Psychosocial Impacts And Quality Of Life The Egyptian Journal of Hospital Medicine (2006)Vol., 24: 401 414

Psychosocial Impacts And Quality of Life
of Children With Atopic Dermatitis

M. M. Abu-Sekkien, A. M. Ebrahim*, H. M. Hassan**
and Y. A. Baraka***

Departments of Paediatrics, Psychiatry*, Dermatology & Venereology**
and Community Medicine***
Faculty of Medicine, Al-Azhar University


This study was conducted on 100 children with atopic dermatitis (AD) attending
Dermatology Clinic, Al-Hussein University Hospital and an equal number of children as
controls. The aim of the study was to determine the psychosocial impacts of AD on children and
their families, to define quality of life (QOL) of children and their families and to determine the
relationship between these items and AD severity. A cross-section, analytical, clinic based study
design was chosen to perform this research. Criteria for diagnosis of depression and anxiety
were according to DSM IV. Also, we used The Children's Dermatology Life Quality Index and
The Dermatitis Family Impact questionnaire to assess the impact of AD on the children's
quality of life and to assess the impact of AD on the quality of family life, respectively. The
most common behavioural and psychiatric impacts in children were dependence (33.0%) and
anger (26.0%). Also, AD interfered with children's' social life and recreation in 73.0% and
29.0% of them, respectively. While, mothers' psychiatric impacts and family disturbances were
more in AD families; 43.0% and 70.0%, respectively. The impacts of AD were more in children
and families with severe AD with statistically significant differences. Also, 86.0% of children
with AD and 62.0% of their mothers had poor QOL.


Atopic dermatitis (AD) is a common
minor dermatological condition. Many
and important skin condition, which is most
believe that it does not present any major
often arises in infants and children. It
difficulties for the patient, family, or
affects up to 21.0% of children in Northern
society. However, research demonstrates
Europe, United States and Japan (Sugiura et
that AD can be a major skin disorder with
al., 1998 and Williams et al., 1999).
very significant costs and morbidity. AD in
Moreover, it has been estimated that
children can have a major effect on their
patients with AD account for 30.0% of
quality of life, disrupting family and social
dermatology consultation in primary care
relationships as well as interfering with
and up to 20.0% of all referrals to
recreational activities and school (Lapidus,
dermatologists (Holden and Parish, 1998).
Despite the frequency of AD, society and
AD has profound effects on many
the medical community often view it as a
aspects of patients' lives and the lives of

Full Paper (vol.24 paper# 1)

Assessment of some medical malpractice cases The Egyptian Journal of Hospital Medicine ( 2006) Vol., 24: 415 429

Assessment of Some Medical Malpractice Cases
During Surgical Procedures in Yemen

Nabil H. S. AL Hamady
Assistant professor, Department of Forensic Medicine and Clinical Toxicology
Faculty of Medicine and Health Sciences, Sana'a University.


Aim of work :-
This research aims to study some cases of medical malpractice and provides
guidance for medical persons to minimize or even avoid medical malpractice among Yemenis.
Subjects and Methods:- This first study in Yemen was done on hundred cases of medical
malpractice during surgery that were collected randomly through the last ten years (1996-2005)
from many places in Yemen. All cases were aging from 3 to 70 years old. The gender of patient
was 54 males and 46 females.
This study showed highly significant increase of number of cases between ages 21- 30,
41- 50 and 51-60 in both sexes as compared to other groups of age, while ages 11-20 and 31-40
showed significant increase in number of malpractice cases versus age 61-70 years. No
significant difference between females and males among the studied cases. There was very
highly statistical significant increase of number of malpractices that done by one physician
when compared to that done by two or three physicians. There was very highly significant
increase in number of malpractice cases in public hospital versus other hospitals and in private
hospitals versus academic hospitals. Positive cases of medical malpractice were very highly
significantly decreased as compared to negative one in public and private hospitals & no
significant difference between positive and negative cases in academic hospitals. There was
very highly significant increase in number of malpractice cases among specialists as compare to
university staff and consultant. There was no statistical significant difference between university
staff and consultants. There was also very highly significant increase in number of negative
cases among university staff and specialists, but significant increase of negative cases as
compared to positive cases was seen among consultants. This study proved that the general
surgery showed very highly significant increase in number of malpractice cases versus other
groups. Urology showed significant increase in number of malpractice cases versus internal
medicine and neurosurgery. It was demonstrated very highly significant increase in number of
malpractice cases during intra-operative and post-operative stages versus other stages.
Appendicectomy and cholecystectomy showed very highly significant increase in number of
malpractice cases versus other types of operations. There was no statistical significant
difference between the distribution of criminal and civil cases among the studied cases. A
statistical significant difference was shown between the final outcome in number of deaths and
complete recovery when compared with cases of permanent deformity.

Introduction and Aim of Work

When a physician accepts patient for
of medical equipments, (Angela and
diagnosis and treatment both of them
Holder, 1974).
acquired legal rights and obligations. These
Once a physician patient relatio-
rights and obligations affect every aspect of
nship has been established the physician
the physician patient relationship, for
has a duty to provide a level of care similar
example, choice of drugs, diagnostic
to other physicians of the same field of
investigations, medical procedures and use
practice. If the patient sufferd compensable

Full Paper (vol.24 paper# 2)

Non-fasting Non-High Density Lipoprotein Cholesterol (Non-HDL-C) AS A predictor of Atherosclerosis in Patients with End Stage The Egyptian Journal of Hospital Medicine (2006) Vol., 24: 430 441

Non-fasting Non-High Density Lipoprotein Cholesterol (Non-HDL-C)
AS A predictor of Atherosclerosis in Patients with End Stage Renal
Disease on Regular Hemodialysis

Sabry Gohar*, Mone Hosny*
Howayda Abdel-Hamid*, and Yasser Ibrahim**
* Internal Medicine Department, Ain Shams University
**Damanhour Medical Institute

Fifty patients with chronic renal failure on regular hemodialysis 31 males and 19 females,
aged from 18 to 62 years were included in the study. They were selected from those attending
the Nephrology and Dialysis Unit in Damanhour Medical Institute.
Ten age and sex matched subjects with normal renal function served as control group. Full
history taking, clinical examination, resting ECG and serum cholesterol, HDL (non-fasting),
fasting LDL, non-fasting non-HDL from special equation, Non- HDL = total cholesterol - HDL
and Duplex scanning of both carotid and femoral arteries.
Non fasting non-HDL was more than 130 mg/dl in more than 65% of patients group
versus 30% in control group, serum level of non-fasting cholesterol and non-fasting non-HDL
were significantly elevated in hemodialysis patients as compared with control group, while
serum level of non-fasting HDL and fasting LDL were significantly decreased in hemodialysis
patients as compared with control group. Intima-Media thickness (IMT) of both carotids and
both femoral arteries was elevated in hemodialysis patients as compared with control group.
There was a significant positive correlation between non-fasting non-HDL and IMT of both
carotids and both femoral arteries and a significant positive correlation between fasting LDL
and IMT of both carotids and femoral arteries. There was a significant positive correlation
between duration of dialysis and IMT of both carotids and left femoral arteries.
A positive correlation exists between ECG ischemic changes and IMT of both carotids and
left femoral arteries and between carotid plaques and IMT of both carotids and left femoral

Aim of the Work

To study and compare between the level of non-fasting non-HDL-C and fasting LDL in
predialysis serum as predictor of atherosclerotic changes in patients with end stage renal disease
on regular hemodialysis.


with progressive renal insufficiency and in
abnormalities in plasma lipids and
lipoproteins that are called uremic
hemodialysis (Jungers et al., 1997).
dyslipidemia (Shoji et al., 1997).
Cardiovascular disease is the most
Atherosclerosis and cardiovascular
important cause of mortality in end-stage
disturbance are common among patients
renal disease (Merzog et al., 1999).

Full Paper (vol.24 paper# 3)

Microbiological Study On Respiratory Tract Infections In Libya The Egyptian Journal of Hospital Medicine(2006) Vol., 24: 442 459

Microbiological Study On Respiratory Tract Infections In Libya

*A. H. Eldeeb and **E.M. Khashan.
*Surgery Depantment, Faculty of Medicine , El-Margeb Univ., and **Clinical Pharmacy
Depantment, Faculty of Medical Technology, Mesrata, the Great Socialist People's
Libyan Arab Jamahiriya
Introduction: Recent reports revealed that 10% of the worldwide burden of morbidity and
mortality relates to respiratory tract infection.
Patient and methods: Five hundreds and fifty nine clinical strains were isolated and
identified from 322 patients suffering from respiratory tract infections. Patients represented
different ages, sexes, and types of infections. Out of the 322 patients, 204 were suffering from
upper respiratory tract infections and 118 patients were suffering from lower respiratory tract
infections. Patients of upper respiratory tract infections were suffering from chronic suppurative
otitis media (63 patients), tonsillitis (50 patients), pharyngitis (48 patients), and sinusitis (43
Results: Out of the total isolates, Staphylococcus aureus was the most prevalent organism,
followed by Streptococcus pyogenes and Klebsiella pneumoniae (17.71, 12.34, and 11.27%
respectively). Pseudomonas aeruginosa represented 6.26%. Serratia marcescens and
Morganella morganii were the least isolated organisms. The results revealed that 52.42% of the
strains were isolated from males and 47.58% from females. Staphylococcus aureus was the
most prevalent organism in males (21.16%) while in females Strept. pyogenes was the most
prevalent organism (14.29%). Also, the study revealed that Staphylococcus aureus was the most
frequent isolate in age groups between 1-20, 21-40 and 41-60 years old (20.85%, 17.02% and
16.67% respectively). However, both Staphylococcus aureus and Klebsiella pneumoniae were
isolated with equal incidences, 12% each, in elder patients (more than 60 years). The
susceptibility pattern of the isolated bacteria to different antimicrobial agents was studied. Both
levofloxacin and gatifloxacin showed the highest activity (100%), followed by ofloxacin and
ciprofloxacin (96.44% and 93.39%, respectively). Those are followed by amikacin (91.86%),
cefotaxime (89.31%), cefoperazone (86.26%), gentamicin (84.22%), ampicillin-sulbactam
(70.48%), amoxycillin-clavulanic (62.34%), cefuroxime (62.09%), lincomycin (61.83%),
vancomycin (61.07%), chloramphenicol (57%), cephalexin (48.35%), cephapirin (45.29%),
erythromycin (44.78%), and trimethoprim-sulphamethoxazole (43%). Amoxycillin and
tetracycline were the least active ((36.64% and 32.06% respectively). Staphylococcus aureus
strains resistant to amoxycillin were tested for B-lactamase production. Out of the tested strains,
62.5% were B- lactamase producers and it may be responsible for the resistance to amoxycillin.
In conclusion, the study revealed that evaluation of respiratory tract infections and
antimicrobial susceptibility is still in need for more studies. This is due to the continuous
development of newly resistant strains and the relatively little number of isolates in some
species. Moreover, the differences in the previous antimicrobial treatment, the history of
subclinical infections and the immune status of patients involved in each study have increased
the difficulty in evaluation.

Recent reports revealed that 10% of
million people annually. The majority of
the worldwide burden of morbidity and
these cases are children under five years old
mortality relates to respiratory tract
in developing countries (Ball et al., 2002).
infections as they kill an estimated 10
Upper respiratory tract infections account 442

Full Paper (vol.24 paper# 4)

Evaluation of the Structural Changes of Extremely Low Frequency The Egyptian Journal of Hospital Medicine ( 2006)Vol., 24: 460 476
Evaluation of the Structural Changes of Extremely Low Frequency
Electromagnetic Fields on Brain and Testes of Adult Male Mice

Aisha A. Saad El-Din*, Nabila A. Abd El-Motaal*
Haidy F. Abd El Hamid** Yasser F. El-Akid***
*National Centre of Radiation Research and Technology, Egypt, **Department of
Anatomy, ***Department of Forensic Medicine and Clinical Toxicology, Faculty of
Medicine, Ain Shams University.
The increasing number of devices emitting magnetic fields raised valid questions concerning
their safety and potential risk for human exposure and its limits. For this purpose fifteen adult
mice were exposed to extremely low frequency electromagnetic field (ELMF) at a frequency of
60 Hertz (Hz) and intensity of 20 millitesla (mT) for 2 hours for 2 consecutive days. Other 10
animals served as a control.
After their sacrifice, serum testosterone was determined. In addition, electron
microscopic study of mice brains and testes was done.
The present study revealed that exposure to EMF caused significant increase in serum
Electron microscopic examination of brain cells showed marked demyelination of nerve
fibres with degeneration of nerve cells. There was also degeneration of some spermatogenic
cells with abnormal sperm morphology.
In conclusion, the present study showed evident biochemical and histopathological changes of
ELMF on the brain and testis. Further studies would be useful to assess the effect of other
doses of exposure and to follow the degree of reversibility of these changes. Other
investigations are also advisable to minimize the above biological effects and protect against


The term electromagnetic field is
extremely low frequency electromagnetic
applied to a type of energy that is beamed
field (ELMF) produced by household
through the air, having two components, an
wiring and fluorescent lighting is common.
electric field and another magnetic one. The
Other sources are any appliances that are
electric component influences primarily
plugged into the wall or battery operated. In
particles of the surface of nearby object,
addition, electric clocks and clock radio
while the magnetic field penetrates to the
have been mentioned as major sources of
interior (Santini et al. 2005). High magn-
night time exposure of children (Preece,
etic field strengths may be encountered near
switching stations, research facilities and
The increasing numbers of devices
video display terminals (David et al.,
emitting magnetic fields raised a valid
2002).Moreover, application of magnetic
question concerning their safety and the
field devices in medicine as a diagnostic
potential risk of human exposure and its
tool (magnetic resonance imaging or magn-
limits (Valberg, 1996). During the past
etic resonance spectroscopy used to study
20years a number of studies have suggested
tissue metabolism) or as therapeutic techn-
an increased risk of cancer induced by
iques (to enhance bone fracture healing and
electromagnetic fields (Yasui, 1997 and
tissue regeneration), increased the chance of
Simko, 2004). The National Institute of
exposure to magnetic fields (Otter et al.,
Environmental Health Science (NIEHS)
1998).On a daily basis, exposure to
declared that ElMF should be regarded as a

Full Paper (vol.24 paper# 5)

Flow cytometric analysis of peripheral T lymphocyte The Egyptian Journal of Hospital Medicine (2006) Vol., 24: 477 483

Flow Cytometric Analysis of Peripheral T lymphocyte
Subpopulations in Psoriasis

Hanan M.A. Darwish, Nahla M. Abd EL-Aziz* , and
Fatma M. EL-Marzouky.

Departments of Dermatology and Venereology & Clinical pathology
Faculty of Medicine for Girls AL-AZhar University


Background :
Psoriasis is a common inflammatory skin disorder, has received attention
as a target for new pathogenesis and oriented therapies .

Autoimmunity and T lymphocyte subsets are suggested to be involved in the
development of psoriasis.
The aim of this work is to asses the role of T lymphocyte subsets in the pathogenesis of
psoriasis .
Material And Methods :We investigated the peripheral blood lymphocyte
subpopulations obtained from psoriatic patient before and after treatment and from healthy
controls, using two colour flow cytometry.
Results :We found highly significant suppression of total CD +
3 T Cells and CD3 CD56
NKT lymphocytes in psoriatic patient as compared to control. Also, we observed significant
reduction of T helper cells in patients as compared to control.
Conclusion : The highly significant reduction of CD +
3 T cell and CD3 CD56 NKT
lymphocytes proved their actively involvement in the development of psoriasis.

Introduction and aim of the work:

Psoriasis is a common genetically
The generation of psoriasis skin lesion
determined inflammatory and proliferative
has been described in animal models by a
disease of the skin (comp RDR,1998).It
process based on T cell regulation.
occurs in 1-3% of the world's population
(Schon et al .,2003) In addition, the role of
T lymophocytes as key affector cells is
pathogenesis of psoriasis undergo intense
strongly supported by work from various
investigation during the past decade
groups in xanthotransplantation models,
(Kenneth et al., 2003)
injection of activated T lymphocytes from
There are characteristic features of the
the same patient onto severe combined
disease which suggest an immunological
immunodeficiency mice resulted in the
mediated process. (Mends et al., 2000)
generation of psoriatic lesions ( Boyman et

Several direct and indirect evidence
al., 2004)
suggest that T lymphocytes play a crucial
Antipsoriatic therapy acts on dual
role in the pathogenesis of psoriasis (Paul
populations of cytokines secreting T helper
et al., 2001) .
cells (Th1 cells secrete proinflammatory
The presence of T helper cells, that
cytokines [IFN-,TNF IL2] and Th2 which
secrete type 1 cytokines [ IFN-, TNF ]
secrete inhibitory cytokines [IL4 , IL 10] .
was demonstrated in psoriatic skin lesions.
(Austin et al., 1999) .
(Nickoloff., 1999)
Induction of immunodeviation of

Full Paper (vol.24 paper# 6)

Macrophage Migration Inhibitory Factor in Systemic Lupus Erythematosus and its expression in Lupus Nephritis The Egyptian Journal of Hospital Medicine (2006) Vol., 24: 484 500

Macrophage Migration Inhibitory Factor in Systemic Lupus Erythematosus
and its Expression in Lupus Nephritis

Nahla Khattab1, Nihad A. El Nashar1, Nevine Badr2,
Hanan Fahmy2, Ragia Fahmy3, Amal Alouba3.
Health Radiation Research Departments1, National Centre for Radiation Research &
Technology; Physical Medicine & Rehabilitation Department2, Faculty of Medicine Ain Shams
University; Early Cancer d Dtection Unit Department3, Ain Shams University Hospitals.
Objective: the aim of this study was to access the potential involvement of MIF in SLE,
its relationship with corticosteroid dose, also, to measure serum and urinary MIF levels in SLE
as well as detecting renal MIF expression in SLE GN.
Methods: Serum and urine MIF concentrations were measured by enzyme-linked
immunosorbent assay in 20 SLE female patients with lupus nephritis , World Health
Organization class II, III, IV, with mean age of 35.1510.42 years and in 10 normal healthy, age
matched, female volunteers. All patients were subjected to detailed clinical assessment and
laboratory investigations. Serum and urinary MIF concentrations were measured by ELISA
technique. Renal MIF expression was assessed by immunostaining of biopsy tissue. Univariate
and multivariate regression analysis were used to examine the associations between serum and
urine MIF concentrations, renal MIF expression, disease-related indices of SLE and
corticosteroid use.
Results: A statistically significant 2.98-fold-increase was detected in mean urinary MIF
(U MIF) levels in SLE patients compared to controls. While, mean Serum MIF (S MIF) showed
no significant difference between cases & control. Both S & U MIF concentrations were
positively correlated with SLICC/ACR DI but not with SLEIDAI. Corticosteroid doses showed
a highly positive correlation with S MIF, serum creatinine & SLICC/ACR DI. Also a positive
correlation was found between the different histopathologic grades of renal affection & the U
MIF. Immunohistochemistry staining of all normal kidney specimens showed that MIF is
constitutively weakly expressed by some glomerular & parietal epithelial cells & by most
tubular epithelial cells. In contrast, there was a significant increase in glomerular & tubular MIF
protein staining in SLE nephropathy. This increased MIF expression correlated positively with
both S MIF and U MIF, SLICC/ACR DI & the daily steroid dose
This study shows that serum MIF is over-expressed in SLE patients and that
the urine MIF concentration is significantly increased in SLE World Health Organization class
IV patients and correlates with the degree of renal injury. Thus, urine MIF levels reflect MIF
expression within the kidney.

Key words:
SLE, MIF, GN, renal biopsy.


ability to kill intracellular parasites and
macrophage migration inhibitory factor
tumour cells (David,1966). Recent data
(MIF) was initially identified as a 12.5-kD
indicate that other types of cells, such as
protein secreted by activated T lymphocytes
capable of inhibiting random migration of
fibroblasts, can produce MIF (Steinhoff et
macrophages, concentrating macrophages
al., 1999), and many other functions have
at inflammatory loci, and enhancing their
been attributed to this molecule, such as the

Full Paper (vol.24 paper# 7)

Biological studies on fresh water snails target to Schistosoma mansoni infection The Egyptian Journal of Hospital Medicine (2006) Vol., 24: 501 514

Biological studies on fresh water snails target to Schistosoma
mansoni infection

Abdel Hamid Z. Abdel Hamid , * Samia M. Abd El Wahab * Mona M. El
Tonsy and Rehab M. Abdel Megeed
( From Medicinal Chemistry Department , National Research Center , * Zoology Department ,
Faculty of Science , Al Azhar University for Girls , Cairo , Egypt)


In this study ,upon exposure of laboratory Egyptian B. alexandrina and B. glabrata snails to
its homologus strain of S. mansoni , two different phenotype strains " susceptible and resistant "
were distinguished . The aim of this study is to investigate the biological differences between
the two types of Biomphalaria snails either susceptible or resistant at different ages . The
investigated parameters included mortality , survival , percentage of susceptibility / resistance to
parasitic infection and fecundity . The results of the preliminary exposure experiment revealed
that parental snail stock was not completely susceptible and tend to be partially refractory to
infection . The results also showed a strong association between the levels of egg production
and susceptibility to parasite infection . Where breeding experiment revealed that , total egg
number , E/M and EM values produced by resistant phenotype of both snail species were more
than those produced by susceptible progeny snails . Also , it was noticed that , egg production is
associated inversely proportion with snail age .


Schistosomiasis is a serious public
cercaria ( Pitchford , 1981 ; Coelho &
health problem and second most important
Bezerra , 2006 ) . While , Richards ( 1984 )
parasitic disease ( WHO , 2004 ) . More
suggested that the susceptibility of snails to
than 600 million people in 74 countries are
at risk while more than 200 million were
Outcrossing and self-fertilization are
infected ( Gibodate and Bergquist , 2000 ) .
common modes of reproduction in
The schistosome parasites are transmitted
pulmonate gastropods ( Jarne and Stadler ,
by snail intermediate hosts found in water
1995) Some species reproduce predomin-
bodies like lakes , ponds , streams , rivers ,
antly by self-fertilization , others are
irrigation canals and dams .Snails prefer
facultative self-fertilizers ( selfing only
lightly shaded areas , though they show
occurs when no mating partners are
considerable adaptability to light conditions
available), and others reproduce exclusively
. The snails may live up to 18 24 months ,
by cross-fertilization . Furthermore ,
unless infected with schistosomes or other
Biomphalaria snails are simultaneous
parasites , where they may die earlier .
hermaphrodite with ability of self-
Young snails reach sexual maturity in about
fertilization ; however , in the presence of
two months and under favorable conditions
partner ( when paired ) cross-fertilization is
can lay 10 15 eggs daily ( Ayad , 1974 ) .
preferred ( Vidigal et al., 1998 ) . Selfing
Certain environmental factors have
snails often have a lower fecundity than
pronounced effects on the susceptibility of
cross-fertilizing snails ( Bayomy and Joosse
snails to infection. For example ,
,1987 ) . It is important to verify the
temperature affects the penetration of
influence of self-fertilization performance
miracidia to snails and their development to
and copulation behaviour in breeding of

Full Paper (vol.24 paper# 8)

Plasma Adiponectin and Resistin Levels in Type 2 Diabetic Obese Female Patients With and Without Hypertension and Retinopathy The Egyptian Journal of Hospital Medicine (2006) Vol., 24: 515 523

Plasma Adiponectin and Resistin Levels in Type 2 Diabetic Obese
Female Patients With and Without Hypertension and Retinopathy

Seham M. S. EL Nakeeb*, Manal A.Lattif**, Ahmed M.Ragheb***,
Adel Balaha***, Baker M.A. Albow****
Biochemistry Dept.* Internal Medicine Dept.** Faculty of Medicine for Girls AL-Azhar
University Clinical Pathology Dept.*** Faculty of Medicine AL-Azhar University,
Faculty of Medical Technology****,Mesalata- El- Margeb University.


In the past, adipose tissue was largely regarded as a depot for fuel storage in
the form of triglyceride. However, adipose tissue is an active endocrine organ that secretes a
variety of metabolically important substances including adipokines. The adipocyte is now
known to secrete a variety of proteins such as tumour necrosis factor (TNF)- , adipsin,
plasminogen activator inhibitor-1, leptin, resistin, and adiponectin. Adipose tissue regulates
insulin sensitivity via the circulating adipocytokines, resistin and adiponectin. These factors
affect insulin sensitivity and may represent a link between obesity, insulin resistance and type 2
diabetes (DM). The objective of this study was to compare the levels of resistin and adiponectin
in type 2 diabetic obese female patients with and without hypertension and retinopathy.
Subjects and Methods: In this study the plasma adiponectin and resistin concentrations
were investigated, in 20 control obese non-diabetic females and 40 obese female patients with
type 2 diabetes mellitus. The diabetic females were divided into 2 groups. GI included 20
controlled uncomplicated diabetics & GII included 20 diabetic patients with hypertension and
Results: The plasma concentration of adiponectin was significantly lower (P< 0.01) in
diabetic females in G & G than non-diabetic control females. In diabetic patients with
hypertension and retinopathy ( GII) there was a significant decrease in plasma adiponectin levels
(P< 0.01) as compared to their levels in diabetic females in G and control females. Our results
also show that there were non-significant changes in plasma resistin in diabetic patients in both
groups G & GII as compared to their levels in control group.
Conclusion: These results suggest that adiponectin may play a key role in
pathophysiology of type 2 diabetes mellitus and its microangiopathy and macrovascular
Key words: diabetes mellitus . obesity . adiponectin . resistin.


Obesity is associated with an
physical inactivity, intensive insulin therapy
increased incidence of diabetes, hyperte-
to obtain good metabolic control to reduce
nsion, dyslipidaemia and coronary artery
complications is associated with weight
disease. Current management strategies of
gain (Williams et al., 1999 and DCCT
obesity include lifestyle interventions and
Research Group, 1993). The relationship
pharmaco therapy (Filippatos et al., 2005)
control and
.Overweight (BMI 25 kg/m2) and obesity
development of chronic complications
(BMI 30 kg/m2) are becoming increas-
(retinopathy, neuropathy, and nephropathy)
ingly prevalent in the industrialized world
is a primary concern of clinicians. Factors
(James et al., 2001), not only in type 2 but
involved in the development of vascular
also in type 1 diabetic patients (Libman et
complications of diabetes include long
al., 2003 and Kibirige et al., 2003). Besides
diabetes duration, poor glycemic control,

Full Paper (vol.24 paper# 9)

The Effect of Monosodium Glutamate (MSG) On Rat Liver The Egyptian Journal of Hospital Medicine (2006) Vol., 24: 524 538

The Effect of Monosodium Glutamate (MSG) On Rat Liver
And The Ameliorating Effect Of "Guanidino Ethane Sulfonic acid (GES)"
(Histological, Histochemical and Electron Microscopy Studies)

Hanaa F. Waer and *Saleh Edress
National Center for Radiation Research and Technology, Atomic Energy Authority
Faculty of Medicine,Banha University

Food additives are chemical substances added intentionally to food stuffs to preserve,
color, sweeten and flavor food. Monosodium glutamate (MSG) is used as a flavor enhancer and
found in most soups, salad dressing and processed meat. The use of MSG in food is growing.
Irrational fear had increased in the last few years due to the adverse reactions and toxicity of
The present study was designed to investigate the effect of MSG on the rat liver and the
ameliorating effect of taurine analog "Guanidinoethane sulfonic acid (GES)". Sixty albino rats
(2-3 months old) were used in the present study. MSG was given orally at a daily dose of 60
mg/1000 g for one month, two months and was given at a daily dose of 100mg/1000gm for one
month. The results revealed that the deleterious effects of MSG were dose related and
cumulative. In MSG treated rats, the examined sections showed remarkable alterations varied
considerably from moderate structural changes to cytoplasmic lysis and signs of degeneration of
cellular organelles. The histological changes showed disturbed liver architecture, hemorrhage in
the central veins, areas of necrosis, vacuolation and increased inflammatory cells infiltration.
The glycogen granules increased as well as the collagen fibers in the liver cells. Ultrastructural
changes showed loss of cytoplasmic differentiation, vacuolation, pyknotic nuclei with irregular
nuclear membranes and elongated electron dense mitochondria. Conversely, treatment of rats
with taurine analog (GES) significantly attenuated the cellular toxicity of MSG.


Monosodium glutamate (MSG) is the
may kill brain cells and cause neuro
sodium salt of glutamic acid, a naturally
endocrine disorders in laboratory animals
occurring amino acid which is produced in
(Hardikar et al., 2001; Praputpittaya and
small quantities by the human body.
Wililak 2003; Elefferious et al., 2003 ,
Monosodium glutamate is used as a flavor
Nagata et al., 2006 ).
enhancer in a variety of foods prepared at
The adverse effects of MSG ingestion
home, in restaurants and by food processors
may be cumulative. Authors have reported
(Walker and Lupien, 2000).
that eating of small amounts of MSG once a
The safety and toxicity of MSG had
week without experiencing reactions, while
become controversial in the last few years
having reactions when the same products
because of reports of adverse reactions in
were consumed two or three days in a raw.
people who have eaten foods that contain
Later studies by Samuels, (1999),indicated
MSG. Many studies had confirmed the
that the damage by monosodium glutamate
adverse reactions of MSG. Blaylock and his
was much more widespread.
colleagues (1994) found that MSG caused
Studies with synthetic taurine and
headache, vomiting, diarrhea, irritable
taurine analogs as antioxidants suggested
bowel syndrome, asthma attacks in
that these substances caused a significant
asthmatic patients and panic attacks. MSG
reduction of many toxic agents. Taurine had

Full Paper (vol.24 paper# 10)

Assessment of Anticardiolipin antibodies, Circulating Lupus anticoagulant, Protein C, Protein S, Antithrombin III &Activated P The Egyptian Journal of Hospital Medicine(2006) Vol., 24: 539 547

Assessment of Anticardiolipin antibodies, Circulating Lupus anticoagulant,
Protein C, Protein S, Antithrombin III &Activated Protein C Resistance and
Their Relation to Thomboembolic and Other Clinical Manifestations in
Behcet's Disease

Seham M. S.EL- Nakeeb*, Ahmed M.Ragheb**, H.S.El -Baz**,
Abdel ShafyA.H***, A.M.Salama*****, and Zeinab A.Zakzouk*****
Biochemistry*, Chest***** Dept. Faculty of Medicine for Girls.
Clinical Pathology**, Rheumatology and Rehabilitation***, Vascular Surgery**** Dept.
Faculty of Medicine ALAzhar University


Background: Venous and arterial thrombosis occurs in patients with Behcet's disease and
is associated with significant morbidity and mortality. Studies on a possible association between
the occurrence of thrombosis and thrombophilia in patients with this disease have been
controversial. The objective of this study was to assess the frequency and clinical relevance of
anticardiolipin antibodies (aCL) & other thrombophilic factors and their relationship to
thromboembolic & clinical manifestations in Behcet's disease (BD).
Materials and methods: IgG, IgM and IgA anticardiolipin antibodies (aCL) isotypes,
presence of circulating lupus anticoagulant(LAC), protein C, protein S, antithrombin III &
activated protein C resistance were investigated in 25 patients with BD and 25 patients with
various rheumatic diseases not known to be associated with venous or arterial thromboembolic
phenomena served as controls. Twelve of the patients with BD (48%) had either deep vein
thrombosis (8 patients), arterial thromboembolic phenomena (4 patients), or both (2 patients).
Results: The IgA aCL elevated in14 (56%) patients with BD compared with one (4%)
patient in the control group (P<0.01). IgG aCL levels were elevated in 13 (52%) patients with
Behcet's disease (BD) compared with one (4%) patient in the control group(P<0.01).Also
patients with BD do not have decreased protein S, or antithrombin III activity, activated protein
C resistance, circulating lupus anticoagulant (LAC), or elevated LgM aCL. No significant
differences were found between any variable in both groups. No association between elevated
IgMaCL levels and venous or arterial thrombosis and no statistical correlation was found
between any factor and clinical manifestations of the disease.
Conclusion: A significant number of patients have elevated levels of IgA& IgG aCL but
they are not associated with venous or arterial thrombosis. These results do not suggest a
primary role for aCL in BD and do not support the role of coagulation abnormalities in the
pathogenesis of thromboembolic complications of Behcet's disease but suggest vascular
inflammation as the main pathogenetic event in the vascular lesions in Behcet's disease.

: Procoagulant factors, Anticardiolipin antibodies, Thromboembolic
manifestations, Behcet's disease.


Behcet's disease (BD) is a chronic
thrombosis occurs in 738% of patients
multisystem inflammatory disorder that can
(Sakane et al.,1999).Venous thrombosis is
involve the skin, eyes, central nervous
more common than arterial thrombosis,
system, arteries, veins, lungs, and gastro-
with relative frequencies of 90% and 10%,
intestinal tract. The common manifestations
respectively. Deep or superficial venous
are recurrent oral and genital ulcers and
thrombosis in the lower extremities is the
ocular inflammation. Venous or arterial
common sites of thrombosis (Gul et al.,

Full Paper (vol.24 paper# 11)

The Egyptian Journal of Hospital Medicine (2006)Vol., 24: 548 555

Serum level of IL13 and expression of BCL2 in Behcet's disease

Hanan.M.A Darwish*, Sabila Gomaa Mousa** Noha Hamdy ,
and Sahar Zalam.
Departments of Dermatology and Venereology*, General Mmedicine** and Clinical
Pathology. Faculty of Medicine for girls Al-Azhar University.


Background BD:
BCL2 family is a large family of apoptosis regulating proteins
consisting of both blockers and promoters of cell death. Immunological processes and a variety
of cytokines may play a role in pathophysiological process. Defective regulation of programmed
cell death (apoptosis) also play a role in development of Behcet's disease
Objective: To investigate the level of BCL2 and IL13in BD and to determine their to
relation monitory disease activity.
Patients and methods: This study was conducted on thirty patients (15 active and 15
inactive) and 15-health control, the activity of BD was evaluated according to international
study group for BD disease, using ELISA technique for IL 13 and flow cytometry forBCL2.
Results: Elevated serum levels of IL13 in patient with active BD than inactive and both
had elevated levels than control(P< 0.01) and also the serum levels of Bcl2 was elevated in
patient with active BD than inactive and control(P< 0.01).
Concolusion: The data suggested that IL13 and BCL2 could be involved in the pathogenesis of
BD and its serum levels can be used as marker to monitor disease activity.


Behcet's disease
(BD) is an inflam-
profile of TH1/TH2 cell type is very
matory multisystem disorder chara-cterized
important in the immune response
by recurrent oral genital and aphthous
occurring in BD (Raziuddin et al.,1998) .
ulcers , arthritis,uveitis and therombophle-
Programmed cell death (apoptosis) is
pitis that can involve several organs
important in down-modulation immune
(Emmi et al., 1997).
response after activation and proliferation
Hulusi Behcet, is Turkish dermat-
of inflammatory cells. It has been suggested
ologist ,described the recurrent orogenital
that dysregulated apoptosis of lymphocytes
ulceration and uveitis in1937. The preval-
may be linked to the development of
ence of BD is highest in Japan, south Asia
autoimmune disease as Sjogrens syndrome
,the middle east and southern Europe .The
(Ichikawa et al.,1995), systemic lupus
disease is rare in northern Europe and the
erythematosus (SLE)(Aringer et al.,1991)
United state (Jorizzo,1999).Although the
and rheumatoid arthritis(RA ) (Isomaki et
etiology and the pathogenesis of BD still
al.,1996). Defective regulation of progra-
remain uncertain, it has been suggested,
mmed cell death (apoptosis) may play a
that three major pathophosiologic changes,
role in the development of BD and the
neutrophil hyperfunction, vasculitis and
protoncogene Bcl-2 is involved in the
autoimmune response may be involved in
control of apoptosis in immunocompetent
its pathogenesis ( Sakane et al.,1997)
cells (Hamzaoui et al., 1999).
Recent studies have indicated that
The diagnostic criteria established by
cytokine- producing cells play an important
the international study group for Behcet's
role in the immunopathogenesis of inflam-
disease requires the presence of recurrent
mation in BD (Sugi et al., 1998). In part-
oral ulceration and two of the following:
icular, a divergent cytokine production
recurrent genital ulceration, eye lesions,

Full Paper (vol.24 paper# 12)

Copper, Zinc, Selenium, Cadmium and Lead Levels The Egyptian Journal of Hospital Medicine (2006) Vol., 24: 556 563

Copper, Zinc, Selenium, Cadmium and Lead Levels in plasma
of Hemodialysis Patients.

Shawkia S. A. El-Sherbeny*, Asmaa, M. Abd Allah**, Waleed Massoud***

*Nutritional Biochemistry Department. National Nutrition Institute.
**Clinical Nutrition Department. National Nutrition Institute.
***Nephropathy Department-Ahmed Maher Teaching Hospital.


Introduction: Hemodialysis patients are at risk of developing trace elements imbalance
and increase in heavy metals. Objective: The objective of this study was to asses plasma levels
of copper, zinc, selenium, cadmium and lead of hemodialysis patients. Design: The study
comprised 40 patients aged 27-65 years under regular hemodialysis for 1.8-13 years and 28
healthy age and sex matched the control. Copper, zinc, selenium, cadmium and lead plasma
levels were determined by atomic absorption spectrophotometry. Results: Levels of copper,
zinc and selenium were significantly decreased in dialysis patients compared with the control
group; the percentage decrease was 25.5%, 20.4% and 19.0% for copper zinc and selenium,
respectively. Moreover, cadmium and lead plasma levels showed significant increases among
hemodialysis patients versus their matched controls with percentage of 144.6% and 28.1% for
cadmium and lead, respectively. Conclusions: Levels of trace elements are altered and heavy
metals showed increased plasma levels by hemodialysis. Regular monitoring of trace elements
and heavy metals in hemodialytic patients is advisable.

Hemodialysis, Copper, Zinc, Selenium, Cadmium, Lead.


Altered blood and tissue concen-
(Lee et al., 2000). Suspected copper defic-
trations of trace elements have been descr-
iency was also supposed to play a role in
ibed in patients with chronic renal failure
the pathogenesis of anemia and growth
treated by hemodialysis (HD) (Berlyne,
retardation of dialyzed patients. (D'Haese
1995). The most important factors for this
and De Broe, 1996).
alteration are the degree of renal failure and
Zinc (Zn) is an essential trace
the modality of renal replacement therapy
element; it is used by a great number of
(Vanholder et al., 1996).
enzymes, such as alkaline phosphates,
Copper (Cu) is an important element
superoxide dismutase, protein kinase C and
for hemoglobin synthesis, connective tissue
carboxypeptidase A, B (Brody, 1994).
metabolism and bone development (Brody,
Serum and plasma zinc in HD patients were
1994). Copper may play a role in the
found either to be normal (Agenet et al.,
antioxidant defene system such as coppe-
1989) or more often decreased (Cabral et
r/zinc superoxide dismutase (Cu/ZnSOD),
al., 2005). Zinc depletion was suggested to
ceruloplasmin and intracellular thioneins.
play a role in the pathogenesis of some
(Linder, 1996). Serum copper tends to be
uremic symptoms, e.g. impotence (testic-
generally low in patients treated with HD
ular atrophy), immunological impairment,

Full Paper (vol.24 paper# 13)