The Egyptian Journal of Hospital Medicine (2006) Vol., 25: 564 577
The Effect of Pioglitazone on Matrix Metalloproteinase-9, Matrix
Metalloproteinase-2, Tumor Necrosis Factor-, Vascular Endothelial
Growth Factor and E-Selectin in Skin Lesions in Psoriatic Patients
with and without Psoriatic Arthritis
Seham M. S.EL Nakeeb*, Sahar Fawzy**, Magda H Osman***
Biochemistry* Dermatology and Veneriology ** Clinical Pathology*** Dept.
Faculty of Medicine for Girls AL Azhar University
Background: Psoriasis is a common inflammatory skin disease characterized by
infiltration of inflammatory cells into the epidermis and altered keratinocyte differentiation.
The aim of the present study was to investigate the role of MMP-9 in the development of
psoriasis by assessing the presence of MMP-9 in lesional skin and in sera of psoriatic patients
with & without psoriatic arthritis, the association of MMP-9 with the activity of the disease, the
relationship between MMP-9 and TNF- production as well as to evaluate the effect of
pioglitazone (one of the agents thiazolidinediones) on TNF-, MMP-9, MMP-2, VEGF and E-
selectin production and in treatment of psoriasis.
Subjects and Methods: Thirty-five psoriatic patients (28 males, 7 females) were included
in this study. They were divided into 2 groups. Group I (PsA) included 15 psoriatic patients,
clinically presenting joint symptoms associated to the cutaneous disease (PsA). Group II (Ps)
included 20 psoriatic patients, clinically presenting cutaneous disease without psoriatic arthritis
(PsA). Each psoriatic patient received pioglitazone 30 mg/day orally for 10 weeks. Lesional
tissue specimens were taken, in the same skin area before and after 10 weeks pioglitazone
treatment. Tissues were kept in short term cultures and production soluble mediators such as
TNF-, MMP-9, MMP-2, VEGF and E-selectin, which include angiogenic molecules associated
to the development of plaque psoriasis, were measured in the culture supernatants by ELISA.
MMP-9 concentrations were also measured in the sera. The cutaneous activity of disease was
evaluated by the Psoriasis Area and Severity Index (PASI).
Results: Clinical and laboratory assessment indicated that all patients had a significant
improvement of the PASI score after 10 weeks of pioglitazone therapy. The clinical
improvement was associated to a significant decrease of TNF-, MMP-9, MMP-2, VEGF& E-
selectin levels (P< 0.05) , spontaneously released by lesional biopsies before and after therapy.
A significant decrease of MMP-9 (P< 0.01) in the sera, associated to the clinical improvement
was also found. In addition, significant positive correlations (P< 0.01) were found between the
TNF- and PASI score, MMP-9, MMP-2, VEGF& E-selectin (r=0.85, 0.84, 0.58, 0.63, 0.67
respectively), as well as between the MMP-9 and PASI, MMP-2, VEGF& E-selectin (r=0.82,
0.39, 0.69, 0.41 respectively) of patients with PsA after pioglitazone treatment. In psoriatic
patients without psoriatic arthritis after pioglitazone treatment there were also significant
positive correlations between the TNF- and PASI score ,MMP-9, MMP-2, VEGF& E-
selectin(r=.0.87, 0.68, 0.53, 0.61, 0.51 respectively), as well as between MMP-9 and PASI,
MMP-2, VEGF& E-selectin (r=0.95, 0.51, 0.58, 0.45 respectively).
Conclusion: The current study shows the existence of a direct relationship between MMP-
9 and TNF- production strongly suggesting that MMP-9 may play a key role in the skin
inflammatory process. Our findings also demonstrated that pioglitazone could be considered as
an efficacious and safe agent for the treatment of psoriasis. The optimum dose and duration of
pioglitazone therapy remain to be determined.
Key words: Psoriasis . Psoriatic arthritis . Matrix metalloproteinase-9 . Pioglitazone
STRUCTURE OF VOCAL PROCESS OF
The Egyptian Journal of Hospital Medicine (2006) Vol., 25: 578 585
Nasal Mucosal Morphology after Altera tion
of Air Stream
Abdulsalam Hussein* and Reda Awadalla**
*ENT and ** Anatomy Department, Al-Azhar Faculty of Medicine
Introduction The nocturnal application of nasal continuous positive airway pressure is
used for treatment of sleep apnoea. The study of the histopathological changes that accompany
its application is needed for proper evaluation.
Subjects and Methods: Fifteen adult rabbits were used in this study, 14 were the subject
of the experiments and one animal used as control. Under combined general and local
anaesthesia, ring of skin and epithelium was removed from the left nostril, the margins of the
wound were undermined, averted and brought together with mattress sutures, effectively closing
the nostril. The animals were sacrified at intervals. The duration of surgical closure of one
nostril was four days in 7 animals and three months in 7 others. Strip of bony and cartilaginous
septum was removed after marking the closed side with a silk stitch. In each interval 4 animals
were used for transmission electron microscope (TEM) and 3 for scanning electron microscope
Results: On the side with sealed nostril the number of goblet cells increased, while the
number of ciliated cells decreased. In contrast, on the open side of the nose disappearance of the
ciliated cells and a transformation of the respiratory epithelium into thickened multilayered
squamous epithelium with no goblet cells.
The nocturnal application of nasal
Long-term acceptance of the n CPAP-
masks by patients ranges from 67.4% to
(nCPAP) was first described in 1981 by
89.7% (Partinen et al., 1988) when nCPAP-
Sullivan et al. Then in 2003 by Lang et al.
therapy is discontinued, the patients'
and recommended for treatment of sleep
apnoea. Since then n CPAP has established
Long-term therapy can; however, be a
itself in the therapeutic management of
burden for the patient if various compli-
moderate and severe obstructive sleep
cations develop. Apart from problems
apnoea syndrome (Hoffstein et al., 1992).
related to mask usage (e.g. pressure spots,
Room air is supplied with a positive
skin reaction, claustrophobia, and problems
pressure to the nose through a nasal mask
with traveling) there have been reports of
by means of a blower unit, thus leading to a
eye irritation, noise disturbance caused by
pneumatic stabilization of the upper respir-
the nCPAP-blower, headache and tinnitus
atory airways. The apnoea phases are thus
(Katsantonis et al.,1988). The most frequ-
eliminated, snoring is distinctly reduced
ent and significant side-effect of nCPAP-
and subjective patient complaints, such as
therapy, with a reported frequency of 20-
daytime somnolence and lack of conce-
70%, is irritation of the upper respiratory
ntration, are largely overcome (Ripberger &
pathways and in particular of the nasal
Pirsig, 1994 and Kelly et al., 2000).
mucosa (Kuhl et al., 1997). Changes in the
Only continuous therapy is able to
mucosa that are causative for the entire
prevent severe consecutive cardiopulmo-
spectrum of symptoms are induced by
nary disorders and to lower mortality rate
applying cold and dry room air under
(He et al., 1988 and Partinen et al., 1988).
elevated pressure. Typical complaints that
Plasma Retinol, Thyroid Stimulating Hormone and Zinc as Predictors of Bone Mineral Density Status
The Egyptian Journal of Hospital Medicine (2006) Vol., 25: 586 596
Plasma Retinol, Thyroid Stimulating Hormone and Zinc as Predictors of
Bone Mineral Density Status
Shawkia S. A. El-Sherbeny*, Effat A. A., Afifi**, Wafaa M. A. Saleh**, Asmaa, M.
Abdallah***, Lobna M. S. Hadidy****.
*Nutritional Biochemistry Department. National Nutrition Institute.
**Food hygiene Department. National Nutrition Institute
***Clinical Nutrition Department. National Nutrition Institute.
****Nutritional Requirement and growth Department. National Nutrition Institute
Background: Conflicting results on the association between serum retinol level and bone
mineral density (BMD) have been published. Thyroid hormones are essential for skeletal
development and have direct effect on bone formation and resorption. Bone has one of the
highest concentrations of zinc of all tissues, and has been shown to release zinc during
deficiency for soft tissue metabolism. Objective: The objective of this study was to assess the
relation between plasma levels of retinol, thyroid stimulating hormone (TSH) & zinc and BMD
of Egyptian adolescents and adults. Method: The study was a part of a cross sectional national
survey conducted by National Nutrition Institute. The sample was a multistage stratified
random. Target individuals were classified into two age groups (10- 18 and 28- 59 years).
Bone mineral density and plasma levels of retinol, TSH and zinc were determined. Results:
Low and high plasma retinol levels were more prevalent among osteoporotic adolescent and
adult males respectively than in normal subjects.. The reverse was observed in adult females.
Bone mineral density correlated negatively with plasma retinol level in adult males and females
and positively in adolescent males, while among females the association was significant (P =
0.030) and stronger. The highest deficiency of TSH was found among adult and adolescent
osteoporotic males, followed by osteopenic adult males and adolescent females. Highly
statistically significant difference (P < 0.001) existed between osteoporotic and normal adult
males concerning TSH deficiency. The prevalence of zinc deficiency ranged from 5.7% to 9.5%
for all target individuals. Plasma Zn levels were correlated negatively with bone mineral density
in adult males and females. Conclusion: The results of this study reflects the controversy on the
association of plasma retinol and BMD. However, the predominant finding revealed that both
low and high plasna retinol levels compromise bone health. Bone status and thyroid function
support the adverse effect of hyperthyroidism upon either bone osteoporosis or osteopenia and
subsequently upon fracture risk. Plasma zinc deficiency correlated negatively with BMD in
adult osteoporotic men.
Key words: Human BMD. Osteoporosis. Osteopenia. Fractures Plasma. Retinol. TSH. Zinc
Osteoporosis is a complex, multi-
style early in life play an important role in
factorial condition characterized by reduced
the development and maintenance of bone
bone mass and impaired micro-architectural
mass as well as prevention and management
of osteoporosis (Kawahara et al., 2002).
susceptibility to fractures. In spite of being
Normal bone growth and development
a geriatric disease , it has an adolescent
require adequate levels of vitamin A. Both
onset so nutrition, environment and life
low and high doses of vitamin A may
Influences of Short -term Aerobic Exercise and Supplementation of Carnitine With or Without Choline on Body Weight, Serum Lept
The Egyptian Journal of Hospital Medicine (2006) Vol., 25: 597 609
Influences of Short -term Aerobic Exercise and Supplementation of
Carnitine With or Without Choline on Body Weight, Serum Leptin and
Carnitine as Well as Lipid Status In Male Rats
Neamat E. Hishem*, Bushra H. El-Zawahry*, Seham M.S. El Nakeeb** and
Layla A. Ahmad**
Physiology* and Biochemistry** Departments, Faculty of Medicine for Girls,
Al- Azhar University
Background: Carnitine is essential for fatty acids translocation, muscles function and
exercise performance. Choline is a lipotropic agent that prevents deposition of fat in the liver.
The studies concerning the effects of carnitine and choline supplementation with exercise on
carnitine status and serum leptin are rare. The aim of the present study was to study the effect
of carnitine and its combination with choline, with or without exercise on body and total fat pad
(TFP) weights, serum carnitine, leptin, -hydroxy butyric acid (-HBA), triacylglycerols (TAG)
and Free Fatty acids (FFA). Also, total lipids (TL) and TAG content of TFP and urinary
carnitine were investigated.
Material and Methods: 48 male rats were equally divided to the following groups: control
(C), carnitine (5 g/Kg diet) supplemented, carnitine plus choline (5 and 11.5 g /Kg diet
respectively) supplemented. Half of each group was subjected to short term aerobic exercise on
manual treadmill, in which the speed and duration were gradually increased via the course of
the experiment, to be 10 m/min for 20 min/day, 5 days/week in the last 2 weeks. Body weights
were recorded weekly. After 6 weeks, The 24 hours urine was collected then the fasted rats
were sacrificed and blood and the total fat pad (TFP) were collected for analysis.
Results: Carnitine supplementation, tended to decrease body weight, TFP, TAG content
and serum FFA, and significantly decreased the TL content, serum leptin, TAG (P<0.0005).
Carnitine feeding resulted in a significant elevation of serum carnitine, -HBA and urinary
carnitine (P<0.0005), compared to sedentary control rats. These values became more
pronounced on choline addition to the diet except for serum and urinary carnitine that reversed
(i.e. decreased) by choline addition. Exercise intervention resulted in a significant decrease in
body weight, TFP, TL content and serum leptin, TAG and FFA. These values were more
pronounced in both supplements with exercise, specially serum carnitine. However, exercise
caused reduction of urinary carnitine in non-supplemented and carnitine supplemented groups
and this was reversed by choline and exercise.
Conclusion: Our study demonstrated that the beneficial effects of carnitine supplements
is promoted by choline with or without mild exercise to reduce body weight, body fat, serum
leptin and promote fat loss by increasing lipolysis as indicated by increased serum -HBA.
These results may or may not be applicable to humans, so further research is recommended to
determine whether similar effects would result in humans or not.
Key words: Carnitine . choline . leptin . -hydroxy butyric acid . total lipids . exercise
L-carnitine, is a naturally occurring
fish and dairy products), whereas plants
substance found in most cells of the body,
have very small amounts (Iossa et
particularly the brain and neural tissues,
al.,2002). A number of studies in a variety
muscles, and heart. Carnitine, whose
of species have shown that, carnitine
structure is similar to choline, is widely
supplementation influences body compo-
available in animal foods (meat, poultry,
sition (Heo et al., 2000). It is conceivable
The Egyptian Journal of Hospital Medicine (2006)Vol., 25: 610 619
Serum Leptin in Patients with Chronic Renal Failure on Different
Modes of Management
Hala M. EL-Mougi*, Samiha Abo EL-Yazeed **, Zeinab A. Yousry** and
Abir Abdel Fattah **
Departments of Medical Biochemistry* and Internal Medicine** Faculty of Medicine
(Girls), AL-Azhar University
Aim: To study serum leptin level in chronic renal failure (CRF) patients on different
modes of management and to analyze the impact of the mode of therapy on serum leptin level.
Subjects and Methods: This study was conducted on 64 patients (33males&31females)
with chronic renal failure divided into three groups: group I: Twenty-six patients treated
conservatively and did not start dialysis yet (predialysis), group II: Twenty-four patients treated
by hemodialysis, group III: Fourteen patients treated by continuous ambulatory peritoneal
dialysis (CAPD). Twenty healthy subjects were included as control group. All patients and
controls were subjected to full clinical examination including height and weight to calculate
body mass index (BMI). Blood urea and serum creatinine were measured as renal function tests.
Serum leptin was measured by EASIA and so serum insulin.
Results: In predialysis and CAPD groups, there is a significant increase in leptin , leptin/
BMI and insulin in patients in comparison to control subjects. In hemodialysis group, there is a
significant increase in leptin and leptin/ BMI and a non-significant increase in insulin level in
patients in comparison to control subjects. Insulin is significantly correlated with leptin in the
first group, while in the second and third groups there is no correlation. The highest leptin level
is found in the CAPD group of patients followed by the predialysis one then the hemodialysis
Leptin level is significantly higher in females than males in all groups. This difference
remained after adjusting leptin level to BMI.
No correlation was found between leptin level and age or between leptin level and renal
function in the three groups of patients. No correlation was found between leptin level and the
duration of dialysis in the hemodialysis and CAPD groups.
Conclusion: Serum leptin is elevated in CRF patients irrespective of the type of
management they are undergoing. Dialysis, has no significant effect on leptin level. The two
main predictors of serum leptin level are sex and BMI in CRF patients and in healthy subjects.
Leptin level may serve as a valuable clinical marker for body adiposity.
Leptin is a 16KD protein hormone
placenta, liver, muscle, kidney, pancreas,
produced mainly by white adipose tissue
small intestine, colon, testes, ovary, prostate
(Kuwahara et al., 2003). It is involved in
and brain (Hardwich et al.,2001)).
energy homeostasis that acts to inhibit food
Both the structure of leptin and its
intake, to stimulate energy expenditure and
receptor suggest that leptin should be
influence insulin secretion, lipolysis and
classified as a cytokine (Madej et al.,
sugar transport (Mistrik et al., 2004).
The action of leptin is mediated
Hyperleptinemia is an essential
through the leptin receptor(Ob-R), which is
feature of human obesity as leptin is highly
encoded by the diabetes (db) gene. Leptin
correlated with the percentage of body fat
receptors isoforms have been reported in
and body mass index (Haupt et al., 2005).A
wide variety of tissues: heart, lung,
decrease in the body weight resulted in a
Assessing the Nutritional Status and Blood Glutathione
The Egyptian Journal of Hospital Medicine (2006) Vol., 25: 620 629
Assessing the Nutritional Status and Blood Glutathione
Level for Preschool Children.
Hanaa H. Elsayed * and Amr Abd El-Hafez**
*Chemistry of Nutrition and Metabolism Department, National Nutrition Institute.
** Hotel Department Higher Institute for Tourism & Hotel in 6th October City.
This study was designed to assessment nutrition status and blood glutathione (GSH) level
for preschool children. Subjects and methods: The study included 70 (boys and girls preschool
children) at aged from 2-5 years. Children was randomly selected from the out patients clinic at
the National Nutrition Institute Cairo. Weigh and height were measured for them to evaluate
the effect of nutrients on bodies, dietary intake was collected for the children were subjected to
estimation of (Energy, Protein, Fat, Carbohydrate, vitamins A, folic acid and minerals iron,
zinc and selenium) in their daily diet. Blood samples were collected to determine hemoglobin,
glutathione and total protein concentration. Results: The dietary analysis showed that, every
nutrient was lower than the requirement except total protein was higher than the recommend.
Stunting showed (25.5%) of boys and (20%) of girls, underweight (23%) of boys and 14% of
girls were the problems among preschool children. A glutathione deficiency was found among
97% of boys and 100% of girls. The hemoglobin ratio 77.1% from children was equal or less
than normal concentration. Total protein noticed 82.9% of boys and 85.7 of girls in normal
value. Conclusion: There was little quantity of nutrients intake, glutathione level and growth.
The study can be recommended to improve their daily dietary intake and nutrition habits by
education programs for their parents or supplement of studied cases with special ferrous and
protein specially contains sulphur amino acids in daily diet to cover Recommended Dietary
Allowances and can improve tissue GSH concentration.
Key wards: Preschool Children Glutathione dietary intake growth.
Nutritional status is a major determinant of
infections influence body size and growth
child health, and it is important to follow its
through their effect on metabolism and
evaluation over time not only for individual
nutrition (Torun and Viteri, 1981).
children but also at the community level.
Growth can be defined as: "The
The classical use of anthropometry as the
progressive development of a living being
most readily available method of assessing
or any of its parts from its earliest stage to
nutritional status is logical although other
maturity, including the attendant increases
methods (Briend et al., 1987). Nutritional
in size". Similarly, the definition of
deficiencies may give rise to a relative
"development" is "The series of changes by
failure to grow in height (stunting) as well
which the individual embryo becomes a
as a reduction in body mass for height
(wasting). The latter is the condition
Clearly, a range of controls must
dangerous to life in famines, but it responds
influence the growth of a child. Genetic
much better in the short term to increased
factors are important, as tall families have
intake of nutrients than does the shortness
tall children and short families tend to have
of stature (David &. Peter1998). In
small children. Nutrition and environment
developing countries growth deficits are
are important contributors to the picture, as
caused by two preventable factors,
the child dose not growth well if it is
inadequate food and infection. In general,
starved or denied a good balanced diet or
Efficiency of Immunization of Mice with Irradiated antigen against Schistosoma mansoni Infection in comparison with praziquant
The Egyptian Journal of Hospital Medicine (2006) Vol., 25: 630 655
Efficiency of Immunization of Mice with Irradiated Antigen Against
Schistosoma mansoni Infection in Comparison with Praziquantel
Mona A. El-Gawish, Manar N. Hafez, Fatma A. Eid* Maha G. Soliman* and
Shymaa M. Khalil*
National Center for Radiation Research and Technology. Faculty of Science
Introduction: The present study is an attempt to evaluate the protective effect of
schistosomula antigen and the current antischistosomal drug praziquantel (PZQ) as a reference
drug on mice infected with S. mansoni.
Material and Methods: Mice were vaccinated by irradiated or non-irradiated
schistosomula antigen, both at a dose of 100 ug protein/mice once weekly for 3 weeks, before
infection with alive cercariae and compared with the treatment with i.m. injection of
praziquantel at a dose of 40 mg/kg b.wt. 4 times once weekly for 4 weeks after infection. The
degree of resistance or protection induced by immunization and chemotherapy was assessed 45
days postinfection and evaluated by physiological, parasitological, immunological as well as
Results: The results indicated that immunization with -irradiated antigen at 20 Krad or
the treatment with PZQ resulted in significant reduction in ova count in liver and intestine
tissues more than those vaccinated with non-irradiated antigen compared with infected group.
Immunized group with irradiated antigen and the group treated with PZQ showed a significant
decrease in liver enzymes activity (ALT, AST and -GT), while in immunized group with non-
irradiated antigen, there was a significant increase in AST and -GT as compared to infected
group. The level of alkaline phosphatase enzyme was significantly increased in all investigated
groups compared to infected one. Treatment with PZQ or immunization with irradiated or non-
irradiated schistosomula antigen induced amelioration in serum IL-10 and TNF-. Scanning
electron microscope demonstrated normal mature worms in infected group after 45 days from
infection. In contrast, many changes were detected in the rest groups as alterations in the
tegument, implosion of tubercles which appeared pealed and sloughed off and most of the
spines were detached and separated.
Histological examination of liver sections of infected mice revealed lobular cellular
infiltration and cloudy swelling in hepatocytes with occurrence of necrotic foci. Also,
granuloma of infiltrating cells was noticed around the portal structures and inbetween the
degenerated cells. Congested portal vein could be seen lodged with adult worms and the portal
tracts showed fibrous thickening. Whereas, the lung revealed destructed bronchioles which
appeared surrounded by intense inflammatory foci. Thickened interalveolar septae were also
marked, however many alveoli appeared with shed destroyed epithelium. Moreover,
peribronchiolar and perivascular fibrosis was quite prominent. Gross pathological alterations
were observed in both liver and lung of immunized groups with non-irradiated antigen. In
controversy, immunization with irradiated antigen can reduce the granulomatous reaction and
collagen deposition. There are also little inflammation and less congestion, however the hepatic
and pulmonary architectures appeared otherwise normal. The present histological findings
proved that PZQ has a valuable schistosomicidal effect but some pathological changes are still
Conclusion: On the whole, it could be concluded that irradiated antigen produced marked
protection against S.mansoni infection and this may reflect its possible beneficial effect on the
diseased liver and lung.
Sodium Barbital Induced Biochemical, Histological And Histochemical Changes In The Liver Of Albino Mouse
The Egyptian Journal of Hospital Medicine (2006) Vol., 25: 656 671
Sodium Barbital Induced Biochemical, Histological and Histochemical
Changes in the Liver of Albino Mouse
Shadia Ali Radwan*, Aziza M. El-Wessemy*, Samia M. Sakr*
and Samira E. El-Harras**
* Department of Biological Sciences, Faculty of Education, Ain Shams University,
Cairo, Egypt. ** High Institution of Applied arts, 6th October City
Introduction:The present work was planned to assess and evaluate some physiological
parameters, histopathological and histochemical impacts of sodium barbital on the liver of adult
male albino mice.
Material and Methods :The mice were divided into 3 groups, the first group served as a
control group, while the other two groups were treated with the therapeutic dose (60 mg/kg
b.wt., i.p.) for 7 days (short-term group) and 21 days (long-term group) as repeated daily doses.
Results: Biochemical analysis showed a significant increase in serum glucose level
(hyperglycaemia), AST, ALT and bilirubin, in all treated groups. Also, total lipids and
triglycerides showed a significant increase in the long-term group and non significant change in
the short-term group. On the other hand, alkaline phosphatase ALP, showed a significant
decrease in both treated groups. Total cholesterol level showed a significant decrease in the
short-term group but exhibited a significant increase in the long-term group. The results
obtained from the present study showed marked alterations in the liver tissue. Histopathological
changes in liver tissue were congestion of the central veins, wedening of the blood sinusoids,
activation of the phagocytic küpffer cells and cytoplasmic degeneration (fatty and hydropic)
with nuclear lesions. Histochemical changes in liver tissue revealed depletion of
polysaccharides and total proteins in both short-term and long-term groups.
Conclusion So these results came to conclusion that barbiturates should be prohibited and
carefully used specially when prescribed as tranquilizer.
Key words : Barbital, Serum, Liver functions, Histopathology, Histochemistry.
Barbiturates gained a wide usage as
high significant increase in hepatic ALT
tranquilizers, sedatives and hypnotics.
activity after 1st week, which increased with
continuous PB treatment. Following with,
prescribed where a general depression of
high significant increase in hepatic ALT
nervous system activity is described.
after PB withdrawal. Also, Khalil (2000),
Mansour et al. (1995) studied the effect of
studied the effect of phenobarbital on the
oral administration of phenobarbitone (PB)
serum and liver alkaline phosphatase of
and/or alcohol and the drug withdrawal on
albino rats. The animals received low dose
transaminases in blood and liver of albino
(68.18 mg/kgb.wt.) and high dose (136.36
rat. The animals were given 25mg/kg.b.wt.
mg/kgb.wt.) for several periods exhibited
in the 1st week, then 37.5 mg/kg.b.wt. in the
significant increase of serum alkaline phos-
2nd week and 50 mg/kg b.wt. in the 3rd
phatase activity in all treated groups, while
week. Phenobarbitone (PB) administration
the liver alkaline phosphatase activity was
decreased hepatic ALT activity after 1st
significantly decreased in those treated rats.
week, which increased with continuous PB
Infante et al. (1971) found that treat-
treatment. The effect persisted showing
ment of rats with phenobarbitone increased
The Egyptian Journal of Hospital Medicine (2006)Vol., 25: 622 690
Combined Spinal Epidural versus Epidural Sufentanil and
Bupivacaine in Labour (Clinical and Histological comparative Study)
*Nagia M. Abd El Moeti, *Zinab B. Youssef, *Soaad S. Abd El Aal
**Mahmoud Ahmed Abd El Haliem
*Anaesthesia department Faculty of medicine Al-Azhar university
** Histology department Faculty of Medicine Al Azhar university
Introduction:- Regional analgesia provides excellent pain relif in labour. This study was
designed to compare combined spinal eqidural (CSE) versus epidural block using a narcotic
(sufentanil) and local anaesthetic bupivacaine regarding their effects on progress of labour,
method of delivery, pain relif, side effects and neonatal outcome.
Patients and Methods :-Forty pregnant women ASA I and II were enrolled in this study.
The women were randomly allocated to receive either CSE or epidural ( 20 patient of each ). In
CSE group analgesia was initiated with 10ug sufentanil with 2mg bupivacaine. In epidural
group 10ml bupivacaine 0.125%.and 10ug sufentanil injected epidurally. In both groups the
continuous infusion of 0.83% bupivacaine with 0.33ug/ml sufentanil at 10ml/hr adjusted as
required. Maternal haemodynamics, analgesia characteristics VAPS, degree of motor block,
were measured. Duration of labour, cervical dilation, maternal satisfaction and mode of delivery
were assessed. Foetal outcome was assessed by 1 and 5 min. Apgar score and umbilical venous
blood gases. Maternal and neonatal side effects were observed.
The experimental study was done on 30 rats divided into 3 groups 10 rats of each. Control
group (A) injected intrathecally with saline, group (B) injected intrathecally with 1.5ug/kg
sufentanil (low dose), and group (C) injected intrathecally with 7.5ug/kg sufentanil (high dose),
the pervious doses were injected every 2hr. for 3 times then the spinal cord was obtained and
stained for histological evaluation.
Results:- The clinical study showed that no difference between the 2 groups for the degree
of motor block or adequacy of analgesia, mode of delivery and Foetal outcome. The onset of
analgesia was faster with CSE technique, more patient satisfaction and more pruritis.
The histological results revealed that no detectable significant neurotoxic changes with the
use of small dose of intrathecal sufentanil but mild changes occurred with high dose.
Conclusion :- So the study concluded that both CSE and epidural analgesia with sufentanial
and bupivaine can provide effective labour analgesia with minimal or no side effects.
There has been considerable controv-
ence of cesarean deliveries between groups.
ersy in the past few years regarding the
Sharma et al. ( 1997 ).
effect of epidural analgesia on the outcome
Combined spinal epidural (CSE)
of labour. Chestnut (1997). Labour epidural
analgesia with intrathecal sufentanil is a
analgesia is associated with an increased
technique that offers the potential to
incidence of cesarean deliveries for dysto-
minimize the effects of epidural analgesia
cia in nulliparous women and an increase in
during labour on the cesarean birth rate.
forceps deliveries in all parturients.
This technique necessitates smaller doses of
However, a more recent study, which
local anaesthetics which theoretically could
compared epidural analgesia with intrav-
reduce motor block.
enous patient controlled analgesia during
The benefits of intrathecal sufentanil
labour showed no difference in the incid-
include rapid onset of pain relief and the
The Egyptian Journal of Hospital Medicine (2006) Vol., 25: 691 702
Ropivacaine versus Bupivacaine for Inter Scalene Block
Clinical and Pharmacological Comparative Study
*Nagia M. Abd El Moeti, *Zinab B. Youssef
*Soaad Said Abd El Aal, ** Enas Abd El Aaty Ouda
*Anaesthesia Department **Department of Pharmacology
Faculty of Medicine Al-Azhar University
Introduction : The interscalene approach to the brachial plexus for shoulder surgeries
provides excellent anaesthesia with remarkable safety and minimal or no systemic
Material and Methods : 60 abult patients ASA I-II undergoing elective shoulder surgery.
Patients were randomly allocated into 3 groups. The patients recived 20ml of either ropivacaine
1% GI (20 patients), ropivacaine 0.75% GII (20 patients) and bupivacaine 0.5% GIII (20
patients). Onset time of sensory and motor block, duration of analgesia and the need for
supplementary analgesics were recorded. Pain was assessed by using VAPS. Haemodynamic
parameters, oxygen saturation and respiratory rate were recorded. Unwanted side effects,
cardiovascular, neurological, nausea and vomiting etc were recorded. Also, patients satisfaction
The pharmacological study was done on pentobarbitone cats to determine the effect of
different doses of ropivacaine (0.35-2.8mg/kg) versus buipvacaine (0.5-4mg/kg) on arterial
blood pressure, ECG and respiratory rate.
Results: The mean onset time of analgesia was faster in ropivacaine groups than
bupivacaine group (p<0.005). The studied groups were comparable regarding the duration of
analgesia, motor and sensory block, cadio vascular and respiratory effects. The incidence of
paraesthesia was more frequent in bupivacaine group than both ropivacaine groups (30% vs
10%) There was more patient satisfaction in ropivacaine groups than bupivacaine groups.
On the other hand the pharmacological study showed that ropivacaine had more less toxic
effects on cardiovascular and respiratory systems.
Conclusion : This study concluded that interscalene block performed with either 0.75% or
1% ropivacaine allows for a prolonged postoperative pain relief similar to bupivacaine 0.5%
with shorter onset time, more cardiovascular stability and higher patient satisfaction.
Interscalene brachial plexus block
duration anaesthesia especially when small
(ISB) is used to provide anaesthesia and
volumes of anaesthetic are injected. Fanelli
analgesia for shoulder surgery. Single
et al. (1999).
injection interscalene brachial plexus block
Ropivacaine is a new long acting local
is an effective anaesthetic; however it is
anaesthetic with smaller potential for
limited by the duration of action of local
anaesthetic. Bupivacaine and ropivacaine
Markham and Faulds (1996), and useful
have been compared both at different an
clinical properaties when used
equal volumes and concentration for ISB.
peripheral nerve blocks. Fanelli et al.
Kinnard and Lirette, (1996).
Bupivacaine is a long-acting local
Because of its long duration of action
anaesthetic which has been reported to be
bupivacaine is frequently the local
associated with slower onset time for nerve
anaesthetic chosen for regional analgesia
blockade compared with other intermediate
techniques. However lethal arrhythmias,
CD 34 GLYCOPROTEIN AS A DIFFERENTIATING MARKER BETWEEN BASAL CELL CARCINOMA AND TRICHOEPITHELIOMA
The Egyptian Journal of Hospital Medicine (2006) Vol., 25: 703 710
Cd 34 Glycoprotein as A Differentiating Marker Between Basal Cell
Carcinoma and Trichoepithelioma
Amr M. Zaky1 and Ahmed H. Abdel-Rahman2
From the Department of Dermatology, Venereology & Andrology1, Al-Azhar University
(Cairo); Department of Pathology2 Al-Azhar university (Assuit)
Trichoepithelioma (TE) is a benign skin tumor with follicular differentiation, which is
sometimes difficult to distinguish clinically and histologically from basal cell carcinoma (BCC).
One of the most helpful differences is the histologic appearance of the stroma. CD34 is an
antigen known to stain the spindle shaped cells located around the middle portion of normal hair
follicles. We selected twenty clinically confused cases. After routine histopathological staining
by haematoxylin and eosin, all cases showed typical diagnosis in seventeen cases (9BCC& 8TE)
while the remaining three cases revealed overlapped features. Immunoperoxidase technique
using anti-CD34 antibody carried out in all cases displayed two out of the three overlapped
cases had a staining pattern similar to the typical BCC cases; the immediate tumor stroma
together with the spindle cells intermixing the tumor nests were CD34 negative. Moreover, the
remaining uncertainly diagnosed case had a pattern resembling the typical TE cases; the
immediate tumor stroma as well as the spindle cells surrounding the tumor islands were focally
From our study, we concluded that the CD34 staining pattern can be considered as a
helpful tool in differentiation between TE and BCC particularly when these lesians are in doubt
about the clinical or routine histologic diagnosis.
Key words: CD34 antigen-Immunohistochemistry- Trichoepithelioma- Basal cell carcinoma.
Trichoepithelioma (TE) and basal cell
mesenchymal bodies strongly suggests the
carcinoma (BCC) are basaloid neoplasms
diagnosis of TE (Brooke et al., 1989). On
the other hand, there are some cases in
differentiation between TE& non-ulcerated
which the histologic distinction between TE
BCC can be difficult for the clinician as
and BCC may be difficult, especially in
well as the pathologist. Both tumors can
small biopsy specimens (Kirchman et al.,
present as a solitary slowly growing, firm,
skin-colored papule, or nodule with a pearly
CD34 is an antigen known to stain the
appearance commonly located on the face
spindle-shaped cells located around the
(Mackie and Calonje, 2004). Moreover,
middle portion of normal hair follicle
some lesions of TE may become quite large
(Kirchmann et al., 1995). Also, CD34 has
with telangiectasias and ulceration, making
been detected in the endothelial cell, in
the distinction from BCC even more
perivascular dendritic cells and in spindle
challenging (Pham et al., 2006).
shaped cells in the basement membrane
Some histologic criteria can help to
zone of the eccrine glands (Nickololff,
differentiate between TE and BCC. The
presence of necrotic cells, mitotic figures,
stromal retraction, and deposition of mucin
believed to be derived from follicular
in the stroma are characteristic of BCC
epithelium. The hypothesis was made that
,however, the presence of papillary
the stroma around the TE tumor nests also
Prehospital thrombolytic therapy prior to precancerous coronary intervention A comparative study with conventional approach in
The Egyptian Journal of Hospital Medicine (2006) Vol., 25: 711 724
Prehospital Thrombolytic Therapy Prior to Percutaneous Coronary
Intervention a Comparative Study with Conventional Approach in Acute
ST-segment Elevation Myocardial Infarction
Hussein Shaalan MD
Ain Shams University - Cardiology Department
Background: early revascularization post MI is the corner stone in the therapy of acute
myocardial infarction. Primary PCI proved itself in the management of STEMI with patency
rate more than 90%.However, not every hospital has PCI facility. New thrombolytic agent
(tenecteplase) is now available which can be given easily outside hospital (Prehospital) to
facilitate PCI and preserve the cardiac muscle.
Aim of the work: comparing primary PCI results in patients with STEMI when
tenecteplase was given prior to intervention as early as possible (Prehospital), with those who
had only PCI without thrombolytic therapy.
Patients and Methods: the presenting study included 60 patients, divided into two equal
groups, group I patients received tenecteplase followed by primary PCI and group II underwent
primary PCI only in acute STEMI. 12 leads ECG, cardiac enzymes, echocardiographic study,
and coronary angiography were done for all patients. PCI results were recorded in addition to
immediate and 6 month follow up. All patients received the same adjuvant medical therapy
(aspirin, clopidogrel, heparin and tirofiban if needed).
Results: both groups showed non significant differences in peak cardiac enzymes, ejection
fraction before and after PCI, and angiographic success post PCI. The hard end points (death,
MI) did not show statistical difference between both groups both inhospital and on follow up.
However group I showed significant difference (P<0.05) in more direct stenting, less procedure
time, and more recurrence of chest pain post PCI compared with group II. There were highly
significant differences( P<0.001) in favor of group I in more TIMI 3 flow, less thrombus
burden, and less pathological Q waves; and in favor of group II in more clinical success post
PCI without complications. The call to balloon interval was shorter in group II (P<0.05). No
major bleeding was seen in both groups.
Conclusion: facilitated PCI has the advantages of decreasing thrombus burden in acute
STEMI, decreasing procedure time and achieving more TIMI 3 flow; however the hard end
points are not different from primary PCI and the recurrence of chest pain is significantly more
with facilitation. Tenecteplase use is not associated with major bleeding before PCI.
KEY words: tenecteplase facilitated PCI, Prehospital thrombolysis.
Acute ST-segment elevation myoca-
New thrombolytic agents such as
rdial infarction (STEMI) is a potentially life
tenecteplase (metalyse) are given as bolus
IV dose and do not need long infusion time
Early revascularization of the infarct related
needed for other agents like streptokinase
artery is required to salvage the myoca-
(SK) or rt-PA (ASSENT)-3 Investigators
rdium at risk. Thrombolytic agents have the
advantage of being given early after the
onset of chest pain either in the ambulance
coronary intervention (PCI) in acute
or inside the coronary care units of nearby
myocardial infarction has a higher patency
hospitals (Morrison et al., 2000).
rate of the infarct related artery with better
Protective effect of simvastatin against adriamycin-induced nepherotoxicity in rats
The Egyptian Journal of Hospital Medicine (2006) Vol., 25: 725 739
Protective Effect of Simvastatin Against Adriamycin-Induced
Nepherotoxicity in Rats; Biochemical and Histological Study
Nayira A. Abd Elbaky1, Lamiaa N. Hammad2, Tarek A. Atia3
1 Department of Pharmacology, 2 Department of Biochemistry, Faculty of Pharmacy (girls),
3Department of Histology, Faculty of Medicine (boys). Al-azhar University, Cairo, Egypt.
Introduction: The usefulness of adriamycin (ADR), a potent anti-tumor antibiotic, is
limited by the development of life-threatening cardiomyopathy and nephropathy. The cellular
changes leading to these toxicities are suggested to be mediated by increased free radicals and
Aim of the study: The current study was aimed to investigate the protective role of
simvastatin (SIM) on adriamycin-induced nephrotoxicity in rat using biochemical, and
Material and methods: Twenty eight healthy male Swiss albino rats were used and
divided into four groups : CONT (control), ADR (adriamycin treated), SIM (simvastatin
treated), and SIM+ADR (simvastatin plus adriamycin treated). Blood samples were collected
and used to determine the serum urea, creatinine, albumin, and total protein levels. Both kidneys
were removed ,one of them was prepared for histological examinations and the other was
stored at -70 °C for subsequent measurement of malondialdehyde (MDA), glutathione (GSH)
contents and phase II antioxidants enzymes activities.
Results: Glutathione (GSH) level, glutathione-s-transferase (GST) and DT-diphorase
activities were decreased, while the lipid peroxidation was increased in kidney tissue.
Administration of SIM (cumulative dose, 60 mg/kg body wt) in 12 equal injections (PO), before
and concurrent with ADR, more or less prevented these nephropathic changes, normalized
kidney function, and eliminated ascitis. Treatment with SIM was also accompanied by an
increase in kidney GSH level as well as DT-diphorase activities with a concomitant decrease in
lipid peroxidation. Histological examination revealed extensive and marked tubular necrosis in
the ADR-treated kidney. Administration of Simvastatin reversed kidney damage with a marked
reduction in tubular damage induced by ADR
Conclusion: These data show that SIM can provide coma protection against ADR
nephropathy. This protective effect of SIM may be related to the antioxidant status on the kidney
Key wards: Adriamycin, Nephrotoxicity, Simvastatin, antioxidant enzymes, DT diaphorase.
Since 1969, adriamycin (ADR) an
characterized by proteinuria, albuminuria,
anthracycline antibiotic is widely used as
anticancer agent. In spite of its high anti-
(Desassis et al., 1997). This experimental
tumor efficacy, the use of ADR in
nephropathy resembles histologically and
therapeutic doses is limited due to its
clinically minimal change nephropathy, or
diverse toxicities, including cardiac, renal,
focal and segmental glomerulosclerosis
hematological and testicular toxicity
(Zima et al., 1997). ADR also increases
(Gillick, et al., 2002; Kang et al., 2002;
glomerular capillary permeability and
Yagmurca et al., 2004). Intravenous
cause glomerular atrophy (Saad et al.,
administration of ADR was noticed to
2001). ADR-induced toxicity has been
induce kidney functional changes in rats,
believed to be mediated through different