury in the
adhesion molecules primes the vascular
pathogenesis of SLE has been well
endothelium for subsequent injury, as
described {Belmont et al ; 1999, Cronstein
reflected by increased release of thromb-
omodulin (TM) into the circulation
complexes of auto antibodies and self-
(Belmont et al; 1997 , Boehme et al ;2000).
antigens are deposited in the vascular walls
TM is a cell-surface glycoprotein
of SLE patients and activate the
located at the luminal surface of the
complement pathways .The resulting
vascular endothelium and acts as a
complement products stimulate leucocytes
membrane bound; high-affinity thrombin
to injure the vascular endothelium, leading
receptor (Dittman and Majerus; 1990).It
Refree: Prof; Dr. Azza Shawky Ghanem

Full Paper (vol.12 paper# 1)

The Egyptian Journal of Hospital Medicine Vol., 12 : 12 ­ 27 September 2003


Microscopic Studies Of The Effect Of Some Food
Additives On The Kidney Of Albino Rat

Abd El-Tawab M. Ismail - Ashraf M.Moustafa
and Gamal Abd El-Rhman B.

Histology Department , Faculty of Medicine Al-Azhar University

Recently the use of synthetic food coloring additives was increased and the levels of human
exposure to such agents are very broad, thus feeding over long periods may continually possess
potential hazards to the human health. Also most of the food colors tested in the conventional toxicity
experiments showed toxic effects at very high level of intake i.e. 1-5 % in the diet.
The aim of this study was to evaluate the histological and histochemical effects of some of
these substances (Sodium nitrate and sunset yellow) on the liver of adult albino rats.
The study included three main parts:
A. Histological studies on the liver under the effect of (Sodium nitrate and sunset yellow)
substances. Using paraffin sections, which were stained with Hx & Eosin, Masson
B. Evaluation of histochemical activity of both alkaline phosphates enzyme and succinic
dehydrogenase enzymes on the renal tissue.
C. Statistical evaluation using image analyzer to detect glomerular area, area percentage
of collagen fibers distribution and optical density of both alkaline phosphatase enzyme
activity in glomerulus and succinic dehydrogenase enzyme activity in renal tubules.
Seventy adult male albino rats were used. Nitrate and sunset yellow were given orally
through a gastric tube in dose of 1 mg / kg / b.w. daily. The animals were classified into
seven groups.

1. Group I (Control group)
2. Group II: The animals were given sodium nitrate in a dose of 1mg/kg/bwt for one
3. Group III: The animals were given sun set yellow in a dose of 1mg/kg/bwt/day for one
4. Group IV: The animals were given sodium nitrate and sunset yellow for one month in a
dose of 1mg/kg/bwt/for each drug in a separate manner.
5. Group V: The animals were given sodium nitrate similar to the previous dose as group
II for one month and left 2 weeks without oral intubations.
6. Group VI: The animals were given sun set yellow No 6 in a dose and route of
administrations as group III for one month and kept without intubations for 2 weeks.
7. Group VII: The animals were given both sodium nitrate & sunset yellow by the same
dose and route of administration as in group IV for one month and kept without
intubations for 2 weeks.

Food additives are common in our life
international food additive added to the
and plays an important role in human
original food or mixture of foods for specific
being's life. Nitrate and nitrite are ubiquitous
purposes (Kilgore and Li.,1980).
in nature and their presence are essential for
The continuous use of nitrogenous
the fertility of the soil, and used as
fertilization in agriculture is the major source

Full Paper (vol.12 paper# 2)

ž’ The Egyptian Journal of Hospital Medicine Vol., 12 : 28 ­37 September 2003


Significance of tumor necrosis factor- and B2 microglobulin in
patients having chronic lymphocytic leukemia

Mona Hilmy Alrayes, MD* and Hoda Hasan Abd Albaset, MD**,

Department of Clinical and Chemical Pathology* and Department of General
Medicine**. Girls` Faculty of Medicine- Alazhar University

Background and objectives:
Tumor necrosis factor- (TNF-) is important for the
growth and survival of the leukemic cells in B-cell chronic lymphocytic leukemia (B-CLL). B2
microglobulin (B2MG) is elevated in tumors, it is clinically used for lymphoproliferative
diseases, where serum B2MG is related to tumor cell load, prognosis, and disease activity. The
aim of this study was to investigate the serum levels of TNF- and B2MG in B-CLL patients
with correlation to relevant haematological data and disease characteristics. Patients, materials
and methods:
The study included 15 newly diagnosed untreated B-CLL patients obtained from
the outpatient clinic at the National Cancer Institute in Cairo and 15 ages and sex matched
controls. Venous blood samples were obtained from B-CLL and control groups for complete
blood count (CBC). Serum was separated for measurement of TNF- and B2MG levels by
ELISA. Bone marrow (BM) aspiration was done to all B-CLL cases. Results: The studied B-
CLL group consisted of 7 females and 8 males with mean ± SD age (54.9 ± 11.6 years). The
clinical staging according to Rai classification was: 66.7% cases in stage 0-II and 33.3% cases
in stage III-IV. There was highly significant elevation of white blood cell count (WBC),
absolute lymphocytes in peripheral blood (PB), serum TNF- and serum B2MG with high
significant reduction of haemoglobin (Hb) in B-CLL group when compared with the control
(P<0.001). There was significant reduction of platelets and significant elevation of absolute
monocytes in PB in B-CLL group (P<0.01 & P<0.02 respectively). There was significant
elevation of TNF- in B-CLL patients with anaemia and B-CLL patients with
thrombocytopenia in comparison with B-CLL patients without anaemia and B-CLL patients
without thrombocytopenia (P=0.02 and P<0.05 respectively). There was highly significant
positive correlation between TNF- and both absolute monocytes in PB & serum B2MG with
inverse highly significant correlation with Hb. A significant positive correlation was found
between TNF- and: WBC, BM lymphocytes and Rai III-IV disease stage with inverse
significant correlation with platelets. A significant positive correlation was detected between
B2MG and both WBC and absolute peripheral blood lymphocytes (P=0.01) with highly
significant positive correlation with Rai III-IV disease stage (P<0.001), while no correlations
were demonstrated with the other parameters. Conclusion: TNF- and B2MG are important for
the process of leukemogenesis and progression and may serve as bad prognostic markers for B-
CLL. On the basis of these observations, therapeutic inhibition of TNF- and B2MG could be a
new strategy of importance in the treatment of B-CLL.

Tumor necrosis factor- (TNF- ) is a
been localized to the short arm of
cytokine having a peptide structure that
chromosome 6 (Wingfield et al, 1987).
possesses pleiotropic biological activities.
TNF- plays a physiological role in host
The active form of TNF- is a homotrimer
defense, inflammation, and cell different-
having a molecular mass of 53 kd (Le and
tiation and a pathological association with
Vilcek, 1987). The gene for TNF- has
diverse conditions such as fever, cachexia,

Full Paper (vol.12 paper# 3)

ž’ The Egyptian Journal of Hospital Medicine Vol., 12 : 38 ­46 September 2003


Serum Levels Of Interleukin­12 And Tumour Necrosis Factor­ In Patients
With Active And Inactive Rheumatoid Arthritis

Daad F.I. El Fouhil*, Amany M. Abdel Wahab*,
Nour H. Madbouli* and Sabila G. Mousa.

*Microbiology and Internal Medicine Departments,
Faculty of Medicine for Girls, Al­Azhar University

Abstract :
Seventeen patients with active rheumatoid arthritis (RA) (group I) and fifteen patients with
inactive RA (group II), in addition to ten healthy control subjects were included in the present
study. All patients were evaluated clinically and biochemically according to the American
College of Rheumatology (ACR) core set measures, and a comparison was set between both
groups of patients. Serum levels of interleukin­12 (IL­12) and tumour necrosis factor­ (TNF­
) were measured using enzyme linked immunosorbent assay (ELISA) in all patients and
control subjects. It was found that there was no significant difference in age, sex, disease
duration, degree of disability or physician's and patient's global assessments between both
groups of patients (P>0.05), but patients with active RA had significantly higher tender joint
score, swollen joint score, visual analogue pain scale, erythrocyte sedimentation rate and C­
reactive protein compared to patients with inactive RA (P<0.05). Detectable levels of IL­12 in
serum were found in 13 out of 17 (76.5%) active RA patients, 6 out of 15 (40%) inactive RA
patients and 1 out of 10 (10%) healthy controls. TNF­ was also detected in the serum of 12 out
of 17 (70.6%) active RA patients, 7 out of 15 (46.7%) inactive RA patients and 1 out of 10
(10%) healthy controls, with significantly higher detectability and significantly higher mean
serum levels of IL­12 and TNF­ in patients with active RA compared to patients with inactive
RA and healthy controls (P<0.05). However, patients with inactive RA had significantly higher
detectability and significantly higher serum levels of IL­12 and TNF­ compared to the healthy
controls (P<0.05) which may reflect the role of IL­12 and TNF­ in the pathogenesis of RA.
Serum levels of IL­12 correlated positively with TNF­ levels in serum in case of active RA
patients (r=0.493) and inactive RA patients (r=0.474). It was concluded that significantly
elevated serum levels of IL­12 and TNF­ may be associated with clinical and laboratory
markers of activity of RA; and measurement of serum IL­12 and TNF­ levels could be used
for assessment of RA activity. IL­12 and TNF­ may play an important role in the
pathogenesis and inflammatory activity of RA.

Introduction :
Their central role include cell to cell
autoimmune disease characterized by the
communication, inflammatory response
infiltration of chronic inflammatory cells.
regulation (Peters, 1999).
Cytokines and inflammatory cells are
Interleukin­12 (IL­12) is recognized as
thought to be important in the initiation and
a critical cytokine in terms of regulating the
perpetuation of RA (Kim et al., 2000).
balance between T helper 1 (Th1) and T
Cytokines are small proteins produced
helper 2 (Th2) cells, as well as enhancing
by immune and non immune cells in
cytotoxic Tcell­mediated lysis and natural
response to foreign antigens (Peters, 1996).
killer cell activity (Trinchieri, 1995). It has

Full Paper (vol.12 paper# 4)

Role of Diet in Management of Different Forms of Chronic Hepatitis in Young Adolescence The Egyptian Journal of Hospital Medicine Vol., 12 : 47 ­ 52 September 2003


Role of Diet in Management of Different Forms of Chronic Hepatitis in
Young Adolescence

M.M.H.Osfor, El Minshawy O***, M.S.S.Arbid* , and Nabila El-lithey**
Department of nutrition, pharmacology*, and medical physiology** of the national research
center and internal medicine department***El-Minia university,El Minia, Egypt

Introduction young adolescence liver disorder have in general mode of presentation
distinct from that in adult population. Chronic hepatitis especially hepatitis C and B are the most
common etiological agents of cirrhosis in Egypt The aim of work is to explore the role of diet
in treatment of chronic hepatitis in young adolescence Patients and methods 110 patients with
chronic hepatitis were classified into 3 groups : group I 46 patients with chronic hepatitis C,
group II 37 patients with chronic hepatitis B , group III 27 patients with chronic hepatitis due to
other causes rather than C or B infection. Liver biopsy is done for all patients. Anthropometric
parameters and blood samples were taken before and after diet program for 6 months Results
The biochemical parameters revealed a significant increase in the serum level of total protein
and hemoglobin concentration, significant decrease in total and direct bilirubin alkaline
phosphatase ALT, and AST. Non significant difference in weight ,height, arm and waist
circumference, WHR and BMI in patient group after diet program. Conclusion these data
suggest that diet can be effective in the treatment of chronic hepatitis in young adolescence.


Liver disorders of young adolescents have
role of diet in treatment of chronic hepatitis
in general mode of presentations that are
in young adolescents
distinct from those in adult populations. It

is due to varying etiology and natural
Material and methods
history of liver diseases in young adole-

scence (Thapa,1999)1. Chronic hepatitis
One hundred and ten patients with
especially hepatitis C & B, are the most
chronic hepatitis were included in this
common etiological agents in cirrhosis in
study. All patients were selected from the
Egypt (El-Gohary et al., 1995)2.
hepatology Clinics of Al-Ahram and El-
Chronic hepatitis are classified into
Minia University Hospitals (Central Egypt)
chronic persistent and chronic aggressive
and were within a range from 12 ­ 16 years
form. The latter, with mild or strong
mean ± SD 13.9±1.5 Ten normal subjects
inflammatory activity has proven valid and
were matched and served as a control
has been widely accepted. The long term
group. According to the results of serolo-
therapy of the chronic persistent form to be
gical markers as well as their clinical,
confirmed histologically consists merely of
laboratory, radiological and histopatholo-
a basic therapy diet, abstinence of alcohol
gical diagnosis, the patients were classified
physical rest and vitamins (Morl, 1997)3.
into three groups:
The most important and often

neglected component of management of
Group-I : Included 46 patients with
chronic liver diseases in young adolescents
chronic HCV infection or cirrhosis with
are nutritional management (Thapa, 1999)1.
ages that range from 12 ­ 16 years with a
Dietary measures have achieved mixed
mean ± SD 14.08 ±15 They were 30 male
results in the management of liver disorders
and 16 females.
(Messner and Brissot, 1990)4. Therfore the
Group-II : Included 37 patients with
aim of the present study is to explore the
chronic HBV infection or cirrhosis with age

Full Paper (vol.12 paper# 5)

Effect of Aloe vera extract on some physiological parameters in diabetic albino rats The Egyptian Journal of Hospital Medicine Vol., 12 : 53 ­ 61 September 2003


Effect of Aloe vera extract on some physiological parameters in
diabetic albino rats.

*Eman G.E. Helal; **Mohamad H.A. Hasan;***Ashraf M. Mustafa and
*Anwaar Al-Kamel .

*Dept. of Zool., Fac. of Sci, Al-Azhar Univ. ** Dept. of Phys., Fac. of Med., Menofeyah Univ.
*** Dept. of Hist. Fac. of Med., Al-Azhar Univ .

The present study aimed to clarify antidiabetic activity of aqueous extract from Aloe vera
on thirty adult male albino rats were divided into three groups, the first served as a control
group, the second was injected with alloxan (120mg / kg B.wt. ) and served as diabetic group
and the third was injected with alloxan and treated with Aloe vera water extract ( 0.5 ml / 100 g
). After thirty days of treatment half of each group were scarified and the other one were
left for 15 days without any additional treatment as a recovery period .
The results revealed highly significant decrease ( p> 0.01) in blood glucose, and highly
significant increase in both liver glycogen content and serum insulin level in the diabetic group
treated with aqueos extract of A. vera when compared with the diabetic untreated group.
It seems, therefore that water extract of A. vera results in a definite hypoglycemic,
hyperinsulinemic effect. On the other hand, a significant increase of body weight gain and liver
glycogen content was achieved. The results of this study clarify the role of Aloe vera active as
antidiabetic plant and suggest a relationship between drenching. A. vera extract and insulin
production which needs further investigation .
Key words:- Aloe vera ­ Diabetic rats ­ Physiological parameters .

Diabetes mellitus is one of the most
have long been used all over the world for
common noncommunicable world wide
their various medicinal properties. In the
diseases . When compared with the general
past 15 year, There have been controversial
population, mortality and morbidity incre-
reports on the hypoglycemic activity of
ase in diabetes due mainly to the associated
Aloe species, probably due to differences in
chronic complications both specific micr-
the parts of the plant used or to the model
ovascular as nephropathy and nonspecific
of diabetes chosen ( Okyar et al; 2001 ).
as atherosclerosis. Acute metabolic compl-
The present study was a trial to clarify
ications , e.g. diabetic ketoacidosis, contin-
the antidiabetic effect of Aloe water extract
ue to be cause of mortality in developing
on alloxan-induced diabetes in rats.
countries ( Motala et al., 2000 ).

Traditional antidiadetic plants might
Material and Methods
provide new oral hypoglycemic compounds
Thirty adult male albino rats of local
which can face the high cost and the poor
strain ( weighing 120 ­ 140 gm ) were used.
availability for many rural populations, par-
They were divided into three groups :
ticularly in developing countries ( Merles
1- control group ( 10 rats ),
and Fransworth, 1995).
2- Diabetic group : received alloxan only
Aloe vera (L) Burm-fil (A. barbad-
( 10 rats ).
ensis Miller) ( Liliaceae ) is native to North
3- Diabetic treated group : received alloxan
Africa and also cultivated in Turkey. Aloes
and Aloe vera water extract ( l0 rats ).


Full Paper (vol.12 paper# 6)

Genetic and Ultrastructural studies in bone marrow and testis of mice cells under the effect of Glurenor drug The Egyptian Journal of Hospital Medicine Vol., 12 : 62 ­ 71 September 2003


Genetic and Ultrastructural studies in bone marrow and testis of mice
cells under the effect of Glurenor drug

Sekena, H. Abd El-Aziem and Aziza, M. Hassan
Department of Cell Biology, National Research Centre


Mutagenetic effects and ultrastructural changes of antidiabetic Glurenor drug were studied
in vivo in the highly sensitive micronucleus test.
Eight groups of forty male mice used in this study to detect chromosomal abnormalities in
somatic and germ cells. Three groups orally administrate therapeutic doses of Glurenor at (30,
60, 120) mg/kg daily the fourth group act as control group. Control group and the treated group
with 120 mg/kg were used for ultrastructural examination. While the other four groups were
used for bone marrow micronucleus test which receives successive doses of Glurenor as (0.0 &
30) mg/kg for 1, 10 &20 days. A cytogenetic examination of treated and untreated mice showed
a significant increase of total chromosomal aberrations (P< 0.01) in both somatic and germ
cells at dose 120 mg/kg. when compared by control group. Also Glurenor induced micronucleus
polychromatic erythrocytes. Glurenor revealed ultrastructural changes in liver cells represented
by deep condensation in the nucleus which revealed by the appearance of a large gap around the
nucleus. The condensed chromatin appeared as large sharply marginated electron dense mass
that a butted on the nuclear envelope. In addition to electron dark distanced elsewhere
(prenuclear), swollen endoplasmic reticulum, Also, observed enlarged nucleolus, and thickening
the nuclear membrane. Large vacuoles "hydropic degeneration" also was noticed in the
Our studies had the objective of examining experimentally whether the supposed
mutagenic effect of Glurenor can be demonstrated and verified by methods of mutagenicity
testing using expermintal mammals.
In conclusion, this study revealed that Glurenor gave a positive reaction with a clear
dose response in mice. Glurenor gave a mutagenic response from of the chromosomal aberration
in somatic and germ cells as well as in micronucleus test. Glurenor showed ultrastructural
changes in the liver cells of mice.
Key words: Glurenor, chromosomal aberrations, polychromatic erythrocytes (PCEs),
ultrastructural, liver


Glurenor is one of sulphonylureas (to
lbutamide, chlorpropamide, libenclam-ide,
sensitizing insulin receptors, and inhibiting
glipizide, gliclazide, glimepiride) that
the production of glucose by the liver.
stimulate pancreatic insulin release.
The sulfonylurea drugs lower plasma
glucose concentrations in diabetic patients
secretion from pancreatic cells and are
by stimulating insulin secretion and by
widely used in the treatment of type 2
potentiating the biologic effect of the
diabetes (Ashcroft, and Ashcroft 1992).
insulin on tissues such as skeletal muscle,
They commonly used in the reduction
fat and liver. The mechanism of the latter
of blood sugar levels. Sulfonylureas work
so-called extra-pancreatic effect may be

Full Paper (vol.12 paper# 7)

Microsoft Word - 88 The Egyptian Journal of Hospital Medicine Vol., 12 : 72 ­ 81 September 2003
I.S.S.N: 12084


S.I.Enany*, H.T. Kandeel** N. Abd-El-Lateef***, and M. Hussein****

Urology*, Endocrinology** Radio diagnosis***, and Clinical Pathology****
Faculty of medicine Al-Azhar University

The aim of this study is to evaluate the clinical significance of the total and free
testosterone in aging men. This study was carried out on 45 healthy men. They were divided
into three groups, according to the age, each group contains 15 men. Group I: age ranged from
50-60 years. Group II: From 61-70 years and Group III: From 71-85 years. For each subject,
history was taken and clinical examination, routine laboratory investigations: total and free
testosterone levels, also total and free prostate specific antigen (PSA). Transrectal
ultrasonography (TRUS) was done. Bone densitometry by ultrasonography also done. Our
results revealed that, the mean values of the total and free testosterone levels were progressively
decline with increasing age. The lowest levels of total and free testosterone were found in-group
III, but these lowest levels were still at the accepted normal range. The mean values of the total
and free PSA levels in the different three studied groups were progressively increased with
aging men, but its levels were still within the normal range. There was positive correlation
between the total and free levels of testosterone. Also positive correlation was found between
the total and free PSA values. Additionally an inverse relationship was found between
testosterone levels either total or free with PSA values. Erectile function declined significantly
by age, the worst was group III with significant correlation with the level of total and free
testosterone in the three studied groups. In this work the broadband ultrasound attenuation
(BUA) in-group II was significantly lower than group I (p<0.001) but insignificant difference
between group II and group III. Relative Risk Fracture (RRF) in-group II was significantly
increased compared to group I (p>0.003), but insignificant difference between groups II and
group III (p>0.998).T-score was significantly lower in group II and III compared to group I
,(p<0.001), (p<0.02)for both respectively. Z-score showed highly significant reduction in groups
II and III compared to group I (p<0.000) for both of them. While, non-significant differences
between group II and III regarding T and Z-score(p>0.38),(p>0.554)respectively. Correlation
between free (FT) and total (TT) testosterone, with bone densitometry, there were positive
correlation between (FT) versus BUA, T and Z-score. It was positively correlated between (TT)
versus BUA and T-score only, while the correlation of both was negative with RRF.
We concluded that, total and free testosterone progressively decline with aging. It was
associated with progressive increase in the level of total and free PSA. These findings were
associated with progressive decline in erectile function. Bone mineral density decreased
gradually with increasing age, and increased incidence of bone fracture.

In men there are progressive declining
significant low level. These hormonal
in androgen production associated with
changes require further researches and
aging. This phenomenon has been named
acceptance by the medical community (2).
male climacteric, andropause or more
Therefore, urologists and endocrinologist
appropriately, androgen decline in aging
should view the elderly men who constitute
male (1). Aging is associated with alteration
such a large component of everyday
in many hormonal levels in general,
practice as patients with more than specific
particularly in androgens, which has
genitourinary and endocrinal complaints.

Full Paper (vol.12 paper# 8)

The Egyptian Journal of Hospital Medicine Vol., 12 : 82 ­85 September 2003
I.S.S.N: 12084

Ropivacaine plus lidocaine versus Bupivacaine plus lidocaine for
peribulbar double injection regional anesthesia

Omar Elsafty MD, Ahmed M.S. Hamed MD, Sherif Wadie MD &
*Ahmed Shoeir MD

Departement of anesthesia Ain shams university
*Research institute of ophthalmology

Abstract :
Our study was designed to evaluate the efficacy of Ropivacaine 0.75% plus Lidocaine
2% versus Bupivacaine 0.5 % plus lidocaine 2 % to provide peribulbar anaesthesia for cataract
surgery .Time to adequate block for surgery, ocular eyelid movement scores at 8 min after
block and quality for postoperative analgesia were recorded. Sixty patients are randomly
divided into two groups of 30, to receive a peribulbar block with 8 ­ 10 ml of either
Ropivacaine ­ Lidocaine or Bupivacaine ­ lidocaine,and 15U Hyaluridase per ml with each
combination .
There was no difference between the two groups in clinical endpoint , Median time at
which the block was adequate to start surgery was 8 min. ( 4-10 min ) in each group . Median
eyelid movement scores were similar in both groups, yet the lower potential for systemic
toxicity of ropivacaine compared with bupivacaine enables it to be used for surgical anesthesia
in higher concentration which may facilitate diffusion of local anesthetic molecules into
peripheral nervous tissue, improving the onset of nerve blockade.

Regional anesthesia with peribulbar
status I ,II,OR III patients scheduled for
block is the technique of choice for most
cataract surgery with expected duration of <
patients undergoing cataract surgery (1). A
90 min were included .Patients allergic to
mixture of bupivacaine and lidocaine is the
local anesthetic solutions , with local sepsis
most frequently used local anesthetic ,
, serious impairment of coagulation , and
lidocaine providing a rapid onset and
orbital abnormalities , or who were unable
bupivacaine a long duration of action .
to cooperate in maintaining a relatively
(2)Ropivacaine has the potential advantage
motionless supine position or who refuse
of reduced cardiovascular and neurological
the anesthetic technique were not included.
toxicity compared with other local
All patients underwent topical anesthesia of
anesthetics that are commonly used for
the conjunctiva using 2-3 drops of 0.4%
peribulbar anesthesia . However, the motor
oxybuprocaine and premedicated with 0.03
sparing attributed to ropivacaine is a
-0.05 mg/kg medazolam together with
potential disadvantage that might reduce the
0.2--0.4Ug/kg fentanyl I.V.
onset of motor block required for ophth-
Patients were randomly divided into
almic surgery(3).Hyaluronidase hydrolyses
two equal groups each of 30 patients ,
the C1-C4 bonds between glucosamine and
Group R who received preibulbar block
glucuronic acid in ground substance ,thus
with 8 -10 ml of mixture of ropivacaine
promoting spread of anaesthetic through the
0.75% & lidocaine 2% 1 : 1,and group B
tissue .The proposed advantages of using
who received the same volume of local
hyaluronidase include enhanced speed of
anesthetic with a mixture of bupivacaine
onset and improved operating condition (4).
0.5% & lidocaine 2% 1 : 1 . The amount of
Patients & method:
anesthetic mixture injected was determined
After having approved written consent
by the degree of lid fullness and the
from each patient, sixty ASA physical
intraorbital pressure assessed.

Full Paper (vol.12 paper# 9)

ž’(3E The Egyptian Journal of Hospital Medicine Vol., 12: 86 - 91 September 2003
I.S.S.N: 12084

Association of Islet Cell Antibody and Human Leucocyte Antigen
DQB1 Alleles (0201/0302) in siblings of type 1 diabetes mellitus

*Hassan Z.A.,*Kandeel H.T., *Abaza D.M. ***Bostamy H.F. **Hssan H.A.
*Endocrinology and **General Medicine Departments ­ Al Azhar University (girls)
***Biochemistry Department ­ Cairo University

Type 1 diabetes is most often associated with auto antibodies (AAbs) against beta cell
antigens and high levels of HLA mediated genetic susceptibility. The purpose of this study was
to identify at risk siblings of type1 diabetic patients at an early stage by screening for HLA­
DQB1 alleles, which carry the high-risk genotype (DQB1 *0201 / 0302) and its associations
with measured islet cell antibody (ICA). Twenty-five siblings of subjects with type 1 diabetes
aged 4 ­ 13 yr, median age (8.4 ± 1.02) were studied. They were screened for ICA as well as
HLA-DQB1 (0201 and 0302) alleles.
Results of the study showed that among the 25 siblings, 20% tested positive for ICA.
HLA-DQB1 was detected in 16% of siblings. Allele DQB1 0201 presented higher frequency
(48%) than DQB1 0302 (36%). Association of DQB1 0201 and / or 0302 with ICA positive
cases was detected in 20% of cases, while frequency of DQB1 0201 and / or 0302 in ICA
negative cases was detected in 48% of them.

In conclusion: - Our results showed that among siblings of type 1 diabetes HLA-DQB1 alleles
associated with highest genetic susceptibility i.e. DQB1 0201 and / or 0302 were detected with
high significance. Also HLA-DQB1 0201 is more frequently associated with ICA.
Initial screening by high risk DQB1 *0201/0302 with subsequent autoantibody testing is shown
to be useful in the assessment of diabetes risk among siblings of subjects with type 1 diabetes.


Type 1 diabetes is most often
al, 1991). The relationship between HLA
associated with auto antibodies ( AAbs )
markers and the occurrence of AAbs has
against "beta" cell antigens as AAbs to
been previously examined in recent onset
glutamic acid decarboxylase (GADA),
patients of type 1 diabetes indicating
insulin (IAA) as well as the heterogeneous
positive correlation (Vande walle et
islet cell cytoplasmic antibodies (ICA).
al,1997) in recent years, several studies
Although the complex associations
have been conducted to identify subjects at
and linkage of HLA antigens with type 1
risk of developing type 1 diabetes by
diabetes are not yet fully understood, HLA­
screening for ICA as well as by human
DQB1 and DQA1­DQB alleles provide the
leukocyte antigen (HLA) typing.
strongest genetic contribution to the

disease (Robinson etal, 1989) accounting
for approximately 50% of the genetic risk
Aim of the work
in type 1 diabetes ( Todd and Farral 1996).

In Caucasian, DQB1 0302 and
To identify at risk siblings of type 1
diabetic patients at an early stage, by
specificities DR4 and DR3 provide disease
screening for HLA­DQB1 alleles which
susceptibility (Michelson et al,1990),
carry the high-risk genotype (DQB1 0201
where's dominant protection is conveyed
and 0302) and its associations with
by DQB1 0602 linked to DR2 (Reijonen et
measured islet cell antibody (ICA).

Full Paper (vol.12 paper# 10)

Quantitative microscopical and histochemical study of the skin of mice under the effect of exposure to ultra violet rays type- The Egyptian Journal of Hospital Medicine Vol., 12: 92 ­ 100 September 2003
I.S.S.N: 12084

Quantitative microscopical and histochemical study of the skin of mice
under the effect of exposure to ultra violet rays type-B

Somaya H. Mohamed*, Fouad M. Badr*, Howayda Abed El-Aal,Rushdy W.
Mohamed, and Bassem S. Ahmed

From Departments of Histology*, Pathology and Dermatology Suez Canal Faculty of
Medicine and Histology department Al-Azhar Faculty of Medicine - Assuit


The modern industrial era, has benefits and also disadvantages. The main disadvantages are
environmental pollution and ozone layer depletion. Ozone layer depletion leads to failure of
absorption and prevention of harmful rays from penetration of earth atmosphere.
The current work studied the effect of ultra violet-B rays on the skin of mice. Twenty-four mice
were subjected to ultra violet-B rays in dose of 1.4J/cm2 for 15minutes every other day for 10weeks.
Paraffin sections slides were prepared and stained with suitable histological stains to study the
morphology, collagen and elastic fibers, mast cells and glycosaminoglycans materials in the skin.
The study included quantitative morphometric analysis by image analyzer on some obtained
data. The study revealed a statistically significant increase in the epidermal thickness (p<0.001),
associated with necrotic cells, compact ortho-keratosis in the stratum corneum. A degenerated
collagen fibers was observed in exposed dermal skin with statistically significant decrease in optical
density of collagen fibers (p<0.001). There was a loss of elastic fibers fibrillary pattern. Also there
was an increase in melanin pigments concentrations, mast cells, deposition of PAS positive
materials in the basement membrane at dermo-epidermal junction, around blood vessels, sebaceous
and sweat glands and hair follicles.
The study concluded that there was a defined pathological change in the skin exposed to ultraviolet
rays and adequate protective prophylactic application must be used to minimize the effect of
ultraviolet radiations exposures.


Solar rays contain a spectrum of light
and coarse), roughness, laxity, mottled
wavelengths with range of 200-400nm. These
spectrum is subdivided into 3 categories;
keratosis), scaling, xerosis and telangiectasia
Ultraviolet A (with range of 320-400nm),
(Leyden, 2001). Many factors can accelerate
Ultraviolet B (290-320nm) and Ultraviolet C
the effect of exposure to UV rays on the skin;
(200-290nm). Ultraviolet C is the most potent
time of the day, season of the year, duration
and dangerous rays and is absorbed by ozone
to exposure, skin thickness and skin color
layer and doesn't reach the earth. Ultraviolet
(Harber et al., 1989). Photodamage and
B is responsible for most of photodamage of
photoaging are associated with an increased
human skin. Ultraviolet A is weak rays
incidence of benign, pre-malignant and
(Kaminar, 1995). Clinically ultraviolet rays
malignant skin lesions (Griffith 1992).
exposure causes photodamage of the skin.
According to US environmental protection
The photodamage includes; wrinkles (fine
agency, the continuous ozone layer depletion

Full Paper (vol.12 paper# 11)

Evaluation of silymarin and / or ginger effect on induced hepatotoxicity by carbon tetrachloride in male albino rats The Egyptian Journal of Hospital Medicine Vol., 12: 101 ­ 112 September 2003
I.S.S.N: 12084

Evaluation of silymarin and / or ginger effect on induced
hepatotoxicity by carbon tetrachloride in male albino rats

Hassan H. A.* and EL-Gendy A. M**

*Zoology Department, Faculty of Science, Mansoura University, Mansoura, Egypt.
**Zoology Department, Faculty of Science (Girls), AL-Azhar Univfersity, Nasr City,
Cairo, Egypt.


Liver disease appears to be increase. Part of this increase may be due to our frequent
contact with chemicals and other environmental pollutants. The amount of medicne consumed
has increased greatly which could be danger to the liver.
The hepatoprotective flavonoid, silymarin (7.56 mg/Kg b. wt.) and ginger (Zingiber
) (1% of diet) for 4 weeks were used to ameliorate the liver injury in rats intoxicated
with carbon tetrachloride (CCL4 , single acute dose 4 ml/ Kg b. wt. of 50% v/v CCL4 in olive
oil, subcutaneous).
The obtained results showed that CCL4 decreased serum and liver total protein and
albumin. Also reduced glutathione content. The antioxidant enzymes; glutathione-S-transferase,
superoxide dismutase and catalase activity decreased in the liver of CCL4 toxicity group. On the
other hand, CCL4 toxicity increased serum and liver bilirubin, total lipid and total cholestertol
levels. In addition, liver function (aspartate aminotransferase, alanine aminotransferase and
alkaline phosphatase) and liver lipid peroxidation content showed significant increase in the
CCL4 treated group.
Previous parameters turned back to normal values in carbon tetrachloride intoxicated rats
after treating with silymarin and/ or ginger for one month. Meanwhile, the most interesting
effect was induced by a combination of silymarin and ginger. Hence, the present findings will
provide a potential scope for future use of ginger for the treatment of liver disorders.

Key words: Silymarin-ginger-carbon tetracholoride-hepatotoxicity- rats.


The liver plays an astonishing array of
provide the support that the liver needs on a
vital functions in the maintenance and
daily basis.( Treadway, 1998).
performance of the body. Some of these
Silymarin is the active constituent of
major functions include carbohydrate,
Silybum marianum cited as one of the
protein and fat metabolism, detoxification
oldest known medicinal plants, since 1970s,
and secretion of bile. Therfore, the
silymarin has been used for treatment of
maintenance of healthy liver is vital to
liver disease (Giese, 2001) and a dose of
overall health and well being (Treadway,
420 mg/day was shown to improve indices
1998 and Aris et al., 2001). Unfortunately,
of liver function (AST, ALT, GGT and
the liver is often abused by environmental
bilirubin) in patients with liver diseases of
toxins, poor eating habits and over the
various aetiology (Wellington and Jarvis,
counter drug use, which can damage and
2001). Silymarin is used for the treatment
weaken the liver and evantually leads to
of several hepatic disorders (Hakova and
hepatitis, cirrhosis and liver disease.
Misuruva, 1993) and is mainly indicated for
Conventional medicine is now pursuing the
acute and chronic hepatitis, liver cirrhosis,
use of natural products such as herbs to
fatty degeneration and toxic metabolic liver


Full Paper (vol.12 paper# 12)

Analgesic, Sedative and Hemodynamic Effects of Dexmedetomidine Following Major Abdominal Surgeries: A Randomized, Double-Blind The Egyptian Journal of Hospital Medicine Vol., 12 : 113 ­ 120 September 2003
I.S.S.N: 12084

Analgesic, Sedative and Hemodynamic Effects of Dexmedetomidine
Following Major Abdominal Surgeries: A Randomized, Double-
Blinded Comparative Study with Morphine

Khaled Taha
Assistant Professor, Anesthesia Department, Faculty of Medicine,
Ain Shams University

This was a randomized double-blinded study; in which 60 ASAI-II adult patients
scheduled for major abdominal surgeries (colostomy, radical cystectomy, major gynecological
surgery, and abdominal vascular surgery) were received standard general anesthesia. Twenty
minutes before the anticipated end of surgery, patients were randomized into two equal groups:
dexmedetomidine group (group D) and morphine group (group M). Group D received
dexmedetomidine IV infusion 4µg/kg/h for 15 minutes (1µg/Kg) followed by 0.4µg/kg/h for 3h.
Group M received morphine sulfate IV (0.07mg/kg). All patients were given a morphine patient
controlled analgesia (PCA) pump in the post anesthesia care unit (PACU), delivering IV
morphine 2mg with a lockout time of 5 minutes if pain score assessed through visual analog
scale (VAS) was more than 5 at any given 5-min assessment. During the PACU recovery
period, morphine consumption; pain and sedation scores; hemodynamic variables (heart rate,
mean arterial blood pressure, oxygen saturation and respiratory rate); and postoperative nausea,
retching and vomiting (PONV) were recorded every 30 min for 3h (study period) by a member
of staff blinded to the treatment. The study demonstrated that the use of dexmedetomidine led to
significant decrease in the total amount of morphine consumed throughout the entire PACU
recovery period (P<0.05). This was associated with reasonable pain and sedation scores;
significant slowing in heart rate (P>0.05); significant decrease in mean arterial pressure
(P<0.05); less incidence of PONV (P>0.05); without any significant changes in oxygen
saturation (P<0.05) or respiratory rate (P<0.05). In conclusion, dexmedetomidine exhibited both
analgesic and sedative properties. The associated cardiovascular protective pharmacological
profile and the lack of respiratory depression made it potentially extremely interesting for
postoperative analgesia after major abdominal surgeries.


Dexmedetomidine is a potent alpha-2
Aim of the Work
adrenoceptor agonist with an alpha-2 to
The aim of this study was to assess
alpha-ratio more than 7times that of
the analgesic, sedative and hemodynamic
clonidine (1). Because of its potency, it can
effects of dexmedetomidine and to compare
be safely administered as an infusion (not
it to morphine in early postoperative period
as a bolus). Dexmedetomidine has analg-
following major abdominal surgeries.
esic and sedative properties (2, 3). Its use is
Patients and Methods
not associated with respiratory depression
The study was approved by the
despite profound levels of sedation (3).
hospital ethical committee. A written infor-
Because of analgesia sparing, sedation and
med consent was obtained from all patients
lack of respiratory depression, dexmedeto-
to participate in this study. Sixty adult
midine may
patients ASA physical status class I and II
postoperative period for patients having
scheduled to undergo major abdominal
major surgical procedures that are assoc-
surgeries under general anesthesia were
iated with significant pain.
enrolled in the study. Exclusion criteria


Full Paper (vol.12 paper# 13)