Case Study: Giant Retroperitoneal Presacral Ancient Schwannoma The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol., 50: 1­ 9

CASE REPORT: Giant Retroperitoneal Presacral Ancient Schwannoma
Al-Jiffry, B.O1, 2; Othman,B.S2; Hatem, M1
1. Department of Surgery, Taif University, Taif, Saudi Arabia
2. Department of surgery, Al-Hada armed forces Hospital, Taif, Saudi Arabia
Summary: Ancient schwannoma, is a rare variant of schwannoma with characterization of
degenerative changes and diffuse hypercellularity. Retroperitoneal presacral form is often
found incidentally, because they present with vague symptoms or symptomless. Schwannoma
occurring in this area occasionally presents with enormous dimensions, known as a giant
schwannoma. The tumor removal is a surgical challenge due to the difficult approach and
abundant vascularity. In this report we describe a 61 ­year old female presented to ER with
vaginal bleeding and lower abdominal pain. The case diagnosed on clinical, CT and MRI
findings to be a fibroma of the left ovary. Exploration by the gynecology team revealed a huge
retroperitoneal presacral tumor compressing the left external iliac vessels and displacing the
left ureter; they took a biopsy and closed the abdomen. Histopathological result was benign
schwannoma. The patient were referred to our hospital (Al Hada Armed Forces Hospital, Taif,
Saudi Arabia) to be managed from postoperative DVT when her family asked our department
of surgery for further management and signed a high risk consent. We explored the case after
insertion of IVC filter and ureteric catheter. A 20x20 cm mass was thoroughly dissected and
resected with part of sacrum. The final histopathological result was benign nerve sheath tumor
with features consistent with degenerated (ancient) schwannoma and the tumor was completely
resected. The patient was discharged from the hospital without complications and follow up for
three years revealed no recurrence. The clinical, radiological, and pathological features of this
disease are discussed in this report.
To conclude, retroperitoneal giant ancient schwannomas are a rare variant of the benign
schwannoma and often present as unrecognized slow growing masses. Keep in mind
potentially severe bleeding and neurological deficit risk of surgical intervention without away
from oncologic principle. Therefore, careful preoperative evaluations and postoperative
monitoring are necessary.
Keywords: ancient schwannomas, retroperitoneal, vaginal bleeding, masses, tumors.

schwannomas produce symptoms, which
Schwannomas are usually benign tumors
are nonspecific and depend on the location
arising from the Schwann cells of the
and size of the mass and results in
peripheral nerve sheath (1). The benign
compression and irritation of the nerve
roots, gastrointestinal system, urinary

Full Paper (vol.50 paper# 1)

ž˙ The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50 , Page 11­ 23

A prospective, multi-center, observational study on the use of interferon beta-1a
(Rebif) therapy in Egyptian patients with Multiple Sclerosis
Ahmed Nemr
Neurology Consultant

Objective: The primary objective of this study is to describe the disease characteristics of the cohort of MS
patients undergoing Rebif treatment.
Design: This is a multicentre, open label, non comparative, non randomized study conducted in Egypt on the use
of interferon beta-1a (Rebif) therapy in Egyptian patients with relapsing multiple sclerosis according to
McDonald criteria.
Subjects: Egyptian patients with relapsing multiple sclerosis who are naļve to interferon and are 18 to 65 years
Settings: A total number of 36 patients were enrolled.
Main Outcome Measures: include the mean number of relapses, time from diagnosis to start of treatment,
number of relapses prior to start of treatment, annualized relapse rate, incidence of adverse events associated with
Rebif therapy and number and location of lesions in MRI.
Results: 7 patients were excluded from Intention-to-Treat Population as they were enrolled regardless of the
inclusion/exclusion criteria. Therefore, the Per Protocol Population included 29 patients including 11 males and
18 females and with a mean age of 31.41 years old. The number of reported relapses was 4.3 and 11 at visit 1,
visit 2 and end of the study respectively. Despite this increase, only 13 out of 29 patients (44.83% - 95%CI:
28.4% to 62.4%) had relapse attacks during the study (48 weeks). The annualized relapse rate was 0.79 ± 0.41
(95% CI) relapse per year. 9 patients out of 36 patients (25% - 95%CI: 13.75 to 41.07%) in the safety population
had adverse events during the study. 2 were reported at baseline, 5 at visit 1, 1 at visit two and 1 at visit 3. The
adverse events were elevated liver enzymes (2), depression (2), injection site pain (1), allergic skin reaction (2)
and flu like symptoms (1).
Conclusion: Compared to previously reported results, this study indicates that Rebif appears to have a favorable
efficacy profile as well as a favorable safety profile in delaying MS progression in Egyptian patients.
Keywords: Multiple Sclerosis, Interferon, Rebif®.

background, exposure to environmental pathogenic
Multiple Sclerosis is considered to be a chronic
triggers (e.g.: viral infections) and the development
autoimmune disease of the central nervous system.
of an immune response directed against the central
It leads to multifocal inflammation, demyelination
nervous system.
and axonal damage of neurons. The etiology is
Of the four different sub-types of MS, the
believed to include several factors such as genetic
relapsing-remitting form (RRMS) is the most

Full Paper (vol.50 paper# 2)

d:\skydrive\Jor\vol50_3 The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50 , Page 24 ­ 33

Screening of renal diseases by urine analysis in primary school aged
children at El-Gharbiya governorate-Egypt
Maha Y. Zein El-Abden*, Omaima I. Abo-ElKheir**, Sanaa M.El-Sadek*, Amany M. El-
Said***, Marwa A.Awaad*
*Pediatric department, **Community and Occupational Medicine department, ***Clinical
pathology department, Faculty of Medicine, Al-Azhar University

Background: Renal diseases are increasingly common causes of childhood morbidity and
mortality. Some of these diseases, if undetected and not treated early lead to debilitating chronic
disease. Urinary tract infection are common in childhood ,may be subclinical or present with non
specific symptoms and signs and have the potential for long term complication.
Objective: to assess the urine examination findings among a group of apparently healthy
primary school aged Egyptian children between 5 and 12 years old and to ascertain the magnitude
of renal diseases among them.
Methodology: a cross-sectional study carried out on 706 (333boys & 373 girls) school aged
children at primary school at El-Gharbiya governorate Egypt. A stratified random sample was
selected from the students. All students enrolled in this study were subjected to complete clinical
examination and a urine sample was taken and tested by using a urine dipstick test for protein,
blood, glucose, nitrite and leukocyte in urine. Those students with persistent abnormal results
with the 2nd urine dipstick test (after 15 days from 1st one) were examined by complete
microscopic analysis, urine culture with antibiotic sensitivity for those with positive pus cells.
Results: with the initial urine dipstick test, we found 116 students (16.4%) of 706 (53 boys & 63
girls) they had abnormal urinary findings. Second dipstick test done for students with positive
findings and revealed that 55 (7.8%) of 706 (26 boys & 29 girls) had abnormal urinary findings,
followed by microscopic urine analysis that revealed that 35 (4.96%) students had abnormal
urinary findings .Urine culture was done for 24 (3.4%) students that had urinary tract infection,
13 students were positive for E-coli and 3 were positive for staphylococci while 8 showed no
growth. Abdominal ultrasound was done for the 35 students with urinary abnormalities by
microscopic urine analysis ,it showed 3 (0.42%) students of 706 had a positive findings (2 of
them had cystitis and another case had bilateral renal gravels).
Conclusion: Urine abnormalities are a common finding among apparently healthy school aged
children with pyouria and heamaturia[ were the most prevailing abnormalities].
Recommendation: Urine analysis must be done for school children as a part of routine medical
examination at the point of school entry and repeated as a screening for renal diseases at a

Full Paper (vol.50 paper# 3)

d:\skydrive\Jor\vol50_4 The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50 , Page 34 ­ 59

Immunolocalization of laminin during postnatal development of the testis,
epididymis and vas deferens of albino rat.
Dina Helmy Abdel-Kader and Safinaz Salah Eldin Sayed.
Histology Department, Faculty of Medicine, Cairo University.

Background: Disorders of testicular function may have their origins in fetal or early life as a result of
abnormal development. Laminin-1 is emerging as the key molecule in early embryonic basement
membrane assembly. Accumulating evidence supported the idea that extracellular matrix (ECM)
molecules and mesenchymal cells might influence Sertoli and spermatogenic cell functions.
Aim of the work: detecting the changes in the distribution and prevalence of laminin-1 assembly during
postnatal development of the testis, epididymis and vas deferens in albino rats.
Materials and methods: Thirty male albino rats were used and divided into six groups (n= 5 each)
according to the age (postnatal day). These were one day, 1 week, 2 weeks, 3 weeks, 4 weeks, and 8 weeks
postnatal. Specimens were fixed and processed, sectioned and stained by hematoxylin and eosin and
immunohistochemical stain for laminin-1. The area percent of positive laminin immunostaining was
measured and results were statistically analyzed.
Results: at day one postnatal, the testis was formed of solid un-canalized cords of seminiferous tubules
with abundant laminin expression in the cells of the cords. With advancement of development the cords
were luminized and the laminin expression declined to involve the basement membrane and the apical
portions of the Sertoli cells at the 8th week postnatal. The epididymis at postnatal day one had a small
diameter and narrow lumen and laminin expression involved the cytoplasm of the epithelial lining. As
development proceeded the expression became confined to the apical portion, the site of stereocilia
together with its presence in the basement membranes. The same pattern of changes in laminin expression
together with morphological appearance was detected in the vas deferens.
Conclusion: The present study was able to demonstrate a change in the distribution as well as the
prevalence of laminin-1 immunoreactivity within the testis, epididymis and vas. During the period of
postnatal development starting at postnatal day one up to 8 weeks postnatal. This would reflect an essential
role for laminin in early postnatal period of development.
Key words: Laminin, testis, epididymis, vas deferens, development, immunohistochemistry.

Basement membranes (BMs) are cell-
endothelia, surrounding muscle, fat and
associated sheet-like extracellular matrices
peripheral nerve cells. BMs are essential for
covering the basal aspect of all epithelia,
tissue formation in all animals. They provide

Full Paper (vol.50 paper# 4)

Interferon (IFN)-mediated antiviral activity against the hepatititis C (HCV) through microRNAs ( microRNAs ) The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50 , Page 60 ­ 71

Interferon (IFN)-mediated antiviral activity against the hepatititis C
(HCV) through microRNAs ( microRNAs ).
Saadia Farid, Lila Rashid, and Dina Sabry.
Department Of Tropical Medicine and Medical Biochemistry.
National Hepatology and Tropical Medicine Research Institute and Cairo University Faculty of Medicine.

Background: MicroRNAs are a class of small non-coding RNA molecules that function through
post-transcriptional regulation of gene expression by a process termed RNA interference (RNAi),
and that also have to prominence as critical regulators in a wide array of mechanisms of cell
Aim of the work: The study will attempt to evaluate the expression of several microRNAs in
peripheral blood mononuclear cells (PBMCs) from patients with chronic hepatitis C (CHC) at 12
hours after the first injection of pegylated interferon in comparison with healthy controls.
Patients and methods: forty patients with chronic hepatitis C virus infection (CHCV), their age
ranged between (20-56) years, selected from the National Hepatology and Tropical Medicine
Research Institute were included in this study, after 12 hours of the first interferon injection, and
twenty healthy individuals were included to serve as controls. All the patients and controls wer e
subjected to the following history, clinical examination, abdominal ultrasonography and
collection of samples for routine laboratory investigations. CBCs and Taqman quantitative RT-
PCR for MicroRNAs expression analysis of miR- 128a, miR 196a, miR- 196b, miR 296.
Results: Our study revealed that the microRNAs had a higher levels of expression in cases of
CHCV infection.
Conclusion: Our study concluded that there's a highly significant increase in expression levels
of IFN-induced microRNAs were observed in patients of microRNAs-128a, 196a, 196b, 296.
Recommendations: The future use of miR inhibitors or mimics and / or siRNAs might be useful
for the development of diagnostic and therapeutic strategies aimed at the recovering of protective
innate responses in HCV infections.
Key Words: Interferon regulated microRNAs , ( 128a, 196a, 196b, 296 microRNAs modulated
by HCV replicon clones.
The hepatitis C (HCV) is a major public
infection is the combination of a pegylated
health problem and a leading cause of
interferon and ribavirin (2).
chronic liver disease (1). The currently
Recently an even more direct link between
recommended therapy of chronic HCV
IFN and miRNAs has emerged (3). It has

Full Paper (vol.50 paper# 5)

d:\skydrive\Jor\vol50_6 The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50 , Page 72 ­ 77

Homocystiene Profile in Elderly
Ola A. Hafiz1, Sarah A.Hamza1,Walaa W. Aly1,Wessam E.Saad2, Ahmed K.Mortagy1
Department of Geriatrics and Gerontology(1) , Department of Clinical Pathology(2) Faculty of
Medicine ,Ain Shams University

Background: Homocysteine (Hcy) is a sulfurated amino acid an elevated homocysteine level
is a marker for a pathogenic process as well as a cause of pathology.
Method: it is across sectional study conducted on 91 elderly participants 60 years and older
selected from geriatric outpatient clinic and geriatric inpatient departmentthey underwent
comprehensive geriatric assessment, and homocysteine (Hcy) level in blood by Enzyme
Immunoassay (EIA).
Results: homocysteine not significantly related to age, sex and functional status. Also mean
Hcy level is 15.4 mol/liter.
Conclusion: further studies to evaluate Hcy level in elderly with different ages are
Keywords: Homocystiene, profile, elderly
Homocysteine (Hcy) is a sulfurated amino
an important antioxidant. Transulfuration
acid derived from ingested methionine
requires vitamins B6 and B12. The
found in cheeses, eggs, fish, meat, and
poultry. It is directly toxic to neurons and
methionine cycle are affected by genetic
blood vessels and can induce DNA strand
variation, diet, kidney and gastrointestinal
diseases, and prescribed and over the-
counter drugs. Since homocysteine is a
metabolic pathway intermediaries are S-
deficiency, an elevated homocysteine level
is a marker for a pathogenic process as
well as a cause of pathology(2).
produces methyl groups required for the
Elevated blood concentrations of the
synthesis of catecholamines and DNA.
amino acid homocysteine are frequent in the
elderly (3), especially as a consequence of
remethylatinghomocysteine--using B12
nutritional deficiencies of vitamin B12 and
and folate as cofactors--back to
folate (4).
methionine (2).
Ueland and Refsum (5) noted
Homocysteine is cleared by
impaired homocysteine metabolism seems
transulfuration to cysteine and glutathione,
to exist in 15­30% of patients with

Full Paper (vol.50 paper# 6)

d:\skydrive\Jor\vol50_7 The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50 , Page 78 ­ 102

Administration of Three Natural Products as Protective Agents Against The
Genotoxic And Cytotoxic Effect of Methotrexate in Mice (Mus Musculus).
Zowail, M.E.M.; Awwad, M.H.; Khater, E.H. and Nafie, Ebtesam. H.O.
Zoology department, Faculty of science, Benha University, Egypt

Background: Methotrexate is an antimetabolite and antifolate drug. It is used in treatment
of cancer, autoimmune diseases.
Material and methods: 210 healthy adult male Swiss albino mice (Mus musculus), were allotted among
three groups. The animal were given daily (0.065mg/ml) of methotrexate intraperitonealy followed by
injection of Omega-3 plus at dose (8.58 mg/20g mice), Apple at dose (1.43 mg/20 g mice) and Psyllium
at dose (18.2mg /20 g mice) for five days.
Results: Various Structural and numerical chromosomal aberrations in bone marrow cells; mitotic
activity and sperm head abnormality were recorded, quantitated, and statistically analyzed. Also DNA
extraction and apoptosis detection in liver was done. The intensity of apoptotic bands located at 200 b p;
400b p ; 600 b p;800 b p and intact DNA measured by software Gel Pro program as maximum optical
density values.
Conclusion:, Methotrexate had adverse effect on chromosomal and sperm head structure, also it induce
apoptosis, necrosis and decrease total DNA in mice liver.Omega-3 plus, Apple, and Psyllium attenuate
the methotrexate-related toxic effects.
Key words: Methotrexate ­ Omega-3 plus- Apple- Psyllium-chromosomal aberrations- sperm- DNA-

review article of Muriel [2] provides information
as amethopterin. It is an antimetabolite and
about 47 herbs and natural products that have the
antifolate drug. Methotrexate (MTX), an
potential to protect humans against cancer. The
antineoplastic drug, which is widely prescribed
majority of these herbs and natural products are
for the treatment of acute lymphoblastic
fruits, vegetables, animal or fish products,
leukaemia, non-Hodgkin's lymphoma, various
grains, and molecular components of plants or
types of sarcomas, carcinomas, breast and
herbs that are found in human diets. Several
testicular cancers [1]. The drug was developed
grains such as barley, rice bran, and wheat bran
by Yellapragada Subbarao.
protect against cancer. Various vegetables,
Patients with cancer take numerous alternative
fruits, and plants also show promise as
products to protect themselves from cancer. The
protection against cancer: apple, asparagus,

Full Paper (vol.50 paper# 7)

d:\skydrive\Jor\vol50_8 The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50, Page 103 ­ 107

Occult HCV in Egyptian volunteer blood donors
Mostafa A. Amin 1, Kouka S. E. Abdel-Wahab 2 and Adel A. Mousa 3
1 Blood Bank, Nile Hospital, Health Insurance Organization
2 Department of Microbiology, Faculty of Medicine for Girls, Al-Azhar University.
3 Department of Microbiology, Faculty of Science for Boys, Al-Azhar University.

Objective: The study aims to investigate the risk of post-transfusion transmission of hepatitis c
virus (HCV) in the circumstances of occult HCV when anti-HCV is undetectable by ELISA and HCV-
RNA is detected by RT-PCR in the plasma and or in peripheral blood mononuclear cells (PBMCs) of
donor blood and the recipients are immunocompromised. Patients & methods: The study covered 18
chronic renal failure patients (CRF) [12 males (66.7%) their age ranged from 28 to 65 years and 6 females
(33.3 %) their age ranged from 15 to 55 years] undergoing hemodialysis in Nile Hospital as part of their
therapy have to receive blood transfusions (275 blood units) for the first time. Commercial ELISA kits for
anti-HCV and nested-RT-PCR (N-RT-PCR) kits were used. Results: Anti-HCV was positive in one
serum from the eighteen (5.5%) poly transfused CRF patients at the end of the study while the seventeen
sera were negative. This serum was also positive for HCV RNA by N-RT-PCR. Out of the 20 transfused
blood units, one blood unit (three components) were tested by blood banking anti-HCV negative by
ELISA, were positive for HCV RNA by N-RT-PCR. The collective markers of this blood unit represent
an occult HCV. The risk of acquiring post-transfusion HCV infection from an occult HCV blood unit is
5%. Real time PCR showed variation in the viral load of the serum of the infected CRF patient, the
plasma of blood unit, the PBMCs of this blood unit whether activated by PHA-M or not.
Key words: Occult HCV, Egyptian, blood donors.


The existence of hepatitis C (originally
Generally, most studies of HCV prevalence use
"non-A non-B hepatitis") was postulated in the
nonpaid blood donors to represent the
1970s and proven in 1989 (1).
community infection frequency. Screening is
HCV is a small, enveloped, single-stranded,
usually done by anti-HCV antibodies. Using
positive-sense RNA virus (2). It is a member of
blood donors as a prevalence source may
the hepacivirus genus in the family Flaviviridae
underestimate the real prevalence of the virus
because donors are generally a highly selected
HCV is a human infection affecting
population (10). Also Blood banks do not report
primarily the liver. HCV infection is often
follow-up HCV testing of recipients.
asymptomatic, making it very difficult to detect

it at an early stage and this is the major reason
Material and Methods
why early treatment is difficult. It is often
Study Samples:-
referred to as ' silent disease' (4).
Eighteen CRF patients [12 males (66.7%)
HCV is spread primarily by blood
whose age ranged from 28 to 65 years and 6
transfusion, intravenous drug abuse, poorly
females (33.3 %) whose age ranged from 15 to
sterilized medical equipments and vertically
55 years] undergoing hemodialysis in Nile
from an infected mother. An estimated 130­
Hospital who received blood transfusion (275
170 million people worldwide are infected with
blood units) for the first time. For follow up
hepatitis C. In some countries, e.g., Egypt, the
study a 5 ml blood was collected from these
prevalence is as high as 22% (5).
CRF patients before dialysis every three months
There are seven major genotypes of HCV,
for a period from November 2011 to October
which are indicated numerically from one to
2012 for time-lapse detection of acute HCV
seven (6). The prevalent genotype in Egypt is
infection by screening for anti-HCV in their sera
type 4 (73%) followed by genotype 1 (26%)
by ELISA (Axiom kits, Germany).
whereas mixed HCV genotypes infection was

found in 15.7% (7).
Detection of anti-HCV by ELISA during
Although HCV is mainly hepatotropic, its
follow up of transfusion-recipient CRF
presence in extrahepatic sites has been widely
demonstrated (8). Several investigators have
Plasma samples of the transfused blood units
demonstrated that HCV infected peripheral
(275 units) were screened for anti-HCV by
blood mononuclear cells (PBMC) are the major
ELISA using a commercial kit (Axiom,
extrahepatic site of viral replication (9).
Germany). Peripheral blood mononuclear cells

Full Paper (vol.50 paper# 8)

QUANTITATIVE AND ULTRASTRUCTURAL STUDIES OF TESTICULAR TISSUE USED IN CASES OF ICSI The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50 , Page 108 ­ 126

Comparative epidemiological studies on Echinococcosis of local and
imported livestock in Al-madina Al-munawwarah in Saudi Arabia
Yousef Abdal Jalil Fdaladdin*, Ahmad I. Alsaggaf* and Majed H. Wakid**
* Department of Biological Sciences, Faculty of Science,King Abdul Aziz University , Jeddah, K.S.A.
**Faculty of Applied Medical Sciences, Abdul Aziz University, Jeddah, K.S.A.

Aim of the work
- This research aims to study the epidemiology of the parasite in livestock by
using statistical methods for analyzing the numbers of infections and prevalence of the disease
among one year (1431HD) in the camels, cattle, sheep and goats..The genus Echinococcus is of
great importance because it can cause the cystic echinococcosis( CE), or hydatid cyst, this
disease is one of the serious parasitic diseases that may lead to death, and only can be treated
surgically This disease can bring a lot of material loss to livestock and can cause serious ill
health in man. The genus Echinococcus contains a number of zoonotic species.There are at least
4 species in the genus.

Material and methods : The data where collected regularly each week for among one year
from the official slaughter house records for the infected camels, cattle, sheep and goats with the
cystic echinococcosis, all the collected data were inserted in tables and divided to four
quarters(Q1,Q2,Q3 and Q4) three months in each quarter, then statistical analysis (Chi test for
goodness of fit and for independence) where used to analysis the numbers and prevalence of
infected animals.

The present study have been demonstrated that the prevalence of the CE in the year
1423HD was higher in camels with percentage of 7.21% followed by cattle (6.35%) then sheep
(2.60%) and the least in goats (1.84%) for both local and imported livestock ,there were very
high significant relation between the local and imported livestock and there were very high
significant relation between types of animals and between the fourth quarter Q4 and the other
quarters (Q1, 2,&3).

Conclusion: The results obtained in this study showed abundant rate of CE in slaughtered
animals, and it proved the presence of echinococcosis the deadly disease in the region of the
study, which leads to think strongly to find intensive controlling programs to eliminate or
eradicate this disease to avoid losing livestock and reducing man mortalities or infections. More
epidemiological studies are needed to watch the changes in the prevalence of the cystic
echinococcosis because it is a major public health problem throughout the world and causes
serious socio-economic effects
Echinococcusis, cystic echinococcosis , hydatidosis , epidemiology.

The genus Echinococcus is of great
patients within 10 years [4,5,6],carnivores
importance because it contains a number of
such as dogs and foxes serve as final host,
zoonotic species that can cause the disease
they become infected with the adult worm
called cystic echinococcosis ,or hydatidosis
when they consume offal of the
(CE). The larval stage of the Echinococcus
intermediate host that contained a hydatid
grnulosus- is called hadatid cyst which is
cyst. Adult parasites are found in the
highly pathogenic and can make serious ill
intestine of dogs. Eggs passed in feces,
health in man , Echinococcus multilocularis
infect a large number of herbivore
causes the alveolar cyst which is deadly and
mammalians which serve as intermediate
fatal [1,2].
hosts including camels, sheep, pigs and
The rate of infection in human reaches 1
cattle. The larval stages (hydatid cysts)
million infected human worldwide [3] ,there
develop in the liver and lungs and
are at least 4 species in the genus, some of
these species are forming deadly disease
intermediate host. Humans are infected
which can be fatal in 90% of untreated

Full Paper (vol.50 paper# 9)

Physiological and Histopathological studies on Bisphenol-A compound as xenoestrogen in male albino rats The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50 , Page 127 ­ 136

Physiological and Histopathological studies on Bisphenol-A compound as
xenoestrogen in male albino rats
Eman G.E.Helal *; Mohamed M.M. Badawi **; Maha G. Soliman *; Nadia A. Abdel-Kawi *; Hewaida
A. E. Fadel ***; Nashwa M. G. Abozaid .**
Department of Zoology, Faculty of Science, Al-Azhar University (Girls)*; Department of Biochemistry, National
organization for Drug Control and Research**. Department of Nutritional Chemistry and Metabolism, National Nutrition

Back ground:
Xenoestrogens are compounds like estrogens in effect but not in structure which are
mimicking the action of endogenous estrogen and activate estrogen receptor. Xenoestrogens are chemically
distinct industrial products potentially able to disrupt the endocrine system by mimicking the action of
endogenous steroid hormones. Among such compounds, the ubiquitous environmental contaminants
bisphenol-A (BPA) may promote adverse effects in humans triggering estrogenic signals in target tissues.
Bisphenol- A is widely used in food and drinks packaging.
Aim of the work: The present study is carrying out to evaluate the effect of bisphenol-A on sexual
hormonal pattern in male albino rats.
Material and Methods: 64adult male Sprague ­ Dawley rats (100-120 g) were divided to four groups
(16 rats/group).Group (1): control group without any treatment. Group(2): positive control group was injected
subcutaneously (s.c) with sesame oil daily. Group (3): received BPA daily with low dose (10 mg/kg/day s.c).
Group (4): received BPA daily with high dose (30 mg/kg/day s.c). The experiment durated 30 days, half rats
of each group were sacrificed after 15 days of treatment and the other half of groups after 30 days. The blood
was collected, serum was separated and used for estimation of (hormonal levels, prolactin, gonadotrophin and
testosterone) and some biochemical parameters (liver enzymes, kidney function, protein and lipid profile).
Testis, liver and kidney were taken for the histopathological examination.
Results: Biochemical results showed significant elevation in prolactin and FSH levels and significant
reduction in LH and testosterone levels in all groups compared to the control group. Increased serum enzymes
(ASAT, ALAT& ALP) levels with increased concentration of urea and creatinine were detected in all the
treated groups compared to the control group. Decline in protein profile and elevation in the concentration of
lipid profile, while HDL was decreased in all the treated groups. Histopathological results showed dystrophic
changes in the form of congestion in the blood vessels of the testis, liver and kidney of rats with thickening of
walls of the blood vessels especially in the testis. In liver, focal inflammatory areas, with dilated and congested
central and portal veins were found. Vacuolar degenerative changes in hepatocytes were seen. In the kidney,
mild nephritis, sclerotic changes in glomerular tuft, hyaline casts in the lumen of epithelial cells which lining
convoluted tubule were noticed.
Conclusion: From the previous results we concluded that bisphenol-A has dangerous effects on the testis,
liver and kidney tissues. Also it disrupted sexual hormonal pattern and affect biochemical and lipid
parameters. So, we recommended minimizing the utililizing of these compound to protect people from its
hazardous effects.
Key words- Xenoestrogens , Bisphenol-A , Hormonal assay , Biochemical parameters , Histopathological

Xenoestrogens are small lipophillic molecules
to ER and hormonal activity is extremely weak,
that mimic physiological estrogens [1] and whose
making the intrinsic significance of low dose
exposures have been linked to a variety of disease
effects obscure. We thus supposed that BPA might
states even when present at concentrations far
interact with nuclear receptor(s) other than ER
below those currently allowed by federal
Bisphenol-A (BPA) is a high production volume
chemical used principally as a monomer in the
Bisphenol A (BPA) has been acknowledged as
manufacture of numerous chemical products [4].
an estrogenic chemical able to interact with human
Bisphenol- A (BPA) is a chemical used for lining
estrogen receptors (ER). Many lines of evidence
metal cans and in polycarbonate plastics, such as
reveal that BPA has an impact as an endocrine
baby bottles. In rodents, BPA is associated with
disruptor even at low doses. However, it's binding
early sexual maturation, altered behavior, and

Full Paper (vol.50 paper# 10)

d:\skydrive\Jor\vol50_11 The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50 , Page 137 ­ 140
Mubarak Ali AlGahtany
Department of surgery, Neurosurgery Division, King Khalid University,KSA.

Adeloye-Odeku disease, also known as congenital inclusion dermoid cyst (CIDC) of the anterior
fontanelle was first described by Adeloye A and Odeku EL, as a solitary congenital subgaleal
inclusion dermoid cyst of the anterior fontanelle. This rare lesion was initially thought to be
confined to Africans . The universal distribution of this cyst has subsequently been shown in
accumulated literature of other ethnic distribution ,Caucasian, Indians, Chinese, Japanese, Turkish
and others. This is the first published report that we know of Adeloye-Odeku disease in Arab-
Saudi children in Abha, Saudi Arabia. Four patients with Adeloye-Odeku disease, two boys and
two girls, Saudi patients with ages ranging from 3months to 9 years are presented. Successful
surgical excision of the cyst was achieved in each of the three patients who consented for surgery
with no recurrence. The oldest patient did not go for surgery due to parental refusal but the lesion
proved to be stable on follow up.
Key Words: Adeloye-Odeku, inclusion dermoid cyst, Saudi, Congenital.


Congenital inclusion dermoid cyst
recorded (Aslan 2004). All patients had no
(CIDC) of the anterior fontanelle is a rare
associated neurological findings and
lesion; 0.1-0.5% of all cranial tumors
surgical excision is curative. Other
(Aslan, 2004) and 0.2% of all inclusion
important differential pathologies are
cysts (Carvalho et al; 2001). It is noticed
encephalocele, meningocele, sebaceous
soon after birth in all affected patients and
cyst , lipoma , haemangioma and
is usually a solitary lesion.
cephallhematoma. Some authors however
Adeloye and Odeku in 1971, were the
have reported inclusion cysts diagnosed
first authors who published a full
for the first time in adults (Ojikutu and
description and management of
Mordi, 1980 & Castro et al; 2007).
congenital subgaleal cysts over the

anterior fontanelle in Nigerians and
Patients and Method
named it Adeloye-Odeku disease. This
Between 2004 and 2010,consecutive
condition was initially thought to be an
patients with Adeloye-Odeku disease
African cyst (Peter et al, 1992).
were prospectively recruited into this
Worldwide occurrence of congenital
study involving Arab-Saudi patients.
dermoid cyst of the anterior fontanelle
Four patients with non-tender swellings
has since been shown in publication
over the anterior fontanelle were seen in
(Parizek et al; 1989, Aquino; 2003,
the neurosurgical outpatients department
Tateshima et al; 2000, Kanamaru et al;
of Asir Central Hospital, Abha, the
1984, Agrawal et al; 2007 and Majed et al;
regional referral center of the southwest of
the kingdom of Saudi Arabia.
CIDC is a developmental anomaly in
The patients presentation is as follow:
which displaced dermal elements are
(1) A one and half year old female Saudi
included in the Neuroaxis along the
patient was admitted from the outpatients'
embryonic fusion line. There is no
clinic because the parents wanted cosmetic
communication between the cysts and
correction of a small painless scalp
the intracranial contents. The cyst is a
swelling in the middle of her head that had
solitary slow growing, non tender
failed to disappear since her birth. There
fluctuant mass that transilluminate and is
was no other complain in this thriving
covered with intact skin over the anterior
baby girl. Routine blood test were
fontanelle. The size of the cyst varied
normal. CT & MRI brain confirmed the
with the age of the patient at the time of
cyst, 15x20mm in diameter with no
presentation (Aquino 2003) and a
measurement range of 1-7cm have been

Full Paper (vol.50 paper# 11)

The IL-18 Promoter Polymorphisms ( -607 C/A and 137 Q/C ) indetermining HCV clearance or persistence The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50 , Page 141 ­ 149

The Role of Interleukin-18 Promoter Polymorphisms ( -607 C/A and
137 G/C ) in Determining HCV Clearance or Persistence.
Saadia Farid, Laila Rashid and Samya Swelam
Department Of Tropical Medicine and Medical Biochemistry.
National Hepatology and Tropical Medicine Research Institute and Faculty of Medicine Cairo

Two interleukin (IL-18) Polymorphisms ( - 607 C/A and -137 G/C ) and their
haplotypes are known to affect the IL-18 expression. A number of SNPs ( single nucleotide
polymorphisms ) that influence IL- 18 production are found in the gene promoter region.

Aim of the work: The study will determine HCV clearance or persistence as a result of IL-18
promoter polymorphisms (-607 C/A and 137 G/C ) in chronic hepatitis C virus infected patients
during interferon and ribavirin treatment.

Patients and methods: Eighty patients with chronic hepatitis C virus infection, their age ranges
between (23-57) years, selected from the National Hepatology and Tropical Medicine Research
Institute were included in this study, during interferon and ribavirin therapy and fifteen healthy
individuals were included to serve as controls. All the patients and controls were subjected to the
following history, clinical examination, abdominal ultrasonography and collection of blood
samples for routine laboratory investigation, CBCs and serological assay and specific sequence
primer polymerase chain reaction (PCR) IL-18-137, 607 SNP.

Results: There was no significant difference in the frequencies of -137 allelic distribution in
CHCV infection patients and healthy controls.
The -607 AA allele was higher among controls than in patients with CHCV infection.
The -607 CC allele was higher among the CHCV patients than in the healthy controls.
87.5 % of the studied CHCV patients had response to IFN therapy, the majority of cases had
A1F1 biopsy results.

Conclusion: IL-18 promoter polymorphism at -607 position with AA allele is a potential
protective marker, as it is higher among healthy controls than the CHCV patients.

that IL-18 could be considered as a target for therapeutics.

Key words:
IL-18 promoter polymorphism -607 C / A, - 137 G / C, hepatitis C virus, single
nucleotide polymorphisms.

IL 18 promoter polymorphism may affect
respectively, therefore mutation at these two
the outcome of HCV infection in certain
sites could influence IL-18 expression and
groups (1). Three single nucleotide
change the production of the cytokine (2).
polymorphisms (SNPs) are found in the IL-
IL-18 is a pleiotropic proinflammatory
18 gene promoter in positions -656 G-T, -
cytokine that stimulates production of INF-
607 C-A, and ­ 137 G ­ C. Two of these, -
, TNF-, IL-1, IL-2, adhesion molecules
607 C ­ A and ­ 137 G ­ C, are located at
and apoptosis factors, increasing T-
the binding sites for CREB transcriptional
lymphocyte prolipheration, and enhancing
factors cAMP response-element binding
the lytic activity of NK-cells. It participates
proteins and the H4TFI nuclear factor,
in the cellular and humoral immune

Full Paper (vol.50 paper# 12)

Biochemical studies of some Diagnostic Enzymes in Diabetic patients The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50 , Page 1 50 ­ 1 55

Evaluation of Some Biochemical Changes in Diabetic Patients
M.A.El-desoky1; A.E.Amin1;M.O.El-refai 1;R.J.Farid2;A.A.Labib3
1-Department of Chemistry,Biochemistry Division, Faculty of Science, Cairo University.
2-Department of Clinical Pathology, Faculty of Medicine, Cairo University.
3-M.Sc candidate, Faculty of Science, Cairo University.

Patients and methods:
The present study consisted of 50 subjects were classified into three groups ;
Group (GI) Control group consisted of 10 clinically healthy adult subjects of both sexes free from any liver ,
kidney or cardiovascular diseases .
Group (GII) diabetes mellitus type 1 consisted of 20 patients of both sexes.
Group (GIII) diabetes mellitus type 1 with nephropathy consisted of 20 patients of both sexes . All subjects
were undergo to the following investigated parameters; Ascorbic acid (vitamin C) ,Catalase ,Total
antioxidant capacity, Aldolase and Pyruvate kinase enzyme.
Results: vitamins C, catalase, total antioxidant capacity enzymes were highly significant decreased (P < 0.
01) in diabetes mellitus type 1 (GII) and diabetes mellitus type 1 with nephropathy (GIII) when compared
to the control group. Adolase activity was highly significant increased (P < 0. 01) in diabetes mellitus type 1
with nephropathy (GIII) when compared to the control group . Pyruvate Kinase activity was highly
significant increased (P < 0. 01) in diabetes mellitus type 1 (GII) when compared to the control group .
Conclusion: The antioxidant and enzymes can be used for follow up in patients suffering from diabetes
mellitus type 1 and predict other complications.
Key words: Diabetes Mellitus, diabeteic nephropathy, Ascorbic acid, Catalase enzyme, Total antioxidant
capacity, Aldolase enzyme and Pyruvate kinase enzyme.

Diabetes mellitus is a major public health problem
established, but not before. However, it is clear
in the developed as well as developing countries.
today that some subjects could have diabetic
It is ranked seventh among the leading causes of
nephropathy without increased UAE (6).
death, and third when its fatal complications are

taken in to account (1). The strict division into
L-ascorbic acid, also known as Vitamin C, is a
type 1 and type 2 diabetes based on an
water-soluble vitamin that is naturally present in
autoimmune etiology versus a primarily metabolic
some foods, added to others, and available as a
pathology (2).
dietary supplement (7). vitamin C is well known
Type 1 diabetes has been previously known as
for its antioxidant activity, acting as a reducing
insulin-dependent or juvenile-onset diabetes. It
agent to reverse oxidation in liquids. When there
results from the destruction of pancreatic beta
are more free radicals (reactive oxygen species,
cells which leads to insulin deficiency and lifelong
ROS) in the human body than antioxidants, the
dependency on insulin therapy (3) The variation in
condition is called oxidative stress (8). The roles
age at onset could be indicative of disease
of vitamin C as an aldose reductase inhibitor and a
heterogeneity, with different mechanisms leading
water soluble antioxidant in body fluids are
to cell destruction in childhood onset versus
potentially very important as adjuncts to tight
adult onset diabetes (4)
glycemic control in the management of diabetes
Diabetic nephropathy is the leading cause of
chronic renal disease in patients starting renal
Catalase is a common enzyme found in nearly all
replacement therapy (5). Diabetic nephropathy has
living organisms exposed to oxygen (10). It is a
been classically defined as increased protein
tetrameric enzyme consisting of four identical,
excretion in urine. Early stage is characterized by
tetrahedrally arranged subunits of 60 kDa, each
a small increase in urinary albumin excretion
containing in its active center a heme group and
(UAE), also called microalbuminuria or incipient
Nicotinamide adenine dinucleotide phosphate
diabetic nephropathy (5) .More advanced disease
NADPH. (11)
is defined by the presence of macroalbuminuria or
An antioxidant is a substance capable of
proteinuria. The latter is classically named overt
preventing or slowing the oxidation of other
diabetic nephropathy. In most cases, proteinuria
molecules. Generally, an antioxidant can protect
and decreased glomerular filtration rate (GFR)
against metal toxicity by trapping free radicals
occur in parallel. Traditionally, GFR has been
thus terminating the chain reaction, by chelating
expected to decrease when proteinuria is
metal ion and preventing the reaction with

Full Paper (vol.50 paper# 13)

Ashraf M
The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50 , Page 156­ 168

Ashraf M. Mostafa, 1 Abdel Hamid A. Serwah, 2 Waleed S. Mohamed, 3
And Khaled M. Mohamed 4
Anatomy and Histology Department, College of Medicine, Taif University, KSA.1Internal Medicine Department,
College of Medicine, Taif University, KSA.2Internal Medicine Department, College of Medicine, Taif University,
KSA.3Pharmacognosy Department, College of Pharmacy, Taif University, KSA. 4
Author of Correspondence: Ashraf M. Mostafa, Anatomy and Histology Department, College of Medicine, Taif
University. E-mail: . Mobile: 00966/551410080

Background and aim of the study-
Diabetes is a chronic metabolic disease which affects large number
of population all over the world. More than 400 traditional medicinal plants have been recorded for
helping in controlling such disease. This study investigated effects of some plants used in Saudi Arabia
and some other Arab countries as antidiabetic agents.
Materials and Methods: One hundred fifty adult male Albino rats were divided into six experimental
groups each consist of twenty five rats. The first group was considered as a control group. The rest of
groups were affected by induction of experimental diabetes by subcutaneous injection of Alloxan. The
second group consisted of diabetic rats without any treatment. The third group was treated by the aqueous
extract of mixture contains Foenugreek, Nigella and Termis seeds. The fourth group was treated with the
aqueous extract of Nigella sativa seeds, while the fifth group was treated with the aqueous extract of
Foenugreek seeds.The sixth one was treated with the aqueous extract of Termis seeds with the administered
dose of the plant extracts (100 mg/kg body weight).After four weeks of treatment, different biochemical
parameters were performed including estimation of blood sugar level and serum insulin level. Pancreatic
and liver samples were obtained and processed for microscopic and quantitative evaluation after staining
the prepared sections with both heamatoxylin and eosin as well as a special stain for demonstration of the
different pancreatic cells in the Islet of Langerhans.
Results: The usage of the mixture or each plant alone corrected the glucose level and insulin level.
Microscopically there was definite decrease in the number and diameter of beta pancreatic cells in the
diabetic group, while the other pancreatic cells were not affected (alpha and delta cells). The use of
medicinal plants in the different groups of this study greatly improved such cellular changes and the level of
blood sugar level was corrected. The present results showed that the activity of the mixture was the best
when compared with Nigella, Foenugreek and Termis seeds.
Conclusions: The water extract of the mixture is the most powerful in amelioration hyperglycemia and
most of all damage effects of Alloxan on the liver and texture, hematological parameters, and lipid profile.
So it is advised to use the plant mixture as an antidiabetic agent rather than the use of each plant separately.
Repeating such study with the use of variable doses may be helpful in better evaluation for the required
Key words: Alloxan - Diabetes - Antidiabetic plants - Pancreas

Diabetes mellitus (DM) is possibly the world's
glucose production from liver and antagonize the
fastest growing metabolic disease, so there is a
problem of insulin resistance (2). Traditional
great need for more appropriate therapies (1).Many
remedies which are often free from side effects
plants have been investigated for their beneficial
are still in use by some diabetic patients in
use in treating DM and reports are published in
developing countries, and may therefore; present
numerous scientific journals. The active
new avenues in the search for alternative
principles present in medicinal plants have been
hypoglycemic drugs.
reported to possess pancreatic beta cells re-
Literature survey revealed that Nigella sativa oil
generation, increase insulin secretion, enhance
lowered blood glucose concentration in the
glucose uptake by adipose or muscle tissues and
diabetic rats and the hypoglycemic effect of
inhibit glucose absorption from intestine and
Nigella sativa may be mediated by extra

Full Paper (vol.50 paper# 14)

d:\skydrive\Jor\vol50_15 The Egyptian Journal of Hospital Medicine (Jan. 2013) Vol. 50 , Page 169­ 178
Effect of Air Pollution, Contamination and High Altitude on
Bronchial Asthma
Nesriene El margoushy*, Mohamad El Nashar**, Hatem Khairy*, Nihad El Nashar*,
Hala Mohamad*
Taif University, Gizan University

Epidemiological studies have shown that the prevalence of asthma has risen dramatically worldwide
and evidence suggests that environmental factors have an important role in the etiology of the
disease. Most respiratory diseases are caused by airborne agents. Our lungs are uniquely vulnerable
to contamination from the air we breathe. Air pollution exposure is associated with increased asthma
and allergy morbidity and is a suspected contributor to the increasing prevalence of allergic
conditions. Observational studies continue to strengthen the association between air pollution and
allergic respiratory disease.
The effects of air pollution should be viewed in two different groups: healthy people and people
with chronic heart or lung disease. Although the fundamental causes of asthma are not completely
understood, the strongest risk factors for developing asthma are inhaled asthma triggers. These
include: indoor allergens (for example house dust mites in bedding, carpets and stuffed furniture,
pollution and pet dander), outdoor allergens (such as pollens and moulds), tobacco smoke and
chemical irritants in the workplace. Other triggers can include cold air, extreme emotional arousal
such as anger or fear, and physical exercise. Even certain medications can trigger asthma such as
aspirin and other non-steroid anti-inflammatory drugs, and beta-blockers. Urbanization has also
been associated with an increase in asthma; however the exact nature of this relationship is unclear.
Medication is not the only way to control asthma.
It is also important to avoid asthma triggers - stimuli that irritate and inflame the airways.
Prevalence of asthma is generally low within the Middle East, although high rates have been
recorded in the Kingdom of Saudi Arabia, Kuwait, Lebanon, and Israel.
The prevalence of asthma and asthma-related symptoms is high among 16- to 18-year-old
adolescents in Saudi Arabia, and the symptoms are more common in boys than in girls, associated
with a high rate of rhinitis symptoms and hay fever. In addition to bronchial asthma, prevalence of
al ergic diseases in a sample of Taif citizens assessed by an original Arabic questionnaire (phase I) evidenced a high
prevalence of allergic diseases as Urticaria, allergic rhinitis with or without other co-morbidities,
and atopic dermatitis. Effect of high altitude on bronchial asthma is controversial; at high altitudes,
the concentrations of the allergens are reduced due to the reduced amounts of vegetation, animal
populations and human influences, high UV light exposure and low humidity could be contributing
factors to the benefits of high altitude other than allergen avoidance. On the contrary, Lower
altitudes have significant beneficial effects for bronchial asthma patients but lessen with increasing
altitudes; the mountain climate can modify respiratory function and bronchial responsiveness of
asthmatic subjects.
Hypoxia, hyperventilation of cold and dry air and physical exertion may worsen asthma or enhance
bronchial hyper-responsiveness while a reduction in pollen and pollution may play an important role
in reducing bronchial inflammation. Increasing attention has to be paid to the potential of urban air
toxics to exacerbate asthma. Continued emphasis on the identification of strategies for reducing
levels of urban air pollutants is warranted to reduce respiratory diseases and other diseases related to
pollution. Efforts for reducing the asthma burden must focus on primary prevention to reduce the
level of exposure of individuals and populations to common risk factors, particularly tobacco
smoke, frequent lower respiratory infections during childhood, and environmental air pollution
(indoor, outdoor, and occupational).

Epidemiological studies have shown that the
environmental factors have an important role
prevalence of asthma has risen dramatically
in the etiology of the disease. Although the
worldwide and evidence suggests that
fundamental causes of asthma are not

Full Paper (vol.50 paper# 15)