Prophylactic role of combined treatment with wheat germ oil and ginseng against radiation injury in male rats The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 403 ­ 415

Prophylactic role of combined treatment with wheat germ oil and ginseng
against radiation injury in male rats

S.M. Abdel Fattah*, Th. M. Fahim* and N.M. El-Fatih**
*Drug Radiation Research Dept., **Radiation Biology Dept. National Centre for
Radiation Research and Technology (NCRRT).


Background: This study was designed to investigate the possible ameliorating effect of
combined treatment of rats with wheat germ oil [a rich source of vitamin E, octacosanol,
policosanol and the essential fatty acids (linoleic and linolenic)] and the antioxidant properties of
panax quinquefolium ginseng on radiation-induced oxidative body damage.

Materials and Methods:
Animals received wheat germ oil by gavage at a dose of 80 mg/kg
body wt and panax ginseng was intraperitioneally injected with 100 mg/kg body wt for 10
successive days pre as well as during irradiation and supplementation was extended during the
period of radiation exposure of rats to fractionated doses 8 Gy (4 x2Gy).

Results: Experimental investigations were performed at 7th and 10th days after the last dose of
irradiation revealed that whole body -irradiation of rats produced a significant rise in the
activities of serum markers for liver damage as aspartate aminotransferase (ASAT),
alaninetransaminase (ALAT), ammonia and buytryl cholinestase associated with decrease in the
serum content of total protein, albumin (A), golublin (G) and A/G ratio indicating acute hepato-
toxicity, at the 7th and 10th days post-irradiation. Also, radiation-induced biochemical disorders
manifested by significant elvation in serum creatinine and urea levels. Serum lipid profile as total
cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C) and low
density lipoprotein-cholestrol (LDL-C) levels were significantly higher than normal control rats
associated with significant decrease in HDL/LDL ratio. Radiation induced an elevation of lipid
peroxidation measured as thiobarbituric acid reactive substance (TARS) in plasma and liver. The
rats that received combined treatment with wheat germ oil and panax ginseng supplement
showed significantly less severe damage and remarkable improvement in all of the measured
parameters when compared to irradiated rats. According to the results obtained it could be
concluded that combined treatment with whole germ oil and panax ginseng might be a useful
candidate against radiation-induced oxidative stress and metabolic disorders without any toxicity.

Key words: -irradiation, wheat germ oil, panax ginseng, liver injury

well as, disorders in blood biochemical

parameters (El-Masry and Saad, 2005) and
Ionizing radiation produces harmful effects
causing chain reaction of oxidation
on the organisms and due to wide spread use
(Ammar, 2009).
of radiation in diagnosis therapy, industry;
Wheat germ oil is extracted from the germ
so many pharmacological interventions
of the wheat kernel. Wheat germ oil is a
could be most potent strategy to protect or
valuable source of essential fatty acids,
amelioration the deleterious effect of
including linolenic, palmitic and oleic,
ionizing radiation (Jagetia, 2007). Ionizing
protein, minerals, it is naturally rich in
radiations induce significant elevation in the
vitamins A, D and E, and also, contains
physiological and metabolic processes, as
vitamins B1, B2, B3,B6, policosanal and

Full Paper (vol.45 paper# 1)

The Role Of Prophylactic Antibiotics In The Management Of Post Surgical wound Infection The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 416 ­ 423

The Role of Prophylactic Antibiotics in the Management of Post Surgical
wound Infection

Hanaa Abu Ria, Bosat Olwani, and Altahr Abed Alhamid
Assistant professor of Obstetrics and Gynecology, Lecturer of Surgury, Assistant
Professor of Urology
Faculty of Medicine, Al-Azhar University, Cairo, Egypt


Introduction: Prophylactic antibiotics have been shown to be effective in reducing the
incidence of febrile morbidity associated with surgical operations. Surgical site infections
(SSI's) account for approximately 15% of nosocomial infections and are associated with
prolonged hospital stays and increased costs.

Objective: To improve the outcome and to reduce the time stay at the hospital.
To determine the independent risk factors for post surgical infection.
To decrease the incidence of post surgical wound infection.

Study Design: An intervention randomized study.

Aim of the work: To evaluate the efficacy of prophylactic antibiotics in reducing the
incidence of post surgical wound infection.

Place and Duration: Department of Obstetrics and Gynecology,
Department of Surgery and Department of urology, Faculty of Medicine
Al-Azhar University from January to June 2011.

Patient and Method: Three hundred patients undergoing surgical operations were enrolled in
this study and classified into two groups:
Group1:150 patients received parental prophylactic antibiotics, 1st dose at the time of
induction of anesthesia, 2nd dose after 12hs from the surgery.
Group2: 150 patients received oral antibiotics for five days postoperative.

Results: In this study ,Total 300 patients were enrolled,6 patients from group 1 developed
wound infection(4%),39 patients from group 2 developed wound infection(26%) ,with
prolonged stay at the hospital,2.3 days in group1, and 4.9 days in group 2.

The use of prophylactic antibiotics therapy is satisfactory in our surgical
environment, this practice would be efficient, cost effective and prevent
the emergence of nosocomial infection in developing countries.

Key words: Surgical Sit Infections (SSI's) ­ Prophylactic antibiotic.


Despite the knowledge about preventing
successful surgery (Boribonhiunsarn et al.,
2007& Ledger, 2006).
contemporary surgery, in many hospitals,
Sources of infection may be endogenous,
infection of surgical wound is the most
exogenous, or hematogenous.
common nosocomial infection (25%) and
Most infection occurs due to organisms
the one of the major limiting factor of
implanted during the procedure. In
obstetrics and gynecological patients the

Full Paper (vol.45 paper# 2)

ž’'DGJ&G The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 424 ­ 433

Neutropenia in chronic hepatitis C during Interferon and Ribavirin Therapy.

Saadia Farid, Hala Morad and Samya Sweilam.
Department Of Tropical Medicine , Hematology and Biochemistry.
National Hepatology and Tropical Medicine Research Institute.


Neutropenia is a condition characterized by an abnormally low number of a type of white blood
cells called Neutrophils, up to 25 % of people who take pegylated interferon, ribavirin and an HCV protease
inhibitor experience Neutropenia.

Aim of the work:
The study will be intended to analyze neutrophil counts and associated conditions of the
liver and spleen , platelet count, liver enzymes and infections, during Interferon and Ribavirin therapy.

Patients and methods:
One hundred forty two patients with chronic hepatitis C virus infection, their age
between (18-59) years, selected from the National Hepatology and Tropical Medicine Research Institute
were included in this study, during Interferon and Ribavirin therapy.
All the patients were subjected to the following history, through clinical examination, abdominal
ultrasonography and collection of blood samples for routine investigations, CBCs and serological assay for
ALT, Bilirubin.

Resuls: Our results revealed presence of 32.4 % anaemia, 18.3 % Thrombocytopenia, 16.9 % elevated ALT, 2.8
% elevated bilirubine, 16.9 % coarse liver, 25.4 % hepatomegaly, 16.2 % splenomegaly, and 16.9 % of cases
complained different shapes of infection, associated with Neutropenia in patients of chronic hepatitis C during
interferon and ribavirin therapy.

Conclusion: Our study concluded that the prevalence of Neutropenia in chronic hepatitis C virus infection
patients 23.8 % during interferon and ribavirin therapy but it is not usually associated with infection.

Neutropenia is a complicated process that requires expert guidance from a medical

Key Words: Neutropenia, chronic hepatitis C, side effect of interferon and ribavirin therapy.


Many patients with chronic hepatitis C (HCV)
stable equilibrium exists between marrow
infection undergoing treatment with pegylated
neutrophil production and peripheral utilization.
interferon-alpha (PEG-IFN-alpha) and ribavirin
When the production of neutrophils by the bone
develop neutropenia requiring dose reduction or
marrow is outspaced by utilization in periphery,
granulocyte colony-stimulating factor (G-CSF)
the number of circulating neutrophils in the
supp (Koirala, et al 2007). Hematologic side
peripheral blood decreases and Neutropenia
effects are common during treatment with pegylated
results ( Bolyard, et al.,2010 ).
interferon and ribavirin (Nachnani et al, 2009).
A common side effect of interferon alpha therapy is
To meet normal physiologic needs, a healthy adult
bone marrow suppression and particulary a
produces roughly 60 billion neutrophils each day.
reduction in white blood cell counts. Absolute
While neutrophils are produced by the bone marrow
neutrophil and lymphocyte counts typically
at a prodigious rate, their blood halph-life is short, 8
decrease by 30 % to 50 % of baseline during
hours in a normal individual-Hence, lifespan vastly
therapy with the doses of interferon required to treat
outnumber neutrophils by a ratio of about one
hepatitis C (Wongs, et al., 1996).
thousand to one in the peripheral blood ( Bolyard, et
Neutrophil counts can fall to levels that are
al., 2010 ).Under normal physiologic conditions, as


Full Paper (vol.45 paper# 3)

A Combination anti-HBV regimen using lamivudine and other agents in treatment of resistant chronic hepatitis B The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 434 ­ 442

A Combination anti-HBV regimen using lamivudine and other agents in
treatment of resistant chronic hepatitis B

Saadia Farid and Samya sweilam
Department of Tropical Medicine and Biochemistry.
National Hepatology and Tropical Medicine Research Institute.


Several difficulties remain in formulating treatment for chronic hepatitis
B (CHB), 350 million people are chronically infected with HBV, Chronic
infection with hepatitis B virus accounts for an enormous burden of disease
worldwide, including up to half of all cases of cirrhosis, end stage liver disease , and
hepatocellular carcinoma.

Aim of the work:
To maximize the elimination of the viral infection while
minimizing or preventing damage to the liver cells and tissues and development of viral
resistance to more antivirals.

Patients and Methods:
Eighty eight patients of chronic hepatitis B virus infection with
resistance to lamivudine treatment as proved by quantitative PCR (more than 200 IU/
ml). Their age between (20-60) years, (85 males, and 3 females) were selected from
the National Hepatology and Tropical Medicine Research Institute and were
included in this study. The included patients were two groups, the first group 42 patients ,
were receiving Lamivudine, plus (Baraclude) Entecavir (tablet 0.5mg / day) treatment
at the time of assessment. The second group 46 patients were receiving ( Hepsera
tablet 10 mg / day ) Adefovir dipivoxil plus lamivudine (tablet).
All the patients were subjected to the following : thorough history and clinical
examination, abdominal ultrasonography and collection of blood samples for routine liver
and kidney function investigations and serological assay for HBsAg, HBsAb, HBeAg,
HBeAb, HBcAb quantitative HBV DNA (PCR).

Our results revealed significant differences between the two groups of patients
of CHBV infection, resistant to Lamivudine drug, the first group were higher in
response to a combination between Lamivudine + (Baraclude) Entecavir, than the second
group who were receiving Lamivudine + (Hepsera) Adefovir dipivoxil combination

Our study concluded that the clinical benefit is apparent with high
percentage after a combination regimen using Lamivudine + Entecavir than a
combination regimen using Lamivudine + Adefovir dipivoxil for the treatment of resistant
chronic hepatitis B virus who were treated with Lamivudine only before.

Optimal management of chronic hepatitis B,that may require
long-term and sometimes lifelong treatment to maintain its clinical benefit is
challenging. It is important to initiate treatment with a drug that has the least
potential for induction of drug resistance as sequential monotherapy which may result
in selection of multidrug resistant HBV mutatants.

Key words:
A combination anti-HBV, Antiviral drug resistance, Nucleos(t)ide analogues,
Lamivudine, Entecavir, Adefovir dipivoxil.


Full Paper (vol.45 paper# 4)

d:\skydrive\Jor\vol45_5 The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 443 ­ 456

Effects of Aging and Anti-Aging Hormones on The Kidney, The Thyroid
Functions and The Histology of The Testis of Male Albino Rats

Shadia Ali Radwan; Samia Mohamed Sakr; Mohamed Salah Al-Shinnawy and
Enas Saleh Abdel-Bakey
Department of Biological and Geological Sciences, Faculty of Education, Ain Shams


The present study was carried out to evaluate the effect of aging and anti-aging hormones on
the kidney, the thyroid and the testis of aged male albino rats from the physiological and
histological points of view.

Material & Methods
Thirty five male rats were used in the present study. They were allocated into five groups.
The first group (5months old) served as control group and the other remaining groups are (18
months old). The second group 1 ml/kg b.w. corn oil intramuscular injection through a period
of two weeks .The third group received 2mg/kg b.w. of melatonin hormone orally daily for
two weeks. The fourth group received 0.57 mg/kg b.w. of testosterone hormone via
intramuscular injection through two weeks. The fifth group received the same dose of both
hormones (Melatonin & Testosterone) for two weeks. Some biochemical parameters of the
kidney, the thyroid and histological structure of the testis were examined.

The untreated aged group showed insignificant change in urea level with highly significant
decrease in creatinine, T3 and T4 hormones levels. The melatonin treated group showed
significant decrease in urea level with highly significant decrease in creatinine, T3 and T4
hormones. The testosterone treated group showed highly significant increase in urea, T3 and
T4 hormones and highly significant decrease in creatinine level. Whereas, fifth group showed
significant decrease in urea accompanied with a highly significant decrease in creatinine and
highly significant increase in T3 with a significant increase in T4.
The histological changes induced by aging and anti-aging hormones included intertubular
haemorrhage, odematous areas present between the seminiferous tubules. The interstitial
tissue was degenerated. The degenerated seminiferous tubules revealed maturation arrest in
late-stage spermatides.

In conclusion, aging and anti-aging hormones administration into adult male rats exerts a
clear effect on the kidney and the thyroid functions and on the testicular structure. On the
other hand, amelioration in T3 &T4 serum level was found in anti-aging treated rats compared
with untreated aged rats.

Aging; Anti-aging Hormones; Melatonin; Testosterone; Biochemical Parameters;
Testis; Histology; Male albino rats.


loss of physiological functions, decline in
fertility, decreased ability to respond to a
phenomenon but our understanding of
wide range of stresses, increased risk of
why and how the human being age
age­associated diseases and disorders, and
remains limited. It refers to a progressive
more likelihood of mortality.

Full Paper (vol.45 paper# 5)

d:\skydrive\Jor\vol45_6 The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 457 ­ 476

Comparison of Lipopolysaccharide binding protein and C-reactive protein
gene expression levels in a Rat model of induced Atherosclerosis

Kholoud S. Ramadan*1; Rasha E. Hassan1: Abd El Rahman B. Abd El
Ghaffar1 and Asmaa A. Deghedy1
*Department of Biochemistry, Faculty of Girls Science, King Abdulaziz University, Jeddah, Saudi Arabia,
1Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo, Egypt.
Atherosclerosis is an inflammatory disease characterized by the accumulation of lipids within
arterial walls that eventually go on to form plaques, which can cause narrowing, hardening,
and/or complete blockage of arteries. This study was designed to examine the cholesterol feeding
induction of cardiovascular diseases exemplified by atherosclerosis in rat and induction of CRP,
LBP, SAP and P4H on the transcriptional activity of the inflammation / related gene expression
by a semi-quantitative RT-PCR in liver and heart tissues, and make comparison between CRP
and LBP as biomarker for atherosclerosis.
Material & Methods:
Experimental Rats were fed with cholesterol diet (2.5% pure (wt/wt) cholesterol, 1% cholic acid
and 5% oil) and sacrificed after 18 weeks of feeding.
Histopathological examination for heart showed fatty cells deposition in atherogenic rats.
Expression pattern of CRP, LBP, SAP & P4H genes were investigated, in liver and heart, these
genes were highly expressed while some of them showed no expression pattern in heart tissues.
Key words: Cardiovascular diseases, Atherosclerosis, C-reactive protein, Lipopolysaccharide
binding protein, Serum amyloid P component & Prolyl-4-Hydorxylase.
Atherosclerosis can be regarded as a chronic
low-density lipoprotein (LDL) cholesterol,
inflammatory response limited to the
diabetes mellitus, and infection, influence
vascular bed. New insights into the
the development and progression of
pathogenesis of atherosclerosis clearly
atherosclerosis (Shehata & Yousef, 2010).
indicate that multiple factors, such as
Research over the last 15 years has provided
hypertension, high plasma concentrations of
convincing evidence that atherosclerosis has

Full Paper (vol.45 paper# 6)

d:\skydrive\Jor\vol45_7 The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 477 ­ 503

The immunological and histopathological changes of Tramadol,
Tramadol/Acetaminophen and Acetaminophen in male Albino rats
"Comparative study"

Hanan Mostafa Rabei
Narcotic Department, the National Centre for Social and Criminological Research,
Cairo, Egypt.



Tramadol is a synthetic opioid analgesic. It is commonly prescribed for moderate to
severe pain, becoming abused more popular among teens in most countries. Paracetamol as
anti-inflammatory drugs (acetaminophen) (APAP) is widely used as an analgesic and
antipyretic agent. Meanwhile, tramadol/acetaminophen (tramacet) is effective in acute or
chronic moderate-to-moderately severe pain. In comparative study, the current investigation
threw the light on the effect of over doses of tramadol and/or APAP on the immune function
and hepatocytes in adult male Sprague-Dawley rats.

Material and methods:
Treated rats received oral doses of each drug for 15 consecutive days and after last
treatment, they kept three days later for withdrawal studies. The rats were divided into four
treatment groups, in the first group, rats received saline and used as control. The second, third
and fourth groups treated with tramadol (45 mg/kg), tramadol/APAP (45/450 mg/kg), APAP
(450 mg/kg) respectively, once a-day at the first week and ending with 90, 90/900, 900 mg/kg
at the second week. Rats were sacrificed at the end of the first, second weeks and three days
of last treatment.

Daily doses of tramadol and /or APAP exposure in rats decreased the cellularity of
spleen. Moreover, phagocytic and killing of S. aureus by PMN and macrophage cells caused
a highly significant decrease in treated groups. IFN- was reduced in a statistically different
treated group of rats. Serum IL-10 was unaffected by any of the treatment regimens but
increased only in tramadol/APAP treated rats. Spleen histology exhibited mild pathological
alteration with different injures between treated groups. Splenic white pulp accompanied by
ill deformed which reflected the reduction of white pulp zones, thickened vasculature in the
splenic net work, fibrous trabeculae become prominent feature, where splenic red pulp
occupied large areas of the splenic network with predominant edema and megakaryocytes. On
the other hand, the effect of tramadol and/or APAP induced DNA alterations of hepatocytes
in dose dependent pattern as elucidated by dendrogramatic analysis. Liver histopathological
changes of treated groups included vacuolated hepatocytes, dilated sinusoid with proliferated
Kupffer cells; atrophied hepatocytes with nuclei reduced in size and darkly stained. Many
areas of hepatocytes showed loss of architecture, congested central vein, expanded portal area
with edema and inflammatory reaction.


It could be concluded that the effect of tramadol/APAP induced anti-inflammatory
cytokines than tramadol and APAP alone. Tramadol and/or APAP may display severe
pathological consequences of hepatocytes. These hepatic lesions may be caused impairment
of the liver function.

Keywords: Tramadol, Tramadol/Acetaminophen, Acetaminophen, Cytokines,
Phagocytosis, Histopathology of spleen and liver, DNA fragmentation, Albino rat.

Full Paper (vol.45 paper# 7)

The Role of Fas Receptor and Ligand System, In the Pathogenesis of the Liver Cirrhosis Converting Into Hepatocellular Carcinoma The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 504 ­ 521

Early Detection of Hepatocellular Carcinoma on top of
Liver Cirrhosis: The Fas Receptor and Ligand System

Olfat Hammam 1, Manal Zahran 2, Ola Mahmoud 2, Sohair Aly3, Karim Hosny 4,
Amira Helmy 5, Amgad Anas 6
1 Department of Pathology, Theodor Bilharz Research Institute, Cairo, Egypt
2 Department of Hematology , Theodor Bilharz Research Institute, Cairo, Egypt
3 Advanc Dental/Medical institute IPPT,USM, Malysia & Medicinial Chemistry Department
of NRC,Cairo, Egypt
4 Department of Surgery. Faculty of Medicine (Kasr El Aini Hospital), Cairo University, Egypt
5 Department of Electron Microscop (Hematology), Theodor Bilharz Research Institute, Cairo, Egypt
6 Department of Hepatology & Gasteroenterology, Theodor Bilharz Research Institute, Cairo, Egypt.
Address for correspondence : Theodor Bilharz Research Institute, Cairo, Egypt

Hepatocyte aberrations, accumulation of chromosomal damage and possibly initiation of
hepatic carcinogenesis is thought to be caused by the continued viral replication and the
persistent attempt by a less than optimal immune response to eliminate hepatitis C virus
(HCV) infected cells. The identification of the "death factors" including Fas and its Ligand
(Fas-L) as a major regulator of both apoptosis and immune function has provided insight into
an attractive mechanism of tumor escape from immune clearance.
Aim: To assess the hepatic expression of Fas/Fas-L, the Fas receptor (Fas-R) expression on
lymphocyte, and serum soluble Fas (sFas) in an attempt to analyze the role of Fas
receptor/ligand system in the multistep process of fibrosis/carcinogenesis and the possible use
of the serum marker as possible candidate biomarkers for an early detection of hepatocellular
carcinoma (HCC).

Material and Method:
The current study included 100 samples from cases at Theodor Bilharz Research Institute and
Kasr Al Aini Hospital in Egypt. There were 90 cases of chronic hepatitis C (CHC) infection
(and negative hepatitis B virus infection). There were 30 cases without liver cirrhosis, 30
cases with liver cirrhosis and 30 cases with HCC. 10 liver biopsies were taken from healthy
livers as normal controls. Histopathologic study and immunohistochemistry for detection of
hepatic Fas and Fas-L expression were determined for all cases. Electron microscopy (EM)
and immunoelectron microscopy (IEM) examination for detection of Fas-R expression on
lymphocytes were also done. sFas, liver function tests, serologic markers for viral hepatitis,
and serum alpha-fetoprotein level (alpha-FP) were done.


Full Paper (vol.45 paper# 8)

Effect of Cichorium intybus L The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 522 ­ 535

Effect of Cichorium intybus L. on fatty liver induced by oxytetracycline in
albino rats.

Eman G.E. Helal* , Samia M. Abd El-Wahab* , Atef M.Moussa Sharaf**
and Ghada A. Zedan*

*Zoology Department, Faculty of Science, Al-Azhar University, For Girls.
**Department of Physiology, Faculty of Medicine, Al-Azhar University


Background: Fatty liver is now one of the most common diseases in Egypt. People prefer to
use the medicinal plants instead of using chemical compounds because they are cheap and have
few side effects compared to chemical compounds.The current investigation was carried out to
examine the possible potential therapeutic and protective effects of Cichorium intybus (chicory)
against oxytetracyclin-induced fatty liver in an attempt to understand its mechanism of action,
which may pave the way for possible therapeutic applications.

Material and Methods: Albino rats were divided into two major groups, 15 rats for each. The
first group was divided into three sub-groups: a) control, b) fatty liver group; that was injected
intraperitonealy with oxytetracycline (120mg/kg) for three consecutive days resulting in
steatosis and c) chicory treated group; which was treated with chicory water extract (70 mg/kg)
for 30 days after fatty liver induction . All animals were scarified after 33 days of the beginning
of the experiment. The second group was divided into three subgroups: a) control, b) fatty liver
group; that was injected intraperitonealy with oxytetracycline (120mg/kg) for three consecutive
days and c) drug protection group; which received chicory for 15 days before induction of fatty
liver, then sacrificed after induction of fatty liver (3 days). Blood samples were collected for
biochemical analysis. Liver specimens were obtained and fixed in 10% formalin for histological

Results: Fatty liver groups showed high significant increase in serum glucose, cholesterol,
triglycerides, LDL cholesterol, ALAT, ASAT, GGT, LDH, urea, creatinine and A/G ratio while
total protein, albumin, globulin and HDL cholesterol were significantly decreased compared to
control group. These biochemical changes were accompanied with histopathological alterations
in fatty liver tissue. The treatment with chicory ameliorated most of the evaluated biochemical
parameters and improved the induced degenerative histopathological changes. The pre-
treatment with chicory before the induction of fatty liver gave some protection against factors
that experimentally induced fatty liver.

Conclusion: Chicory as diet additive is recommend for fatty liver patients or those people who
have hyperlipidemic family history.

Keywords: Fatty liver, Chicory, Lipid profile, Albino rats, Physiological parameters,


Any body organ is a potential target for
gastrointestinal tract and after absorption
injurious effects from chemicals but some
they are carried by the hepatic portal vein to
organs are more vulnerable to adverse
the liver. Thus the liver will be exposed to
effects than others. The liver is often a
the highest concentrations of these
target organ for a number of reasons. First,
chemicals (Reed, 1994; Lu, 1996).
most toxicants enter the body via the
Chemicals encountered by other routes of

Full Paper (vol.45 paper# 9)

Amelioration of aluminium - intake oxidative stress by some antioxidants in male albino rats The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 536 ­ 546

Amelioration of aluminium - intake oxidative stress by some antioxidants in male
albino rats

Ahkam M. El-Gendy
Zoology Dep. Faculty of science (Girls' branch), Al-Azhar University, Cairo, Egypt.


Back ground:
Aluminum is potentially toxic to humans. The Agency for Toxics Substances and Disease Registry
(ATSDR) reported that aluminum accumulates mainly in the bone, liver, testes, kidneys and brain. The
goal of the present study was to assess in rats the pro-oxidant effects induced by Al3+ exposure, as well
as the protective role of exogenous melatonin (M), vitamin E (vit. E) or N-acetylcystiene (NAC). The
effect of aluminium (Al) alone or combined with antioxidants (M), (vit. E) or (NAC) on some
physiological parameters and antioxidants in male albino rats were studied.

Material and methods:
The animals were assigned to 5 groups: control (group I); Al3+­intake (53.5 mg AlCl3/litre drinking
water , group II) ; 5 mg melatonin/kg b.wt. plus AlCl3 (group III); , or vitamin E(100 mg/kg b.w.) plus
AlCl3 (group IV)or 100mg N-acetylcystien plus AlCl3 (group V). Rats were orally administered their
respective doses daily for 30 days. At the end of the treatment period, blood was obtained. Thereafter,
brain, liver, kidney and testes were removed. These tissues were processed to examine oxidative stress
markers: reduced glutathione (GSH), superoxide dismutase (SOD), glutathione peroxidase (GSHpx)
and lipid peroxidation end products {malondialdhyde(MDA) + 4- hydroxynonenal (4- HNE)}. Samples
of these tissues were also used to determine Al3+ concentrations.

Results :
In Al- toxicated group ,serum glucose and total cholesterol levels, liver enzyme activities (ASAT and
ALAT), as well as, lipid peroxidation end products {malondialdhyde (MDA) + 4- hydroxynonenal (4-
HNE)} were elevated significantly in the brain , liver ,kidney and testes tissues when compared with
control group. On the other hand, serum triglycerides and tissue (liver, kidney and testes) intracellular
antioxidants glutathione (GSH) and superoxide dismutase (SOD) and liver glutathione peroxidase
(GSHpx) activity decreased significantly. Brain GSH also decreased but SOD showed no significant
changes. Melatonin, vit. E and NAC improved the levels of the different changed parameters when
combined with Al. The most improved correction was recorded when Al3+ combined with vit. E
followed by M ,then NAC. Serum Al3+ levels were increased in Al3+ treated group as well as groups
exposed to Al3+ combined with vit. E, M or NAC when compared with control group. Al3+ could not be
detected in tissues by atomic spectrophotometer (aluminium metal concentrations were below the limit
of detection by AAS).

The results show that Al3+ exposure promotes oxidative stress in different tissues while melatonin,
vitamin E and N-acetylcystiene exert antioxidant actions in Al3+-treated animals. The protective effects
of these antioxidants against cellular damage caused by Al3+-induced oxidative stress, together with its
low toxicity, make them worthy of investigation as potential supplements to be included in the
treatment of neurological disorders in which the oxidative effects must be minimized as well as
protection against liver, kidney and testes damage by Al- exposure.
Dietary vitamin E supplementation may offer further protection.

Key words: Aluminium, melatonin, vitamin E, N-acetylcystiene, antioxidants, lipid peroxidation ,


Full Paper (vol.45 paper# 10)

Table (II): Shows comparison between adverse parturition outcome in both groups (mean+SD) The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 547 ­ 553

Maternal obesity and its adverse impact on labor outcome
Inas Mahmoud Hamdy
Department of Obstetrics &Gynacology faculty of medicine, Al Azhar University Hospital
Objective: to study the impact of maternal obesity on the outcome of labour. Setting: Al
zahraa University hospital.Design: prospective randomized control study.Patients: a total of
(80) pregnant women were included in this study from April 2009 to March 2010. Patients
and Methods:According to the BMI the patients were classified into two groups. Group (I):
(Control Group):Included (30) patients with (body mass index) (BMI) ranging from 20 to 25
kg/m2.Group (II): (Obese Group): Included (50) patients with (BMI) ranging from 25 to
30kg/m2. Each patient were subjected to full clinical examination (General) Abdominal and
pelvic) U/S pelviabdominal examination that is to confirm the inclusion and exclusion criteria of
the study. Results : A significant differences was noticed between 2 groups as regard the BMI.
The current study showed significant difference in cases subjected to induction of labour with p-
value < 0.001. Also significant difference between control group and obese group regarding
failed induction, failure to progress 1st stage, 2nd stage, shoulder dystocia with p-value <
0.01.Case of C.S showed the highest significant diff. with P-value < 0.0001 .In the present study
no sig. diff. between cases of both groups as regard 3rd stage complication, 4th stage (PPH) and
blood transfusion with P-value 0.658, 0.684 and 0.658 respectively. A high significant diff.
between the two groups as regard case of macrosomia, Apgar score < 7 1st minute, and birth
injury with p-value < 0.01. A significant diff. were showed between the cases of both groups as
regard the incubation with p-value > 0.05.No significant diff. were noticed between the 2 groups
as regard the cases with Apgar score < 7 at 5 minutes with p-value 0.06. A positive correlation
coefficient between the BMI (25-29), (29-33) kg/m2 with the case of induction of labour,
failure to progress 1st stage, shoulder dystoca, cesarean section and fetal low Apgar score. While
a negative correlation was recorded between the BMI of the control group and all the adverse
outcomes. Conclusion:Obesity of the gravid women is a sensitive predictor of the adverse
outcome during pregnancy, labour, and post partum. Researches are needed into effective,
applicable and acceptable community -based program for obese women planning a pregnancy.
Key words: Maternal obesity. labor


Full Paper (vol.45 paper# 11)

ž’E9'ED The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 554 ­ 560

The predictive value of studying the Uterine & umbilical artery
resistance indices in cases of pre term labour
Naemat M. Hafei El Din Shiry & Inas Mahmoud Hamdy
Department of Obstetrics & Gynecology, Faculty of Medicine , AI Azhar University (Girls)
to assess the value of uterine artery and umbilical artery resistance indices
changes in predicting cases of PTD
Setting: The study was carried on gravid women attending AI zahraa University Hospital
between February 2009 to September 2010.
Design: A prospective study on gravid women picked up at 24 week gestation during ANC .
They were subjected to Doppler velocimetry study of the Umbalical & Uterine artery blood
flow to measure the resistive indices changes on going GA.
Patients & Methods: Participants were 24 weeks pregnant with a singleton pregnancy,
Participants were seen at three study visits: at recruitment, at, 28 weeks gestation; and finally
at 34 weeks gestation. Patients who later developed PTL formed the study group n=28.
The control group were the women who completed 40 weeks gestation at the time of delivery.
For each patient seen at the three visits Doppler velocimetry ultrasound study of the umbilical
and uterine were performed to assess the RI indices changes.
Results: The current study revealed a high significant difference in the RI value of the
umblical artery starting from 28 weeks visit to be (0.74), (0.61) in the study group and control
group respectively with p-value (0.001) also a highly significant diff. were noticed at the 34
weeks visit to be( 0.65),(0.49) in the study group and control group respectively with p-value
(0.0001). As regard the uterine artery RI the study group showed a highly significant
difference at 28 weeks visit when compared to the value of the control group with p-value(
0.001) in the same manner the RI value at 34 weeks visit showed a highly significant
difference between both groups with p-value(0.0001).In the current study the mean RI for
both uterine and umbilical arteries decreased steadily across all study visits from 24 weeks to
34 weeks gestation. In linear regression models, the relationships of both uterine and
umbilical artery RI with gestational age were significantly different between study group and
control group. The mean umbilical artery RI and uterine artery RI indices decreased
significantly more slowly across gestation for study group than for control group. In
univariate analyses, a 2.9 fold increase in risk for PTD was associated with a 0.1 unit increase
in uterine artery RI across gestation; while a 3.4 fold increase in risk for PTD was associated
with a 0.1 unit increase in umbilical artery RI across gestation.


Full Paper (vol.45 paper# 12)

Embryonic Heart Rate in early pregnancy and the fate of pregnancy in women with first trimester bleeding
The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 561 ­ 569

Embryonic Heart Rate correlation with pregnancy outcome in women
with first trimester bleeding
Naemat Mohamed H.ELDin Shiry
Department of Obstetrics and gynaecology, AL zahraa University Hospital
Objective : To assess the correlation between fetal heart rate and the fate of pregnancy in women
with first trimester bleeding.
Methods :
This prospective observational study included 281 consecutive women with first trimester bleeding
and Singleton pregnancies. The embryonic heart rate measured at the time of first trans-vaginal scan
as per protocol in our university hospital for the evaluation of pregnancy. The heart rate was classified
as slow if it was fewer than 110 beats per minute. The primary outcome measure is the occurrence of
spontaneous early pregnancy loss prior to 12 weeks. Other outcome measures included the occurrence
of late pregnancy loss (prior to 24 weeks), gestational age at birth, and fetal weight at birth.
Results :
Embryonic heart rate at less than 110 bpm was associated with a high likelihood of pregnancy loss.
The sensitivity, specificity, positive and negative predictive value, and accuracy were 43.1%, 86%,
40.7%, 87.2%, and 78.2%, respectively. The OR (95% CI) of first-trimester pregnancy.
embryonic heart rate can be an independent predictor of the outcome of pregnancy in women with
intrauterine pregnancy complaining of first trimester bleeding.
The advent of high-resolution transvaginal
good understanding of its pitfalls are essential
ultrasound (TVS) has remarkably changed the
for the diagnosis and management of early
management of early pregnancy failure.
pregnancy failure. Nonetheless, no single
Knowledge of the ultrasound appearances of
ultrasound measurement of the different
normal early pregnancy development and a
anatomical features in the first trimester has

Full Paper (vol.45 paper# 13)

d:\skydrive\Jor\vol45_14 The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 570 ­ 584

Association between Helicobacter Pylori infection and autoimmune
hypothyroidism in Egyptian population
Fatma Kamel Hammad , Zeinab Abd El-Baset Hassan , Dina Mohammed Abaza ,Sabila Gomma
'Mosua,² Ahmed Ahmed Saad ³ and Hesham Mohamed Abou El-Soud
Endocrinology and Metabolism Department , Internal Medicine Department ² (Al Azhar University for girls),
Internal Medicine Department ³(Faculty of Medicine ­ Cairo University).


Autoimmune hypothyroidism commonly affecting females is one of the commonest causes of thyroid
disease in adults. Among the various autoantibody tests applied in research and clinical practice, the
determination of thyroid microsomal antibodies (TPO) and thyroglobulin antibodies (TG Ab) still retains
its strong value in the screening for thyroid autoimmunity. Helicobacter pylori (H. pylori) infection plays
an important role in the pathogenesis of chronic gastritis, peptic ulcer disease, MALT (Mucosa
Associated lymphocyte T) Lymphoma and gastric cancer.
Aim of the work:
The aim of this work was to study the relationship between H.pylori infection and autoimmune
hypothyroidism in Egyptian population.
Subjects and Methods:
This study was carried out on 147 Egyptian persons divided into 3 groups: Hypothyroid Group:
Included 49 patients with autoimmune hypothyroidsm and positive antithyroid antibodies with no history
of dyspeptic symptoms or peptic ulcer. H.pylori positive Group: Included 50 patients with dyspeptic
symptoms or peptic ulcer with H.pylori positive antibodies with no history of any thyroid disease. Control
Group: Included 48 apparently healthy persons serving as control. Serum Free T3, Free T4 and TSH
were done for all subjects together with Antimicrosomal antibodies (TPO-Ab), Antithyroglobulin
a n t i b o d i e s ( T G - A b ) a n d H e l i c o b a c t e r P y l o r i a n t i b o d i e s ( H . p y l o r i A b ) .
There was no significant difference between all groups as regards age. Also there was significant
difference between Hypothyroid and H.pylori positive groups as regarding TSH and Free T3, TG-Ab,
TPO-Ab and H. pylori Ab. There is also significant difference between Hypothyroid and control groups
regarding TSH, free T3, TG-Ab, TPO-Ab, and H. pylori Ab. There is significant difference between
H.pylori positive and control groups regarding FT3 and H. pylori AB. Hypothyroid Group was divided
according to the presence of H. pylori Ab into ­ve &+ve H. pylori Ab subgroups. There was significant
difference between the ­ve and +ve subgroups as regard TSH, free T4 and TG-Ab. H.pylori positive

Full Paper (vol.45 paper# 14)

d:\skydrive\Jor\vol45_15 The Egyptian Journal of Hospital Medicine (Oct. 2011) Vol., 45: 585 ­ 594

The Relation between Asthma, Body Fat Distribution and Serum Adiponectin in Obese Egyptian Children.
Dina M Abaza, Amany E. El Arab, Ensaf K. Mohamed And Hoda E. El Arab.
Endocrinology And Metabolism Chest Disease And Tuberculosis Pediatric
Departments Al-Azhar University And Bacteriology Department Ain Shams University

Childhood obesity is an emerging global public health challenge. That is because the prevalence of
obesity among children and adolescents has increased greatly in all parts of the world. A number of
studies have reported an inverse relation between respiratory function and various indices of obesity or fat
distribution (El-Baz et al., 2009). Adiponectin, an antiinflammatory adipocytokine, circulates at lower
levels in the obese, which is thought to contribute to obesity-related inflammatory disease as bronchial
asthma ( Medoff et al., 2009).
Aim of the work
The aim of this work was to assess the correlation between the bronchial asthma, obesity, fat distribution
and serum adiponectin in obese Egyptian children.

Subjects and Methods
The present study included a group of obese fifty (50) children (25 boys & 25 girls) without the co
morbidities of the metabolic syndrome; aged 7-18 years, mean age (14.2±3.9). Obesity without the co
morbidities of the metabolic syndrome was defined as a BMI above the 85th percentiles according to BMI
Charts of Egyptian Growth Charts for boys and girls from 2-21 years (2002). They were compared to
thirty (30) lean sex and age matched controls mean age (14.1±4.8) (15 boys & 15 girls) with BMI
between the 10th and 75th percentile. Anthropometric measurements (body weight, BMI, WC and fat
mass% by DEXA) were done for all children together with pulmonary function test and assessment of
serum adiponectin levels.

Weight, Waist circumference (WC), Body mass index (BMI), fat mass% and adiponectin were significant
higher in obese compared to non obese groups (p<0.001 for all). Parameters of pulmonary function was
significant lower in obese compared to non obese groups as regard forced vital capacity (FVC), forced
expiratory volume in one second (FEV1), peak expiratory flow maximum (PEF) and forced
midexpiratory flow 25%(FEF25%) (p<0.01 for all). while no significant difference was found between
both groups as regard FEV1\FVC ratio and forced midexpiratory flow rate( FEF25-75% )(p>0.05 for
A negative association of BMI with parameters of pulmonary function was found but only FEV1, FVC &
FEF 25% were statistically significant(p<0.01 for all). As regard WC it was negatively correlated with
FEV1, FVC and FEF 25 %( p<0.01 for all) but no correlation was found with other parameters of
pulmonary functions (p>0.05). In the present study a negative correlation was found between fat mass %
and parameters of pulmonary function but none of them was statistically significant (p>0.05 for all).
A negative significant correlation was found between adiponectin and age in obese group (p>0.05) .As
regard anthropometric parameters in obese group a significant negative correlation was found between
adiponectin and BMI, WC & fat mass %(p<0.01 for all) while no correlation was found with body
weight(p>0.05). As regard of pulmonary function parameters a negative significant correlation was found
between serum adiponectin and FVC and PEF %( p<0.01 for both) while a negative correlation was found
between adiponectin and FEF 25% but this correlation was statistically insignificant (p>0.05), While no
correlation was found with FEV1\FVC ratio (p>0.05).
The increasing prevalence of overweight and obesity among Egyptian children may be an important
contributor to the increasing incidence and prevalence of asthma. Adiponectin may be one of the signals
linking obesity with asthma.

Full Paper (vol.45 paper# 15)