Non-Polio Enteroviruses As Causative Agents Of Aseptic Meningitis The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 486­492
Non-Polio Enteroviruses
Aseptic Meningitis:Embaba Fever Hospital Admissions 2010-2011
Raafat A. Abdel-Twab¹, Kouka S. Abdel-Wahab2. Ahmed O. El-Kafrawi3, Moustafa A.
Aly3, Laila A. EL-Bassiony4, May EL-Maamoun4, Caroline Fayez5.
Microbiology Department,faculty of medicine,al-Azhar university

Human enteroviruses (EV) cause a wide spectrum of both common and uncommon illnesses
among all age groups. Enterically transmitted. The objective of this study was to identify non-
poliovirus EV as a cause of viral aseptic meningitis (VAM) by two methods (cell culture and Real
time PCR). From October 2010 to August 2011 cerebrospinal fluid (CSF) samples were collected
from 85 patients Embaba fever hospital admitted with symptoms of aseptic meningitis of any age
and both sexes. The 85 CSF samples were inoculated into RD (human rhabdomyosarcoma) cell
line in three blind passages to amplify isolates producing EV-like CPE. A total of 14 (16.5%) out
of 85 CSF samples showed EV-like CPE. By Real time PCR 11 out of the 14 culture positive
samples and 5 out of the 14 source of virus isolation original CSF were non polio EV positive.
The frequency of non-polio EV meningitis hospital admissions was in the summer season (50%),
spring (25%), late autumn (16.6%) and least frequency in winter (8.4%). non-polio EV meningitis
was detected in 6 out of 41 male patients (14.5%) and in 6 out of 44 female patients (13.5%).
Also non-polio EV meningitis was detected in all ages with marked increase of incidence in
young children (41.6%) and old age (50%) and less in adult (8.4%).
In conclusion
Our data showed that the non-polioviruses EV was associated with the majority of VAM during
2010 ­ 2011 at the Embaba fever hospital which serves Embaba, Shoubra Elkheema, Qualyba
and neighbors localities in Egypt. Rapid detection of non-polio EV meningitis is essential for
making decisions about patient management and treatment.

Key words: Aseptic meningitis, cerebrospinal fluid, cell culture, Real time PCR, non-polio EV.


The EVs are small RNA viruses belonging
VP4, that surround a positive-stranded RNA
to the Picornaviridae family. Currently,
genome of approximately 7500 nucleotides
more than 111 serotypes of EV have been
(White and Fenner, 1994)2. The lack of a
identified divided into 4 species, including
lipid envelope contributes to the in vitro
enterovirus A (EV-A) (23 serotypes
stability of the enteroviruses, permitting EVs
including some coxsackie A viruses and
to survive the gastric pH as well as
environmental stresses. The EVs remain
enteroviruses, coxsackie
viable for prolonged periods in sewage,
viruses, echoviruses, and swine vesicular
water, fomites and on hands, thereby
disease virus), EV-C (23 serotypes including
enhancing their transmissibility. When
poliovirus (PV) 1-3, some coxsackie A
frozen, these viruses are stable for years and
viruses and enteroviruses), EV-D (5
even decades (Racaniello, 2007)3. The non-
serotypes: EV-68, EV-70, EV-94, EV-
polio EV can cause a broad spectrum of
D111and EV-D120) (1).
illnesses such as febrile
disease, hand-foot-
Enteroviruses are small, icosahedral
mouth disease, herpangina, viral aseptic
RNA non-enveloped particles of about 30
meningitis and encephalitis (Michos et al.,
nm diameter, composed of sixty copies of
2007 and Irani 2008)4,5. Myocarditis and
each of the four structural proteins VP 1 to
neonatal sepsis (Afifi, et al., 2009)6. Aseptic


Full Paper (vol.52 paper# 1)

d:\skydrive\Jor\vol52_2 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 493­505
Assessment of Nutritional Status among Preparatory School Girls
in Talkha City
Abd El-Rahman, S. I. & Aly Hassan S. A. & EL-Bastawesy S.I
Community health nursing faculty of nursing zagazig university-Egypt.

Background: Adolescence is the period of transition from childhood to adulthood, and it occupies
a crucial position in the human life. Nutrition for adolescents is important in which there was found
changes in growth and hormones, activity, and food intake.
The objective of the work: was to assess the nutritional status of preparatory school girls in Talkha city.
Patients and methods: a descriptive cross- sectional study on a group of 500 students from the second
and third year of the preparatory school girls at Talkha City in Dakahlia governorate , the tools used : 1-
A self-administered questionnaire for assessing socio-demographic characteristics of students,
anthropometric measurements included weight and height, nutritional health problems, assessing dietary
knowledge, and eating habits.2 - An observational checklist to observe signs of malnutrition for the
Results: majority of students, girls aged from 13- 14 years old and their mothers were house wife
(69.6% &77.3%) , Only less than half studied sample has correct knowledge about the balanced diet, the
components of healthy diet, and the effect of healthy balanced diet on individual's health (34.6
%&20%&78.4%) respectively. Majority of students prefer eating food during watching TV., eating spices
and salty food, and eating much candies (76.2% &74.6%& 73.6%) respectively. The most common
health problems were headache, GIT problems and dental decay respectively. Conclusion: only one
quarter of the studied sample had correct and complete answers about balanced diet. The present study
recommended that, health education for nutrition and healthy balanced diet should be integrated in the
curriculum of preparatory school girls. Nurses and medical staff must play a significant role in screening,
teaching, and guiding of adolescents about healthy balanced diet.
Key words: Nutrition- health problem- adolescent- malnutrition.

Nutrition is one of the most important single
Healthy eating in childhood and adolescence is
factors for the health of the individual or the
important for proper growth and development
community, and is consequently a fundamental
and can prevent health problems such as obesity,
issue in modern public health (1). Optimal health
dental caries, iron deficiency, and osteoporosis
is found in good nutrition. So that eating the
(1,2) .
right kinds and amount of food with good
Adolescents have been found to have the
dietary habits throughout the entire life cycle
highest prevalence of any age group of an
means healthier bodies and minds, greater
unsatisfactory nutritional status (3).
vitality and energy, greater resistance to
Adolescent girls are particularly vulnerable to
diseases, efficiency and happiness (2) .
malnutrition because they are growing faster
Nutrition is an essential component of total
than at any time after their first year of life. They
adolescence health care. Changes occurring
need protein, iron, and other micronutrients to
during adolescence can cause a crisis in the
support the adolescent growth spurt and meet the
nutritional needs. Eating habits may change
body's increased demand for iron during
from regular meals prepared at home to irregular
meals, skipped meals, nutrition, poor snacks and
pregnant are at greater risk of various
fast food meals. Healthy eating is associated
complications since they may not yet have
with reduced risk for many diseases, including
finished growing (4). Most adolescents consider
several of the leading causes of death: heart
themselves to be generally healthy.
disease, cancer, stroke, and diabetes. (3).
However, in Egypt, studies reveal a number of
widespread health problems among boys and

DOI: 10.12816/0000586

Full Paper (vol.52 paper# 2)

The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 506­514

Role of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of
Suspicious Breast Lesions
Marwa E Abdelrahman *, Aida M Elshibiny *, Marwa I Fahmy *,
Ahmed F Abdelghany *, Mohamed Elshinawy **.
* Departments of Radiodiagnosis and** General Surgery, Ain Shams University.

Diffusion weighted Imaging "DWI" is a specific modality to produce images of tissues
weighted with the local microstructural characteristics of water diffusion. DWI can give information
as regards cellularity of breast lesions and it can be used for distinguishing between benign and
malignant breast lesions, differentiating surgical scar from recurrence and monitoring therapies in
locally advanced breast cancer
Aim of the work: To assess the diagnostic value of diffusion weighted imaging as an adjuvant to
breast magnetic resonance imaging for detection and differentiation of suspicious breast lesions and
correlation with histopathologic findings, available clinical data or follow up.
Methods: The studied group included 50 female patients referred for MRI breast for workup of a
suspicious clinical, mammographic, or sonographic abnormality. Diffusion weighted imaging (DWI)
was added to the routine study. Results of the contrast enhanced bilateral breast MRI and DWI of the
50 patients were all reported and compared with the histo-pathological results of surgery or biopsy and
with the results of follow up of lesions that were not surgically removed or biopsied.
Results: there was a highly significant relation between DWI and histopathological/ Follow Up results
with p value = 0.000. The sensitivity, specificity, positive and negative predictive values of DWI for
characterization of suspicious breast lesions in patients included in the study, were 89.5%, 100%,
100%, and 93.94% respectively.
Conclusion: DWI is a short unenhanced scan that can be inserted easily into standard clinical breast
MRI protocols as a potential adjunct that can be added routinely to conventional breast MRI, and can
accurately differentiate benign from malignant breast lesions with high sensitivity and specificity.
Key words: Magnetic Resonance Imaging, Suspicious Breast Lesions.

Compared with mammography and
To increase breast MRI specificity,
breast ultrasonography, contrast material­
DWI, that has shown great promise in the
enhanced MRI is a breast imaging technique
detection of most tumor types throughout the
that offers not only information on lesion
entire body and showed superior lesion to
cross-sectional morphology but also on
background contrast, could represent an
functional lesion features such as tissue
important resource(3).
perfusion and enhancement kinetics(1).
Diffusion Weighted Imaging is a
Although, breast MRI demonstrated
specific modality to produce images of tissues
excellent sensitivity, its low specificity
weighted with the local microstructural
continues to represent a limit, particularly in
characteristics of water diffusion(4). Diffusion
patients referred for further clarification of an
Weighted Imaging reflects the random thermal
inconclusive conventional breast imaging
motion of molecules (Brownian motion) (4).
The Brownian motion of protons in bulk water
produces the signal in DWI. So, DWI can

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Full Paper (vol.52 paper# 3)

Introduction: The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 515­521

Role of Peritoneal Ports for Treatment of Intractable Ascites
Haytham M Nasser, Maha M Abd El Raoof, Maha K Abd El Ghafar, Mohamed Y Mostafa,
Mohamed Sobhi Hassan.
* Departments of Radiodiagnosis and** Oncology, Faculty of Medicine, Ain Shams University.

Ascites is a common complication of advanced malignancies and cirrhosis. Symptoms
of marked abdominal distention, shortness of breath, diminished appetite, fatigue, and lower-extremity
edema can significantly compromise a patient's everyday life. Treatment options for intractable ascites
include serial paracentesis, peritoneovenous shunting, transjugular intrahepatic portosystemic shunt
(TIPS) creation, and tunneled peritoneal catheters that may be external or, more recently, attached to
subcutaneous ports. It is therefore appropriate to evaluate a port specifically designed for peritoneal
access as a mean of controlling intractable ascites. We present a minimally invasive treatment for
palliative drainage of symptomatic ascites in patients with advanced malignancy.

Aim of the work: The aim of this work is to evaluate the percutaneous implantable access system
specifically designed for peritoneal access as a method to control intractable ascites as regards
complications and patency.

Methods: This is a prospective intervention study will be conducted on 40 patients with intractable
ascites referred from the oncology clinic to the diagnostic imaging department for percutaneous
placement of peritoneal portcath as a palliative treatment for the patient.

Results: Good technical success rate (100%) in insertion was found with removal of ascites gradually.
Immediate relief of symptoms (100%). There were no major complications. There was one minor
complication(2.5%), a leakage at the port placement site in a patient with pancreatic carcinoma. The
leakage stopped spontaneous with removal of ascites and the patient underwent conservative

Conclusion: peritoneal port systems for treatment intractable ascites is efficient way to avoid
ascites related morbidity with increases patient compliance, satisfaction by decreased hospital visits as
the drainage and patients monitor can be done in their homes. Port aspiration can be performed in
some cases by patients or family members without nursing assistance. In comparison with tunneled
peritoneal catheters with external components, the complication rate appears to be minimal.
Key words: Peritoneal Ports, Intractable Ascites.

Ascites is a common complication of
considered viable treatment options for
advanced malignancies and cirrhosis (1, 2&3).
intractable ascites as a result of problems with
Symptoms of marked abdominal distention,
infection, malposition, and occlusion (4,5).
shortness of breath, diminished appetite,
However, tunneled peritoneal catheters
fatigue, and lower-extremity edema can
have been used for many years for peritoneal
significantly compromise a patient's everyday
dialysis with acceptable complication rates
function (2).
(6,7). In 1999, 27,000 people received
peritoneal dialysis in the United States,
constituting 9% of the dialysis population,
where mortality rates was similar to or lower
than those in hemodialysis patients (8).
peritoneovenous shunting, liver transplantation
Tunneled catheters have generally been placed
and tunneled peritoneal catheters with external
in operating rooms (6). Recently, 2-year
component yet recently peritoneal port
catheter survival rates with percutaneous
represent minimally invasive effective option
placement have been reported to be 49%­82%
for treatment of intractable ascites..
(8). Rosenblum et al (4) described the use of a
subcutaneous venous access port to treat
catheters with external component was not
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Full Paper (vol.52 paper# 4)

d:\skydrive\Jor\vol52_5 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 522­533

Role of Multidetector Computed Tomography In The Diagnosis Of
Congenital Thoracic Vascular Anomalies
Sahar M El Fiky , Hanan M Hanafy , Mohammed S Hassan , Mostafa M Mansour
Department of Radio-diagnosis, Faculty of Medicine, Ain shams University

Introduction & purpose:
Congenital vascular anomalies of the thorax represent an important group
of entities that can occur either in isolation or in association with different forms of congenital heart
diseases. CT scan is a non invasive & rapid technique used for evaluation of the pediatric vascular
disease as an alternative to conventional angiography. Purpose: To assess the role of MDCT scan in
evaluation and its ability to diagnose congenital thoracic vascular anomalies as well as to recognize
these anomalies early for proper treatment and post operative follow up.
Subjective & Methods: The studied group included 80 patients, who underwent MDCT angiography
and had diagnosed of congenital thoracic vascular anomalies, post operative follow up or
asymptomatic (incidentally discovered) were included in this study.
Results: CT angiography can diagnosis about 13% (n=6) of cases not seen very well by
echocardiography (inconclusive) and 26% (n=12) of cases appear as different findings by CT scan
than echocardiography. Three dimensions (3D) images allow excellent display of vascular anomalies
that can be used as a vascular road map by surgeons.
Conclusion: MDCT provides reliable diagnostic information on the normal anatomy of the aorta,
pulmonary & vena cava as well as congenital anomalies in pediatric and adult patients. MPR and 3D
VR images have increased the diagnostic value of CT. Furthermore, coronal and sagittal views of the
vessels facilitate the orientation of a surgeon, and thus aid in planning surgery.
Key words: Multidetector Computed Tomography, Congenital Thoracic Vascular Anomalies

From a clinical viewpoint, they can be totally
conscious sedation for pediatric patients
silent or, because of associated cardiac
undergoing imaging and therapeutic procedures
anomalies or compression of the airway and
oesophagus, result in cardiovascular, respiratory,

or feeding problems that result in morbidity and
Patients & methods:
mortality. It is extremely important to have a
Patient population:
clear understanding of these entities, their
Eighty patients (50 male and 30 female)
imaging characteristics, and their clinical
who underwent MDCT angiography of the
relevance. (1,2). Multi-detector row computed
chest between October 2010 and December
tomography (MDCT) has changed the approach
2012 and had diagnosis of congenital thoracic
to imaging of thoracic anatomy & disease.
vascular anomalies were included in this
MDCT with multi-planner & three dimensional
study. MDCT angiography was done either
reconstructions has become an important
due to presence of congenital vascular
examination in the evaluation of systemic &
anomaly or as post operative follow up of a
pulmonary vasculature and the trachea-bronchial
known case of thoracic vascular anomaly.
tree (3).The aim of this study is to assess the role
Some cases were asymptomatic and
of MDCT scan in the evaluation of congenital
discovered incidentally during doing routine
thoracic vascular anomalies.
MDCT of the chest.
Due to the fast scanning times of MDCT,
Patient preparation:
sedation is seldom required for older children Patient must be fasting four hours prior to the
and adults. For infants and children younger
examination. Informed consent was obtained for
than 5 years of age, however, sedation may be
all patients. Patients who are known as asthmatic
necessary. The American College of Radiology
received prednisolone according to the patient's
has issued helpful guidelines to assist
age as follows; 1mg/kg divided on three days
radiologists in the safe and effective use of
prior to the examination for children and 60 mgs

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Full Paper (vol.52 paper# 5)

Introduction: The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 534­543

Role Guided Intraperitoneal Port-A-Cath Insertion in The Managment of
Cancer Ovary of Fluoroscopic
Ahmed H Soliman *, Saad Ali Abd-Rabou *, Maged Abou Seada *,
Mohsen Gomaa El-Sharkawy ** Hesham Ahmed El-Ghazaly * , Mohamed Sobhy Hassan *,
Amr Mahmoud Abdel-Samad *
* Departments of Radiodiagnosis , Gynecological Oncology and ** Oncology, Faculty of Medicine,
Ain Shams University.

Introduction :
The use of intraperitoneal (IP) chemotherapy as a treatment for ovarian cancer has been demonstrated
to result in improved survival.
Aim of the work: The aim of this work is to evaluate the applicability and efficacy of fluoroscopic
placed intraperitoneal port-A-cath and to assess the response rate to intraperitoneal chemotherapy in
cases of ovarian carcinoma .
Methods: The studied group included ,22 female patients with malignant ovarian cancer whom
referred from gynecological surgery and gynecological oncology units to the Vascular and
Interventional Radiology Unit, Ain Shams University Hospitals, for peritoneal port-A-cath
application. All the patients were known cases of either primary or recurrent ovarian cancer ,
underwent cytoreductive surgery and referred to us .
Results: Intraperitoneal port-A-cath with the aid of fluoroscopy showed highest technical success (
91.9% ) and lowest complication rate on the long run compared to other methods of peritoneal access .
Patients with cancer ovary showed significant improvement of the disease process denoted by
changes in the degree of ascites , peritoneal nodules and tumor marker level after receiving combined
IV/ IP chemotherapy.
Conclusion: Port catheters proved to be the most safe method of long term access to the peritoneal
cavity with the lowest complication rate compared to other methods of access to the peritoneal cavity.
Key words: port-a-cath.,ovarian cancer,fluoroscopy,intraperitoneal chemotherapy.


Ovarian cancer is the most common cause of
times higher than it would have been tolerated
through the systemic circulation .(4)
gynecological malignancies (1).
The Gynecologic Oncology Group (GOG)
The high mortality rate is attributed to the fact
that >75 % of the patients are diagnosed at an
combination IV/IP therapy compared to IV
advanced stage of the disease (1).
chemotherapy alone (1).
The initial lines of treatment with ovarian
Women proved to have adenocarcinoma
carcinoma include cytoreductive surgery with
by biopsy or cytology with stage III/ IV
tumor debulking whenever possible to the
(pleural effusions only) epithelial ovarian,
greatest possible extent with the remaining
fallopian tube or primary peritoneal carcinoma
amount of the disease after surgery (2).
if optimally debulked they receive IV
Intravenous (IV) combination chemotherapy
paclitaxel 175mg/m2 and IP carboplatin 5 (day
became the standard postoperative treatment
1) and IP paclitaxel 60mg/m2 (day 8) q28
regimen for women with advanced-stage
days×6 cycles .(1)
ovarian cancer . (3).
An effective and safe method for delivery
The characteristic feature of ovarian cancer
of the chemotherapeutic agent into the
specially epithelial ovarian cancer (EOC)
peritoneal cavity is recently achieved by the
being chemo sensitive and the intraperoitoneal
placement of intraperitoneal port-A-cath under
spread of disease even in the early stages have
fluoroscopy guidance .(5)
enhanced the strategy of locoregional
The aim of this work is to evaluate the
chemotherapeutic agent directly into the
applicability and efficacy of fluoroscopic
peritoneal cavity.This resulted in reduction of
placed intraperitoneal port-A-cath and to
assess the response rate to intraperitoneal
concentrating the drug to the tumor site many
chemotherapy in cases of ovarian carcinoma .
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Full Paper (vol.52 paper# 6)

Introduction: The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 544­554

Role of Multislice Dental CT in Assessment of Dental Implants
Safa A Elaty *, Ahmed M Monib *, Yasser A Mohamed *,Ahmed F Abd elghany *.
* Department of Radiodiagnosis: Faculty of Medicine, Ain Shams University.

The use of dental implants to restore missing teeth has become increasingly widespread
over the past two decades. Dental MSCT plays an important role in the preoperative planning of dental
implants because it provides accurate measurement of the width and depth of the edentulous ridge as
well as the bone density. And postoperatively, dental MSCT images can show the failure of an
endosseous implant to osseointegrate, improper placement of an implant, and violation of important
Aim of the work: Is to determine the success of dental implants following pre-operative multi-slice
dental CT planning and for early detection of post-operative complications.
Methods: The study included 25 patients that were divided in to 2 groups, Group I included 14
partially edentulous patients who underwent pre and post- operative dental MSCT, while group II
included 11patients that already have dental implants and underwent post-operative dental MSCT
using16-slice helical CT scanner.
Results: There is highly significant (P < 0.001) relation between preoperative dental MSCT
assessment and postoperative results and dental MSCT was very accurate in the evaluation of
osseointegration and very sensitive in the detection of postoperative complications.
Conclusion: Dental MSCT is a promising method that can be used as an imaging tool in the
preoperative planning and postoperative assessment of dental implants.
Key words: Multi-slice CT, dental implants, bone density, preoperative evaluation, postoperative

Partial or total edentulism is not only a
bone density in the implant recipient sites
cosmetic impairment but may substantially
identifying sites suitable for implant placement
affect oral and general health as well as overall
and favorable for osseointegration (5).
quality of life. Self-esteem, speech, and dietary
Postoperatively, dental MSCT images can
intake are affected (1). In response to these
show the failure of an endosseous implant to
problems, dentists developed non-removable
osseointegrate, improper placement of an
bridges that are attached to oral implants (2).
implant, and violation of important structures
Restoration using dental implants is now
(e.g., the mandibular canal, nasal cavity, or
the most popular treatment in the field of
maxillary sinus) (6).
dentistry (3). Dental implants are metal posts
that are surgically implanted in the jaw to
The aim of the work is to highlight the role
support a fixed dental prosthesis (4).
of dental MSCT in the preoperative planning
The successful outcome of any implant
and postoperative assessment of dental
procedure requires a series of patient-related
and procedure-dependent parameters. The
volume of bone available and quality of the
The study included 25 patients (8 males and
bone are highly associated with the type of
17 females, age range 17 ~ 66 years) that were
surgical procedure and the type of implant, and
divided into 2 groups; Group I included 14
both of these factors play a vital role in the
partially edentulous patients planning for
success of dental implant surgery(5).
dental implantation (9 patients were planning
Dental MSCT has high spatial resolution
for mandibular implant insertion and 5 patients
images and capability of multi-planar
were planning for maxillary implant insertion)
reconstructions in high-quality that help in the
having 28 edentulous areas (each edentulous
preoperative planning of dental implants
area was considered a separate case), this
because it aids in the appropriate choice of
group underwent pre and post- operative dental
implant size through accurate measurement of
MSCT. Group II included 11patients that
the width and depth of the edentulous area and
already have dental implants (8 patients have
helps to avoid injury of critical structures such
maxillary implant and 3 patients have
as the mandibular canal or maxillary sinus (4).
mandibular implant), this group underwent
Dental MSCT is a useful tool to determine the
post-operative dental MSCT.
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Full Paper (vol.52 paper# 7)

Immunological assessment of the ex-vivo studies of curcumin and taurine as protective agents against human hepatocarcinogenesis The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 555­565

Clinical Significance of TGF Alpha, TGF Beta1 and VEGF in Sera of
Egyptian Patients with Breast Cancer
Motawa E. El Husseini 1, Fatmaelzahraa Hussein Elewa 2, Nahed Sadek Bassily M.3 ,
Basma Abdelghany M.4
1Cancer Biology Department, National Cancer Institute, Cairo University,
2 Faculty of Science, Zoology Department, Mansoura University,
3Surgical Oncology Department, National Cancer Institute, Cairo University, and
4Faculty of Science, Zoology Department, Cairo University, Egypt

breast cancer (BC) is the most prevalent cancer among women and affects
approximately one million women worldwide each year and it is the most prevalent cancer among
Egyptian women and constitutes 29% of National Cancer Institute cases. This study was designed
to determine the crucial role of TGF-, TGF-1 and VEGF in patients with Breast carcinoma.
Patients & method: serum level of TGF-, TGF-1 and VEGF were determined by ELISA in 51
patients with preoperative & postoperative primary (BC), as well as 30 healthy female persons.
Results: this study showed that the TGF-, TGF-1 and VEGF levels were significantly high (p =
0.001) in patients with primary breast cancer compared to control healthy female group.
Meanwhile the levels of these growth factors did show significant decrease after treatment.
Conclusion: this study revealed that serum levels of TGF-, TGF-1 and VEGF in patients with
breast cancer could be useful biomarkers for prognosis of such type of malignancy.
Key words: Primary BC, VEGF, TGF-, TGF-ß1


As general consideration breast
are derived from a 160-residue precursor by
cancer is the second most common type of
proteolytic cleavage. TGF- is physically
cancer after lung cancer (1), and the fifth
constrained into three ring structures by
most common cause of cancer death after
disulfide bridges formed between six
lung cancer, stomach cancer, liver cancer,
cysteine residues. It has been isolated from a
and colon cancer (2).
retrovirus-transformed mouse cell line (6), it
Breast cancer caused 502,000 deaths
has subsequently been found in human
worldwide (2). The number of cases
tumor cells, in early rat embryo cells, in cell
worldwide has significantly increased, a
cultures from the bovine pituitary gland, and
phenomenon partly blames on modern
normal keratinocytes from human adults (7).
lifestyles in the western world (3).
The roles for TGF- have been proposed in
In Egypt, breast cancer is the most
transformation, wound healing, bone
common cancer among women, representing
resorption, angiogenesis, and cell migration
18.9% of total cancer cases (35.1% in
(8). It is a 6 kDal polypeptide with 40%
women and 2.2% in men) among the
sequence homology to the epidermal growth
patients in National Cancer Institute (NCI)
factor (EGF), with which it shares a
common receptor. Like many growth factor
Metastasis is regulated not only by
receptors. In breast cancer cell lines, TGF-
changes in tumor cells but also by reciprocal
appears to stimulate cellular growth.
The transforming growth factor beta
microenvironment (4). Moreover, breast
(TGF-1) superfamily contains proteins that
cancers metastasize to lungs, bone, liver,
serve a wide variety of biologic functions,
and brain (5).
Transforming growth factor alpha
differentiation, embryologic morphology,
(TGF-) is a 50-amino-acid polypeptide that
and immunity. (TGF-1) is the predominant
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d:\skydrive\Jor\vol52_9 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 566­572
Relation Between Frailty and Common Geriatric Problems in Elderly
Moatassem S Amer*, Sarah A Hamza*, Tamer M Farid*, Samia A AbdelRahman*,
Hoda M Farid*, Heba G Saber*,Enas R Mohamed*, Randa A Mabrouk**
*Geriatrics and Gerontology department, Faculty of Medicine, Ain shams university, Cairo,
**Clinical Pathology department, Faculty of Medicine, Ain shams university, Cairo, Egypt
Correspondance:Heba Gamal Ahmed Saber , Enas Ramadan Mohamed , Geriatrics and Gerontolgy
department , Faculty of Medicine, Ain shams university , Abbasia , Cairo , Egypt.

There is a high prevalence of common geriatric problems (falls, urinary
incontinence, visual and hearing impairment) among frail elderly leading to more disability
and functional impairment.
Objectives: The aim of this study is to compare the prevalence of common geriatric problems
between frail and non-frail elderly.
Design: A Case control study. Participants: 90 participants aged 60 years and above. They
were selected from Ain Shams University Hospital from inpatient wards and outpatient
clinics. The studied sample was divided into 2 groups: Group A (30 frail elderly females and
30 frail elderly males) and Group B (30 healthy elderly subjects; 15 males and 15
females).Measurements: Comprehensive geriatric assessment, including detailed history of
common geriatric problems as mentioned above, physical examination, and also assessment
of frailty using modified Fried criteria ].
Results: Hearing impairment, incontinence and falls were more prevalent in frail elderly with
a highly difference between the two groups, with p values< (0.001,0.009,0.006)
consequently, visual impairment was statistically significant in cases more than controls with
p value (0.012).
Conclusion: There is a significant positive relationship and high prevalence of common
geriatric problems especially falls, urinary incontinence, visual and hearing impairment
among frail elderly.
KEYWORDS: Frailty­ Falls ­ Urinary incontinence ­ Visual impairment­ Hearing
impairment- Elderly


The cornerstone of geriatric medicine
sarcopenia, physical activity, nutritional
is the identification, evaluation, and
treatment of frail older adults and
Sarcopenia leads to poor muscle strength,
prevention of loss of independence and
which limits mobility and physical
other outcomes for which they are at risk.
The proportion of frail within the older
expenditure and nutritional intake. This
population is high and will increase with
leads in turn to weight loss and worsening
the aging of society [1].
sarcopenia [3]
A focus on frailty has been a
Frailty as a clinical entity belongs to
consistent theme in geriatric theory and
the family of geriatric syndromes and
practice. According to Espinoza and
should be distinguished from the aging
Walston frailty is a state of vulnerability
process. As a syndrome, frailty is defined
that carries an increased risk of poor
by symptoms and signs clusters which
outcomes in older adults. There is no
form its clinically complex profile known
single best definition of frailty, as this
as `frailty clinical phenotype'. The most
construct is a constellation of clinical
researched cluster is the physical frailty
attributes[2]. Frailty does not fit easily
phenotype, but currently a much broader
with the typical organ-specific model of
definition of frailty is accepted involving
disease. The frailty phenotype represents
cognitive, functional, and social domains
[4].The widely used domains are


Full Paper (vol.52 paper# 9)

d:\skydrive\Jor\vol52_10 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 573­593
Mobile Phone Radiation Induced Plasma Protein Alterations And Eye
Pathology In Newly Born Mice
F. Eid*, M. Abou Zeid **, N Hanafi *** and A. El-Dahshan*
*Zoology Department, Faculty of Science for Girls, Al-Azhar University, Cairo, Egypt. **Zoology
Department, Faculty of Science, Al-Azhar University, Cairo, Egypt.
*** Radiation Biology Department, National Centre for Radiation Research and Technology (NCRRT),
Atomic Energy Authority (AEA), Cairo, Egypt.

The hazardous health effect of the exposure to 900-1800 MHz radiofrequency electromagnetic
fields (RF-EMF) which emitted from mobile phones was investigated on the plasma protein and eye of
newly born mice. Twenty one newly born mice were divided into 3 groups, the 1st group served as
control, the 2nd group exposed to mobile phone radiation daily for one month (45 min/day) and the 3rd
group remained one month following the end of exposure. The results showed deleterious changes in the
plasma protein pattern by electrophoretic analysis. Also, the microscopic examination demonstrated
numerous histopathological and histochemical changes in the eye mainly represented by degenerated,
hemorrhagic areas and detachment in some layers of the eye with alteration in collagen, polysaccharides,
total protein and marked increase in amyloid beta () protein contents of newly born mice exposed to RF-
EMF from mobile phone (45 min/day) for one month as well as after one month following the end of
exposure. It was concluded that the exposure to mobile phone radiation causes plasma proteins alterations
and eye pathology in newly born mice.

The field of mobile communications is rapidly
developing and mobile technology has a high
decreased [6].
rate of adoption in the daily life of the
Challis [7] demonstrated that possible RF-EMF
population. All layers of the population use
interactions include changes in the conformation
mobile phones. Mobile phones emit RF-EMF
of proteins, resulting in functional changes in
and impulse magnetic fields (MF) during calls.
these proteins. Also, Krstic et al. [8] reported
This RF-EMF can penetrate 4-6 cm into the
that EM radiation caused increase in the levels
human brain [1, 2]. RF-EMF are transmitted and
of protein structural alteration, this increase led
received in the range 400­2000 megahertz
to significant disorders of function and structure
(MHz). However, the cellular target of RF-EMF
of some cells in mice. The results of Lixia et al.
is still controversial, several recent studies have
[9] indicated that exposure to 1.8 GHz RF field
indicated that RF-EMF have an adverse effect
of GSM can increase heat shock protein
on most organs of mice especially on newly
expression in human lens epithelial cells without
born mice.
change in the cell proliferation rate. The results
There are many effects of EMFs on human such
of Karinen et al. [10] suggested that protein
as cancer, epidemiology, acute and chronic
expression in human skin might be affected by
effects. These effects vary according to the field
the exposure to RF EMFs. Sypniewska et al.
strength and environmental conditions [3].
[11] concluded that the plasma of 35 GHz
Modern children are exposed to RF fields from
millimeter waves exposed rats increased the
mobile phone for longer periods than adults,
expression of 11 proteins. These altered proteins
because they started using mobile phones at an
are associated with inflammation, and oxidative
early age and are likely to continue using those
stress. The long-term irradiation to EMF from
[4]. Kabuto et al. [5] confirmed that high EMF
exposure in children's bedrooms was associated
expression of 143 proteins in mice such as
with a significantly higher risk of childhood
neural function related proteins, heat shock
leukemia. On the other hand, children exposed
proteins and the brain metabolism proteins [12].
had less developed memory and attention, their
A study from Germany reported a significant
four-fold increased risk of malignant melanoma


Full Paper (vol.52 paper# 10)

d:\skydrive\Jor\vol52_11 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 594­598
Fixation of Undisplaced Fractures of the Neck of Femur with
Multiple Cannulated Screws.
Abdullah Ali Al-Zahrany
Department of Orthopedics, Taif University, Saudi Arabia

Background and aim of the work:
Treatment of fracture neck of the femur varies
according to patient's age and the pattern of the fracture. Multiple cannulated screws (MCS)
have been commonly used to treat femoral neck fractures. In this retrospective study we
evaluated the outcome of the use of this technique in the treatment of undisplaced fracture
neck of femur.

Material and method: In this retrospective chart review study, we revised the files and
medical records of the cases of stable fracture neck of femur which had been treated by MCS
in patients who were admitted to King Abdul Aziz Specialist Hospital and King Faisal
Hospital, Al Taif, Saudi Arabia from January 2007 to December 2011.

Results: Sixteen patients with impacted and undisplaced fracture of the neck of femur were
treated with multiple cannulated screws. The mean follow up was 26 months; mean age was
38 years (range 14-58 years). Thirteen/16 patients (81.25%) were satisfied with the excellent
results of the treatment. Two patients (12.5%) showed non- union and valgus osteotomy,
compression of the fracture and rigid internal fixation were used to promote union. One case
developed avascular necrosis and treated by total hip Arthroplasty.

Conclusion: Fixation with cannulated screws usually is adequate for most femoral neck
fractures specially the undisplaced type with acceptably low incidence of complications.

INTRODUCTION: In elderly, the
1OO% (2 & 4). The stability In Garden
femoral neck fractures are caused by mild
type II fracture is minimal as there is no
or moderate trauma, however; high energy
impaction and almost all subsequently
trauma is the usual cause of femoral neck
displace if not internally fixed (4). Rates of
fractures in young patients and often are
nonunion and avascular necrosis for
associated with high rates of avascular
undisplaced fractures are low if these
necrosis and nonunion(1). The treatment
fractures are stabilized internally using
of choice for femoral neck fractures is the
multiple (two to four) cannulated screws
placement of multiple screws across the
(5). Swiontkowski, (6) determined that the
fractured femoral neck and may be
best results were obtained with anatomical
performed following either closed or open
reduction and fixation with multiple
reduction using a standard lateral approach
screws. In this retrospective study we
or a more limited percutaneous technique
evaluated the outcome of the use of MCS
(2). Garden classification is the most
in the treatment of undisplaced fracture
commonly used classification system for
neck of femur.
femoral neck fractures where the fractures

are divided into 4 groups according to the
degree of displacement and fracture
retrospective chart review study, we
fragments and it can be used as guidance
reviewed the hospital records of all patients
for treatment options and surgical implants
with femoral neck fracture admitted to
(3). In Garden type I, the fracture is
King Abdul Aziz Specialist Hospital and
incomplete with valgus impaction and in
King Faisal Hospital, Al Taif, Saudi Arabia
Garden type II fracture it is complete but
from January 2007 to December 2011.
undisplaced. In type I fracture the
Sixteen patients with final diagnosis of
impaction allows a significant amount of
undisplaced fracture neck of femur (Garden
stability at the fracture site and the union
type I & II) were included in this study. We
following the fixation with MCS is nearly
excluded cases of displaced fractures. We


Full Paper (vol.52 paper# 11)

d:\skydrive\Jor\vol52_12 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 599­607

The Protective Value of Hesperidin in Mitigating the Biochemical
Perturbations and Trace Element alterations induced by Acrylonitrile
in Rats.
N. M. Abdallah*, N. E. Amien**, M. R. Mohamed*, A. S. Nada**, M. A. Mohamed**
*Department of Biochemistry, Faculty of Science, Ain Shams University, ** Department
of Drug Radiation Research, National Center for Radiation Research and Technology,
Atomic Energy Authority.

Objective: Acrylonitrile (a chemical pollutant) has been reported to induce harmful effects
in humans. Therefore, this study was designed to evaluate the protective effects of hesperidin, a
natural bioflavonoid, against the toxicity induced by acrylonitrile (AN) in rats.
Material&Methods: This study includes determination of serum total scavenger capacity "TSC",
liver enzymes (aspartate transaminase "ASAT", alanine transaminase "ALAT" and alkaline
phosphatase "ALP"), total proteins, albumin, glucose, creatinine, urea and lipid profile.
Moreover, liver and kidney homogenate glutathione content "GSH", catalase, superoxide
dismutase "SOD", glutathione peroxidase "GPx", malondialdehyde "MDA" and some minerals
were estimated.
Results: revealed that administration of AN (orally 50mg/ kg b.wt.) induced alterations
in TSC level as well as liver, kidney and lipid profiles. In addition, a decrease in GSH-content
and catalase, SOD and GPx activities was observed with an increase in MDA levels in both liver
and kidney. There was disturbance in certain minerals such as Cu, Zn, Fe, Se, Ca, Mg and Mn.
Conclusion: particularly, Hesperidin administration (orally 200 mg/kg b.wt.) ameliorates the
oxidative stress induced by AN, consistent with the reported antioxidant activity of hesperidin.
Key Words: Acrylonitrile, hesperidin, antioxidants and rats.

Acrylonitrile (AN) is a colorless,
they are also supply bioflavonoids,
liquid and synthetic chemical with a sharp,
substances that may improve health. The
onion- or garlic-like odor. It can be
major bioflavonoids found in citrus fruits are
dissolved in water and evaporates quickly.
AN is used to make other chemicals such as
plastics, synthetic rubber, and acrylic fibers
neahesperidin, nobiltin, and quercetin
(1). The important use of AN in clinical
(6).They exhibit higher biological activities
practice is in the manufacture of high
permeable dialysis tubings (2) and in the
synthesis of artificial membrane to
Hesperidin is a flavanone glycoside
encapsulate Langerhans islet implants (3).
abundantly found in sweet orange and lemon
AN has been found in drinking water,
and is an inexpensive by ­ product of citrus
occupational environments, food and
cultivation (7). A deficiency of this
cigarette smoke (4). International Agency
substance in the diet has been linked with
for Research on Cancer (IARC) reported
abnormal capillary leukiness as well as pain
that acrylonitrile is possibly carcinogenic to
in the extremities causing aches, weakness
humans based on sufficient evidence of
and night leg cramps. No signs of toxicity
carcinogenicity in experimental animals and
have been observed with the normal intake
inadequate evidence for carcinogenicity in
of hesperidin or related compounds. Both
humans (5).
hesperidin and its aglycone hesperitin have

been reported to possess a wide range of
Citrus fruits are well known for
pharmacological properties (8).
providing ample amounts of vitamin C. But


Full Paper (vol.52 paper# 12)


Uric Acid Metabolism in a Sample of Egyptian Hypertensive Patients With
Normal Kidney Function
Adel Afifi ,
¹ Iman Sarhan¹, Magdy El Sharkawy¹, Mostafa Kamel¹, Waleed Anwar ¹,
Nermine Helmy ², Shereen Omar ³
¹ Nephrology department, Ain Shams University; ² Clinical and Chemical pathology department, Ain
Shams University; ³ Electricity hospital

Background: Hyperuricemia is commonly associated with hypertension. Also, it is well known to
coincide with the metabolic syndrome but is still not recognized as a risk factor. So, we aimed to evaluate
hyperuricemia among a sample of hypertensive Egyptians with normal renal function.
Methods: this study was performed on 303 hypertensive patients aged 30-69 years. Patients were
divided into 2 groups according to the level of uric acid: group 1 composed of 168 hypertensive
hyperuricemic patient sand group2 composed of 135 hypertensive normouricemic patients. All patients
were subjected to complete medical history and detailed clinical examination including body mass index
(BMI), complete blood count (CBC), serum creatinine, BUN, FBS, cholesterol, triglycerides, uric acid,
sodium, potassium, urinary uric acid, urinary creatinine, urinary uric acid to creatinine ratio and fractional
excretion of uric acid(FEUA).
Results: The overall prevalence of hyperuricemia was 55.4%. Uric acid correlated significantly with
age (p<0.05). BMI was significantly higher in group1 than in group 2(p<0.05), and there was a significant
positive correlation between serum uric acid and BMI (p<0.01).Serum triglycerides and cholesterol were
significantly higher in group 1than in group 2 (p<0.05for both) denoting risky metabolic effects. Serum
uric acid correlated significantly with systolic blood pressure (p<0.05), but not with diastolic blood
pressure. No significant difference found between group 1 and group 2 as regards SBP, DBP or blood
pressure control(all p values>0.05). Serum uric acid found to correlate significantly (p<0.001) with
urinary uric acid, urinary creatinine and negatively with FEUA denoting early tubular defect of the
kidney. Also, Urinary uric acid, urinary creatinine and urinary uric acid/creatinine ratio were higher in
group 1than in group 2 (p values were<0.001, <0.001 and <0.05 respectively). FEUA was found to be
significantly lower in group 1 than in group 2 (p<0.01). We found, also, that serum sodium level was
significantly higher in the hyperuricemic group than in the normouricemic group (p<0.001) denoting the
role of Na+ in the development of hypertension and defective renal excretion of uric acid.
Conclusion: We conclude that the incidence hyperuricemia in our sample of Egyptian hypertensive
patients was (55.4%). Impaired renal clearance of uric acid occurs before deterioration of GFR. Serum
uric acid should be measured in all cases of hypertension together with BMI, total cholesterol,
triglycerides and should be treated to avoid consequent metabolic complications. Hypertensive patients
with hyperuricemia should be warned strictly of high sodium diet.
Key words: Hyperuricemia- Hypertension- Kidney function- Metabolic syndrome.

Hyperuricemia is commonly associated
develop the metabolic syndrome than subjects
with hypertension (1). Serum uric acid was
with normal uric acid levels (3) .So; we aimed to
closely linked to the development of
investigate the prevalence of hyperuricemia
hypertension and that it might be a marker of
among a sample of hypertensive Egyptians and
susceptibility or an intermediate step in the
to evaluate uric acid metabolism and excretion
pathway leading to hypertension(2).Also, it is
among hypertensive subjects with normal renal
well known that hyperuricemia coincides with
the metabolic syndrome but is still not
Patients and Methods
recognized as a risk factor. Subjects with
This cross sectional study was performed
hyperuricemia were 3.5 times more likely to
on 303 hypertensive patients selected from the


Full Paper (vol.52 paper# 13)

Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption The Egyptian Journal of Hospital Medicine (July 2013) Vol. 53, Page 615­ 623

Lipid Profile and Some Hormonal Disorders in Serum of High-Fat Diet Fed Rats
Hany Nady Yousef* and Afaf Abbass Saleh**
*Department of Biological and Geological Sciences, Fac. of Education, Ain Shams University
**Zoology department, Women's college, Ain Shams University

Chronic consumption of high-fat diet (HFD) induces obesity. The purpose of the
current study was to evaluate the impact of high-fat diet-induced obesity on lipid profile and levels of
certain hormones in male albino rats.
Material and Methods: A total of forty two 12-week old male albino rats were divided into three
groups: control group fed a normal diet, obese group I fed 25% HFD and obese group II fed 50%
HFD. Each group was divided into two subgroups (seven rats for each) feeding on the corresponding
diet for four and eight weeks. Serum total cholesterol (TC), triglycerides (TG), high density
lipoprotein cholesterol (HDL-Chol), low density lipoprotein cholesterol (LDL-Chol), free
Triiodothyronine (FT3), free Thyroxine (FT4), Insulin, Leptin and Adiponectin were assessed at the
end of 4th and 8th weeks. Also LDL/HDL-cholesterol ratios of control and obese groups were
calculated at the same time intervals.
Results: The obtained results indicated significant increase in all parameters of serum lipid profiles in
addition to elevation of the LDL/HDL-cholesterol ratios of obese rats compared to those of the
controls. In response to HFD, marked increase was recorded in the levels of insulin and leptin while
values of FT3 and adiponectin were reduced significantly. On the other hand, HFD did not change the
levels of FT4. Most of the recorded changes were more obvious by increasing either the percentage of
fats or the feeding period.
Conclusion: In conclusion, HFD induces some hormonal disorders accompanied by disturbance of
the lipid profile.
Keywords: High-fat diet; lipid profile; hormones; LDL/HDL ratio; rats.
Corresponding author: E-mail:

The rise in obesity rates at the end of the
free fatty acids, many peptides, and other
twentieth and the beginning of the twenty-first
adipokines by hypertrophic adipocytes (6).
centuries remains one of the major public
Obesity is characterized by hyperlipidemia,
health issues in the developed world today (1).
Recently fast-food consumption has received
hypothalamic satiety center to anorectic effect
considerable attention in terms of its
of adipose tissue hormones (7, 8&9).
contribution to the rising prevalence of obesity.
Moreover, Obesity is associated with
Fast-food consumption in particular has been
significant adverse effects on health including
associated with poor diet quality and adverse
metabolic, endocrinologic and cardiovascular
dietary factors related to obesity, including
complications (10, 11&12).
higher intakes of calories, fat, saturated fat, and
sugar-sweetened drinks (2&3).
Numerous studies have been done to seek the
effect of dietary fat on hepatic lipid
High-fat diets are known to lead to a positive
homeostasis. Fungwe et al. (13&14)
fat balance and consequently to adipose mass
investigated the effect of cholesterol on the
accumulation (4&5). The increase in adipose
accumulation of liver lipids and proposed that
tissue causes the clinical problems associated
with obesity, due to either the weight of the
developed by the enhancement of hepatic
extra fat mass or to the increased secretion of
triglycerides synthesis and the reduction of


Full Paper (vol.52 paper# 14)

d:\skydrive\Jor\vol52_15 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 624­629

Impact of Hyperuricemia on Cardiovascular System in ESRD Patients
Mostafa Kamel, Magdy El-Sharkawy, Essam Afifi, Medhat Ali, Ahmed Ramadan
Internal medicine& Nephrology department, Ain Shams University, Cairo, Egypt

Hyperuricemia was found to be associated with hypertension, coronary heart disease,
metabolic syndrome and chronic kidney disease. However there are no specific data about the relationship
of uric acid to cardiovascular disease and mortality in ESRD patients on chronic hemodialysis.
So, we
aimed to study the impact of hyperuricemia on cardiovascular system in chronic kidney disease and in
ESRD patients on regular hemodialysis
Patients and methods:
This study included 100 patients in Ashmoun hospital, nephrology department.
Patients were chosen and divided into two groups: Group A, 50cases with chronic kidney disease and
Group B, 50cases of ESRD on regular hemodialysis. All cases were subjected to full clinical
examination, measurement of eGFR, laboratory tests for blood urea, serum creatinine and serum uric acid
and ECG.
Results: Serum uric acid was significantly higher in dialysis group than CKD group (p<0.01). There was
a highly significant correlation between uric acid and both systolic and diastolic blood pressure in Group
A (all p values <0.01). Also, there was a significant correlation between serum uric acid and eGFR
(p<0.05).No significant difference found between Group A and group B as regards ECG findings
Conclusion: In cases of CKD uric acid is involved in the pathogenesis of renal failure and hypertension.
In patients with ESRD
, hyperuricemia is not a risk factor for the development of cardiac disease; but it
shows reversed epidemiology and becomes a marker of good nutritious status. Further studies should be
done on wider scales to evaluate the impact of hyperuricemia on cardiovascular system in hemodialysis

Key words: Hyperuricemia- chronic kidney disease- ESRD- Cardiovascular risk

Previous studies have shown that gout is
chronic kidney disease and in ESRD patients on
associated with increased risk for cardiovascular
regular hemodialysis.
mortality in the general population (1,2,3,4).

Also, hyperuricemia is found to be associated
Patients and methods
with hypertension, coronary heart disease (5),
This observational study was conducted in
metabolic syndrome (6) and chronic kidney
Ashmoun hospital; nephrology department.100
disease (7). Cardiovascular disease is the leading
patients were chosen and divided into two
cause of morbidity and mortality in chronic
groups. Group A, composed of50 Cases with
kidney disease (CKD) and in end stage renal
chronic kidney disease and Group B, composed
disease (ESRD) (8).
of50 Cases of ESRD (End Stage Renal Disease)
In patients of ESRD on hemodialysis,
on regular hemodialysis.
some studies described hyperuricemia as a factor
All the participating patients were subjected to
which increases mortality (1,9,10). Other studies
full history taking and clinical examination
including measurement of body mass index
concluded that low level of uric acid is a risk
(BMI).Estimated glomerular filtration rate
factor of mortality among patients on
(eGFR) was done using the MDRD equation
hemodialysis (8,11).
So, we aimed to study the impact of
hyperuricemia on cardiovascular system in


Full Paper (vol.52 paper# 15)

þÿ The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 630­636

Evaluation of the Role of CXCL8 and NOx in Pediatric
Type 1Diabetes Mellitus
Ali K Alzahrani1, 2, Humaid Al-Swat2, Nihad A Al Nashar3, Hala A Mohamed3
1Department of Pediatrics, Taif University
2Department of Pediatrics and Neonatology, King Abdul Aziz Specialist Hospital
3Department of Pathology, Taif University

Background and aim of the work:
Genetic and environmental factors may play a role in the etiology
of type 1diabetes (T1D) but a well-accepted view is that autoimmunity is the predominant
effector.The aim of this study is to investigate the profile and the relationships between interleukin
(IL, CXCL) -8 and nitric oxide metabolite (NOx) in T1D and to reveal their possible role in the
development and progression of the disease and its complications.
Material and method:Twenty children with Type 1 diabetes (T1D) were enrolled for the study and
compared to twenty healthy age and gender matched non-diabetic controls.
Results:The data revealed that children with T1D established high glycated hemoglobin (HbA1c %)
values versus the control group (P<0.0001). Significantly higher serum CXCL-8 concentration
(23.54±11.92pg/ml) was detected in T1D children versus the control group(5.69±1.67pg/ml). 0n the
other hand, serum nitric acid metabolite (NOx) showed a significant reduction in the T1D children
(2.38±1.14 mmol/l) compared to the control group (4.63±1.2 mmol/l). Correlation analysis showed
positive correlation between CXCL-8 with duration of the diabetes and with HbA1c.
Conclusion: It could be concluded that CXCL-8 and NO may play important roles in the
pathophysiology and progression of T1D with increased possibility to develop premature
atherosclerosis which should be considered in the development of new strategies for monitoring the
disease as well as for developing effective preventive and therapeutic interventions.
Keywords: Pediatric T1D, CXCL-8, NOx, endothelial dysfunction, premature atherosclerosis.


progressive destruction of the islet beta-cells
Diabetes mellitus is very common in KSA
and the final outcome is insulin deficiency
(25-30% of the population), and T1D
and hyperglycemia (2, 3, 5). CXCL-8 with
accounts for about 5-10% of all cases of
other chemokines stimulates the adhesion of
diabetes (1). The etiology of T1D is not
the monocytes to the endothelial cells
clearly known but it is well-accepted to be
leading to its dysfunction and subsequent
genetically predisposed as it is closely linked
development of atherosclerosis (6, 7).
to HLA-DR3/4 and DQ2/8 antigens and
Endothelial dysfunction will lead to decrease
commonly precipitated by virus or food
in the activity of the endothelial nitric oxide
factor leading to a progressive chronic
synthase (eNOS) with consequent reduction
autoimmune process (2). This process is
in the levels of plasma nitric oxide (NO), the
mediated by autoreactive CD4+ and CD8+ T
main molecule derived from the endothelium
cells, the formation of antibodies to islet
and is involved in vascular homeostasis (8-
autoantigens (AAgs), and the release of high
10). A low level of NO is strongly linked to
amounts of cytokines and chemokines
endothelial dysfunction and is considered to
be the earliest sign of atherosclerosis (11,
Interleukin-8 belongs to a chemokine family
12). Nitric oxide has a fast half life, so we
known as CXC chemokines, because the two
can measure the nitric oxide metabolite
first cysteines in their molecules are spaced
(NOx) which is the sum of nitrite and nitrate
by another amino acid, so it is currently
levels and it is used to reflect the bioactivity
known as CXCL8 (CXC ligand 8) (4, 5).
of NO and eNOS (11). The aim of this study
CXCL8 governs the traffic of inflammatory
is to investigate the profile and the
and immune cells, playing the major role in
relationships between interleukin (IL,
the infiltration of the pancreas with
CXCL) -8 and nitric oxide metabolite (NOx)
in T1D and to reveal their possible role in
1111111 01801.01

Full Paper (vol.52 paper# 16)

d:\skydrive\Jor\vol52_17 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 637­641

Endoscopic Thoracic Sympathectomy: A Comparative Study of Resection
And Electro-diathermy Ablation in the Treatment of Primary Palmar
Hyperhidrosis, Taif Experience
Mohammed Al Saeed*, Majed Al Mourgi**, Mohamed Hatem*
Department of Surgery AL Taif University, Saudi Arabia* Department of Surgery Al Hada Armed
Forces Hospital, Saudi Arabia**


Background and aim of the work:
Palmar Hyperhidrosis is an excessive and unpleasant sweating
and it is under control of the thoracic sympathetic chain. At present, endoscopic upper thoracic
Sympathectomy (ETS) offers a safe and durable solution of the condition. The operation includes
excision, electro diathermy ablation or application of surgical clips on the thoracic sympathetic
ganglia T2 and T3. The present study was done to compare the results achieved by excision and
electro-diathermy ablation.
Patients and methods: This prospective randomized study was conducted in King Abdul Aziz
Specialist Hospital and Al-Hada Armed Forces Hospital, Taif- Saudi Arabia, from January 2007 to
August 2010 and included sixteen patients with primary palmar hyperhidrosis. They were randomized
into 2 groups; each of 8 patients. In one group; the sympathetic chains with T2 and T3 ganglia were
excised on both sides and in the other group, the sympathetic chains and ganglia were ablated
bilaterally using electro-coagulation diathermy hook.
Results: There were 10 women and six men. The mean age of the ablation group was 23.6±7.6 years
and in the resection group it was 22.5±8.4years. The mean operating time for bilateral
Sympathectomy in the resection group was 74±18.6minutes; whilst in the thermal ablation group it
was 32±7.8 minutes. The mean postoperative hospital stay in the excision group was 48±12 hours and
in the ablation group, it was24±6 hours. No deaths occurred and all patients are discharged with dry
hands. The mean follow up was 24±18 months. Intraoperative intercostal venous bleeding occurred in
18.75% of sympathectomies in the excision group but not in the ablation group. Neuralgic pain of the
chest wall developed in 31.25% of sympathectomies of the excision group and 6.25% of the
sympathectomies of the ablation group. Horner's syndrome developed in 6.25% per cent of the
sympathectomies in both groups. Compensatory hyperhidrosis of trunk and thighs occurred in 37.5%
of both groups. Recurrence developed in 6.25% of ablation group but no recurrence in the excision
Conclusion: The rate of recurrence after endoscopic thoracic sympathectomy for treatment of
primary palmar hyperhydrosis, if ablation is used, may be higher than resection, however; it is
practically accepted as the procedure is easier, has shorter operating time with less liability to develop
neuralgic pain and intercostal venous bleeding.
Keywords: Endoscopic Thoracic Sympathectomy, Electro-diathermy Ablation, resection, Taif,
Primary Palmar Hyperhidrosis

Primary hyperhidrosis has an estimated
therefore it was rarely offered, however; at
prevalence of nearly 3­4% and it may affect
present the endoscopic approach becomes the
hands, face, axillae and feet, causing
preferred treatment of primary palmar
significant medical and psychosocial problems
hyperhydrosis once the secondary causes have
(1, 2). Surgical therapy is the most effective
been rolled out (1-3). It is considered now the
approach and recognized as the treatment of
procedure of choice as it is easy and safe in
choice for patients with primary hyperhidrosis
addition; the complications which are
as non surgical treatments alleviate symptoms
normally associated with the conventional
only transiently (1). In the past, upper thoracic
approach can be avoided by the endoscopic
sympathectomy required a supraclavicular
one because of the superior view achieved
approach with possibility of injury of cervical
with the video-telescope system (4).There is a
structures or bilateral thoracotomies and
controversy between the need for resection of



Full Paper (vol.52 paper# 17)

d:\skydrive\Jor\vol52_18 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 642­649

Prevalence, Pattern of Presentation, Risk Factors and Outcome of Acute
Mesenteric Venous Thrombosis in Taif Province,
Saudi Arabia, A Single Center Study
Mohamed Al Saeed*, Mohamed Hatem*Aseel Abu Duruk*Hala A Mohamed**,
Nihad Al Nashar**,Mohamed Ahmed***, Nesreen Al Margoushi****
Department of Surgery, Taif University*, Department of Pathology, Taif University**,
Department of Radiology, Jazan University ***, Department of Medicine, Taif University****

Background and aim of the study:
Mesenteric venous thrombosis has a global incidence of 10-
15% of all cases of mesenteric ischemia; however reports from high altitude provinces of Saudi
Arabia as Taif and Aseer recorded an incidence above 60%. The aim of this study is to record the
incidence, pattern of presentation, risk factors; diagnostic tools and outcome of treatment in a single
center (King Abdul Aziz Specialist Hospital) Taif, Saudi Arabia.
Material and method: In this retrospective chart review study, we reviewed the records and data
of all patients presented to King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia from January
2009 to January 2013 and their final diagnosis were proved to be acute mesenteric venous throm-
bosis. Traumatic, postoperative and non occlusive cases were excluded from the study.
Results:Sixteen patients with final diagnosis of acute mesenteric venous thrombosis were included
in this study, out of 26 patients (61.5%) presented and diagnosed as acute occlusive mesenteric is-
chemia. Males were more affected than females. The mean age of the patients was 55±13.4 years.
The mean duration of symptoms was 4.9±1.4 days.The most common presenting symptoms were;
abdominal pain followed by nausea, vomiting, anorexia, bloody diarrhea and fever. The most preva-
lent physical findings was tachycardia followed by ileus, 5 patients presented by marked peritoneal
signs 3 of them were shocked. Multiple risk factors were detected in all patients. Laboratory find-
ings were not conclusive and diagnosis was established by CT angiography in most of the patients.
During operation, all patients were found to have a segment of infarction of the small intestine and
in one of them the cecum was involved. Resection of the gangrenous parts was done for all patients.
Second look operation was performed in 25% of patients. The total mortality was 18.75%.
Conclusion: Acute mesenteric venous thrombosis is the most common cause of acute occlusive
mesenteric ischemia in Taif province and this may be related to multiple risk factors. Being familiar
with this disease is essential in making the correct diagnosis to be followed by prompt resuscitation
with heparinization to be continued postoperatively to prevent recurrent thrombosis. Laparotomy
should be performed as soon as metabolic and hemodynamic correction is done with resection of
any infracted segment. A second look operation may be required. If these steps are followed strictly
and without delay, the prognosis of mesenteric venous thrombosis is often favorable.
Keywords: Mesenteric, venous thrombosis, Taif, Saudi Arabia.

decreases, with reduction of the partial pres-
(AMVT) is defined as new-onset symptomat-
sure of oxygen and starts to affect humans at
ic thrombosis with presenting symptoms of
altitudes above 1,500 meters (4,900 ft) (3, 5).
less than 4 weeks duration (1). The disease
As a consequence of the hypobaric hypoxic
accounts for approximately 10-15% of all
environments, human residents at high alti-
cases of acute mesenteric ischemia (AMI),
tudes develop numerous physiologic respons-
however, reports from high altitude regions of
es, especially on coagulation system and in
Saudi Arabia recorded a very high incidence
particular, increased factor VIIa activity, in
of this disease approximating 60% of AMI or
addition to dehydration, polycythemia and
even more (2, 3). The risk of acute mesenteric
vascular spasms which may lead a higher lia-
venous thrombosis increases in patients with
bility for thrombo-embolic disorders (2- 6).
hypercoagulable states (4). Taif, Saudi Arabia
Smoking, diabetes, pancreatitis, perforated
is located in the western region at
viscus with intra-abdominal sepsis, malig-
1,879 meters (6,165 feet) above sea level. As
nancy, portal hypertension and congestive
the altitude increases, atmospheric pressure
heart failure are also common risk factors for

Full Paper (vol.52 paper# 18)

d:\skydrive\Jor\vol52_19 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 650­657

Characteristics of pregnant Women admitted with 2009 H1N1 Influenza
in a referral maternity hospital at Al-Madinah, Saudi Arabia.

Inass Taha
Department of Medicine, College of Medicine, Taibah University, Madinah, Saudi Arabia.

: To date there has been no study done in Saudi Arabia to identify the risk factors
for poor outcome of H1N1 infection in pregnancy.
Objectives: we aimed to evaluate the epidemiological data, clinical course, treatment modalities,
and maternal and fetal outcomes of 33 pregnant women diagnosed with H1N1 Influenza A in a
referral maternity and children hospital at Al- Madinah Saudi Arabia on the period from June
2009 till February 2010.
Methods: This retrospective cohort study reported 33 pregnant women (9.1% primigravida) aged
27.7±5.6 years who were laboratory-confirmed cases diagnosed with H1N1 Influenza A in a
referral maternity and children hospital at Al- Madinah Saudi Arabia on the period from June
2009 till February 2010. Their mean gestation age was 23.5±10.9 weeks with history of bronchial
asthma in 45.5%.
The mean duration between symptoms' onset and hospital presentation was 5.0±2.2
days with late presentation in 10 cases (30,3%). Large number of cases presented with fever more
than 39 (24 (72.7%), sore-throat (24 (72.7%) and cough (29 (87.9%) while 19 patients presented
with dyspnea (57.6%). Pregnant patients with H1N1 received Tamiflu (oseltamivir)) from 2 to 7
days with a mean of 4.7±1.3 days. They stayed at hospital for variable periods from 2 to 28 days
with a mean of 7.9±6.6 days (Table 4). Most patients (31(93.9%)) received antibiotics. Maternal
poor outcome included hypoxia in 6 patients (18.2%), ICU admission for 2-3 days with
mechanical ventilation in 4(12.1%)). The main fetal poor outcome was intrauterine fetal death in
2 (6.1%) babies .
The main presentation of H1N1 among pregnant women was typical influenza-like illness.
Considerable percentage of patients presented late (30.3%). The duration of hospital admission is
variable up to 28 days. Bronchial asthma was prevalent (45.5%) among pregnant women with
H1N1 infection. The main poor outcomes were maternal respiratory failure (18.2%) and
intrauterine fetal death (6.1%). There is increased risk of intrauterine fetal mortality (6.1%)
rather than materanl mortality (0%) .

Keywords ; H1N1 , Pregnancy .

The 2009 pandemic H1N1, a novel subtype
Apart from patients with immune-
of the influenza A virus, has been reported
suppression and neurologic diseases, studies
to cause broad spectrum of clinical
showed that the risk groups for severe 2009
syndromes, ranging from afebrile upper
H1N1 virus infection include pregnant
respiratory illness to fulminant viral
women especially in their second or third
pneumonia (WHO) (1). The rates of illness
trimester and women who are less than 2
(7.5%-11%) and hospitalizations varied
weeks post partum (3-8). Among patients
according to country (2). The overall case
with 2009 H1N1 virus infection, 7 to 10% of
fatality rate has been less than 0.5% and
hospitalized patients (3-5), 6 to 9% of ICU
occurred mainly among children and
patients (6,7), and 6 to 10% of mortal
nonelderly adults (3).
patients (4,8) were pregnant women. It was


Full Paper (vol.52 paper# 19)

d:\skydrive\Jor\vol52_20 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 658­669

Assessment of Iron Status in Anemic Children with Chronic Kidney
Ali K Alzahrani1, 2, Abdrahman Alzahrani3, Nihad A Al Nashar4 , Hala A Mohamed4
1Department of Pediatrics, Taif University, Taif, Saudi Arabia
2Department of Pediatrics and Neonatology, King Abdul Aziz Specialist Hospital, Taif
3Pediatrics' Hospital, Taif, 4Department of Pathology, Taif University

Iron deficiency is the commonest cause of resistance to erythropoiesis
stimulating agents (ESAs) in dialyzed children treated from anemia of chronic kidney disease
Aim of the work: This study was conducted in order to evaluate the significance of different
biomarkers in assessment of iron status during management of anemic children with CKD.
Patients and method: Twenty five children with diagnosis of anemia of chronic kidney
disease were enrolled for the study. They were classified into two groups according to their
stage of the kidney disease. Group I; included 15 children with anemia of CKD and their
Glomerular Filtration Rate (GFR) was 15.5 ­ 29.6 ml/min/1.73m2 (stages; III & IV CKD) and
they were managed conservatively. Group II; It included 10 anemic children with end stage
renal disease (Stage V CKD, GFR was 6.1 ­ 13.7 ml/min/1.73m2) and they were under
regular hemodialysis. Another 10 healthy children with matched age and gender served as
control group (group III).
Results: The study showed that the hypochromic cell percentage was significantly higher in
both groups I and II before treatment when compared to controls (p <0.0001). Serum ferritin
showed very high significant elevation in all the studied groups as compared to controls, also
group II was highly significant when compared with group I before treatment. Improvement
of iron mobilization and metabolism after 8 weeks of therapy with intravenous iron and
erythropoietin was evidenced by significant increase in hemoglobin (Hb) level, RBCs and
HCT % when comparing the group II patients before and after treatment. Also significant
decrease in hypochromic cell percentage and increase in serum ferritin were proved. The
sTfR and sTfR/ F indices showed elevation in the post-treatment group.
Conclusion: No single biomarker is reliable alone in the assessment and monitoring the iron
status in anemic patients with CKD under ESAs therapy. Measurement of hypochromic cell
percentage may be simple and reliable method, and sTfR represents a valuable quantitative
assay of marrow erythropoietic activity as well as a marker of tissue iron deficiency.
However, the sTfR / Ferritin index is considered to be more efficient in anemic patients with
CKD for early prediction of functional iron deficiency and is a sensitive tool for follow up of
iron status during ESAs therapy.
Keywords: Anemia of chronic kidney disease, iron status, erythropoiesis stimulating agents,
serum soluble transferrin.

Chronic kidney disease is the gradual,
progressive reduction in the glomerular
epoetinalfa, and darbepoetin alpha; are
filtration rate (GFR) with deterioration of
analogues of the natural hormone
kidney function and the disease is
erythropoietin (2-6). These agents are used
classified to five stages where the 5th stage
to manage the anemia of CKD instead of
represents the end stage renal failure (1)
the blood transfusion to decrease the risk
The cause of anemia of chronic kidney
of transfusion-related complications with
disease (CKD) is mainly due to a decrease
marked improvement in the outcome
especially in the end stage of the disease
erythropoietin (EPO) which is produced in
(6, 7). However; ESAs mobilize iron
the kidney and the liver and stimulates
stores to promote erythropoiesis; with
erythropoiesis (2). The erythropoietic
subsequent decrease in these stores
stimulating agents (ESAs) as, recombinant
representing the most common reasons for

1111110 01801.01

Full Paper (vol.52 paper# 20)

d:\skydrive\Jor\vol52_21 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 670­677

Diagnostic and Screening Utility of Biochemical Markers for
Osteoporosis and Osteopenia in Saudi Women
*Abdullah Ali Al-Zahrany, **Nihad A. El-Nashar, **Hala A. Mohamed
*Department of Orthopedics, **Department of Pathology
Taif University, Saudi Arabia

Background and aim of the work: Postmenopausal osteoporosis is a major health problem
worldwide and in Saudi Arabia as it leads to bone fragility and increased liability for fragile
fractures, particularly in neck of femur and vertebrae. The present study was designed to
determine the value of different screening tests to find out the most sensitive serum and
urinary markers of osteoporosis among Saudi women and to clarify the relationship between
E2 deficiency and these markers in peri-menopause, early or postmenopausal women without
hormonal replacement therapy.
Material and methods: This study included 37 Saudi women aged 40 to 60 years. They were
categorized into 3 groups according to their bone mineral density (BMD): Group I: 15
Normal control (T-score up to -1.5), Group II: 12 Osteopenic women ( T-score between ­1.5
to ­2.5)and Group III:10 Osteoporotic women ( T-score below ­2.5). For all subjects, dual
energy X-ray absorptiometry (DEXA) was performed. Osteocalcin (OC), alkaline
phosphatase (ALP), free galactosyl hydroxylysine (Gal-Hyl), calcium (Ca), inorganic
phosphorus (P) and estradiol (E2) were measured in serum, whereas, deoxypyridinoline
(Dpd) and creatinine levels were measured in urine.
Results: Simultaneously both osteopenic and osteoporotic groups showed significant
decreases in BMD when compared to the controls. Osteocalcin, ALP and Gal-Hyl showed
significant increase (p<0.0001) among the osteopenic and osteoporotic groups versus the
control group. Significant decrease in E2 levels were obvious among the osteopenic
(p<0.0001) and osteoporotic (p<0.0001) women when judged against the controls. Urinary
Dpd was significantly increased in the osteopenic and osteoporotic groups (p<0.001). In
osteoporotic group, significant negative correlations were observed between OC and BMD.
Positive correlations were detected among the osteoporotic group between OC and ALP and
between OC and Gal-Hyl. High significant negative correlations were confirmed between E2
and OC among both the osteopenic and the osteoporotic groups. Also, a significant negative
correlation was established between E2 and Dpd in the osteoporotic group. In comparing
between osteopenic and osteoporotic groups, significant decrease was recognized in BMD
and significant increase was predicted regarding ALP, (p<0.05), Gal-Hyl (p<0.0001) and
Dpd (p< 0.001).
Conclusion: Urinary Dpd may be a simple indicator for osteoporosis in postmenopausal
women; however, screening should include the measurement of serum estradiol, galactosyl
hydroxylysine, alkaline phosphatase and Osteocalcin to increase the sensitivity and specificity
of primary screening to identify the groups at higher risk of osteoporosis which is the
keystone in prevention of disabling fragility fractures.
Keywords: Bone turnover markers, osteoporosis, postmenopausal, Saudi women.

Twenty five per cent of Saudi Arabian
women over 50 years are reported to have
Osteoporosis is a multi-factorial disease
osteopenia and the estimated prevalence of
and the role of estrogen deficiency in
osteoporosis is 23-34% (1, 2). Studies
have revealed that large number of middle
aged and elderly Saudi women is unaware
described in 1940 by Fuller Albright (4).
of osteoporosis risk factors as low calcium
Riggs (5), found that, estrogen deficiency
intake, lack of exercise and positive family
increases bone turnover and enhances
history of the disease, moreover; it was
osteoclast activity. Other studies have
found that less than 50% of them correctly
revealed that postmenopausal estrogen



Full Paper (vol.52 paper# 21)

d:\skydrive\Jor\vol52_22 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 678­684

Prevalence of Cervical Cellular Abnormalities by Liquid Based
Cytology in Taif Province: A Hospital Based Study
Dalal M Nemenqani1,2, Moemen M Hafez2, Hala Al Nashar1, Mohamed Hatem3,
Samia, H Al Malki4, Afnan, H4 Al Salmi4, Sawsan, S Al Khammash4
1Department of Pathology, Taif University, 2Department of Pathology King Abdul Aziz
Specialist Hospital, Taif, 3Department of Surgery, Taif University
4College of Medicine, Taif University, KSA

Aim of the work:
The aim of this study was to determine the prevalence of the cervical
cellular Abnormalities using liquid based thin-layer preparations as screening test for
women who attended the gynaecology outpatient clinic at King Abdul Aziz Specialist
Hospital, Taif, Saudi Arabia.
Material and method:
In this retrospective chart review study, we reviewed the records
and data of all women for whom liquid base cytological studies were performed as
screening test to detect the cervical cellular abnormalities at King Abdul Aziz Specialist
Hospital, Taif, Saudi Arabia from June 2010 to June 2012.
Results:The total number of women for whom liquid base, thin-layer cytological studies
were performedwas 2168 patients 79.9% of them were symptomatic. The mean age was
38.6 years. Liquid based thin-layer preparations were used for all patients. Cervical
abnormality was seen in 25.6% of the patients, of which 6.5% were malignant or
premalignant and 19.1% were of benign nature.
Conclusion: Liquid-based, thin-layer cytology reduces sampling and preparation errors of
the conventional smear; however, screening should include human papilloma virus (HPV),
DNA testing to increase the sensitivity and specificity of primary screening.

Since the introduction of Papanicolaou
Recent studies show that high risk
(Pap) smear as a screening test for
(oncogenic) human papilloma virus (HR-
cervical cellular abnormalities in 1960s,
HPV) types are strongly associated with
deaths due to squamous cell carcinoma of
severe squamous intra-epithelial lesions
the cervix have fallen by 75% in the
(SILs) and the subsequent progression to
western world (1). The traditional Pap
cancer and the majority of SILs without a
smear had a sensitivity of about 70% for
HR-HPV type usually regress (4). In
Saudi Arabia, most centre are using
precancerous lesions and cancer because
conventional cytology for opportunistic
of sampling and interpretive errors,
screening for cervical cancer, however
however, the introduction of 2 liquid-
some centres (including our hospital)
based Pap smear collection systems in the
have adopted the use of liquid based
1990s, especially the thin-layer cytology
cytology as a methods of screening in
preparations has reduced these errors in
addition tothe use of HPV testing as a
addition that, screening time of a thin-
triage and co-testing (5). According to
layer slide is also considerably shorter
Cancer Incidence Report Saudi Arabia
compared with the conventional smear
2005, data about the prevalence of
(2& 3). Liquid-based Pap smear
cervical cellular abnormality and the
collection systems have improved the
human papilloma virus (HPV) burden in
specimen adequacy and sensitivity for the
the general population of Saudi Arabia
detection of cervical cancer and the
are still lacking (5).The aim of this study
precancerous, squamous intraepithelial
was to determine the prevalence of the
lesions (SILs) in addition to the detection
cervical cellular Abnormalities using
of the benign cellular changes (which
liquid based thin-layer preparations as
have no malignant potential) as bacterial
screening test for women who attended
and fungal vaginosis or inflammation(3).
the gynaecology outpatient clinic at King



Full Paper (vol.52 paper# 22)

EFFECT OF BOSWELLIA ON ALLOXAN-INDUCED DIBETES MELLETUS IN MALE ALBINO RATS The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 685­698

Hypoglycemic Effect of the Aqueous Extracts of Lupinus albus, Medicago
sativa (Seeds) and Their Mixture on Diabetic Rats
Eman G. E. Helal*, Samia M. Abd-Elwahab **, Tarek A. Atia*** and Anwaar Alkamel
Mohammad ****
Departments of Zoology ­ College of Science - Al-Azhar University (Physiology* & Histology **);
Departments of Histology ­ College of Medicine - Al-Azhar University, and working at College of
Applied Medical Sciences - Salman Bin Abdul-Aziz University, KSA***;
Departments of Zoology - College of Science - Al-Azhar University and Department of Medical
Science - College of dentistry - Sinai University****.

The number of people suffering diabetes mellitus is increasing worldwide at an alarming
rate. A huge number of populations in the world are entirely dependent on traditional medications. This
practice may be due to their safety, effectiveness, and availability as well as their fewer side effects
when compared to the synthetic hypoglycemic agents. The present study was carried out to investigate
and compare the activity of Lupinus albus (seeds), Medicago sativa (seeds) and the mixture of both
plants seeds on some biochemical, hematological and histological parameters in alloxan-induced
diabetic rats.
Material and method
: Twenty-five male adult albino rats were divided into two groups: group 1:
control group (five animals) and group 2: alloxan induced diabetic rats. Diabetic rats were further
divided into four subgroups, five animals each. Subgroup1: diabetic untreated rats; subgroup 2:
diabetic rates treated with aqueous extract of Lupinus albus seeds; subgroup 3: diabetic rats treated
with aqueous extract of Medicago sativa seeds; and finally subgroup4: diabetic rats treated with
aqueous extract of the mixture of Lupinus albus and Medicago sativa seeds. After thirty days of
treatment all rats were sacrificed, blood sample were collected to estimate some biochemical and
hematological parameters. Liver samples were collected to determine their glycogen content and
pancreatic samples were obtained and processed for microscopic and quantitative evaluation.
In diabetic group, there was reduction in body weight's, hyperglycemia, hypoinsulinemia,
significant increase in some parameters of liver and kidney functions as well as significant changes in
lipids profile and proteins level with significant decreased liver glycogen content. All treated groups
restored most of the mentioned parameters to their normal values. Moreover, these treatments recorded
partial improvement in the histopathological changes produced by alloxan.
The aqueous extract of Lupinus albus or Medicago sativa (seeds) or by their mixture has
hypoglycemic and hypolipidemic effects by increasing insulin level and decreasing insulin resistance.
In addition, they ameliorate most complications of diabetes.

Key words:
Alloxan; Hypoglycemia; Diabetes; Lupinus albus; Medicago sativa

Diabetes mellitus is a chronic metabolic
effects of diabetes and the high cost and poor
disease with life-threatening complications.
availability of current medications for many
The International Diabetes Federation (IDF)
estimates that 285 million people (6.4% of the
countries [3]. Most people in Africa rely on
world population) suffered diabetes in 2010
herbal concoctions for their primarily health
and this prevalence will increase to 439 million
care, but so far, scientific studies supporting the
people, 7.7% of the world population by
use of plants in traditional medicine remain
2030[1]. Despite the great efforts invested in
poor [4].
diabetes research, its prevalence continues to

grow, and the current medications cannot cover
Lupine is a medicinal food plant with
all of the symptoms and complications of the
potential value in the management of diabetes.
disease [2]. Indeed, alternatives are clearly
The seeds of Lupinus termis are used in the
needed because of inability of the current
Middle East and Africa as food and in folk
medications to control most of the pathological
medicine. In traditional medicine, the seeds are

DOI 111
1110 018

Full Paper (vol.52 paper# 23)

d:\skydrive\Jor\vol52_24 The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 699­707

Role of Multisclice And Virtual Cystoscopy Versus Ultrasound and Color
Doppler Study in Evaluation of Urinary Bladder Neoplasms
Hanaa Abdel Kader Abdel Hamed a , Rania Aly Maarouf a, Togan Taha Abdel Azez a, Sameeh
Shoukry Sobhey b
a Radiodiagnosis Faculty of medicineAin Shams University
b Radiodiagnosis police authority hospital

the virtual cystoscopy and the color Doppler examinations are good modalities in
assessment of the urinary bladder neoplasms. This study is done to assess the accuracy of CTVC and
color Doppler ultrasound in detection of the urinary bladder neoplasms.
Patients and methods: The examination was done between June 2010 and December 2012 on 60
patients known or suspected to have urinary bladder neoplasm. They were examined using CTVC and
color Doppler ultrasound. Bladder scanned using multislice CT at a slice thickness of 1 mm. The data
were transferred to a workstation for interactive navigation. Findings obtained from CTVC and
ultrasound were compared with results from conventional cystoscopy and with pathological findings.
By the conventional cystoscopy; the 43 patients in the group A showed 53 lesions. There were (35/43
patients) with single lesion while there were (8/43 patients) more than one lesion. While the other 17
patients in group B showed 11 patient with no focal lesions and 6 patients with 6 focal lesions.
By virtual cystoscopy; 56 lesions were detected in both groups; 51 plus 5 lesions in group A and B
respectively. There were 3 false negative lesions with a failure rate of 3/56.
By ultrasound; 56 lesions were detected in both groups; 53 plus 3 lesions respectively.
So in virtual cystoscopy and ultrasound the results were as follows: positive predictive values: 100%;
negative predictive value: 78.6 %; sensitivity: 94.9%; specificity: 100%
Conclusion: Although the definitive diagnosis of some suspected urinary bladder tumors is only possible
with conventional cystoscopy and biopsy, CTVC and color Doppler ultrasound are a minimally or non-
invasive techniques which provide beneficial information about urinary bladder lesions.
Keywords: CTVC, color Doppler ultrasound, bladder neoplasm.

The function of the lower urinary tract is
CT is the most recent advance in CT technology.
basically storage of urine in the bladder and the
An increased number of detector rows and more
at-will periodic evacuation of the stored urine.
powerful x-ray tubes result in faster scanning
The urinary bladder is a musculo-membranous
time, increased volume coverage, and improved
sac which acts as a reservoir for the urine.
spatial and temporal resolution. MDCT (multi-
Cancer of the urinary bladder is one of the most
detector computed tomography) technology
common urothelial neoplasms. It has high rates
allows superior image quality, decreased
of recurrence at the initial tumor site and
examination time, and the ability to perform
elsewhere throughout the transitional epithelium
complex multiphase vascular and three-
(30­80% of cases) and of multi-focal
dimensional examinations.
manifestations (as many as 50% of cases). Gross
Ultrasound is an inexpensive and allow
painless haematuria is the classic clinical sign of
visualization of the bladder. With advent of
bladder carcinoma.
color Doppler ultrasound determination of
Conventional cystoscopy plays a key role in the
vascularity within a lesion is possible.
diagnosis and follow-up of bladder cancer.

Virtual endoscopy is a minimally invasive
Pathology of the urinary bladder neoplasm:
technique that has promising results in the
Carcinoma of the urinary bladder is one of the
evaluation of the entire urinary tract. CT virtual
most common malignant tumors of the urinary
cystoscopy has been proposed as an alternative
imaging technique with potential advantages in
Histopathological types of bladder tumors are
the detection of urinary bladder neoplasms and
based on the WHO classifications that are
has good patient acceptance. Multi-detector row
classified bladder tumors into epithelial and non
111111. 01801.01

Full Paper (vol.52 paper# 24)

The Role of Pre-Operative Magnetic Resonance Mammography In Obese Women With Suspected Breast Cancer The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 708­724

The Role of Pre-Operative Magnetic Resonance Mammography In
Obese Women With Suspected Breast Cancer
Darine HA Saad, Hana H Nassef, Sherine K Amine, Salwa R El-Batrawy
Radiodiagnosis department, Faculty of Medicine, Ain Shams University

To high-lighten the role of MR mammography as a pilot pre-operative
modality in the staging of breast cancer and its impact on surgical planning and management;
aiming to decrease morbidity and mortality of this increasingly spreading cancer. In addition,
to clarify the assessment of the relationship between the types of obesity and staging breast
cancer. Moreover, to evaluate the diagnostic validity of breast MRI in discriminating benign
from malignant lesions in women with suspected breast cancer histopathologic findings used
as the golden standard.

PATIENTS AND METHODS: Contrast-enhanced bilateral breast MRI was performed on
60 women with suspected breast cancer with indeterminate imaging findings by
mammography and/or ultrasonography. Lesions detected by MRI that could represent
potential malignancies in both breasts were evaluated. Morphologic assessment and kinetic
analysis (contrast enhancement) were performed on each lesion using dedicated
postprocessing and display software. Functional MR tools were used in few cases (6 cases) to
help in the differential diagnosis between malignant and benign of suspicious lesions detected
at conventional MRI. All patients underwent clinical and radiological evaluation followed by
Contrast-enhanced bilateral breast MRI using 1.5-tesla superconductive Philips scanner and
General Electric Medical Systems. The diagnostic images were evaluated as regard lesion
morphology (size, shape, margin type, enhancement pattern), signal intensity parameters
(time to peak enhancement, maximum slope of enhancement curve, washout), and the
BIRADS categories. Results of the contrast enhanced bilateral breast MRI of the 60 patients
were all reported and compared with the histopathalogical biopsy.
RESULTS: A total of 60 patients presented with suspected breast cancer were included in the
study with age ranging from 38 to 75 years old. 22 of the studied population had benign
findings, while 38 of the patients were diagnosed as malignant. (18 patients IDC, 6 patients
Invasive Lobular Carcinoma, 3 patient Mucinous carcinoma, no patients Medullary
carcinoma and 4 patients Insitu cancer). In this study population the sensitivity, specificity,
positive and negative predictive values of mammography were found to be 51.6%, 88.4%,
66.7%, and 80.3% respectively. Overall accuracy of mammography was 77%. Among the 38
cases diagnosed by sonomammography as malignant or with irregular densities, 16 turned out
to be benign by histopathological evaluation (false +ve), while among the 22 cases diagnosed
by sonomammography to be benign lesions or non-conclusive studies (dense), 7 were proved
to be malignant by histopathological evaluation (false ­ve). The sensitivity, specificity,
positive and negative predictive values of MRI for occult breast lesions in high risk patients
included in the study, were found to be 100%, 93%, 86%, and 100% respectively. Overall
accuracy of MRI breast was 95%. Among the 38 cases diagnosed by MRI as malignant, there
was no false +ve, while among the 22 cases diagnosed by MRI to be benign lesions, 7 cases
were proved to be malignant by histopathological evaluation (false ­ve). Therefore breast
MRI had higher sensitivity than specificity but general speaking it is considered highly valid
with high specificity also. Due to the limited number of cases in this study, there was a trend
in relation of obesity (BMI) to breast cancer, malignancy rate 55.3% in obese women and
44.7% in non-obese women.
CONCLUSION: From our study, we conclude that MR imaging of the breast in obese
women , is a rapidly evolving modality of excellent sensitivity in detection of breast cancer.
The basic drawback of this modality was its low specificity for breast malignancy. However,
multiple studies including this study have shown that with the improvement in equipment and
technique there is gradual increase in specificity.


Full Paper (vol.52 paper# 25)

EFFECT OF BOSWELLIA ON ALLOXAN-INDUCED DIBETES MELLETUS IN MALE ALBINO RATS The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 725­739

Antidiabetic and Antihyperlipidemic Effect of Balanites aegyptiaca
Seeds (Aqueous Extract) on Diabetic Rats
Eman G. E. Helal*, Samia M. Abd El-Wahab* Hesham El Refaey** and Anwaar
Alkamel Mohammad***
Department of Zoology­Faculty of Science*, department of pharmacology-Faculty of
pharmacy- Al-Azhar University, Department of Medical Science - Faculty of Dentistry - Sinai

Type II diabetes mellitus is increasing health problems that negatively affect
health care systems worldwide. There is a constant urge to develop new therapies with better
effects, lower side effects at lower prices to treat this disease. Therefore, the present study
carried out to investigate whether Balanites aegyptiaca (seeds) could treat the hyperglycemic,
dislipidemic, liver, and kidney toxicity and the pancreatic damage in diabetic rats.
Material and method: fifteen adult male albino rats were divided into two groups; group 1:
control group, group 2: alloxan induced diabetic rats that divided into two subgroups;
subgroup1: diabetic untreated rats, subgroup2: diabetic treated with aqueous extract of B.
(seeds). After thirty days of treatment, all rats were sacrificed. Blood sample were
collected to estimate some hematological and biochemical parameters. Liver samples were
collected to determine their glycogen content and pancreatic samples were obtained and
processed for microscopic and quantitative evaluation of , & -cells number.
Results: diabetic group recorded reduction in body weight's gained, hyperglycemia,
hypoinsulinemia, significant increase in some parameters of liver and kidney functions,
dislipidemia, changes in proteins level and decreased liver glycogen content. While, treatment
with B. aegyptiaca (seeds) was ameliorated most of the toxic effects of alloxan and showed
partially improvement in histological changes produced by alloxan.
The aqueous extract of B. aegyptiaca (seeds) has hypoglycemic, hypolipidemic
effects, increasing insulin level, and decreasing insulin resistance. Moreover, ameliorate the
most complication associated with diabetes mellitus.
Key words: Alloxan; Hypoglycemia; Diabetic; Balanites aegyptiaca.


The importance of human diabetes
tombs of the12th Egyptian dynasty [4]. The
mellitus as a world health problem is
tree is using for food and fodder [5] as
attributes to the fact that at least 150
agro forestry tree [6] and has a wide range
million people are affected, thus the
of medicinal uses. The seed kernel
necessity to seek new drugs [1]. Nature is
contains high amount of oil and protein
an extraordinary source of antidiabetic
that varies among different sources [7].
medicines. Where, many herbal products

have recommended for the treatment of
It known as `desert date' widely
diabetes mellitus since antiquity [2].
distributed in dry land areas of Africa and

South Asia. It contains protein, lipid,

Alloxan causes severe necrosis of
carbohydrate, alkaloid, saponin, flavor-
pancreatic -cells [3] with the consequent
noids, and organic acid. The traditional
lack of insulin secretion. For this reason, it
claims, phytochemistry, and pharmacology
has been widely used to induce
of B. aegyptiaca Del reported [8].
experimental diabetes mellitus, and many
studies have performed using this model to
The present study was designed to
explore pancreatic damage [1].
evaluate the antihyperglycemic and

antihyperlipidemic effect of B. aegyptiaca
B. aegyptiaca Del. (Zygophyllaceae)
(seeds), as we discovered that it
has traditional roles and values known for
ameliorated glucose intolerance and
thousands of years as fruits were found in
reduce body weight in a previous study.
DOI 111
1101 018

Full Paper (vol.52 paper# 26)

Effects of anti-tuberculous drugs on liver function profile
The Egyptian Journal of Hospital Medicine (July 2013) Vol. 52, Page 740­751

Effects of Anti-Tuberculous Drugs on Liver Function Profile
in Libyan Patients with Tuberculosis
Mokhtar Hadida1, Amal Abo-Smhadana2, and Marwan Draid3*
1Department of Family & Community Medicine, Faculty of Medicine, Tripoli University, 13662
Tripoli ­ Libya; 2Division of Zoology, Department of Biological Sciences, School of Basic
Sciences, Academy of Graduate Studies, 72331, Janzour, Libya, and 3Department of
Pharmacology, Toxicology & Forensic Medicine, Faculty of Veterinary Medicine, Tripoli
University, 13662 Tripoli, Libya.
*Correspondence to:Mokhtar M Hadida, PhD, Mtropead. DTCH,
Department of Family and Community Health,Faculty of Medicine, Tripoli University, Tripoli, Libya
Tel: +218 913735613, Fax: +218 21 7217005

The present prospective study was designed to conduct a local survey on patients under
anti-tuberculosis therapy hospitalized in Abo-Seta hospital, Tripoli, Libya from the safety point
of view. The study was carried out on 75 inpatients. The effects of the used drugs on some
hematological parameters and liver function biomarkers were monitored for six-month period of
treatment. Our survey showed that tuberculosis affects people with low and medium levels of
education and with no job. The frequency of adverse effects related to treatment with Abo-Seta
hospital regimen were decreases in WBCs count (-38.7%), RBCs count (-32.1%), platelets count
(-33%) and hemoglobin concentration (-35.5%). However, in most of the cases, it was not
necessary to modify the treatment regimen because of such side effects. Some parameters
showed spontaneous recovery as RBCs count (+22.1%) and hemoglobin level (+20.1%).
Combined therapy of ethambutol, isoniazid, pyrazinamide, and rifampicin has been used in Abo-
Seta hospital, as a regimen for tuberculosis infection, may be associated with a high risk of
hepatic toxicity during first month of treatment. However, during the remaining five months
there was a good recovery of liver enzymes profile. Upon the data obtained from the present
study, it could be concluded that TB patient after 6 month of treatment didn't develop multi-drug
resistant tuberculosis (MDR-TB)

Key words
: Tuberculosis, anti-tuberculosis therapy, safety profile.


Tuberculosis (TB) is one of the
Libyan patients whom tuberculosis has been
most common infectious diseases caused by
bacteriological confirmed (6), table 1.

tuberculosis) (1). Tuberculosis is still a
Table (1): Numbers of Libyan confirmed TB
major cause of death from an infectious
cases during 1990-2009 (6).
agent in developing countries, and
constitutes a serious threat in large cities of
industrialized countries (2). Environmental
of TB /
characteristics such as crowding and social
factors had a large impact on exposure to

the disease (3). In 1990, approximately, 1.7
M. tuberculosis was first isolated in
billion humans were estimated to be
1882 by the German physician Robert Koch
infected worldwide (about one-third of the
who received the Nobel Prize for this
world's population) (4). Tuberculosis has
discovery. TB spreads most commonly by
reemerged as an important public health
airborne transmission and can affect any
problem in past as well at recent time in
part of the body but most often the lungs
Libya. At 2008 about 1000 TB cases had
(5). TB, which occurs scattered throughout
been reported (5). Also, in Libya, there
the body, is referred to as miliary TB. Extra-
were a few studies on such serious problem;
pulmonary TB is more common in
one of these studies shows the number of
immunodeficiency persons and in young


Full Paper (vol.52 paper# 27)