Assessment of Nutrition of Obese Primary Schools Children in Urban and Rural Area in El Bihera Governorate The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 140-153




Nora Ahmed Obaid Al-kaabi
Dep. Of Biology, College of Science for Girls, Dammam University,
Dammam, Saudi Arabia


The present work was carried out using twenty mature Epinephelus tauvina (Perciforms:
Serranidae) collected from Arabian Gulf coast at Dammam City. Fishes of this species are
known to undergo sex change during certain stage of their life cycle. Histological and
enzyme histochemical studies were performed on gonads of the collected fishes. The
examination of the gonads of E. tauvina revealed the presence of three developmental
phases during the sex change process. These were: Female, early transition phase and
late transition phase each one may subdivide into two stages. In female phase several
developmental stages of the oocytes were recognized. At the beginning of early transition
phase perinucleolar mature oocytes began degeneration while late transition phase
characterized by rapid proliferation of spermatogenic cells. The histochemical studies
demonstrated that alkaline phosphatase enzyme gave intense reaction in granulosa cells of
mature oocytes while acid phosphatase gave an intense reaction in the interstitial cells and
atretic follicles but 5 ­3 hydroxysteroid dehydrogenase enzyme gave intense reaction
to special cells in capsule of gonads.


Tropical fishes show an exceptional range
needed for their synthesis. (Guiguen et al.,
of reproductive strategies with regards to
the expression of their sexuality (Devlin

and Nagahama, 2002). Along with this
diversity many different physiological
throughout the tropical and subtropical
regulations of gonadal sex differentiation or
waters of the world and are regarded as a
sex change have been demonstrated or
favourite marine food fish. However, being
suggested, including for instance the
protogynous hermaphrodites, groupers have
been considered as study model for
hermaphrodite's sex change (Grober and
development and reproduction, especially
Sunobe, 1996; Black et al., 2004), and of
for sex determination or sex differentiation,
external factors like temperature in species
owing to the advantage that grouper gonad
having Environmental Sex Determination
development undergoes transition from
(ESD) (Baroiller and D'Cotta, 2001).
ovary to intersexual gonad and then to testis
Despite this diversity of sex determination
( Shapiro, 1987; Zhou and Gui, 2008).
and sex differentiation processes, there is at

least one well conserved factor common to
In such marine hermaphrodite fishes,
nearly all teleost fish in the control of
sex changes are accomplished by complete
ovarian differentiation, which is the
alteration of gonadal anatomy and function
implication of estrogens and the enzyme
as well as changes in behaviour (Tang et al.

Full Paper (vol.39 paper# 1)

Assessment of Nutrition of Obese Primary Schools Children in Urban and Rural Area in El Bihera Governorate The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 154-163

Association of factor V Leiden mutation with deep vein thrombosis among
Egyptian cases

*Sherif H. Abdeen, **Rizk El-Baz, *Wessam El-Gazar, **Ahmad Settin
*Zoology Department, Faculty of Science, Mansoura University
**Genetics Unit, Faculty of Medicine, Mansoura University


Deep vein thrombosis (DVT) is a blood clot in a major vein, usually in the legs
and/or pelvis. If part of the thrombus breaks off, it becomes an embolism, which can travel
through the heart and block the arteries to the lungs. Factor V Leiden (FVL) is a common
genetic risk factor for hereditary hypercoagulability disorder in several populations. The present
study investigates the association of FVL mutation with DVT among Egyptian cases.
Patients & methods: The study included 44 cases (16 males and 28 females) with an age range
of 20 to 80 years in addition to 211 healthy unrelated controls of matched age and sex. A
multiplex allele-specific PCR amplification was conducted for assignment of FVL gene
mutation (G1691A).
Results: Cases having the mutant allele A (AA and AG genotypes) were significantly higher
than controls (38.6% vs. 18.5%; P < 0.05, OR= 2.78 and CI 95%, 1.380­5.589).
Conclusion: These results concluded that FVL mutation has a high frequency and positive
association with the occurrence of deep vein thrombosis among Egyptian cases.

Keywords: factor V Leiden mutation, deep vein thrombosis, Egyptian population


Deep vein thrombosis (DVT) refers
homologous A-type domains, two smaller
to a thrombus in the deep veins, most often
C-type domains and a large B-domain (A1-
in the lower extremities. The thrombus can
A2-B-A3-C1-C2) (Nesheim et al., 1979;
embolize and become lodged in the
Jenny et al., 1987). Proteolytic activation of
pulmonary arteries, resulting in pulmonary
FV results in the removal of the FV B-
embolism (PE). Deep venous thrombosis is
domain and the exposure of regions in the
a common disease with genetic and
FV molecule that is important for the
acquired risk factors. Acquired conditions
expression of its procoagulant activity
that promote DVT include prolonged
(Steen and Dahlbak, 2002; Toso and
immobilization, major injuries and surgery.
Camire, 2004). The released FVa is
Hereditary coagulation defects associated
composed of a 105 kDa heavy chain (A1­
with an increased risk of DVT are protein
A2 domains) and a 74 to 71 kDa light chain
C, protein S, anti-thrombin deficiency,
(A3­C1­C2 domains), held together by a
factor II (20210 G to A) mutation, activated
single calcium ion and hydrophobic
protein C resistance, and factor V Leiden
interactions (Nicolaes and Dahlback, 2002;
(FVL) mutation (Lane et al., 1996; Eekhoff
Mann and Kalafatis, 2003). Besides
et al., 2000; Michota, 2005).
circulating in free form in plasma, FV is
Coagulation factor V (FV) is an
also present in the granules of the platelets;
this form accounts for about 25% of the
activated form (FVa) is functioning as a
total FV content in human blood (Chesney
cofactor in the generation of thrombin
et al., 1981). During coagulation, platelet
(Stormorken, 2003). FV is a single-chain
FV is secreted as a result of platelet
mosaic domain structure composed of three
activation. Although several cellular types

Full Paper (vol.39 paper# 2)

d:\skydrive\Jor\vol39_3 The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 164 - 180


Departments of Community Medicine and Ear, Nose & Throat*
Faculty of Medicine - Al-Azhar University


: Laryngeal cancer is an important health problem causing negative effects on
patients' quality of life (QOL). Objectives: The aim of this research is to study QOL of the
patients with laryngeal cancer who underwent TL, laryngectomees, and to study impact of early
speech restoration on QOL of these patients. Subjects and methods: A case-control, hospital-
based study design was used. A total number of 90 laryngectomees and a control group of the
same number were enrolled in this research. Results: The laryngectomees had a significantly
poorer self-reported health-related QOL domain scores than the controls on all eight Short Form
(SF)-36 domains (P=0.000). Also,
the laryngectomees with primary/secondary
tracheoesophageal puncture (TEP) had significantly poorer self-reported health-related QOL
domain scores than the controls on all eight SF-36 domains (P=0.000). Further, patients with
primary TEP had significantly higher self-reported health-related QOL domain scores than the
patients with secondary TEP on the social functioning, emotional limitation and mental health
domain scores of SF-36 QOL with statistically significant differences (P=0.003, 0.006 and
0.019; respectively). Conclusions: Voice restoration is an important essentiality for the
laryngectomees. Primary TEP is preferred over secondary TEP. Recommendations: More
studies are needed on large number of patients to understand the impact of the laryngeal cancer
and consequent of its therapy on QOL of these patients on short and long term.


Laryngeal cancer is the one of the
Furthermore, the number of women who
most common malignant neoplasia of the
are diagnosed with laryngeal cancer
head and neck. It accounts for 1.0-2.0% of
continues to rise (American Cancer
all cancer and 11.0-22.0% of head and neck
Society, 2003).
cancer (Huang, 2003). In Egypt, laryngeal
There is a perception that total
cancer represents 5.7% of all body
laryngectomy (TL) has a devastating effect
malignancies and 38.7% of the head and
on patients and their family members
neck malignancies (Farghaly, 1991).
because the presence of definitive stoma
Moreover, it remains the second most
and the loss of the larynx (Karnell et al.,
common respiratory cancer after lung
2000). TL results in physical and functional
cancer worldwide (Cattaruzza, 1996 and
changes that can affect the emotional well-
Mohammad et al., 2003). Also, the
being and some of the most basic functions
prevalence of laryngeal cancer is increasing
of life, including breathing, swallowing,
over time in much countries of the world
and communication (Doyle and Keith,
(Cattaruzza, 1996). In the past several
2005). Proper education and counseling
decades, the incidence of laryngeal
from health care providers can help patients
carcinoma has been increasing steadily in
to adapt to the changes related to the
the United States (Shah et al., 1997). The
incidence of laryngeal carcinoma in China
counseling, the changes to communication
was 1.79/100,000, 2.0/100,000, 4.3/100,000
and other body functions are often
and 5.0/100,000 in 1972, 1986, 1990 and
overwhelming for subjects and their
1994, respectively (Li and Tu, 2002).
families (Salmon, 1999). After TL, the

Full Paper (vol.39 paper# 3)

Assessment of Nutrition of Obese Primary Schools Children in Urban and Rural Area in El Bihera Governorate The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 181- 188

Topical corticosteroid drops in the management of dry eye

Mohamed A. Bragheeth, Mohamed I El-Kasaby
Division of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.



To evaluate the efficacy and safety of topical corticosteroid drops for treatment of moderate to
severe dry eye cases.


Fifty eyes of 25 dry eye patients, who were unresponsive to artificial tears only, were treated
with 0.1% fluorometholone eye drops for one week. Subjective symptoms scoring, evaluation of
conjunctival hyperemia, tears break-up time (BUT), vital staining scores, and Schirmer test 1
were performed before starting steroid drops and at 1 week and 1 month after treatment.


All the patients had fewer symptoms as early as one week after topical steroid drops use.
Objective tests were improved in all dry eye patients 1 month after treatment, and the difference
was significant. Hyperemia of the conjunctiva was relieved obviously one month after treatment
(P<0.05). The mean value of BUT increased from (5.13±1.82 sec.) before treatment to
(6.57±1.85 sec.) at one month. The mean value of Schirmer test I was (4.63±0.94) mm/5 min.
increased to (7.12±1.83) mm/5 min one month after topical steroid drops use (P<0.05). No
complications were observed.


Short course of topical corticosteroid drops can rapidly and effectively relieve the symptoms
and signs of moderate or severe dry eye.

Key words:

Steroid drops and dry eye.


Dry eye syndrome (DES) is one of the most
commercially available artificial tear
health problems worldwide. The prevalence
components such as epidermal growth
of dry eye is estimated to be in the range of
5% to 35% and its incidence has recently
fibronectin, neurotrophic growth factor, and
been increasing. (1) DES is a multifactorial
vitamin A, all of which have been shown to
disease of the tears and ocular surface
play an important role in the maintenance
characterized by a deficiency in the
of ocular surface epithelial milieu. (3)
quantity or quality of tears, an unstable tear
Long-term application of artificial tears is
not effective for some patients, especially
bothersome symptoms such as ocular
those with severe symptoms. (4)
irritation, dryness, fatigue, and fluctuating

visual disturbances (2).
Other treatment modalities for DES

include: Punctal occlusion, (5) anti-
Conventional treatment of dry eyes consists
mainly of the use of preservative-free
corticosteroids or cyclosporine, (6) and
artificial eye drops. None of the
acupuncture. (7)

Full Paper (vol.39 paper# 4)

Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 189 - 196

Transdermal Nitroglycerin Enhances Lidocaine And
Neostigmine for Intravenous Anesthesia in Patients Undergoing Hand
Surgery. A Prospective Randomized Double Blind Placebo Control Study.

Osama Farouk**, Jamal Shahin **, Hassan Abudaleh*, Mohammed Abdelkawy*,
and Amr Mokhtar**
*From the Department of Anesthesia and the Department of Orthopedics
**King Abdulaziz Naval Base Hospital, Jubail, KSA.


In a prospective randomized blind study, we investigated the effects of adding transdermal
nitroglycerine for lidocaine and neostigmine for intravenous regional anesthesia in adult patients
undergoing hand surgery.

Patients and Methods
Sixty patients (ASA grade I, aged 20-60 years) of both sexes were enrolled. The patients were
randomly allocated to receive either 40ml of 0.5% lidocaine plus a transdermal placebo patch
(control group n=15), 40ml of 0.5% lidocaine with 0.5mg of neostigmine plus a transdermal
placebo patch (Neostigmine group, n=15), 40ml of 0.8% lidocaine plus a transdermal
nitroglycerine patch (Nitroglycerine group, n=15) or 40ml of 0.5% lidocaine with 0.5mg of
neostigmine plus a transdermal nitroglycerine patch (Neostigmine - Nitroglycerine group,
n=15). All routine hemodynamic parameters and O2 saturation were monitored, surgical time,
sensory and motor block onset times, sensory and motor block recovery times and time to first
analgesic requirement were measured. Operative conditions and quality of anesthesia were also

Sensory and motor block onset times were shorter in the neostigmine ­ nitroglycerine group
compared with all other groups (p<0.05). Sensory block recovery time was significantly
prolonged and the quality of anesthesia was better in the neostigmine ­ nitroglycerine group
compared with all other groups (p<0.05).

We found that the addition of 0.5mg neostigmine to 40ml of 0.5% lidocaine for intravenous
regional anesthesia with a 5mg transdermal nitroglycerine patch improved the operating
conditions and quality of anesthesia and prolonged postoperative relief with no adverse effects.

provide post ­ operative analgesia, and lack

of bloodless field (8). These limitations
Intravenous regional anesthesia (IVRA) is
might be avoided by the addition of various
a technically simple and reliable form of
adjuncts to the local anesthetics including
regional anesthesia for short procedures on
morphine, fentanyl, sufentanil, clonidine,
the extremities, with success rates of 94 ­
atracurium, neostigmine and nonsteroidal
98% (3). It is also associated with a more
anti ­ inflammatory drugs (6).
favorable patient recovery profile than
Previously, an interest had focused on the
general anesthesia (4). However, it has been
cholinergic system that modulates pain
limited by tourniquet pain, delayed onset of
perception and transmission. It was shown
action, poor muscle relaxation, inability
that the spinal or epidural administration of

Full Paper (vol.39 paper# 5)

Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 197 - 207

Chronic Hepatitis C Virus (HCV)-associated Cryoglobulinemia and its
possible impact on the skin in Egyptian Patients

Amin Mohamed Abd El Baki1, Mohamed A.Ezzel Arab2Nabil Abd El Mageed3
1Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute.
2 Internal Medicine Department, National Hepatology and Tropical Medicine Research Institute
3 Dermatology Department,National Hepatology and Tropical Medicine Research Institute.


Chronic hepatitis C virus (HCV) infection may have extremely variable clinical consequences
and is more than just a liver disease; it has been associated with numerous extra-hepatic
manifestations (EHM). According to various international studies Mixed Cryoglobulinemia
(MC) was found to be the most common EHM, however its local prevalence in Egyptian HCV
patients was not clearly studied. The aim of our study was to investigate the frequency of
cryoglobulinaemia in sera of chronic HCV patients and their association with clinical symptoms
especially, vasculitis.


One hundred patients with chronic HCV infection attending the outpatient clinic of the National
Hepatology and Tropical Medicine Research Institute were interviewed. Patients with
decompensated liver disease, on interferon therapy, having end-stage renal disease or coexisting
viral infection like hepatitis B surface antigen positive patients were all excluded from the
research. All patients were subjected to general and dermatological examination for liver
affection signs; cryoglobulinemia related clinical manifestations and/or associated dermatoses.
Cryoglobulins, CBC, LFT. AFP, ALP, KFT, ANA and RF were assessed.

Overall 15% of 100 patients were positive for presence of cryoglobulins in their sera. We found
a relatively high incidence of clinical symptoms commonly accompanying cryoglobulinemic
cases in the form of Purpura, Arthralgia, Generalized weakness, Peripheral Neuropathy and
Reynaud's phenomenon with prevalence of 26.67%, 46.67%, 53.33%, 40% and 6.67%
respectively. Our data also demonstrated that 46.67% (7) of our 15 cryopositive patients had
concomitant skin manifestations in the form of Pruritus 40% (6) and Vasculitis 26.67% (4)
(P=0.004) which was significant in comparison with prevalence of vasculitis in all patients 4.7%
(4 patients). Generalized weakness and fatigue, which is the most prevalent symptoms related
to Chronic Hepatitis C (CHC) patients whether positive or negative for cryoglobulinemia, were
present in 52% of all patients. Other associated dermatological diseases in all patients were
Lichen Planus, Psoraiasis, Urticaria, Necrolytic Acral Erythema (NAE) and Vitiligo with
prevalence of (1%), (1%), (5%), (1%) and (2%) respectively. The most common dermatological
disease was pruritus 36% (36) of all patients and 40% (6) in cryopositive patients. Regarding
liver condition there was no significant correlation between presence of cryoglobulins and
biochemical parameters. However, we found a significant correlation between presence of
cryoglobulinemia and presence of ANA in sera of HCV patients with incidence of 40%) in

Full Paper (vol.39 paper# 6)

Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 208 -217

Clinical value of screening serum squamous cell carcinoma antigen (SCCA)
for HCC

Mohamed A.Ezzel Arab1 , Mohammad A.Hassanein2, Nashwa A. Abd El
Moniem3,Mohamed Hassany 2,Salah Eldeen M. Ahmad2, Amin M. Abd El Baki2.
1Internal Medicine Department, 2Tropical Medicine Department ,3Clinical Pathology
Department -National Hepatology And Tropical Medicine Research


Background: Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the
world. In Egypt, HCC was reported to account for about 4.7% of chronic liver disease (CLD)
patients. Squamous cell carcinoma antigen (SCCA) has been reported to be strongly expressed
in HCC tissue hampering its extensive use in clinical practice.

Aim: Study the value of serum squamous cell carcinoma antigen (SCCA) for screening of

Materials & Method:
The study comprised of two groups. Group A included 60 patients with
HCC diagnostically confirmed by spiral CT, elevated alfa-fetoprotein (AFP), and/or liver biopsy
.Group B CLD patients diagnosed on clinical, laboratory, and ultrasonographical investigations;
group B suclassified into three categories according to CHILD-PUGH score included 30
patients, matched for sex and age. All groups were subjected to thorough history taking, full
clinical examination, and laboratory investigations including liver functions, viral markers, and
AFP and SCCA estimation using ELISA technique.

Results: This study revealed a highly significant difference between patients with HCC and
CLD regarding serum SCCA levels being higher in group A(10.35±20.677) than group
B(1.64±2.462)(p=0.02). SCCA level was elevated in patients with HCC with normal AFP levels
representing its useful role in early detection and follow-up of patients treated for HCC. The
cut-off value was established at 2 ng/ml with sensitivity of 80% and specificity of 70%).

SCCA could represent a useful tool as a marker for detection of HCC.

Key words:
Hepatocellular carcinoma, squamous cell carcinoma antigen, tumor markers

cases per year are diagnosed and mean 5-

year survival is lower than 5 %( Pontisso et
Hepatocellular carcinoma (HCC) is the fifth
al, 2004).HCC as it is a highly malignant
most common cancer in the world. Because
tumor with a very poor prognosis so early
of its increased incidence in the last decade
detection and treatment are required
and the estimated further increase in the
(Nomura et al, 1993).
next 2 decades, HCC is arousing great
In Europe and North America, it
interest (Giannelli et al, 2005).
commonly develops on cirrhotic livers, and

surveillance programs have therefore been
Hepatocellular carcinoma (HCC) is one of
suggested to identify early HCC, at a stage
the most important sanitary problems over
when it remains suitable for surgical
the world for its high prevalence and for its
therapy and has a better clinical outcome
poor prognosis. More than 250.000 new
(Giannelli et al, 2005).

Full Paper (vol.39 paper# 7)

Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 218 - 222

Young adult with liver cirrhosis, portal vein thrombosis, a reported case of
-1anti-trypsin deficiency.

Sameh Seif 1 , Mohamed A. Ezzel Arab 2, Mohammad A.Hassanein1 Mohamed El
Kassas 1, Selim Wadie 3, Khalid Zalata 4,Helmy El Gazzar 5, Mohamed Hassany 1,
Amin Abdel Baki 1

1- Tropical Medicine Department National Hepatology and Tropical Medicine Research
Institute (NHTMRI), Cairo, Egypt.
2-Internal Medicine Department, National Hepatology and Tropical Medicine
Research Institute, Cairo, Egypt.
3- Radiology Department, National Hepatology And Tropical Medicine Research
Institute, Cairo, Egypt.
4- Pathology Department, Faculty of Medicine, Mansoura University, Egypt.
5- Clinical Pathology Department, Hearing and Speech Institute, Egypt


Alpha-1 antitrypsin is a protein with
a 1 AT gene cause derangements in the
inhibitory capability over the proteolytic
intracellular processing of a I AT,
enzyme elastase. Since its first description
in 1963, over 100 different a 1 AT alleles
(Errickson S.,1986). The most severe form
have been described (Folch E., et al,
of deficiency is the homozygous expression
2007).The major clinical manifestations of
of the Z allele or PI*ZZ, when this
a 1 AT deficiency relate to the function of a
expression occurs, it accounts for 95% of
1 AT and where it is made. A 1 AT serves
cases of severe a 1 AT deficiency. The
as an inhibitor of neutrophil elastase (NE),
three organs most commonly affected by a
a powerful, destructive proteolytic enzyme
1 AT are the lungs, liver and skin.a 1 AT
stored in neutrophils (Carrell R. W, et al.,
1982) (Janoff A, .1985). The liver is the
recognized genetic risk factor for chronic
major site of a 1 AT gene expression,
obstructive pulmonary disease (COPD).
releasing 2 g of a 1 AT into the circulation
Even though it remains under diagnosed, its
daily. A 1 AT diffuses into most organs,
importance continues to grow in the field of
where it protects extracellular structures
solid organ transplantation, accounting for
from attack by NE released by activated or
8-9% of all lung transplants. A 1 AT is the
disintegrating neutrophils. The lower
most common metabolic liver disease
respiratory tract is particularly vulnerable to
requiring liver transplantation in children.
deficiency of a 1 AT, which normally

represents > 90% of the anti-NE protective
The presence of cirrhosis in alpha-1-
screen of the alveolar walls (Gadek J. E., et
antitrypsin deficiency is low, approximately
al., 1981)(Wewers, M. D., et al., 1987)
2.2/100,000 for ZZ homozygotes. The
.When serum a IAT levels are < 11 um,
male-to-female ratio was 2 to 1. In one-
there is insufficient a IAT to protect the
third of the patients alcohol could have
lower respiratory tract from its burden of
been a co-adjuvant or aggravating factor in
NE, permitting progressive destruction of
the liver disease (Folch E.,et al ,2007).
We describe a unique case of a 27 year-old
emphysema (Wewers, M. D., et al., 1987).
man with a 1 AT, presented with liver
The pathogenesis of the liver disease is less
cirrhosis portal vein thrombosis & multiple
well understood, but relates to the fact that
bony deformities.
hepatocytes are the major site of a l AT
Case presentation:
synthesis, and that certain mutations of the


Full Paper (vol.39 paper# 8)

Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 223 - 228

METABOLISM IN Tilapia zillii

Abdel-Salam Mohamed Ibraik Ohaida*, Nuha Mahmoud A. Akrawee** Zoology
Department. Faculty of Science. University of 7 October Misurata* ,
High Institute of Medical Technology, Misurata**


The Effect of organophosphorous insecticides compounds (Malathion and Fenitrothion) on
certain aspects of carbohydrate metabolism in the freshwater fish Tilapia zillii exposed to 1/3
LC50 of both insecticides for 96 hours was studied. Organophosphorous compounds were found
to affect some parameters of carbohydrate metabolism. Muscle and liver glycogen decreased
significantly accompanied with significant increase of the plasma glucose and the specific
activity of phosphorylase enzyme in both liver and muscles. The activity of Succinate
dehydrogenase (SDH), lactate dehydrogenase (LDH) and malate dehydrogenase (MDH) showed
a significant decrease in liver and muscle tissues. Alanine transferase (ALT) and Aspartate
transferase (AST) in liver and muscles also showed a significant decrease. Significant
alterations in the content of metabolites and enzyme activity under malathion and fenitrothion
toxicity seemed to suggest marked shift from aerobic to anaerobic condition.


The use of organophosphorous pesticided is
Materials and Methods
increasing progressively to control a wide

variety of agricultural pests due to inability
Animal sampling and treatment
of insects to develop resistance against
manipulation :

pesticides used in or near aquatic

Tilapia zillii obtained from
ecosystems against the target organisms,
Tawarga pond and transported immediately
enter the water bodies causing toxic effects
to the fish laboratory conditions and kept
on freshwater fish. Stressful situations in
for at least two weeks in 60 liters glass
fish elicit neuroendocrine responses since
aquaria . They were fed on fish food (1%
both olamines (Nakano and Tomlinson,
crude fibre, 7% ash, 54% nitrogen free
1967) and adrenocorticoids (wedemeyer,
extract and recommended catecholamins
1969 and Danasoury et al., 1992) are
and minerals) at 10 a.m. The water in the
secreted in increased amounts due to stress
rearing aquaria was renewed daily.
which cause a depletion of energy stores

Results of preliminary toxicity tests
and induce disturbance in carbohydrate
in the laboratory under static conditions,
metabolism (Mazeaud et al., 1977).
showed that 9 mg/ and 3.5 mg/ are the

The toxicity of organophosphorous
LC50 for fenitrothion and malathion
compounds on fish in the present study
respectively. Bome of the physico-chemical
undertaken as one of a series, dealing with
characteristics of the experimental water
were as follows: temperature 24±1 C, pH
compounds on fish physiology and
7.5, unity 0.19%, and dissolved oxygen 8.0
biochemistry. Hence, this study was carried
ppm. A 12 hrs photoperiod was maintained.
out to determine the effects of exposure to
For studying the effect of malathion
sublethal concentrations of malathion and
and fenitrothion groups of 10 fish were
fenitrothion in Tilapia zillii.

representing 1/3 of the LC50 for both

Full Paper (vol.39 paper# 9)

Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 229-248

Histological and ultrastructural studies on the effect of Cleome droserifolia
plant from Sinai on the liver and kidney tissues of rats

Nahed Mohamed Mansour Emam
Biological and geological Department, Faculty of Education,
Suez Canal University. Ismailia Egypt.


Sinai regions are characterized by the presence of large number of medicinal plants that
are highly used in folk treatments but only a small number of these plants have received
scientific and medical evaluation to assess their efficacy. Among these plants, Cleome
plant, which is commonly used in the Egyptian folk medicine for treatment of many
diseases. The present study was planned to examine the safety of using an extract of Cleome
plant. This study focuses on the histopathological and ultrastructural changes
induced by the plant extract in liver and kidney of the experimental rats. Cleome droserifolia
treatment produced cellular swelling, cytoplasmic granulation with necrotic cells in addition to
appearance of patches of depleted glycogen within the hepatic cytoplasm. The glomeruli were
hypertrophied with thickening of Bowman's capsule and the renal tubules exhibited damaged
epithelial lining cells in addition to the appearance of numerous lysosomes. Such changes in the
present study may be due to the toxic effect or accumulation of one or more of the active
pharmacological compounds of the plant in the liver or kidney tissues of the treated rats. It is
recommended that future studies and chemical analytical techniques are required to separate and
purify the main components from the plant responsible for safety and quality assurances for
good practices of the plant.

Cleome, droserifolia, liver, kidney, histological, ultrastructural


The use of the medicinal plants for
thousand types of plants among which
health started thousands years ago and is
many types are used by patients in treating
still part of the medical practice in China,
different diseases. These plants belong to
Egypt, India and other developing
countries. Modern pharmaceutical still
(Amaranthaceae, Cleomacea, Compositae,
contains at least 25% of drugs derived from
Capparaceae,.ect) according to Tackholm
plants (Thomas, 2000). Moreover, care
(1974); Rizk (1986); Boulos (1995, 1999)
must be taken when using medicinal herbs
and Reda et al. (2000). So that Cleomace
and plants, since many of them are potent
droserifolia (Samwa) from Sinai was
may contain powerful combinations of
chosen for this study,
chemicals and their chemistry is complex

and some other plants are toxic. The
It belongs to family Cleomacea or
toxicity is not only referred to the lethal
Capparaceae, which may be considered as
effects, but also to minor body reactions
very important herb and highly used in folk
such as allergy, irritation and sensitivity
treatments in Sinai. Very few reports have
(Weiss and Fintelmann, 2000).
been reported on the histopathological or
ultrastructural or cytogenic effects of this
characterized by the presence of a large
number of medicinal plants and herbs of
The present study aims to elucidate
medicinal values and highly used in folk
the effects of this plant on the
treatments. In Sinai, there are about

Full Paper (vol.39 paper# 10)

Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 249 - 259

Laryngeal Nerves Monitoring Versus Non-monitoring in Thyroid Surgery

Mohammed Fatehy Zidan, Ahmed Abdou Moustafa
Departments of ENT and Surgery Faculty of Medicine for Girls, Al-Azhar University


Background and objectives: Thyroid surgery is the most common cause of recurrent nerve
(RLN) injury. Deliberate identification of the RLN minimizes the risk of injury. When the nerve
is identified and dissected, the reported RLN injury rate during thyroidectomy is 0-2.1%.
Continuous intra-operative nerve monitoring during surgery remains a controversial issue. The
basic technique involves a skin surface electrode or muscle electrode used to make
electromyography (EMG) recordings, which have an audible alarm to alert the surgeon if
passive (e.g.stretch during traction) or active nerve stimulation has occurred. We aim to evaluate
the use of intra-operative nerve monitoring (IONM) to preserve the laryngeal nerves that may be
at risk for injury during thyroid surgery and show the merits of using electrophysiologic
laryngeal nerve monitoring during thyroid surgery.

Patients and methods:
This study was conducted as a prospective study on 28 patients whom
are thyroidectomy candidates; we elected 14 thyroidectomy candidates in whom we don't use
NIM during surgery (Control group_A). These patients were chosen to be evenly matched with
another 14 thyroidectomy candidates to monitor the recurrent laryngeal (RLN) and external
branch of superior laryngeal (EBSLN) throughout thyroidectomy procedures (NIM group_ B)
to compare the laryngeal nerves risk of injury with and without the use of nerve monitor.

Four patients (2 patients in-group A and 2 patients in-group B) were dysphonic after
operation. Laryngoscopy revealed unilateral recurrent laryngeal nerve palsy in all except one
bilateral in group A. There were no significant differences in RLN paralysis, paresis, or total
injury rates between both groups. The number of patients in the presented study was limited to
draw a statistical conclusion for significance.

The routine application of IONM cannot prevent or reduce recurrent laryngeal
nerve injury. However the study signifies the trend towards the use of INOM in expectedly
difficult cases and in revision surgery with distorted anatomical relationships and fibrous


artery) or may pass between the arterial
Thyroid surgery is the most common cause
of recurrent nerve (RLN) injury, and gives
Deliberate identification of the RLN
a rate approaching 5% in a large series with
minimizes the risk of injury. When the
close follow-up (Lo C et al; 2000). These
nerve is identified and dissected, the
complications are probably more common
in revision neck surgery.
thyroidectomy is 0-2.1%. This rate is
The course of the RLN frequently varies
reportedly higher if surgery is repeated (2-
despite normal anatomy or as consequence
12%) or if the nerve is not clearly identified
of congenital vascular anomalies or
(4-6.6%). Intraoperative hemostasis and a
distortion of regional anatomy by extension
thorough understanding of the anatomy are
of goiter by neoplasm or inflammation
essential for identifying and preserving the
(Henry et al., 1988).When approaching the
nerve. Even the most experienced surgeon
inferior pole of the gland, the RLN may be
may have difficulty identifying and
traversed by the ITA (inferior thyroid
preserving cranial nerves. Intra-operative
nerve monitoring is an important adjunct to

Full Paper (vol.39 paper# 11)

Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 260 - 267

Anticarbohydrate antibodies in patients with inflammatory bowel

Mohammed Fakhraldeen, Lecturer of internal medicine,
Faculty of medicine, Mansoura University
Huseen Saad Mostafa, Consultant clinical pathology,
King Fahd hospital, Riyadh, Saudi Arabia



Evaluating the prevalence of antichitobioside carbohydrate antibody (ACCA),
antilaminaribioside carbohydrate antibodies (ALCA), antimannobioside carbohydrate antibodies
(AMCA) and anti-Saccharomyces cerevisiae antibodies (ASCA), in patients with inflammatory
bowel disease (IBD).

Subjects and methods:

268 serum samples were used; 115 Crohn's disease (CD), 83 ulcerative colitis, and 70 healthy
control samples. All samples were evaluated using enzyme-linked immunosorbent assay for the
following four anticarbohydrate antibodies: ACCA, ALCA, AMCA, and ASCA.


In patients with Crohn's disease the prevalence of the anticarbohydrate antibodies was: ASCA
69%, AMCA 32%, ACCA 28% and ALCA 24% with the highest prevalence being for ASCA
(P-value<0.0001) while in patients with ulcerative colitis the prevalence was: ACCA 46%,
AMCA 35%, ALCA 23% and ASCA 15% with the highest prevalence being for ACCA (P-


Anticarbohydrate antibodies are significantly present in patients with IBD. The use of a panel of
anticarbohydrate antibodies may provide additional help in distinguishing IBD from non-IBD
disease patterns and narrow the range of differential diagnosis in these patients.


sufficiently specific [Marteu P, 2002].
In the past decade, significant advances
Currently, a serology panel that includes
have been made in the discovery of
evaluation of these processes is the subject
(ASCA) is used as an auxiliary diagnostic
of many publications, which report
tool of IBD [Vermeire et al, 2004]. A
correlation between different serological
number of studies have reported that ASCA
markers and IBD; however, relying
titers are significantly greater and highly
exclusively on serum antibodies for IBD
specific for Crohn's disease (CD) [Quinton
diagnosis is not justified yet, because the
et al, 1998 and Nielsen et al, 2000].
available humoral immunological markers
Recently, immune responsiveness to some
are neither adequately sensitive nor
microbe-derived antigens such as outer

Full Paper (vol.39 paper# 12)

Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 268 - 274

Adiponectin multimers in patients with Barrett's Oesophagus

Mohammed Fakhraldeen*, Huseen Saad Mostafa**, Ghada Ali Abdulwahab***
*Faculty of medicine, Mansoura University
**King Fahd hospital, Riadh ,Saudi Arabia
***King Fahd hospital, Riadh, Saudi Arabia



Barrett's oesophagus is associated with abdominal obesity. Adiponectin is a peptide that is
secreted from adipocytes and circulates in three multimeric forms: low molecular weight
(LMW), middle molecular weight (MMW), and high molecular weight (HMW). The anti-
inflammatory effects of adiponectin are specific to individual multimers, with the LMW being
most anti-inflammatory. We investigated the possibility that circulating levels of adiponectin
and its multimers would be associated with the risk of Barrett's oesophagus.

Subjects and methods

This study comprised patients diagnosed to have Barrett's oesophagus, and control subjects
diagnosed to have gastrooesophageal reflux disease (GORD), all were diagnosed in the
gastroenterology and endoscopy unit, King Fahd hospital, Riyadh, Saudi Arabia.
Plasma adiponectin levels and its multimers were evaluated for patients with Barrett's
oesophagus and controls with GORD.


There were 120 cases of Barrett's oesophagus and 250 GORD controls. Total adiponectin was
not significantly associated with Barrett's oesophagus; low levels of LMW adiponectin and low
LMW/total ratio were significantly present in patients with Barrett's oesophagus.


Low levels of LMW adiponectin are significantly associated with Barrett's oesophagus.

Key words: Barrett's oesophagus, GORD, abdominal obesity, Adiponectin.


obesity-promoting GORD (Lieberman et al
Oesophageal adenocarcinoma and its
1997). Possible mechanisms include
precursor, Barrett's oesophagus, are
alterations in the anatomy of the gastro-
obesity, particularly
abdominal obesity (Corley et al 2007).
abdominal pressure, or confounding by diet
Gastroesophageal reflux disease (GORD) is
(El-Serag et al 2006). however, since
well described as a risk factor for both
obesity is a risk factor for other cancers for
Barrett's oesophagus and oesophageal
which there are no known structural
adenocarcinoma (Lagergren et al 1999).
mechanisms (Calle et al 2003), at least
The effect of obesity on the development of
some of the effect of obesity on the risk for
Barrett's oesophagus and oesophageal
Barrett's oesophagus may be metabolic and
adenocarcinoma may be due to an effect of

Full Paper (vol.39 paper# 13)

Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 275 - 280

Allergic bronchopulmonary aspergillosis among patients with bronchial

Al-Najada M, Al-Nadi K, Sharara AM
Department of chest disease, King Hussein Medical Centre, amman -jordan


To determine the different presentations encountered upon diagnosis of ABPA among patients
with bronchial asthma and the two-year-follow-up results.

Patients and method
All patients with bronchial asthma and ABPA were included in the study .Specially formulated
sheet was done include age, gender, duration of bronchial asthma ,new clinical,radiological,and
laboratory findings suggestive of ABPA and two year follow up of them. Diagnosis of ABPA was
based on Rosenberg-Patterson criteria.

Fifteen patients with ABPA 3.9% out of 385 patients with bronchial asthma were included in our
study, (5males)and (10 females) there mean age was 28.8 years , and mean duration of asthma
was 8.9 years, and they represent all stages of asthma severity. Fleeting shadows mainly in the
upper lobes were the most common radiological findings observed in nine patients (60%), five
patients (33.3%) had proximal bronchiectasis detected by high resolution chest ct-scan, one of
our patients had collapsed consolidation. All patients had moderate to severe eosinophilia and
positive immediate skin test for aspergillus.

As the prevalence of ABPA is not uncommon among patients with bronchial asthma regardless
the severity and the level control of asthma, high index of suspicious for ABPA should be
maintained when followed up any patient with bronchial asthma.


The prevalence of ABPA in patients with
Allergic bronchopulmonary aspergillosis
bronchial asthma ranged from 3.7 to 11% in
(ABPA) is an immunologically mediated

al ,
Agbayani BF et al,1967).And in India the
a complex hypersensisitivity reaction in
prevalence reached 16% (Kumar and Gaur ,2000).
patients with asthma which occurs when

Material and Methods:
Aspergillus.Repeated episodes of bronchial
obstruction inflammation and mucoid
Specially formulated data sheet was done to
impaction can lead to bronchiectasis,
all patients with ABPA and bronchial
fibrosis, and chronic lung disease.
asthma, who are on regular follow up in the
The clinical manifestation of pulmonary
chest department at King Hussein Medical
aspergillosis is variable and range from
Centre (KHMC).
saprophytic aspergillosis in the form of
The sheet included age ,gender, duration of
bronchial asthma, clinical presentation,
pulmonary aspergillosis, and invasive
radiological and laboratory findings and
aspergillosis( Soubani AO, Chandrasekar
skin testing .The diagnosis of ABPA was
P ,2000).

Full Paper (vol.39 paper# 14)

Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 281 - 287

Statin Therapy and Serum Testosterone in Men with Type 2 Diabetes

Mohammed Fakhraldeen*, Huseen Saad Mostafa**
*Faculty of medicine, Mansoura University
**King Fahd hospital, Riyadh, Saudi Arabia



There is a high prevalence of hypogonadism in men with type 2 diabetes. Statins could
potentially decrease testosterone levels by reducing the availability of cholesterol for androgen
synthesis. In this study we compared testosterone levels and hypogonadal symptoms with statin
use in men with type 2 diabetes.


Total testosterone, sex hormone­binding globulin (SHBG), and estradiol were measured by an
enzyme-linked immunosorbent assay. Bioavailable testosterone was measured by the modified
ammonium sulfate precipitation method. Free testosterone was calculated using Vermeulen's
formula. Symptoms of hypogonadism were assessed using the Androgen Deficiency in the
Aging Male questionnaire.


Statins were associated with lower total testosterone and a trend toward lower SHBG compared
with untreated patients. Bioavailable testosterone, free testosterone, estradiol, and hypogonadal
symptoms were not affected. Atorvastatin was associated with reduced total testosterone and a
trend toward reduced SHBG compared with no treatment, and there was a dose-response effect
with the lowest levels of total testosterone seen in men treated with 20 mg atorvastatin
.Simvastatin use was not associated with significant reductions in testosterone or SHBG levels.


Assessing androgen status using total testosterone in men with type 2 diabetes treated with
statins, particularly atorvastatin, may potentially lead to diagnostic error. Levels of bioavailable
testosterone or free testosterone are recommended for the assessment of hypogonadism in this
group if total testosterone levels are borderline.

Key words: Type 2 DM, testosterone, hypogonadism, statin therapy.


testosterone deficiency (Kapoor et al,
There is evidence that men with the
2007). Studies have shown that about 20%
metabolic syndrome, type 2 diabetes, and
of men with metabolic syndrome, diabetes,
cardiovascular disease have a high
prevalence of low circulating levels of
testosterone levels below the normal range,
testosterone (Jones TH, 2007). A significant
and there are a further 20­25% with levels
proportion of these men are hypogonadal,
in the low normal range that may also be
defined as a combination of clinical
symptoms and biochemical evidence of

Full Paper (vol.39 paper# 15)

Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption The Egyptian Journal of Hospital Medicine (June 2010) Vol., 39: 288-294

Egyptian Mother-to-fetus transmission of Parvovirus B-19 in the first
trimester abortions

Abo-Elkhier AAK1 and Abdel-Wahab KSE2
1. Clinical Pathology Department, El-Sahel Teaching Hospital, Ministry of Health.
2. Virology Laboratory, Microbiology Department, Faculty of Medicine,
Al-Azhar University, Branch for Females


Parvovirus B-19 infection is a common mild illness in adulthood and usually subclinical
in childhood. Serious illness can be caused by this virus in certain circumstances. When a
pregnant female contracts parvovirus B-19 complications may affect the fetus and/or the newly
born. A study of 240 parturient mothers was carried out to assess the possible role of this virus
in abortion. Detection of virus-DNA in fetal tissues by PCR confirmed mother-fetus


Parvovirus B-19 (Pattison and Patou,
response in acute infection. IgG anti
1996) is a single strand DNA virus of small
Parvovirus B19 is a marker of past
size that infects humans usually by
inhalation, but can be transmitted by blood,
immunosorbent assay (ELISA) test is used
blood products, plasma and bone marrow
to assay these antibodies in patient's sera
transfusion (Siegl and Cassinolty, 1988).
but not in fetal blood due to the immature
In immunocompetent persons subclinical
immune system response. Detection of
infection is predominant. The clinical
Parvovirus B19 ­ DNA by polymerase
chain reaction (PCR) is used to evaluate
infectiosum and of adults are polyarthritis,
qualitatively or quantitatively viral DNA.
transient aplastic crisis, and pure red cell
Viremia titer is up to 1011 to 1013 genome
aplasia. Infected adult pregnant females in
equivalents/ml). There are variations in
Parvovirus B19 PCR results, because of the
parvovirus B19 to their fetus where
choices of primer sites, the PCR procedure
infection of the fetal heart leads to non-
(Anderson et al., 1985) and the existence
immune hydrops fetalis, and erythrocyte
of virus variants (Heegaard et al., 2001;
progenitor cell suppression. Parvovirus B19
Servant et al., 2002; Saldanha et al.,
infects placental endothelia with high titer
2002; Hokynar et al., 2004). In our study
output that enables the virus to cross the
we selected Parvovirus B19 VP1 gene
placenta barrier to the fetus where it grows
primers for PCR according to Koch and
in liver, bone marrow, heart and skin.
Adler (1990).
Multi-organ infection may progress to

abortion, still birth or postnatal death
Aim of Study
(Enders et al. 2004 and Yong et al. 2004).

Parvovirus B-19 may cause chronic
To assess mother to fetus transmission of
infection (Frickhofen and Young 1989
parvovirus B-19 when pregnant mothers are
and Koch & Adler 1990).
hospitalized for spontaneous abortion in the

first trimester.
Parvovirus B19 serological and molecular

tests are used to diagnose infection. IgM

anti-parvo B19 is a marker of early immune


Full Paper (vol.39 paper# 16)