The Egyptian Journal of Hospital Medicine (October 2013) Vol.53;Page 752762
Low Dose Nicotinamide as an Adjunctive Therapy to Calcium Carbonate for
Control of Hyperphosphatemia in Hemodialysis Patients
Magdy El-Sharkawy¹, Manal El-Hamamsy², Shaimaa Allam², Mostafa kamel¹, Ahmed Ramadan¹
¹Ain Shams University, Nephrology Department, Faculty of medicine, Cairo Egypt
²Clinical Pharmacy department, Faculty of Pharmacy, Cairo, Egypt
Background: Hyperphosphatemia remains a common problem in patients on maintenance dialysis and
contributes to the development of secondary hyperparathyroidism. Current therapies for the treatment of
hyperphosphatemia are frequently insufficient to achieve the recommended K/DOQI goal of maintaining
serum phosphorus level between 3.5 and 5.5 mg/dl. Niacinamide inhibits intestinal sodium/ phosphorus
co transporters and reduces serum phosphorus level in some clinical studies. So, we aimed to evaluate the
safety and the efficacy of nicotinamide as adjunctive therapy to calcium carbonate (as calcium based
phosphate binder) in hemodialysis patients.
Methods: Sixty hemodialysis patients with serum phosphorus level 5.0 mg/dl were randomly assigned
to 8 weeks of the study. Patients were divided into two groups: (group I) (control group): 30 cases
calcium carbonate only and (group II) (study group): 30 cases received a combination of calcium
carbonate and nicotinamide. Nicotinamide dose was started as 500mg/day and increased on 8th day to
1000 mg/day. Results: In the study group (nicotinamide group): serum phosphorus level fell
significantly (p<0.001), calcium × phosphorus product dropped significantly (p<0.001), with a significant
elevation of serum calcium (p<0.05). In the control group: there was insignificant change in former
parameters (p values>0.05). Intact parathyroid hormone, uric acid, platelet count, total cholesterol,
hemoglobin, ASAT, and ALAT and lipid profile remained insignificantly changed in both groups.
Diarrhea, flushing and skin rash were the major adverse effects seen with nicotinamide therapy resulting
in early withdrawal of 4 patients from the study. Conclusion: In hemodialysis patients, nicotinamide in
single dose of 1000 mg daily can effectively reduce serum phosphorus level when administered with
calcium carbonate (as phosphate binder) with less potential side effects reported.
Key words: Nicotinamide- Hyperphosphatemia- Hemodialysis
Chronic kidney disease (CKD) is a worldwide
abnormalities, including disordered phosphorus
Approximately 20 million adults in the United
and calcium metabolism. In patients with CKD,
States are in various stages of CKD, with more
these abnormalities cause significant morbidity
than 400,000 individuals with end-stage kidney
and directly influence the mortality associated
disease and over 300,000 individuals requiring
with end-stage kidney disease. Indeed,
maintenance hemodialysis. It has been projected
cardiovascular mortality is 15 times greater in
that by 2030, more than 2 million individuals
patients undergoing hemodialysis than in the
will need dialysis or transplantation for kidney
general population (1,2,3,4).
failure as a result of an aging population and the
As glomerular filtration rate (GFR) declines,
increasing prevalence of type 2 diabetes. The
there is a decrease in phosphate excretion
gradual failure of kidney function is
resulting in phosphate retention, while serum
accompanied by an increase in cardiovascular
calcium decreases and the production of
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 763769
The Effect of Lupinus albus and Hyphaene thebaica on
Chromosomal Aberrations and Histopathological Changes of Liver and
Pancreas in Streptozotocin-induced Diabetic Rats
Amany A Tohamy*, Mohga S Abdalla**, Adel K Ibrahim***, Kawkab A Ahmed****, Khaled
F Mahran***, Rasha S Mohammed*
*Department of Zoology and Entomology, Faculty of Science, Helwan University.
**Department of Chemistry, Faculty of Science, Helwan University.
***Department of Clinical Pathology, Veterinary Medicine, Cairo University.
**** Department of Pathology, Veterinary Medicine, Cairo University.
Background: The folk medicine in Egypt has described several kinds of Egyptian herbs and plant
prescriptions, belonging to various families to be concerned with the treatment of diabetes mellitus.
The present study focuses on evaluating the chromosomal aberration in somatic cells of STZ-diabetic
rats treated with Lupinus albus (termis) and Hyphaene thebaica (doum) as well as their effect on liver
and pancreas histopathology.
Material and methods: STZ was injected intraperitoneally at a single dose of 50 mg/kg to induce
diabetes. Termis seeds suspension (75 mg/100 g b.wt.) was daily orally administered, doum fruit
suspension was daily orally administered (1g/kg b.wt.) and also gliclazide, reference drug, was
administered at a dose equivalent to the therapeutic dose of rat. After four weeks of administration,
bone-marrow metaphases were prepared for examining chromosomal aberration. These were followed
by statistical analysis. Liver and pancreas were dissected, processed and stained with H&E for
investigating histopathological changes.
Results: The results of chromosomal analysis showed that, diabetic rats had a highly significant
increase of chromosomal aberrations compared to that of normal healthy control. Animals which were
treated with Lupinus albus and Hyphaene thebaica showed significant improvements in the
frequencies of chromosomal aberrations. Also, treatment of diabetic rats with termis and doum
revealed marked improvement in liver and pancreas histopathology.
Conclusion: It is concluded that diabetes is much harmful on the histological picture of liver and
pancreas and on chromosomal aberration frequencies in the animal body, whilst the administration of
termis or doum reduced these harmful effects of diabetes.
Key words: Lupinus albus, Hyphaene thebaica, gliclazide, streptozotocin, diabetic rat.
The prevalence of diabetes is
species of plants have been described in the
increasing at an alarming rate, and its
scientific and popular literature as having
incidence is nearing epidemic levels across a
hypoglycemic activity (4).
variety of populations (1). Diabetes mellitus,
Lupinus albus is a member of the
one of the most common endocrine metabolic
Leguminosae family (5). Lupine is the one that
disorders has caused significant morbidity and
has the highest protein content in its
composition apart from being a good source of
(retinopathy,neuropathy, and nephropathy) and
fibres. However, lupin seed is one of the
macrovascular (heart attack, stroke and
legumes with the lowest levels of non-
peripheral vascular disease) complications (2).
nutritional compounds (trypsin inhibitors,
Diabetes mellitus is classified into type I, type
phytic acid, saponins and lectins) (6).
II, other specific types, and gestational
Doum palm fruit (Hyphaene thebaia)
is a desert palm tree with edible oval fruit,
Besides drugs classically used for the
originally native to the Nile valley. It is a
treatment of diabetes (insulin, sulphonylureas,
member of the palm family, Arecaceae (7).
biguanides and thiazolidinediones), several
Effect of Cynara Scolymus L
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 770781
Effect of Curcumin on Some Heavy Metals Induced Renal And Testicular
Injuries in Male Rats
Tamer, M. M. Saad
Medical and Radiation Research Dept., Nuclear Materials Authority, Cairo, Egypt
Back ground Toxic heavy metals in water, air and soil are global problems that are a growing threat to
humanity. Heavy metals are widely distributed in the environment and some of them occur in food, water, air
and tissues even in the absence of occupational exposure. The antioxidant and protective influences of
curcumin on a mixture of some heavy metals (Pb, Hg and Cd) induced renal and testicular injuries in male
rats were detected.
Curcumin, a yellow pigment from Curcuma longa, is a major component of turmeric and is commonly
used as a spice and food-coloring material. It exhibits anti-inflammatory, anti-tumor, and antioxidant
Aim The present study aims to evaluate the antioxidative activities and protective role of curcumin against
some heavy metals induced renal and testicular injuries in male rats.
Material and Method
Male Swiss albino rats were orally administrated by curcumin (150 mg/kg B.W.) using suitable stomach
tube (eight weeks) before receiving mixture of heavy metals (Pd, Hg and Cd) in drinking water for two
weeks. Levels of plasma creatinine, urea, uric acid and serum testosterone concentration were measured,
glutathione content and superoxide dismutase activities in kidney and testis tissues were estimated and also
histological examinations for kidney and testis tissue were detected.
The results revealed that mixture of heavy metals lead to significant increase in the level of plasma
creatinine, urea and uric acid, Meanwhile, significant decrease in serum testosterone concentration.
Glutathione content and superoxide dismutase activities in kidney and testis tissues were significantly
decrease by using a mixture of heavy metals. But groups administrated with curcumin before administrated
with mixture of heavy metals, exerted noticeable amelioration against their damage in most of the
biochemical and histological tested parameters.
Keywords: Ionizing radiation, Curcumin, Antioxidant, Liver and kidney tissues.
Heavy metallic compounds have emerged as a
heavy metals on male reproduction system have
major class of industrial waste product (1).
become a major health concern in the globe (7, and
Heavy metals are persistent environmental
8). The evidence of the past twenty years have
contaminants since they cannot be degraded or
shown a disturbing trend in male reproductive
destroyed. Heavy metals are chemical elements
health hazards due to careless use of these
capable of spreading in the environmental
chemicals which causes detrimental effects on
compartments and circulating between them.
When passed on to the living organisms cause
Lead (Pb) is a poisonous metal, which is
poisoning or death (2).
ubiquitous in both organic (Tetraethyl lead) and
According to the toxicity for humans and
inorganic (lead acetate, lead chloride) forms in
animals, the metals are divided into groups, heavy
environment (9) and is emitted from automobile
metals which have a toxic influence on living
fuels, industrial discharge and paints.
organisms included cadmium (Cd), mercury (Hg)
(10) reported that, workers employed in these
and lead (Pb) (3).
industries are more exposed to lead than general
Continuous environmental and occupational
public. Numerous studies have shown that 1530%
heavy metals exposure can lead to chronic
of lead exposure in humans occurs through
nephropathy. However, many experimental studies
inhalation and 7085% with food and drinks from
showed that several heavy metals caused renal
gastrointestinal tract. Lead remains a considerable
failure associated with severe histopatholgical and
occupational and public health problem, which is
physiological alterations (4, 5, and 6).
known to cause a number of adverse effects in both
Due to the rapid industrialization and
men and women.
overgrowing urbanization, the toxic effects of
DO I: 10.12816/000163 8
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 782788
Self Perception of Community Dwelling Elderly toward Aging
in Shubra El Khima City
Ahmed K Mortagy *,Hoda I Fahim #,Tamer MFarid *, Ekramy E Abdul Rahman *,Asmaa F
*Geriatrics and Gerontology department, # Community department; Faculty of Medicine, Ain shams
university, Cairo, Egypt
Asmaa F AbdellahMScGeriatris and Gerontolgydepartment, Faculty of Medicine, Ain shams
university,Abbasia , Cairo , Egypt.Email:email@example.com Tel. 01221485627
Background: Elderly with positive self-perception of aging tend to engage in additional health behaviors
related to prevention and report better functional health and live longer.
Objectives: The aim of the study is to assess the self-image of community dwelling elderly toward aging
in shubra el khima city.
Design: A cross sectional study.
Participants: Four Hundred of community dwelling elderly. Settings: shubra el khima city.
Measurements: Minimental status examination (MMSE-30), Geriatric Depression scale (GDS-15),
Direct interview by researcher to fulfill a structured battery of questionnaire formed of several subscales
from seven different questionnaires investigating self perception of aging by participating
individual:Age Stereotypes Scale, Quality of Life Scale, Satisfaction with Life Scale (SWLS), Positive
and Negative Affect Schedule (PANAS), Lawton's Philadelphia Geriatric Center (PGC) Morale Scale,
Subjective Age Scale, Ryff'sPsychological Well Being Scales.
Results: Older people feel younger than they actually are generally are satisfied with their aging, have
high levels of positive affect and low level of negative affect and have higher morale, have positive age
stereotype, have positive self-acceptance (good psychological well-being) and positive purpose in life.
The three most important things for a good quality of life among studied participants were in order: good
health followed by having good pension and good relationship with family members or friends.
Conclusion: elderly in shubra el khima city have positive self-perception of aging.
Keywords:self perception of aging- elderly-age stereotype-quality of life-PANAS-morale-psychological
Aging is a part of the life span developmental
Elderly with the more positive attitudes toward
process of humans, it is a constant process of
aging lived 7.5 year longer than those with
change, beginning at birth and ending at death,
negative attitudes. "The effect of more positive
the process involves biological, psychological
self-perceptions of aging on survival is greater
and social influences, all of which are
than the physiological measures of low systolic
blood pressure and cholesterol, each of which is
"Self-perceptions of aging refer to how old
associated with a longer lifespan of four years or
people feel about themselves and see themselves
in relation to others" (1).
Older adults with low expectations for aging are
Elderly with positive self-perception of aging
more likely to report sedentary lifestyles and less
tend to engage in additional health behaviors
likely to report seeking health care for age-
related to prevention (2) and report better
associated conditions. Based on this evidence
functional health (3)and live longer(4). "Positive
and the possibility that older adults might be
changes in society's view of aging may also help
able to change their beliefs about aging and
to reduce and prevent age-related declines in
influence health outcomes, there is substantial
function and the associated deleterious
gerantological community in gaining an
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 789794
The Effect of Lupinus Albus (Termis) and Hyphaene Thebaica
(Doum) on Some Biochemical Parameters in Streptozotocin-Induced
Amany A Tohamy*, Mohga S Abdalla**, Adel K Ibrahim***, Khaled F Mahran***, Rasha S
*Department of zoology and entomology, Faculty of science, Helwan University.
**Department of chemistry, Faculty of science, Helwan University.
***Department of clinical pathology, Veterinary Medicine, Cairo University.
Background: Several plants have been used as dietary adjuvant and in treating the number of
diseases because of their perceived effectiveness, minimal side effects in clinical experience and
relatively low costs. The present study focuses on evaluating the effect of Lupinus albus (termis) and
Hyphaene thebaica (doum) on STZ-diabetic rats at the level of some biochemical parameters
Material and methods: STZ was injected intraperitoneally at a single dose of 50 mg/kg to induce
diabetes. Termis seeds suspension (75 mg/100 g b.wt.) was daily orally administered. Doum palm
fruit suspension was daily orally administered (1g/kg b.wt.) and also gliclazide (reference drug) was
administered of a dose equivalent to the therapeutic dose of rat. After four weeks of administration,
blood samples were collected for biochemical measurement. Results: Blood glucose level was
significantly increased. Diabetes increased serum total lipids, cholesterol, triglycerides and LDL but
serum HDL was decreased. Also activities of serum enzymes ASAT, ALAT, ALP, GGT and LDH
were elevated. However, L. albus and H. thebaica improved the level of mostly all biochemical
Conclusion: It is concluded that termis and doum may be dietary adjuvant in reducing the harmful
Key words: Lupinus albus Hyphaene thebaica, gliclazide, streptozotocin, diabetic rat.
Diabetes was first described by the
composition apart from being a good source of
Ancient Greek physician Aretaeus of
fibres. However, although lupin seed is one of
Cappadocia, who first coined this term (1)
the legumes with the lowest levels of non-
Diabetes mellitus (DM) is a worldwide
nutritional compounds (trypsin inhibitors,
phytic acid, saponins and lectins) (8).
proportion, afflicting the global population (2).
Doum palm fruit (Hyphaene thebaia)
Diabetes mellitus is chronic metabolic
is a desert palm tree with edible oval fruit,
disorders that affect human body in terms of
originally native to the Nile valley. It is a
physical, psychological and social health. It is
member of the palm family, Arecaceae (9).
defined as a group of disorders characterized
Doum palm fruit is also a source of potent
by hyperglycemia (3). It accounts for a high
incidence of morbidity leads to various events
One method which is more uniformly
effective and widely used in inducing diabetes
complications (4). Diabetes mellitus is
is the injection of streptozotocin (11). It causes
classified into type I, type II.Besides drugs
hyperglycemia by its direct cytotoxic action on
classically used for the treatment of diabetes
pancreatic beta cells (12).
(insulin, sulphonylureas, biguanides and
Aim of the study:
thiazolidinediones), several species of plants
The present study was done to elucidate the
have been described in the scientific and
effect of Hyphaene thebaia and Lupinus albus
popular literature as having hypoglycemic
(as antidiabetic agents) on some biochemical
parameters in STZ-diabetic adult male albino
Lupinus albus is a member of the
Leguminosae family (7). Lupine is the one that
has the highest protein content in its
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 795798
Depression as a Predictor of Length of Hospital Stay in Elderly Patients
Admitted to Ain Shams University Hospitals
Sherine M. Elbanouby, Sarah A.Hamza,Samia A. Abdel Rahman and Ahmed Kamel Mortagy
Geriatrics and Gerontology department, Faculty of Medicine, Ain shams university, Cairo, Egypt
Correspondance:Sherine Mohamed El Banouby MSc, Geriatris and Gerontolgy department , Faculty of
Medicine, Ain shams university , Abbasia , Cairo , Egypt.
Email: firstname.lastname@example.org Tel. 01005230213
Background: Depression among the physically ill is common and frequently under-diagnosed. Elderly
patients with depressive symptoms are at higher risk of hospital admission for non psychiatric conditions
and are more likely to have longer hospital stays and worse hospital outcomes, compared with non
Objectives: The aim of this study was to find out if depression can be considered a predictor of
prolonged hospital stay in elderly patients.
Design: A prospective cohort study. Participants: 205 consecutive patients 60 years and over both males
and females. Settings: Ain shams university hospitals. Measurements: All participants were assessed
using comprehensive geriatric assessment including Geriatric depression scale (GDS) and the length of
stay was registered. Results: Depressed patients had longer length of hospital stay compared to non
depressed patients and the least length of hospital stay was for cases with no risk on GDS scale compared
to other groups and the difference is highly significant statistically (p=<0.001).
Conclusion: length of hospital stay is significantly longer among depressed elderly.
Key wards: Depression Length of hospital stay Elderly
Older people are the most frequent users of health services, and the progressive aging of the world's
population may lead to a saturation of available services. Therefore, we must find ways to reduce
preventable admissions to hospital and uncover the factors associated with potentially preventable use of
health service .
In many countries increasing medical costs is an urgent issue, and one of the main contributing factors is
length of stay (LOS) in hospital. Patients in geriatric wards generally have a long LOS and reducing that
time is one way of reducing medical costs, not necessarily only for administrative reasons, but also from
the clinical point of view because unnecessarily long hospitalization may result in a decline in the ability
to perform activities of daily living (ADL) or contracting infectious diseases. On the other hand, the
hospital environment may not be protective to an elderly, but rather dangerous, with enforced bed rest,
undernourishment, and development of iatrogenic illness  .
Depression among the physically ill is frequently under-diagnosed in contrast with overt psychotic
symptoms and/or disorders such as delirium, hallucinations, delusions, manic symptoms and
Prina et al. reported that elderly patients with depressive symptoms were at higher risk of hospital
admission for non psychiatric conditions and were more likely to have longer hospital stays and worse
hospital outcomes, compared with non depressed participants. These results highlight the potential to
target this high-risk group to reduce the burden of health care costs in the elderly .
Study design and setting:
This is a prospective cohort study on 205 elderly
Hospitals in the period between March 2012 and
patients admitted to inpatient `geriatric and non-
geriatric' acute care in Ain Shams University
Effect of Vitamin C and/or Vitamin E on Kidney, Liver and brain Functions of Streptozotocin-Induced Diabetic Rats
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 799808
Effect of Vitamin C and/or Vitamin E on Kidney, Liver and brain
Functions of Streptozotocin-Induced Diabetic Rats
Ghada Z A Soliman
National Nutrition Institute, Cairo, Egypt;
Corresponding Author: email@example.com
Introduction: Diabetes Mellitus is one of the main threats to human health in the 21st century.
Purpose: To evaluate the effect of vitamin C and/or vitamin E on liver, kidney and brain function of
streptozoticin induced-diabetic rats. Study Design: One hundred and twenty male adult Sprague
Dawley rats were divided into 6 groups (20 rats each), normal control, STZ-induced diabetic rat,
STZ-induced diabetic rats treated with: antidiabetic drugs; vitamin C; vitamin E; vitamin C+E.
Material and Methods: Blood samples were collected from all groups, Urea, creatinine, uric acid,
total protein, Alanine/ aspartate transaminase and vitamin E were measured in plasma. Results:
Urea, creatinine, uric acid, ALT, AST, vitamin E, LDH (in brain and liver) and MDA (brain) were
significantly increased in STZ-induced diabetic rats. Treatment with vitamin C and/or E decrease
significantly the increased level of the tested parameters and this may be due to the scavenging free
radicals properties of vitamin C and/or E which prevents damage induced by hyperglycaemia; Also
may be because vitamin C and/or vitamin E decreased lipid peroxidation and augmented the
activities of antioxidant enzymes. Conclusion: Vitamin C and/or E may thus be a useful adjuvant
therapy in the management of diabetes mellitus but it is better to use combination of the two
vitamins rather than in single supplements to prevent the perturb antioxidantproxidant balance.
Keywords: Diabetes Mellitus, Liver and Kidney Function, Vitamin E, Uric acid
Diabetes mellitus (DM) is
micronutrient that acts as a non-enzymatic,
considered as one of the main threats to
human health in the 21st century and the
oxidative damage by free radicals. Vitamin
number of people with diabetes has
C exerts a uricosuric effect that may be
increased worldwide (1). Diabetes mellitus
beneficial (5). Vitamin C may reduce serum
is characterized by abnormally high plasma
concentrations of uric acid that at high
levels could become crystallized in the joint
hyperglycemia and the associated metabolic
and kidney and lead to gout and kidney
abnormalities are responsible for many
stones (5,6). However, the effect of vitamin
disease complications, including damage to
C supplementation on serum uric acid levels
the blood vessels, eyes, kidneys and nervous
has not been well documented.
Vitamin C is known as natural
Free radicals have been implicated in
antioxidant. All known physiological and
the pathogenesis of many degenerative
biochemical actions of vitamin C are due to
diseases, including diabetes, atherosclerosis
its action as an electron donor. After
and cancer (3). Diabetes has been
vitamin C donates electrons, they turned
considered to be associated with oxidative
into a free radical, ascorbyl radical or
stress. Oxidative stress may cause oxidative
damage of cellular membranes. Oxidative
relatively stable with a half-life of 10 -5
stress may cause oxidative damage of
seconds and is fairly uncreative. Ascorbate
cellular membranes and changes in the
is therefore a good free radical scavenger
structural and functional integrity of
due to its chemical properties (7-9). Vitamin
subcellular organelles and may produce
C can recycle the lipid-soluble vitamin E by
effects that result in various complications
reducing alpha-tocopheroxyl radicals in
in diabetic disease. Various studies have
reported protective effects of antioxidant as
Vitamin E (-tocopherol) is found in
vitamin C (4) against oxidative damage of
virtually all cell membranes, especially in the
diabetes. Vitamin C is an essential
inner mitochondrial membrane, the site of the
Effect of Rosmarinus Officinalis on Lipid Profile of Streptozotocin-induced Diabetic Rats
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 809815
Effect of Rosmarinus Officinalis on Lipid Profile of Streptozotocin-
induced Diabetic Rats
Ghada Z A Soliman,
Associate Professor of Biochemistry,
National Nutrition Institute, Cairo, Egypt;
Corresponding Author: firstname.lastname@example.org
Introduction: Diabetes mellitus (DM) is considered as one of the main threats to human health in
the 21st century. The use of herbs as medicines has increased all over the world, gaining popularity
and played an important role in disease treatment especially in diabetes mellitus. Aim: The present
research was designed to evaluate the effects of dried rosemary leaves powder on blood sugar and
lipid profile of streptozotocin-induced diabetic rats.
Material and methods: One hundred (100) male Sprague Dawly rats aged 3 months, weighing
184±11 g, divided into 5 groups (20 rats/group) as follow: G 1: Normal Control; G 2: STZ-induced
Diabetics; G 3: STZ-induced Diabetic+ Glibenclamide; G 4: STZ-induced Diabetic+ Dried rosemary
leaves powder; G: Normal Control+ Dried rosemary leaves powder. At the end of the experiments (6
weeks, 45 days), rats were fasted overnight, and then sacrificed under ethyl ether and blood was
taken for further biochemical analysis.
Results: The body weight and High density lipoprotein were decreased significantly in STZ-
induced diabetic group of rats when compared to normal control rats. Diabetes induced by STZ
resulted in a significant elevation in the levels of fasting blood glucose (FBG), glycosylated
haemoglobin (HbA1c), lipid profile (Cholesterol, low, very low density lipoprotein cholesterol) and
triacylglycerol. Treatment of STZ-induced diabetic rats with dried rosemary leaves powder reduced
the elevated blood glucose, HbA1c, triacylglycerol, cholesterol and LDL-C by 53.97, 24.56, 45.43,
39.31 and 33.89 % respectively in respect to untreated STZ-induced diabetic group. Dried rosemary
powder leaves have no significant influence on body weight, plasma glucose level and lipid profile
of normal rats.
Conclusion: The results of this experiment may indicate that the dried rosemary leaves powder has a
beneficial effect as an anti-diabetic agent and its complications as well as improving lipid
metabolism in diabetics with no effect on normal rats.
Keywords Rosmarinus Officinalis, Antidiabetic, Antihyperlipidemic,
Diabetes mellitus (DM) is considered
The use of herbs as medicines has
as one of the main threats to human health in
increased all over the world, gaining
the 21st century and the number of people
popularity and played an important role in
with diabetes has increased worldwide (1).
disease treatment especially in diabetes
Diabetes mellitus is characterized by
mellitus (5, 6). Herbs contain natural
substances and active phytochemicals that
can promote health and alleviate illness as
abnormalities that are responsible for many
reducing blood sugar, high blood cholesterol
disease complications, including damage to
concentrations, provide some protection
the blood vessels, eyes, kidneys and nervous
against cancer and stimulate the immune
system. The major advantages of herbal
Atherosclerosis and coronary heart
medicine seem to be their efficacy, low
disease are the major health problem in
incidence of side effects (if carefully used),
developed and modern societies (3).
and low cost.
Hyperlipidemia is an associated complication
Rosmarinus officinalis L., known as
of diabetes mellitus (4).
rosemary, is an aromatic shrub and is native
to the Mediterranean region. Its leaves are
Role of PET/CT in Management of Chest Tumors
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 816 826
Role of PET/CT in Management of Chest Tumors
Heba Nabil, Karima M Maher, Khalid Abdel Karim , Sameh AR Mahdy, Hossam M Sakr
Nasser Institute Hospital for Research and Treatment, Cairo, Egypt.
Radiodiagnosis Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Clinical Oncology Depatment, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
OBJECTIVE: to identify the role of PET-CT in management of chest tumors.
PATIENTS AND METHODS: Whole body PET/CT study was performed on 32 patients of variable
primary & secondary chest tumors who were under evaluation for primary or secondary chest tumors by
recent CT, referred for staging before treatment and / or follow up after treatment.
RESULTS: Our findings indicate that FDG PET/CT has an important impact on diagnosis &
management of chest tumors , as it delineated the metabolic activity of the disease in 19 patients (59.4 %),
outlined the metabolic activity of the tumoral residue in 6 patients (18.75%) , differentiated between
tumoral residue & post irradiation pneumonitis in 1 patient (3.1%), followed up the therapeutic response
in 4 patients (12.5 %), differentiated between residual mass & post therapeutic fibrosis in 1 patient
(3.1%) and delineated the metabolic activity of the disease for preparing for BMT in 1 patient (3.1%) and
so had an impact on the management of chest tumor patients.
CONCLUSION: By recognizing the relevant radiologic and metabolic behavior of chest tumors,
understanding the appropriateness of staging disease with the TNM classification system, and being
familiar with potential imaging pitfalls, PET/CT can make an important contribution to diagnosis,
treatment and outcome in chest tumor patients.
Key words: PET/CT Chest Tumors Management.
In oncological imaging, the goals are lesion
planning treatment, determining prognosis,
evaluating treatment results, and facilitating
characterization, proper staging, and treatment
success. Some of these goals require precise
anatomical imaging, whereas others demand
The management of oncology patients depends
molecular techniques. It was, therefore, easily
on accurate local staging of tumor spread, the
acknowledged that FDG-PET and CT are
identification of nodal involvement and distant
complementary, and the employment of the two
metastases. Staging is important at diagnosis,
is imperative in the oncological clinical
assessing treatment plans, determining prognosis
and evaluating response to treatment(3).
Indications of PET/CT in chest tumors
Lung cancer is the leading cause of cancer-
include the evaluation of the solitary pulmonary
related deaths, Lung cancer is classified as either
nodule, the staging of NSCLC, SCLC,
nonsmall cell or small cell lung cancer, with
mesothelioma and lymphoma, the monitoring of
the former accounting for 87% of all lung
treatment response, and the assessment for
cancers. The descriptors of the internationally
recurrent tumor after radio/chemotherapy. PET-
CT is a very powerful imaging tool in thoracic
classification system for staging various cancers
oncology. PET-CT is more accurate than PET or
include the size of and the degree of
locoregional invasion by the primary tumor (T),
PATIENTS AND METHODS
the extent of regional lymph node involvement
This is a cross sectional study included 32
(N), and the presence or absence of intrathoracic
patients who were under evaluation for primary
or distant metastases (M). The goal of such a
or secondary chest tumors by recent CT, referred
classification system is to assist clinicians in
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 827 836
Risk Factors for Coronary Artery Disease in Egyptian Women
Bahnasawy MH*; Habbak LZ*; Al-Ashry MA** and Al-Maie MM*
* Zoology department, Faculty of science, Damietta University, Egypt
** Intensive care unit, Damietta chest hospital, Damietta, Egypt
Introduction: Coronary artery disease (CAD) is a major public health problem both in
developed and in developing countries. The disease is multifactorial and many predisposing
risk factors are responsible for this disease. The present study was performed to determine the
prevalence of CAD risk factors among Egyptian women at Damietta governorate.
Patients and methods: The study was based on investigation of 113 randomly chosen
women who had CAD. Demographic data, risk factors were determined by taking history,
physical examination and laboratory tests.
Results: The results indicated that the age of the patients ranged from 24 to 82 years with a
mean of 55.95±11.04 years. The mean total cholesterol, LDL-C and HDL-C were 233.17,
150.77 and 44.80 respectively. The blood sugar ranged from 75 to 488. Risk factors analysis
revealed a significant higher prevalence of obesity and overweight (96.46%), hypertension
(83.19%), total cholesterol (78.76%), physical inactivity (70.8%), stress (69.03%), diabetes
mellitus (57.52%) and family history of CAD (46.9%).
Conclusion: This study provides useful information about the health characteristics of the
Egyptian women at Damietta governorate and indicates that the development of health
education programs and early chick-up is necessary to prevent the risk factors of this disease.
Key words: Coronary risk factors Damietta - women
TG : triglyceride
mmHg : Millimeter Hg
mg/dl : Milligram per Deciliter
Coronary artery disease (CAD),
were due to a stroke . Advances in the
the most common form of cardio-vascular
field of medicine over the past few
disease (CVD), is the leading cause of
decades enabled the identification of the
mortality and morbidity in developed
risk factors that may contribute toward the
countries and is emerging as an epidemic
development of CAD. The risk factors that
in developing countries [1, 2]. CAD is
can be modified are elevated blood
characterized by the presence
cholesterol, hypertension (high blood
atherosclerosis in the epicardial coronary
pressure), cigarette smoking, overweight
arteries . Atherosclerosis is a disease in
and obesity, diabetes mellitus, alcohol
which fatty substance such as cholesterol,
cellular waste, calcium and other
inactivity. Non-modifiable risk factors of
substance are deposited along the lining of
course include age, gender and family
the artery walls. These sticky, yellowish
history [6, 7].
deposits, known as plaques, may progress
to the narrowing of the arteries and is the
In Egypt, mortality secondary to
most common cause of chronic arterial
CAD is rapidly rising . According to
occlusive disease .
the latest WHO data, coronary artery
disease deaths in Egypt reached 78,879 or
An estimated 17.3 million people
21.73% of total deaths. The age adjusted
died from CVDs in 2008, representing
death rate is 173.98 per 100000 of
30% of all global deaths. Of these deaths,
population ranks Egypt 33 in the world
an estimated 7.3 million were due to
coronary artery disease and 6.2 million
Protective Effect of Urtica Diocia, Natural Honey and Their Mixture Against Oxidative Stress Caused by Chronic Ethanol Consumption
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 837 845
Adverse Effects of Digoxin, as Xenoestrogen, on Some Hormonal and
Biochemical Patterns of Male Albino Rats
Eman G.E.Helal *, Mohamed M.M. Badawi **,Maha G. Soliman*, Hany Nady Yousef *** ,
Nadia A. Abdel-Kawi*, Nashwa M. G. Abozaid**
Department of Zoology, Faculty of Science, Al-Azhar University (Girls)*, Department of
Biochemistry, National organization for Drug Control and Research** Department of Biological and
Geological Sciences, Faculty of Education, Ain Shams University***
Background: Xenoestrogens are widely used environmental chemicals that have recently been under
scrutiny because of their possible role as endocrine disrupters. Among them is digoxin that is
commonly used in the treatment of heart failure and atrial dysrhythmias. Digoxin is a cardiac
glycoside derived from the foxglove plant, Digitalis lanata and suspected to act as estrogen in living
Aim of the work: The purpose of the current study was to elucidate the sexual hormonal and
biochemical patterns of male albino rats under the effect of digoxin treatment.
Material and Methods: Forty six male albino rats (100-120g) were divided into three groups (16 rats
for each). Half of the groups were treated daily for 15 days and the other half for 30 days. Control
group: Animals without any treatment. Digoxin L group: orally received digoxin at low dose
equivalent of 0.0045mg/200g.b.wt. Digoxin H group: administered digoxin orally at high dose
equivalent of 0.0135mg/200g.b.wt. At the end of the experimental periods, blood was collected and
serum was separated for estimation the levels of prolactin (PRL), FSH, LH, total testosterone (total T),
aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase (ALP),
urea, creatinine, total proteins, albumin, total lipids, total cholesterol (total-chol), Triglycerides (TG),
low density lipoprotein cholesterol (LDL-chol) and high density lipoprotein cholesterol (HDL-chol).
Results: Results showed marked elevation in PRL and FSH levels and significant reduction in LH and
total T levels in all treated groups compared to the corresponding controls. Serum enzyme activities
(ALT, AST and ALP) and levels of urea, creatinine, total lipids, total-chol, TG and LDL-chol were
obviously elevated in all the treated groups as compared to control groups. Marked decline was
recorded in the values of total proteins, albumin, A/G ratio and HDL-chol in all the treated groups at
the end of the two time intervals of treatment compared to controls. Regarding serum globulin level,
treatment of rats with the low dose of digoxin for 15 days induced significant reduction in this
parameter, while globulin returned back to its normal level after 30 days of treatment. On the other
hand, the high dose of digoxin caused significant decline in serum globulin concentrations at the two
time intervals of treatment. Most of the recorded changes in hormonal and biochemical parameters
exhibited dose and time-dependent manner.
Conclusion: The results of the current research confirmed that digoxin disrupts the sexual hormonal
pattern and biochemical parameters. So, we recommend replacing of this drug by others without
estrogenic activity, particularly if it is indicated at a high dose or for a long period of time.
Key words: Xenoestrogens, digoxin, Hormones, Biochemical parameters.
In the last few years, increasing interest
synthesis, secretion or bioavailability .
has focused on evaluating the adverse effects
Among EDCs, xenoestrogens have been
of endocrine-disrupting chemicals (EDCs).
extensively studied owing to their capability
EDCs are a heterogeneous group of
to mimic natural estrogens .
substances able to alter many endocrine
Digoxin is a cardiac glycoside derived
functions in organisms . The mechanisms
from the foxglove plant, Digitalis lanata .
of endocrine disruptor's toxicity include direct
Digitalis such as digoxin and digitoxin are
interaction with hormone receptors as agonists
commonly used in the treatment of heart
or antagonists or alteration of hormone
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 846 854
Role of Tumor Necrosis Factor Alpha, Ghrelin, Evoked Potentials in
Wafaa M. Elzefzafy, AbeerAboulEla , Manal H. Maabady*, Radwa S. Shahin**
Departments of Tropical Medicine, Neurology*and Clinical Pathology**, Faculty of Medicine for
Background: Hepatic encephalopathy has a negative effect on patient health-related quality of life.
Apart from increased blood ammonia, alterations in various other substances (Tumor necrosis
Factor- Alpha (TNF-), Ghrelin)have been implicated in the pathogenesis of hepatic encephalopathy
(HE). Ghrelin and TNF-alpha have numerous metabolic actions.
Aim of the work: was to estimate the role of TNF -, Ghrelin and Evoked Potentials changes in
patients with hepatic encephalopathy, and their relation to grades of hepatic encephalopathy
Methods: We measured serum levels of TNF -, Ghrelin in 40 patients with liver cirrhosis (20 with
hepatic encephalopathy & 20 without encephalopathy) and 10 healthy controls. All subjects
underwent to neurophysiological test: p300,visual and auditory evoked potentials.
Results: The results of this study showed highly significant increase in TNF -, Ghrelin & levels in
both groups when compared to the control group with a significant increase in the cirrhotic
encephalopathic group. Also significant correlation between TNF-, Ghrelin & grading of
encephalopathy was found. Delay in latency and decrease amplitude of VEP, p 300 and ABR were
significant in cirrhotic patients with hepatic encephalopathy.
Conclusion: TNF -, Ghrelin levels are sensitive indicators of the severity of liver disease. Patients
with liver cirrhosis can be followed up by measurement of these serum markers which might predict
the development of encephalopathy. The increasing levels of Ghrelin & TNF- is more prominent in
cirrhosis with encephalopathy. The presence of nutritional and metabolic abnormalities, including
malnutrition in cirrhosis, at least partly, elucidates high Ghrelin level. The applied
neurophysiological tests are a simple, suitable and objective method for differentiating the degrees of
encephalopathy and for identifying the preclinical stage of encephalopathy because abnormalities in
these tests may prompt the clinician to initiate treatment.
Keywords: TNF, Ghrelin, evoked potentials, Hepatic Encephalopathy.
Hepatic encephalopathy (HE) is a major
related complications such as hyperdynamic
complication of acute or chronic liver disease
circulation, susceptibility to infection, and
characterized by neuropsychiatric symptoms.
Its etiology and pathogenetical mechanisms
Ghrelin is a novel endogenous ligand for the
are not clearly understood and probably it is
growth hormone (GH) secretagogue receptor
that has been isolated from both human and
precipitated by factors that increase
rat stomach 5. Ghrelin controls energy
inflammation or ammonia production 1.
balance, enhancing fat mass deposition and
There is agreement that ammonia is a key
food intake through the activation of the
toxin involved in the disease process. Many
hypothalamic nuclei and the promotion of
researches aimed to characterize the effects of
neuropeptide Y (NPY) and agouti-related
inflammation, oxidative stress and other
protein (AGRP) expression6.
factors working in synergy with ammonia to
The effect of Ghrelin-like leptin is not
produce astrocyte swelling as a common
exclusively mediated by direct hypothalamic
pathway towards cerebral dysfunction 2.
receptor activation, but also by modulating
Tumor necrosis factor alpha (TNF-) is a
cytokines 7. In catabolic situations like in
cirrhosis, raised Ghrelin levels may induce a
immunologic and metabolic actions 3.The
combination of enhanced food intake,
TNF- system activity is increased in liver
increased gastric emptying and food
cirrhosis and generally thought to be
assimilation. These actions of Ghrelin are the
associated with several known cirrhosis
opposite of leptin8.
Protective Role of Some Natural Products on Phthalate-induced Testicular Toxicity in Offspring Mice
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 855 868
Treatment of Cisplatin Induced Kidney Injury in Rats by Bone Marrow-
derived Mesenchymal Stem Cells
Habbak, L.Z.*; Sobh, M.A.**; Bahnasawy, M.H.*; Amin, M.M.***;
* Zoology Department, Faculty of Science, Damietta University, Egypt.
** Urology and Nephrology Center, Mansoura University, Egypt.
***Pathology Department, Faculty of Medicine, Mansoura University, Egypt.
Background: Cisplatin is one of the most important antineoplastic drugs used in the treatment of
many cancers; however the main dose-limiting side effect of cisplatin is nephrotoxicity. It has
multiple cellular targets and modes of action that lead to nephrotoxicity. The present study aims to test
whether bone marrow-derived mesenchymal stem cells (BM-MSCs) may play a therapeutic role in the
treatment of nephrotoxicity.
Material and methods: Adult male Sprague Dawley rats (SD), were divided into four groups. The
first group was injected (i.p) with 1ml normal saline alone and kept as control, the second group was
injected (i.p) with 1ml normal saline containing 5mg/kg cisplatin, the third group was injected (i.p)
with 1ml normal saline containing 5mg/kg cisplatin and 0.5 ml of culture media containing 5 x106
BM-MSCs into the tail vein in the first day post cisplatin injection and the fourth group was injected
with 1ml normal saline containing 5mg/kg cisplatin and 0.5 ml of culture media into the tail vein in
the first day post cisplatin injection.
Results: Serum creatinine, blood urea nitrogen, creatinine clearance and malonadialdehyde were
decreased in the kidney that received BM-MSCs while; superoxide dismutase and glutathione were
increased to reach the normal values. Infusion of BM-MSCs ameliorated the renal dysfunction and
enhanced tissue injury caused by cisplatin.
Conclusion: The present study shows BM-MSCs can exert a protective effect on cisplatin
nephrotoxicity and suggests that BM-MSCs might be a new therapeutic approach for patients with
Key words: Cisplatin, Kidney, Nephrotoxicity, Stem cells.
Acute kidney injury (AKI) is a
, testicular and ovarian cancers [10, 11],
common condition that affects up to 7% of
cervical cancer  and bladder cancer .
hospitalized patients  Actually, the mortality
Many strategies have been used to
rate in hospital acquired AKI still ranges from
improve clinical outcomes in patients treated
30 to 80% . It is caused by toxic or ischemic
with cisplatin. The most common protocol for
insult from chemotherapy, antibiotics, or shock
administering cisplatin consists of pre- and
occurring from infection. AKI can lead to
post-hydration with concurrent saline diuresis.
dysfunction and apoptosis of renal tubular
The maintenance of adequate hydration is
epithelial cells, in addition to a loss of renal
important for decreasing nephrotoxicity, but
endothelial cells [3, 4].
the mechanism of protection is unknown .
Cisplatin is an antineoplastic drug used
Other common methods used for
in the treatment of many solid-organ cancers.
decreasing the nephrotoxicity of cisplatin
While toxicities include ototoxicity, gastro
include mannitol or furosemide administration
. Diuretic administration significantly
reactions [5, 6], the main dose-limiting side
improved renal function however; some degree
effect of cisplatin is nephrotoxicity [7, 8]. The
of tubular necrosis was still present. Protection
nephrotoxicity of cisplatin has been recognized
from nephrotoxicity was also seen when
since its introduction over years ago. Yet, in
cisplatin was dissolved in a hypertonic NaCl
spite of intense efforts over the ensuing decades
solution (4.5%) relative to distilled water with
to find less toxic but equally effective
no effect on the antitumor action of cisplatin
alternatives, cisplatin continues to be widely
. Additional drugs have been administered
prescribed. It remains as a standard component
in conjunction with cisplatin to reduce
of treatment regimens for head and neck cancers
nephrotoxicity. Amifostine is a SH-containing
compound that when injected before cisplatin
Prescrotal Orchiopexy for the Palpable Undescended Testicle (UDT): Initial Experience and Comparison with the Standard Inguinal Approach
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 869 873
Prescrotal Orchiopexy for the Palpable Undescended Testicle (UDT): Initial
Experience and Comparison with The Standard Inguinal Approach
Suoub, M. &,Fadi Sawaqed. &Sayel Al-Khitan. &Yaser El-Hout
Section of Urology medical school, Mu'tah University, Karak Teaching Hospital, Jordan
Objective: To review our initial experience with prescrotal orchipexy, to illustrate this surgical approach,
and to compare it with the standard two incision inguinal approach.
Material and Methods: This is a single institution retrospective comparative review of 135 patients (pts)
who underwent orchiopexy for UDT over 4 years. Pts undergoing the standard inguinal orchiopexy were
compared to those undergoing the emerging single-incision prescrotal approach in regards to operative
time, complications and cosmesis.
Results: The study was completed on 96 pts who met the inclusion criteria. Group A (72 pts, 75%)
underwent the standard two-incision inguinal orchiopexy while Group B (24 pts, 25%) underwent the
single-incision prescrotal orchiopexy. Average age at surgery was 3.2 years, with a mean follow up of 13
months. Average operative time was 56 minutes for Group A and 32 minutes for Group B, by using SPSS
significant P value difference (p < 0.05) was calculated . All patients from the two groups had uneventful
postoperative period with one pt in Group A who had a scrotal wound infection. None of the pts in Group B
need conversion to the inguinal approach. At last follow-up, all patients in both groups had testicles in the
scrotum with no atrophy. While the cosmetic appearance in Group A was acceptable, cosmesis in Group B
Conclusion: Prescrotal orchipexy is a safe alternative to the standard inguinal orchiopexy for the palpable
UDT. Our study demonstrates similar outcome, shorter operative time and superior cosmesis.
Keywords: undescended testicle, single incision, orchiopexy
Undescended testicle (UDT) is among the
most common conditions encountered in pediatric
Material and Methods
urology (1). With 80% of UDT being palpable,
This is a single institution retrospective
and 60% being distal to the external inguinal ring,
comparative review of all pts who underwent
open orchiopexy at an early age remains the
orchiopexy for primary palpable unilateral UDT
mainstay surgical management (2). The benefits of
between January 2008 to December 2011. Pts
surgery include reduction of testicular atrophy and
undergoing the standard inguinal orchiopexy were
trauma attributed to abnormal location, early
compared to those undergoing the emerging
cancer detection, and avoidance of a psychological
single-incision prescrotal approach. Of a total of
impact of an empty scrotum. Classically, the two-
135 pts, 39 were excluded: 4 pts had intra-
incision inguinal orchiopexy has been performed,
abdominal testicle, 15 pts had high testicles
preferred and perpetuated as the gold standard
located preoperatively at the level of internal ring,
approach in pediatric centers worldwide. Worth
and 20 pts were lost to follow up. The study was
noting, Bianchi and Squire introduced the single-
completed on 96 pts. According to surgical
incision prescrotal approach in 1989 (3). This
approach, we divided patients into 2 groups.
approach has potentially shorter operative time,
Group A, the control group involved 72 pts (75%)
less postoperative pain and better cosmetic result.
Additionally, accumulating literature (4, 5, 6,
orchiopexy, while Group B involved 24 pts who
7) demonstrates favourable applicability of this
had single-incision prescrotal orchiopexy. Charts
approach to acquired cryptorchidism or testicular
were reviewed for demographic data, laterality,
ascent, redo orchiopexy and communicating
preoperative testicular location, operative time,
hydroceles. Herein, we review our initial
presence and ligation of the processus vaginalis
experience with applying prescrotal orchiopexy to
(hernia sac), postoperative testicular location
palpable UDT and compare it to a matched group
complications and cosmesis.
of pts undergoing the traditional inguinal
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 874 882
The Relation of Retinol-Binding Protein 4 (RBP4) With Insulin
Resistance in Hemodialysis Patients
Eman I. Sarhan1, Mohammed R. Halawa2, Ahmed A. Abdelnaby1, Hyam M. Aref1,
Yasser M. El Shahawy1, Nahla M. Teama3.
Ain Shams University,faculty of medicine,Internal Medicine&Nephrology1, Internal
Medicine&Endocrinology2, Internal Medicine3.
Background: Insulin resistance (IR) is one of the important causes of abnormal glucose homeostasis
in CKD even in the absence of overt diabetes mellitus. Retinol-binding protein 4 (RBP4) is a
lipocalin superfamily molecule that is synthesized primarily by hepatocytes and adipocytes. CKD
may contribute to the increased survival and retention of RBP4 in the circulation. RBP has recently been
proposed as a novel adipokine involved in the metabolism of glucose.
To evaluate Retinol Binding Protein 4 in stage 5 Chronic kidney disease patients on regular
hemodialysis and its contribution to insulin resistance in those patients.
The patients divided into 2 groups:
Group I: Patients group consist of 50 ESRD patients on regular hemodialysis; they were 20 females
(40.0%) and 30 males (60.0%) with age ranged from 19 years to 52 years and with mean±SD
Group II: Control group consists of 50 normal subjects; 26 females (52%) and 24 males (48%) with
age ranged from 21 years to 51 years and with mean±SD (35.38±8.77 years).
Results: comparison between group I and group II show that there was highly significant increase in
RBP4 (p 0.000) while no statistically significant difference found between the two studied groups
regarding HOMA (p 0.260).
Conclusion:no correlation betweenRBP4 and HOMA in hemodialysis patients.
Keywords: Insulin resistance, Retinol binding protein.
Insulin resistance is defined as reduced sensitivity
(4)Numerous factors related to CKD have been
of target organs to the biologic effects of insulin.
implicated in the etiology of insulin resistance. (5)
Insulin resistance is often distinguished as either
These include uremic toxins (enhanced
hepatic insulin resistance or peripheral insulin
protein carbamylation), chronic metabolic
resistance. Hepatic insulin resistance refers to
acidosis, intracellular ion homeostasis
impaired suppression of hepatic glucose
disequilibrium, as well as qualitative and
production, whereas peripheral insulin resistance
quantitative disturbances of insulin receptors
refers to impaired response to insulin in skeletal
on adipocytes, skeletal muscle cells and
muscle and adipose tissue. (1)The site of insulin
resistance in CKD is localized to skeletal
muscles. (2) Insulin resistance is increasingly
inflammation as well as low physical
recognized as a `nontraditional' risk factor
contributing to cardiovascular disease through
Initiation of renal replacement therapy by
endothelial dysfunction, oxidative stress, dyslipidemia,
dialysis in patients with irreversible
systemic inflammation, and activation of the renin
kidney failure has long been suggested to
angiotensinaldosterone system. (3)
have a positive effect on the reduction of
Insulin resistance is common in end-stage renal
insulin resistance in this group of patients.
disease (ESRD), and possibly also in moderate-to
severe stages of CKD. Therefore, insulin resistance
hormones, or adipokines, may offer new
may be an important therapeutic target for reduction
opportunity to assess insulin resistance in
of cardiovascular mortality in patients with CKD.
CKD. (7) Retinol-binding protein 4 (RBP4)
Insulin resistance in dialysis patients has been
is a 21 kDa non-glycosylated, non-
linked to accelerated protein catabolism leading to
molecule. (8)It is a lipocalin superfamily
molecule that is synthesized primarily by
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 883 903
Histological Studies on Skeletal Muscles of Albino Rats under the Effect
Hassan S. A. El Dawi ,Gamal S. Elgharabawy ,Ezz El-Dein El Sharkawy,
Abd El Ghany A. Moustafa,Ibraheim M. Amr and Osama I. R.Bayomy
Histology Departments, Faculty of Medicine (Cairo and Damietta),
Introduction:The purpose of this study was to evaluate the effect of atorvastatin on the structure of
skeletal muscles in male albino rats and the possibility of recovery of any changes in the muscles.
Drug used: Atorvastatin (Lipitor 20mg) tablets.The daily single oral dose was 1.6 mg /kg body weight.
Experimental animals: Twenty five adult local strain male albino rats with average weight of 160 gm were
chosen, divided into five equal groups and fed on ordinary rat diet: Group I (control group), Group II
treated with atorvastatin (1.6 mg/kg/b.wt/day) for two weeks, Group III treated with atorvastatin for two
weeks then stopped receiving treatment for two weeks (recovery group 1), Group IV treated with
atorvastatin for four weeks and Group V treated with atorvastatin for four weeks then stopped receiving
treatment for four weeks (recovery group II).
Results: Administration of atorvastatin for long duration resulted in some sort of myotoxic structural
changes and apoptosis as evident by deformity in the mitochondria , lack of striation , degeneration of
nuclei and splitting of muscle fibres in the adult male albino rat skeletal muscle.
Conclusions:Atorvastatin (statin) has many adverse effects on the skeletal muscle tissues with treatmant for
long duration (Group IV). So, patients should avoid the possible side effects.
Keywards: Albino Rats,Atorvastatin drug,skeletal muscles.
Hyperlipidemia is a metabolic disorder
but the available literature demonstrated the
characterized by excess of lipid substances as
apoptotic effect of atorvastatin on the skeletal
cholesterol and triglycerides, in the blood. It is also
muscle are scarce .
called hyperlipoproteinemia because these lipid
MATRIAL AND METHODS
substances travel in the blood attached to proteins
.Its complications such as atherosclerosis ,
myocardial infarction, stroke and peripheral
Atorvastatin (Lipitor 20mg) tablets was
vascular diseases remain important reasons of
mortality and morbidity in industrialized and
pharmaceutical & chemical industries .The
developing countries. Therefore, it is important to
drug was dissolved in distilled water and given
develop strategies for treating and preventing
orally by a gastric tube .The daily single
hyperlipidemia and its complications . Drugs
oral dose was 1.6 mg /kg b. weight 
commonly used to treat high cholesterol level
2- Experimental animals:
The present study was carried out on twenty
Atorvastatin is one of a group of drugs called
five adult local strain male albino rats with
3-hydroxy-3-methylglutaryl-coenzyme A (HMG-
average weight of 160 gm were chosen to be
CoA) reductase inhibitors, or "statins.". It reduces
the model of the present study. Rats were
the levels of "bad" cholesterol (low-density
randomly divided into five equal groups and
lipoprotein, or LDL) and triglycerides in the blood,
fed on ordinary rat diet.
while increasing levels of "good" cholesterol
Animal grouping :
(high-density lipoprotein, or HDL) . These are
- Group I: Rats received no treatment and
usually the drugs of choice inspite of their side
served as control group.
effects. They are easy to take and have few
- Group II: Rats were subjected to treatment
interactions with other drugs. Side effects can
include myositis , joint pain, stomach upset, and
mg/kg/b.wt/day for two weeks (treated group
liver damage. People who are pregnant or have
liver disease should not take statins .
- Group III: Rats were subjected to
In addition, atorvastatin was reported to
treatment with atorvastatin in the same dose
induce apoptosis in vascular smooth muscles
The Relationship Between Serum Leptin Level And Bone Mineral Denisty In Postmenopausal Osteoporotic Women
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 904 908
The Relationship between Serum Leptin Level and Bone Mineral Denisty
in Postmenopausal Osteoporotic Women
* Fahmy Emam; * Sobhia Ali Mahmoud; ** Amany Mohammed El-Said ** Mona Mokhatr El-
* Physical Medicine, Rheumatology and Rehabilitation,
** Clinical Pathology ,Faculty of medicine for girls, Al-Azhar University
Postmenopausal osteoporosis is a heterogeneous disorder characterized by a progressive loss of bone
tissue that begins after menopause and leads to fracture within 15-20 years from the cessation of the
ovarian function. Human leptin is a protein of 167 amino acids. It is manufactured primarily in the
adipocytes of white adipose tissue, and the level of circulating leptin is proportional to the total
amount of fat in the body. Leptin's effects on bone are mediated via a central neuroendocrine
signaling pathway, as well as directly on bone marrow stem cells to enhance their differentiation to
osteoblasts and inhibit their differentiation to adipocytes.
Aim of the Study: to detect the relation between serum leptin level, total lipid profile and bone
mineral denisty in postmenopausal osteoporotic women.
Subjects and Methods: The study was carried on 40 postmenopausal females. According to Dual
Emergy X-ray absorptiometry (DEXA), the subjects were divided into group A, Tt-score <-2.5, group
B, t-score <-1, leptin and lipid profile were measured for all subjects.
Conclusion: The current study has provided evidence that bone mineral density is influced by serum
leptin level in postmenopausal osteoporotic women and positive correlation between serum leptin
level and bone mineral density was found.
Recommendation: Serum leptin level measurement could be used as a simple and non invasive
method for screening programs for osteoporosis in postmenopausal women but the accuracy of this
test still needs furtherer studies.
Abbreviation: Ob gene : Obese gene; BMD : Bone Mineral Density;
NOF: National Osteoporosis Foundation; M-CSF : Monocyte colony stimulating factor;
BMI: Body mass index; DEXA: Dual-energy X-ray absorptiometry
Key words: serum leplin, Bone Mineral Denisty; Postmenopausal Osteoporotic Women
are encoded by a single gene, Ob-Rb is the
osteoporosis as having a Bone Mineral Density
only receptor isoform that can signal
(BMD) that is 2.5 standard deviations below
intracellularly via the JAK state and MAPK
peak bone mineral density(1).
signal transduction pathways and is present in
Osteoporosis affects over 200 million people
hypothalamic nuclei (6). Leptin can also act
worldwide including 40% of women aged 50
directly on bone marrow stem cells to enhance
years and over, and 65% of women aged 70
their differentiation to osteoblasts and inhibit
years and over Kanis et al..(2)
their differentiation to adipocytes (7)
Among the hormones involved in bone and
Shoshana et al. Postmenopausal Osteoporosis
mineral metabolism, leptin has become a
is something that most women are concerned
subject of considerable interest. Leptin has
about. The rate at which bone regeneration
been reported to have bone anabolic, anti-
takes place slows down with age. The rate of
resorptive, and anti-osteoclastogenic effects (3).
regeneration decreases even more after a
Leptin is a circulating neurohormone produced
women goes through menopause. Therefore,
primarily by adipose tissue as the product of
women are more susceptible to osteoporosis
the obese (ob) gene (4). In addition to white
after menopause (8)(Admi, et al.). Estrogen
adipose tissue, it can also be produced by
acts on estrogen receptor- (ER) and
receptor- (ER) which has high affinity
muscle, stomach (the lower part of the fundic
(9)(Manolagas et al.). Two Primary
glands), mammary epithelial cells, bone
marrow and liver cells (5)(Margetic et al.).
Osteoclastogenesis and Bone Resorption in the
Leptin interacts with several types of receptors
Absence of Estrogen. Under estrogen-deficient
(Ob-Ra-Ob-Rf, or LepRa-LepRf) that in turn
conditions, T cells produce elevated levels of
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 909 917
Bioleaching of Rare Earth Elements and Uranium From Sinai Soil, Egypt
Maha Amin Hewedy, Abeer Ahmed Rushdy, and Noha Mohammed Kamal
College of Women for Arts, Science and Education, Ain Shams University Cairo, Egypt.
The use of microorganisms in the recovery of Rare Earth Elements (REEs) and
Uranium (U) from low grade ores provides an appropriate eco-friendly alternative to
chemical methods used in extraction and/or removal of metals from soils, with a higher
efficiency, less destruction to the environment, and lower cost from a commercial view
especially given that high-grade mineral resources that can be used in the chemical
extraction of metals are being depleted. The feasibility of using actinomycetes to recover
REEsand Ufrom a low-grade ore occurring in an Egyptian soil in Wadi Abu Thor, Sinai,
Egypt, was investigated. The most effective isolate in REEs-bioleaching was Streptomyces
fungicidicus YH04, while the most effective isolate in U-bioleaching was Streptomyces
aureofaciens 3001(1). Streptomyces fungicidicus YH04 bioleached 37.13% of the REEs
present in the sample, while S. aureofaciens 3001(1) bioleached of 12.56% of the U present
in the sample. The isolated strains of actinomycetes can be used to extract REEs and U by
better, more economic and less polluting bioleaching processes instead of the chemical
processes which are in common use today.
Keywords: Actinomycetes, Streptomyces, Rare earth elements, Uranium, Bioleaching.
Bioleaching is the extraction of metals
isolates for their bioleaching capacities. The
from their ores using microorganisms. It offers
most active isolates in REE and U bioleaching
an economic alternative to chemical extraction
for the mining industry, at a time when high-
2 -Material and methods
grade mineral resources are being depleted
2.1 Collection of soil samples
(1,2,3). Among metal-solubilizing micro-
Soil samples were collected from Wadi
organisms, actinomycetes are of special
Abu Thor, south western Sinai, Egypt. A
interest because these filamentous sporulating
sterile spatula was used to remove first 5 cm of
bacteria are adaptable to extremely different
the surface layer of the soil followed by the use
soils (4,5). The metals of interest in
of another sterile spatula in the layer subjacent
bioleaching are divided into 4 categories: (i)
(between 5 and 15 cm of depth). Soil samples
toxic heavy metals (6) (ii) strategic metals (7)
(100 g) were collected from three different
(iii) precious metals (e.g. REEs) (8) and (iv)
locations. They were further mixed, ground
radionuclides (e.g. U) (9).
and sieved (< 2 mm) prior to storing in a sterile
Rare earth elements and U are widely
container at 4ºC (5).
used in industry, agriculture, medicine,
2.2 Physical and chemical analysis
military industries and nuclear applications
Physical and chemical properties of the
(10,11). However, they are more expensive to
soil samples were analyzed at Nuclear
recover by conventional techniques (12,13).
Materials Authority of Egypt at Qattamiya.
Bioleaching of REEs and U is of great
The studied samples were subjected to X-Ray
importance as it represents a "clean techn-
Diffraction (Model Phillips XL 30 with Energy
ology" with low cost and capital inputs
Dispersive X-ray) to identify their mineral
required compared to conventional methods
content. The major oxides were analyzed
used in mining industries. Bioleaching allows
according to Shapiro and Brannock (15), while
the cycling of metals by a process close to
chemically extractable trace elements were
natural biochemical cycles reducing the
analyzed using Flame Atomic Absorption
demand for resources such as ores, energy or
(FAA Scan 1, Thermo Jarrel Ash USA). Rare
landfill space (1,14). This study aims to
earth elements (lanthanides) were analyzed
evaluate the possibility of new actinomycetes
using Prism High Dispersion Inductively
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 918 922
A Study of the Effect of Angiotensin Converting Enzyme Inhibitors
and Thiazides on Bone Mineral Density in Hypertensive Elderly
Ahmed K Mortagy*, Sara A Hamza *, Hoda MF Wahba *, Nermien N Adly *, Asmaa
*Geriatrics and Gerontology department, Faculty of Medicine, Ain shams university, Cairo,
Background: Hypertension and osteoporosis are two major age-related disorders. Several
studies have shown greater Bone Mineral Density (BMD) in people receiving thiazides
diuretics compared with controls. The benefit of Angiotensin Converting Enzyme Inhibitors
(ACEIs) to improve bone metabolism has been supported by some clinical studies. Therefore,
these drugs might be a part of the therapeutic regime for osteoporotic hypertensive elderly.
Objective: to compare between the effect of ACEIs and thiazides on BMD when used
separated or combined in hypertensive elderly.
Patients&method: A retrospective comparative study recruiting 171 participants who were
aged 60 years and above from the outpatient clinics of Ain shams University Hospitals. The
participants were divided into three groups: Group I: 57 participants receiving thiazides,
Group II: 57 participants receiving combined ACEIs and thiazides, Group III: 57
participants receiving ACEIs. Each group was subdivided into two subgroups; older and
younger than the median age (65years) of participants. Patients with systemic diseases or on
drugs that affect BMD were excluded from the study. All participants were subjected to:
BMD measurement at lumbar spine (L2-L4) and left femur neck using Dual-energy x-ray
absorptiometry (DEXA) [lunar DPX DEXA system].
Results: As regard lumbar (L2-L4) BMD T-score ,there was no significant difference found
between the groups as a whole sample (P-value 0.383), nor the age subgroups ,when
subdivided into two subgroups older than the median age (65 years old)(P-value 0.832) and
from 65 years old and younger (P- value0.259) (the same was found as regard z-score). As
regard BMD of the Left Femur Neck T-score there was no significant difference found
neither between the groups as a whole sample (P-value 0.921), nor among the age subgroups
when subdivided into two subgroups older and younger (p-value 0.889), (the same was found
as regard z-score). conclusion: the current study found no evidence that there is a difference
between thiazides therapy and ACEIs therapy as regard their effect on BMD in elderly
hypertensive patients when used separated or combined.
KEYWORDS: ACEIs, Thiazides, BMD.
Osteoporosis and hypertension represent a
mass(5). Moreover , Angiotensin II has
problem that increases with age. (1) Aging
been postulated to be able to act upon the
is often associated with reductions in Bone
cells involved in bone metabolism (1).
Mineral Density (BMD) and consequently,
Therefore, ACEIs may have possible
with higher risk for falls and bone
benefits in treating not only hypertension
fractures. (2) Moreover, increasing age is
but also osteoporosis (6) .Therefore, these
associated with changes in the structure of
drugs might be a part of the therapeutic
walls of the blood vessels. These changes
regime of osteoporotic hypertensive
produce loss of vascular compliance and
ultimately result in hypertension. (1)
Patients and methods:
Design: retrospective comparative
abnormalities in calcium metabolism at the
systemic level in hypertension (1). Olmos
et al, suggested that thiazides are
171participants were aged 60 years and
beneficial to prevent bone loss. (4), as they
above were recruited from the outpatient
modify calcium metabolism and bone
clinics of Ain shams University Hospitals.
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 923 934
Role of MR Spectroscopy in Characterization of Breast Masses
Sherif T Gamal El Din *, Mohammed A Darwish *, Ahmed M Monib *,
Togan T Abd El Aziz *.
* Department of Radiodiagnosis, Ain Shams University.
Introduction: Dynamic contrast enhanced magnetic resonance imaging "MRI" is not 100 percent
accurate in distinguishing benign from malignant lesions, resulting in a large number of breast biopsy
procedures recommended on the basis of imaging findings. Proton magnetic resonance spectroscopy
"¹H MRS" can provide chemical information about a lesion by measuring the levels of choline
compounds, which are markers of an active tumor. In most cases, the results indicate whether the
lesion is cancerous without need for biopsy. In addition to being used in breast cancer diagnosis, in
vivo ¹H MRS has also been used to monitor breast cancer response to chemotherapy as well as in
differentiating between scar tissue and recurrent cancer after breast-conserving therapy.
Aim of the work: To evaluate the diagnostic performance of magnetic resonance spectroscopy
"MRS" in characterization of breast masses with histopathologic findings or follow up used as the
Methods: The studied group included 50 female patients referred for MRI breast for workup of a
suspicious clinical, mammographic, or sonographic abnormality. ¹H MRS was added to the routine
study. Results of the contrast enhanced bilateral breast MRI and ¹H MRS 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 ¹H MRS and histopathological. Follow Up
results with p value = 0.005. The sensitivity, specificity, positive and negative predictive values of ¹H
MRS for characterization of suspicious breast lesions in patients included in the study, were 90%,
93.3%, 90%, and 93.3% respectively.
Conclusion: ¹H MRS is a short non-invasive 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.
Detection of choline peak with estimation of the choline signal to noise ratio "SNR" can accurately
differentiate benign from malignant breast lesions with high sensitivity and specificity especially when
its results are combined with the results of the standard dynamic MRI scan.
Key words: MRI,H MRS, Spectroscopy, Breast Masses.
During the past two decades, several
spectroscopy "¹H MRS" imaging is being
well-established clinical imaging modalities
investigated for its potential to improve breast
have been in use to study the architecture,
disease diagnosis at the cost of a small increase
physiology and function of breast cancer.
in examination time (3).
Methods such as X-ray mammography,
ultrasound and physical examination are often
"MRS" offers unique possibilities for non-
limited in sensitivity and specificity, especially
in young women (1).
biochemistry in vivo. Chemical shift, which
MR imaging of the breast is non-
refers to the variation in the resonance
invasive and uses no ionizing radiation. Its
frequency due to the chemical environment,
primary benefit is high sensitivity, the highest
can be explained by the fact that the moving
of any imaging technique for breast lesions.
electrons surrounding the protons can generate
MR offers high soft-tissue contrast, multi-
their own local magnetic field. With its ability
planar sectional imaging with 3-D rendering of
to identify different compounds by their
1 or both breasts, the ability to detect small
chemical shifts, MRS is especially useful in
volume residual tumor and measurement of
studying cellular metabolism to detect cancer
lesion size that corresponds with pathological
measurement (2). Consequently, there has been
Rather than generating an image, MRS
considerable interest in the development of
produces a graph of the resonance amplitudes
adjunct MR imaging methods to improve the
of various metabolites on the y-axis (in
specificity of dynamic contrast-enhanced
breast MR imaging, and proton MR
frequencies on the x-axis (in Hz or ppm). The
Role of PET/CT in Management of Chest Tumors
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 935 946
Role of Diffusion MRI & Dynamic Contrast-enhanced MRI in Assessment of
Hepatocellular Carcinoma after Trans-arterial Chemoembolization
Fatma S.El-dien Mohammed **, Hanaa Abd Elkader Abd Elhamed **, Yosra Abdelzaher Ibrahim **,
Ali Haggag Ali Noreldien **
Radiodiagnosis Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Abstract:Purpose: to assess the effectiveness of diffusion & Dynamic contrast enhanced MRI in imaging of
hepatocellular carcinoma after chemoembolization.
Patients and Methods: between November 2011 & September 2013, 30 patients were treated with
chemoembolization in our interventional radiology unit. All patients underwent pretreatment MRI within 10
days before chemoembolization & post-treatment MRI after one month from treatment. The arterial
enhancement as well as the mean Apparent Diffusion Coefficient (ADC) of the focal lesion was prospectively
assessed & the percent change in both was assessed. The significance of differences between ADC values of
complete & partially responding lesions was calculated.
Results: Thirty male patients, ranging in age between 51 & 73 years who met the inclusion criteria were
prospectively studied. According to the results of this study, there was a statistically significant difference
between patients with partial response & those with complete response as regard the percent change in the
mean ADC value of the focal lesion after treatment with P-value less than 0.001. There was significant positive
correlation between the percent change in the mean ADC value & the percent change in the diameter of the
enhancing tumor tissue after treatment. The percent change in the mean ADC value among patients with
complete response was higher than that among patients with partial response with P-value less than 0.001. The
best predictive cut off value for differentiation between complete & partial response was 24 % increase in the
mean ADC value, with 99 % sensitivity, 84 % specificity, 90 % positive predictive value, 99 % negative
predictive value & 86 % accuracy. The % change of the mean ADC value is considered better positive than
negative predictor for response to treatment. On the otherhand, there was no statistically significant difference
between patients with complete & partial response as regard the mean ADC of the focal lesion before
Conclusion: After chemoembolization, completely responding HCC lesions exhibited more increases in the
mean ADC than partially responding lesions. Pretreatment mean ADC values were not predictive of response
Key words: Hepatocellular carcinoma, chemoembolization, diffusion, dynamic MRI.
Hepatocellular carcinoma (HCC) is the fifth most
In contrast to CT, the high concentration of
common malignancy in the world (14).
iodized oil after chemoembolization does not affect
Transarterial chemoembolization (TACE) of
MR signal intensity. Enhancing portions of the
hepatocellular carcinoma (HCC) is used in some
tumor are presumed to be viable, whereas non-
cases as a bridge to liver transplantation. It is also
enhancing portions are presumed to be necrotic.
used for patients with unresectable HCC, and has
The disadvantage of contrast-enhanced MRI is the
been shown to improve survival (13). Early
incapability to distinguish viable cells from
assessment of the effectiveness of TACE is critical
reactive granulation tissue. (25).
in planning future therapy (5). Assessment of
tumor response after chemoembolization on CT is
functional MRI technique, detects MR signal
generally based on the radio-opacity of the iodized
changes in tissues due to water proton motion that
oil that selectively accumulates in the tumor in
varies based upon the degree of cell membrane
addition to tumor enhancement and tumor size on
integrity. The intact membranes of viable tumor
contrast enhanced CT. Iodized oil impairs the
cells restrict water diffusion, whereas necrotic
assessment of residual tumor enhancement on
tumor cells with disrupted cell membranes exhibit
contrast enhanced CT (25).
increased water diffusion. This mobility of water is
quantified by a constant known as the apparent
Comparative study between the effect of insulin -sensitizer drug and cholesterol lowering agent on some physiological parameters in infertile obese women
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 947 959
Effect of Insulin-sensitizer Drug (Metformin) on Some Physiological Parameters
in Some Infertile Obese Egyptian Women Undergoing ICSI
Eman G.E. Helal*, Samia M. Abd El-Wahab*, Aziza M. Aly Mansour**, Mervat M. Mahmood ** and
Amira B. Mehaney**.
Zoology Department, Faculty of Science, Al-Azhar University (Girls)* and International Islamic Center for
Population Studies and Research, Al-Azhar University**.
Background: Egyptian infertile obese women with polycystic ovary syndrome (PCOS) were markedly
increased in ART Unit for infertility treatment undergoing ICSI. In a trial to enhance the ovulation, fertilization
response and pregnancy outcome treated patients with Metformin as insulin sensitizing drug, 3 months before
The aim of this study was to evaluate the effect of Metformin on the hormonal profile, lipid and lipoprotein
profile and insulin resistance in obese PCOS patients undergoing ICSI.
Setting: This study was conducted at International Islamic Center for Population Studies and Research, Assisted
Reproduction Unit, Al-Azhar University during the period between 2009 and 2011.
Design: A prospective randomized study.
Patient and Methods: A total of 75 patients with obese PCOS were randomized to receive oral Metformin for
three months. For each patient, FBS and Hb, hormonal profile included FSH, LH, FSH/LH ratio, E2 and PRL,
lipid and lipoprotein profile included total cholesterol, LDL, HDL and triglycerides evaluation were performed
at baseline and after 3 months of treatment.
Results: There was a significant decrease in the FBS in cases treated with Metformin when compared with
control or obese PCOS, no significant differences were noticed in the level of Hb% in both groups. Total lipids,
triglycerides and total cholesterol were decreased significantly compared with obese PCOS group. Significant
decrease was also observed in respect to LDL in cases of Metformin than cases of obese PCOS. Significant
increase in the level of HDL was recorded. Significant decrease was detected in FSH, LH and FSH/LH ratio in
Metformin treated group while no difference was observed in prolactin or estradiol hormonal profiles. Observed
improvement was detected in the number of received HMG ampoules, mature oocytes, number of grade A
embryos and in pregnancy outcome.
Conclusion: Metformin as lowering insulin resistance, improving the response in obese PCOS women
undergoing ICSI, by enhance their resistance sensitivity in transadipose tissue leads to improvement the function
of gonads and hormonal and lipids profile .This improvement was detected by decreased total cost for ICSI,
lowering the number of both given stimulation ampoules and mature collected oocytes and finally the percent of
successful pregnancy rate.
Keywords: PCOS, Obese, Metformin, ICSI, Lipid profile, Physiological parameters.
Polycystic ovary syndrome (PCOS) is the most
and oligomenorrhea or amenorrhea. The most
common endocrine disorder in women of
important abnormality in patients with PCOS is
reproductive age. It is a complex disorder with
anovulation manifested by oligomenorrhea or
multiple components, including reproductive,
secondary amenorrhea (2).
metabolic and cardiovascular manifestations; also it
The sonographic appearance of PCOS may occur
has long-term health concerns that cross the life
together, or in isolation with a biochemical status,
which involves metabolic and hormonal changes
PCOS may be an incidental finding on a routine
(3). Concentrations of luteinizing hormone (LH)
ultrasound scan in women of normal weight with
are elevated in 45-75% of cases and raised
regular cycles, who do not exhibit signs of
testosterone levels are seen in 80% of patients. The
hyperandrogenism or conversely, these women may
above hormonal levels are the usual indicators of
present a classical appearance of hirsutism obesity
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 960 966
Biochemical Diagnosis of Peroxisomal Disorders by GC/MS: Egyptian
Patients with X-linked Adrenoleukodystrophy
Ekram Fateen *, Amr Gouda*, Mona Ibrahim *
*Biochemical Genetics Department, Human Genetics and Genome Research Division, National
Background: Peroxisomes are organelles responsible mainly for metabolism of lipids and
peroxides. Lack of peroxisomes or dysfunction in any of their normal functions is the cellular
basis for human peroxisomal disorders (PDs).
Aim of the Work: diagnosis of peroxisomal disorders among a high risk group of Egyptian
patients using gas chromatography mass spectrometry.
Subjects and Methods: Forty six patients suspected to have peroxisomal disorders were included
in this study. Their ages ranged from 2 to 20 years. They were referred to The Biochemical
Genetics Department, National Research Centre from all over Egypt. Forty one (89%) were males
while five were females (11%). Parental consanguinity was positive in 28 cases (61% out of 46).
Very long chain fatty acids were quantified after extraction from plasma of all cases using gas
chromatography/mass spectrometry (GC/MS) technique.
Results: The present study included 46 cases suspected clinically to have one of the peroxisomal
disorders; four of them (8.7%) proved to have X-linked adrenoleukodystrophy by quantitative
determination of the very long chain fatty acids after extraction from their plasma. The other 42
cases showed normal profile for very long chain fatty acids.
This study showed that GC/MS analysis for VLCFA discriminates patients from controls,
representing a non-invasive, reliable, specific and sensitive method for the diagnosis of
Peroxisomes are organelles responsible for
deficiency of a single peroxisomal enzyme
multiple metabolic pathways, mainly related
activity. About a dozen of such peroxisomal
to metabolism of lipids and peroxides. Lack
enzyme deficiencies have been identified
of peroxisomes or dysfunction in any of
their normal functions is the cellular basis
Peroxisome biogenesis disorders (PBDs):
for human peroxisomal disorders (PDs). PDs
The PBD group comprises Zellweger
are clinically and genetically heterogeneous
spectrum disorders (ZSDs) and rhizomelic
and can be classified mainly into two
chondrodysplasia punctata (RCDP) type 1.
categories; peroxisome biogenesis disorders
The former group includes Zellweger
(PBDs) and single peroxisomal enzyme
deficiencies (SEDs) . The PBDs include
adrenoleukodystrophy (NALD) and infantile
Refsum disease (IRD). Patients with ZSDs
adrenoleukodystrophy (NALD), infantile
usually presented with liver disease, variable
Refsum disease (IRD) and rhizomelic
neurodevelopmental delay, retinopathy, and
chondrodysplasia punctata (RCDP) type I.
perceptive deafness with onset in the first
They are all caused by defects in PEX
months of life. In addition, patients with ZS
genes, which encode peroxins, proteins
are severely hypotonic and weak from birth
necessary for peroxisome biogenesis and the
import of the peroxisomal matrix and
periarticular calcifications, severe brain
membrane proteins. The second group
dysfunction associated with neuronal
includes disorders resulting from the
migration disorders and die before 1 year of
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 967 975
Unexplained Somatic Symptoms due toDepression and/or Subclinical
Hala El Said Sayyah1,Maha Mahmoud El Shafei2, Rania Hussein Mohamed3
(1) Assistant professor of psychiatry, BeniSuef University, Egypt.
(2)Lecturer of internal Medicine, Mansoura University, Egypt.
(3) Lecturer of psychiatry, Al-Azhar University ( For Girls ),Egypt.
Background: Unexplained somatic symptoms are common presentation of many diseases
including subclinical hypothyroidism and depression. Subclinical hypothyroidism (mild thyroid
failure) represents an early stage of thyroid disease that will commonly progress to overt
Objectives: To assess the presence of depression and subclinical hypothyroidism (mild thyroid
failure) in patients presenting with unexplained somatic symptoms aiming for better care
provided to those patients. Special care should be provided to females as they are more likely to
be affected by both conditions.
Method: Patients were collected conveniently from those attended internal medicine clinic
during the period from January to August 2013 complaining from multiple unexplained somatic
symptoms. Patients with clinical hypothyroidism or anemia or other cause of their presenting
somatic complaints were excluded from the study. Remaining 48 patients were having only
unexplained somatic symptoms which proved after investigation to have subclinical
hypothyroidism with high TSH while their T4 were normal. Then they were screened for
depression byPatient Health Questionnaire 9 (PHQ-9), fatigue severity scale (FSS), Somatic
Symptom Inventory (SSI), and Sheehan Disability Scale (SDS) for measurement of functional
Results: Females (n=36) represent 75% of cases while males (n=12) represent only 25% of cases.
FSS was significantly higher in females than males (t=2.373, p=0.023). Fatigue is the most
common presenting symptom among all patients (n=21, 43.7%) followed by weight gain (n=16,
and lastly generalized aches (n=11, 22.9%). More females presented with fatigue (n=15, 72.7%)
than males (n=6, 28.6%). Females are earlier than males to seek medical advice. Only 19 patients
(39.6%) were presented early and females were majority of them (n=17, 89.5%). There were
positive correlations between severity of depression and (physical symptoms severity, fatigue,
and degree of functional disability). There were significant negative correlations between T4
serum level and (depression severity and degree of functional disability).
Conclusion: Mild thyroid failure frequently progresses to overt hypothyroidism. It may clearly
be associated with somatic symptoms, depression, memory and cognitive impairment. It is
common more in females than males regardless their age. Early detection & treatment of mild
thyroid failure and depression has been reported to be cost-effective and can prevent further
Primary care physicians, not mental health
patients in a primary care setting may be
professionals, treat the majority of patients
particularly challenging because patients,
with symptoms of depression. Persons who
especially men, rarely spontaneously
are depressed have feelings of sadness,
describe emotional difficulties. On the
contrary, patients with depression who
hopelessness, agitation, and guilt that may
present to a primary care physician often
be accompanied by an array of physical
describe somatic symptoms such as fatigue,
symptoms (1, 2). Recognizing depression in
sleep problems, pain, loss of interest in
"Factors affecting utilization of hospital services in Egypt"
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 976 987
Wheezy Chest in Children: Findings and Outcome
Abdelaziz, A. El-Sadek* and Khaled, Zaed**
Public Health and Community Medicine*, and Pediatrics** Departments. Faculty of
Medicine - Al Azher University
Background: wheezy chest is a serious public health problem throughout the world, affecting
people of all ages and were recognized as leading cause of morbidity and mortality in the
under-five children in developing countries. The disease places a burden on the health
services in term of admission to hospitals and health centers.
Objectives: to identify some epidemiological aspects and fate of hospitalized cases of wheezy
Material and Methods: A descriptive study was used to the study 385 children with wheezy
chest among those admitted to el-Husen university hospital, Cairo, from January to December
2012 using a pre-designed questionnaire to collect data from mothers of the admitted
children. The children recruited were those < 12 years coming with respiratory distress for
one year. The variables included are age, sex, education, income, crowding index, symptoms
presented. Laboratory findings and x ray were done to some cases when needed in the clinical
pathology and x ray departments at hospital in the routine investigation of such cases.
Administrative and ethical issues as patient consent and confidentiality were followed in all
steps of the study. The data were analyzed by SPSS program version 18. Descriptive and
analytic statistics were done. The lowest accepted level of significance was 0.05 or less.
Results: The highest affected age was infants (54%), males (53.7%), and of low income
families (69.6%). Cough, dyspnea and tachypnea are the most frequent clinical findings
(82.3%). Most investigations were normal, and more than half of cases have positive CRP.
High percent had bronchovascular marking plus pneumonic patches and hyper-inflated chest
in about 34.1% and 36.5% respectively. Most of admitted cases stayed at hospital for 10 days
on average. High percent of the studied cases have respiratory distress (41.2%), wheezes
(30.6%) and also recurrent wheezy chest (20.0%). The studied cases diagnosed as acute
bronchiolitis (27.1%), bronchial asthma (18.8%) and bronchopneumonia (34.1%). The fates
of cases were: improved with no complications (72.9%), improved with nebulizer (23.5%)
and no case fatality recorded. Bronchopneumonia recorded highest CRP readings than the
other acute respiratory infections.
Conclusions and recommendations: wheezy chest is a major cause of hospitalization of
male infant of poor families. Cough, dyspnoea and tachypnea were major findings. Wheezy
chest were recognized as pneumonia, acute bronchiolitis, and bronchial asthma with better
outcome. We recommend admission of severe cases of wheezy chest, and the wheezy chest
with other health problems (liable for complications) to minimize over use of beds.
Key words: wheezy chest, cough, dyspnea, outcome
Wheezing is a high-pitched, whistling-type
regardless of level of development. Over
sound that occurs while breathing out 1 .
80% of asthma deaths occur in low and
About 300 million people around the
lower-middle income countries. Asthma
globe suffer from asthma, and 255 000
deaths will increase by almost 20% in the
people died of asthma in 2005.
next 10 years if urgent action is not taken.
Surveillance of asthma as part of a global
Asthma is under-diagnosed and under-
WHO programme is essential 2. WHO 3,
treated, creating a substantial burden to
estimates 300 million people suffer from
individuals and families and possibly
asthma and 255 000 people died of asthma
restricting individuals' activities for a
in 2005. Asthma is the most common
chronic disease among children. Asthma is
The respiratory diseases represent
not just a public health problem for high
about 50% of all illnesses of children
income countries: it occurs in all countries
below five years and 30% thereafter. 95%
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 988 990
Chest Pain in Pediatric Patients Referred to Pediatric
Pediatric cardiologist, Queen Alia Heart Institute, Amman, Jordan.
Objectives: To evaluate causes of chest pain in children referred to pediatric cardiology
clinic and the need for echocardiography in these patient.
METHODS: A prospective study conducted in Prince Ali Hospital, in the southern of Jordan,
between Nov. 2010 till Nov. 2012. Clinical history and physical examination done.
Electrocardiogram, chest X-ray, and echocardiogram for all patients, and a 24-hour Holter
monitoring, if needed.
RESULTS: A total of 145 children were referred to pediatric cardiology clinic.
Musculoskeletal causes were the most common accounting for (36.6%), idiopathic chest pain
(31%), respiratory causes (15%), gastrointestinal causes (4.1%) and miscellaneous disorders
(6.9%), while cardiac causes found in 9 patients (6.2%), echocardiography was positive in 4
CONCLUSIONS: The study reveals that cardiac etiologies for childhood chest pain account
for a small percentage, and these can be excluded by a complete history and physical
examination. Therefore, echocardiogram may not be necessary, and shouldn't be part of
routine evaluation of children with chest pain.
Key words: Chest Pain, Pediatric Patients, Echocardiography.
Chest pain in children had been a
Patients with a previous diagnosis of
concerning complaint for the family and
congenital heart disease or a previous
primary care provider. It is the 2nd most
cardiac arrhythmia were excluded.
frequent cause for referral to pediatric
All patients underwent complete history,
cardiology, heart murmur being the most
physical examination, electrocardiography,
common (1, 2).
and 2D echo. Holter monitor and other
Many studies tackle this complaint among
investigation were done according to case.
children and adolescent, most results were
All patients followed for 1 month after
that the majority of them do not have a
their first presentation to clinic to see the
cardiac disease (1-8).
progress of their chest pain and their
The clinician evaluating a child with chest
pain should keep in mind the broad
differential diagnosis and pursue further
investigation with history and physical
A total of 145 patients were enrolled in the
study, the age range from 4.5 year to 14
year old with a mean of 11 year. Males
were 85 (59%), females 60(41%).
A prospective study conducted in referred
children and adolescent with the complaint
Echocardiography were done for all pts.
of chest pain to pediatric cardiology clinic
Holter monitoring done in 5 pts (3.4%),
Prince Ali Hospital, in the southern of
echocardiography was positive in 4
Jordan, between Nov. 2010 till Nov. 2012.
Effect of lifestyle modification on hypertensive patients attending Health centers in greater Cairo
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 991 1006
Effect of Lifestyle Modification in Hypertensive Patients in Greater Cairo
Fargally M, Elsadek A, Abdelhady AS* and Ghandor A**,
Public Health and Community Medicine Department, Faculty of Medicine, Al-Azhar University,
Cairo (Assiut * and Damietta branch**)
Introduction: The World Health Organization has estimated that hypertension causes one in every
eight deaths, making it as the third leading killer in the world. In Egypt, 2004, hypertension reached
about 26.3% of whole population. Lifestyle modifications have an important role in the
management of patients with hypertension; when used effectively.
Objective: to assess efficacy of lifestyle modifications on hypertensive patients, and also assessing
their compliance towards lifestyle modifications advice.
Subjects and Methods: An intervention study was carried out on 448 hypertensive patients
recruited among those attending 5 accredited health centers in greater Cairo from May 2007 to
March 2008. Patients were divided into 2 groups: case group (240 patient) & control one (248
patient). Both groups were examined for baseline data: blood pressure, obesity parameters & lipid
profile & fulfilled a pre-coded questionnaire containing the relevant variables. Then only
intervention group was submitted for 3 months to an educational program about lifestyle
modifications, while control group received routine outpatient services & asked to maintain their
usual lifestyle including dietary & exercise habits. After 3 months both groups were re-examined
for the same baseline data done before 3 months. Administrative and ethical issues were followed
in all stages of the study, and appropriate statistical design and tests of significance were performed.
Results: The results of this study showed the following findings: Applying of a Comprehensive
lifestyle modifications program including regular physical activity, reducing salt intake, weight
reduction ...etc. had a direct beneficial effect on lowering both systolic and diastolic blood
pressure, weight & lipid profile of the studied cases. Low rate of regular physical exercises
practicing by the studied cases was detected before the intervention .There was a good compliance
of the studied cases towards practicing regular physical activities, consuming little salty & starchy
foods, excess vegetables, fruits, fish & using plant oil in cooking, while they were un-compliant as
regards drinking coffee or tea, consuming eggs ,sweets & quitting smoking.
Conclusion & Recommendations: the study concluded that modifying life style lowers level of
blood pressure, lipid profile and minimizes the use of Anti-hypertensive, and recommended:
increasing the awareness of hypertensive patients about lifestyle modifications program and its
importance to control their high blood pressure through health providers or health educators. Ensure
more focusing on lifestyle modifications as preventive and curative measures for hypertension in
medical curricula. Further research based on evidence based guidelines to improve health related
quality of life of hypertensive patients should be encouraged.
WHO has estimated that high blood pressure
The estimated prevalence of hypertension in
causes one in every eight deaths, making
Egypt was (26.3%) of population.1 & 2.
hypertension the third leading killer in the
The Seventh report of the Joint National
world. Globally, there are one billion
hypertensive patients and four million people
Evaluation and Treatment of High Blood
die annually as a direct result of hypertension.
Pressure 3 classified blood pressure for adults
aged 18 years as the following table:
Blood pressure classification
SBP (mmHg) DBP (mmHg)
< 120 and < 80
120 139 or 80 89
140 159 or 90 99
160 or 100
SBP: systolic blood pressure DBP: diastolic blood pressure
The trans-radial approach for diagnostic coronary angiography and interventions
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 1007 1013
The Trans-radial Approach for Diagnostic Coronary Angiography and
Interventions. Our Experience at Queen Alia Heart Institute / Amman
Walid Sawalha , Ashraf Ahmad Abu Alsamen , Laith Saad Obaidat , Ramzi Abdelmajeed
Queen Alia Heart Institute King Hussein Medical Centre Amman Jordan.
For correspondence: Dr Walid Sawalha. Jordan. Amman 11814. Bayader Wadi Alseer PO BOX 143388.
Email email@example.com. Tel 00962-777419331.
The aim of our study was to assess our experience of coronary angiography and intervention via
the radial artery in comparison to the standard approach from the femoral artery at Queen Alia
This was a prospective study conducted from September 2010 till August 2013. This was a single
operator experience. All adult patients undergoing coronary angiography or intervention were
enrolled into this study. It was left to the operator's discretion to decide which patient is for trans-
radial access. Demographic data, risk factors for coronary artery disease (CAD), the amount of
contrast used, fluoroscopy time, and the diagnosis were collected. We also looked at the time
taken for mobilization of patients following procedure, the incidence of pain from the site, any
local complications and hospital stay. The data was compared to a similar number of patients who
had coronary angiography via the femoral artery.
We looked at 456 patients. There were 346 males (76%) and 110 females (24%). Their age
ranged from 29 76 years with a mean of 53.5 (± 10.5) years. The right radial artery was used in
almost all cases (454 patients, and the left radial in 2 patients). The prevalence of diabetes was
48.5%, hypertension 59.2%, family history of premature CAD 28%, hyperlipidaemia in 30% and
44% were smokers. These figures were the same for patients who had the procedure via the trans-
femoral artery done during the study period.
Successful angiography was feasible in 449 patients (98.46%). Diagnostic angiography was done
in 319 patients (71%), while coronary intervention was done in 130 patients (29%). Total
procedural time averaged 41 (± SD = 22) minutes for trans-radial compared to 40 (± 23) for trans-
femoral approach (P non significant). Fluoroscopy time was 15 (± 10) minutes for the former
compared to 18 (± 13) minutes for the later approach (P non significant). The amount of contrast
used was 180 (± 64) ml for trans-radial compared to 192 (± 73 ml) for the trans-femoral approach
(P non-significant). On average patients in the trans-radial group had less access site
complications with early mobility and earlier discharge.
Coronary angiography and intervention via the radial artery has a high success rate with no
difference in terms of procedure time, amount of contrast or fluoroscopy time. It has
demonstrable advantages in terms of local site complications, early mobility and discharge
leading to better patient's satisfaction.
Key words: coronary angiography; radial artery; Morbidity; Queen Alia Heart Institute.
diagnostic tool for coronary artery disease is
Atherothrombosis is the leading
on the rise, with more complex interventions
cause of death worldwide (Fig. 1) (1). Thus
and more contrast being used per patient.
the use of coronary angiography as a
1007 DOI: 10.12816/0001663
Effect of noise and crowding stress on serum level of TSH and thyroid hormones in female albino rats
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 1014 1018
Effect of Noise and Crowding Related Stress on Serum Level of TSH and
Thyroid Hormones in Female Albino Rats.
Eman G. E. Helal, Samia M. Abd El-Wahab and Neama M.Taha
Zoology Department, Faculty of Science, Al-Azhar University (girls)
Background: Noise and crowding are the most stressful factors for human beings.
This study is aimed to clarify their effect on some thyroid hormones and the amelioration effect of
Material and Methods: Thirty six female rats were divided into four groups (6/each):
1-control, 2-treated with sulpiride drug, 3- rat exposed to noise (90db/3hper day for 45 days) 4-Noise
plus drug, 5 rat exposed to crowded exposure and 6- crowded plus drug.
Results: Noise and crowding stresses caused a significant increase only of T3 and T4 while there
was a significant decrease in TSH. Sulpiride drug was ameliorated these parameters.
Key words: Noise, Crowding, Sulpiride drug, Grave's disease Albino rats, Physiological parameters.
Environmental factors including infection,
Antidepressant drugs are the most successful
smoking and stress such as crowdedness and
drugs in patients with clear vegetative
noise are considered to be of the putative
environmental causes of Grave's disease.
retardation, sleep disturbance, poor appetite and
Genetic and environmental factors other than
weight loss. However, a variety of different
stress are relevant to the development and
chemical structures have been found to have
course of the disease, because the difference of
antidepressant activity. Their number is
stressful life events, which are recorder more
constantly growing, but as yet no group has been
frequently in Grave's patients in many cases (1).
found to have a clear therapeutic advantage over
Although Graves' disease has a well-known
the others (11).
familial tendency, heredity does not explain
Sulpiride is the most favorite drug
everything (2, 3, 4). A study of twins, who are
which used to tolerate stress symptom (12).
not always concordant for the disease, suggests
People who expose to stress take one or some
that genetic factors explain 79% of the incidence
drugs to avoid the effect of stress. So the present
of the disease, while environmental factors are
study deals with the possible protective effect of
responsible for 21% of the cases (5). A recent
one of the antidepressant drugs (sulpiride)
study shows that the risk of having
against crowded in female albino rats.
Graves'disease is multiplied by 5 if there is one
Material and Methods
affected member in the family, by 310 if there
are two affected members in the family, and by
Thirty six normal white female albino rats
16 if one twin is affected. The risk is higher in
weighing (150±30) g. were taken from the farm
men than in women. The finding that the risk is
of National Organization for Control and
increased among spouses by 2.75 highlights the
Research. They were kept under observation for
role of the environment (6).
one week before the beginning of the
Crowding stress is a type of psychosocial stress
experiment to acclimatize. The chosen animals
induced by an increased density of population.
were housed in cages and exposed to artificial
Population density may be raised either by
light for 14 hr. and 10 hr. complete darkness at
increasing the number of species living in the
normal atmospheric temperature. All animals
same area and/or by reducing their living space.
were fed on standard diet contained protein,
Noise stress is a part of everyone's life every
fibers, fats, ash, carbohydrates and supplied with
day. Noise is a kind of stress which is defined as
vitamins and minerals mixture with continuous
unwanted sound. Noise is pervasive aspect of
supply of water.
environments. Numerous studies have indicated
The drug was adiministrated orally by gastric
a connection between stress and autoimmunity
tube at a dose of 0.28mg/100g body weigh/day
and that stress may trigger or worsen
for 40 days. The dose for the rat was calculated
autoimmune disease (7, 8, 9,10).
Risk Assessment of Physical Health Hazards in
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 1019 1035
Risk Assessment of Physical Health Hazards in
Al-Azhar University Hospital in New Damietta, Egypt
Mohammed El-Hady Imam*, Raed Mohammed Alazab**,
Alaa Abdel-Wahed**, Ahmed Ali Ghandour*, and Waheed Hussien Elsaidy**
Departments of Community* and Indusrial Medicine**
Faculty of Medicine, Al-Azhar University
Introduction: Personnel working in hospitals are exposed to many occupational hazards that may
threaten their health and safety. Physical hazards that are encountered in hospital working
environment include temperature, illumination, noise, electrical injuries, and radiation.
Objectives: The objectives of this study were to identify physical health hazards in all departments
of Al-Azhar University Hospital in new Damietta, to measure risk level of these hazards, and to
recognize safety measures in these departments.
Study Site: The study was conducted in Al-Azhar University Hospital in Damietta Governorate.
Study Subjects: All personnel (328) working in the hospital were recruited.
Study Methods: Interview forms; a workplace inspection checklist, assess physical health hazards
in the hospital and a modified checklist (workplace safety and health risk management, assess
leadership commitment towards workplace safety and health). Risk assessment matrix was used to
describe the risk level. Also, environmental measurements of noise, temperature, relative humidity,
and lighting were taken in all departments including auxiliary service offices.
Results: Majority of the staffs reported stairways were free of obstacles, emergency lighting
worked properly, and temperature was suitable. Minority of the staffs reported stairways were
slippery, they were informed on hazards of noise and non-ionizing radiation, and they were given
radiation safety training. Measurements of physical agents revealed noise levels were above
standard of the WHO in all wards and above slandered of OSHA as in laundry, kitchen, etc. Range
of noise level was from 58 dB in renal dialysis unit to 88 dB in kitchen. Lighting level was from
290 to 1150 Lux, temperature level was from 25 to 31°C, relative humidity level was from 45 to
59%, and heat index was low in all departments except kitchen and boiler room, it was moderate.
Risk level of electrical and fire hazards was medium 22 (B), while other hazards were of low risk
level; 01, 11, and 12 (A). Leadership commitment towards safety and health in the hospital was
Recommendations: Workplace environment should be monitored and evaluated. Environmental
and behavioral interventions are indicated for all personnel to prevent undue exposures. Noise
monitoring and noise engineering and administrative control should be established. Increase
leadership commitment towards workplace safety and health. Training programs on health and
safety issues should be conducted to all healthcare workers. Lastly, further studies in different
hospitals in Egypt are needed to investigate this health problem.
Keywords: occupational physical hazards, Damietta,
Risk assessment can be described as a
The current global labor force stands
scientific evaluation of the potential for adverse
at about 2.6 billion and is growing
health and safety effects to workers exposed to
continuously. Approximately 75% of them
hazardous substances. When assessing risk, it
are in developing countries. Each year,
must be determined whether a hazard is present
another 40 million people join the labor force,
and the extent to which a worker is likely to be
most of them in developing countries.
exposed. So, risk involves both presence of a
hazardous agent and the potential for exposure
therefore a threat to a large proportion of the
to that agent. Quantitative and qualitative risk
world population. It is estimated that around
assessment methods are used to evaluate risk (2).
1.2 million work-related deaths, 250 million
Occupational hazards refer to workplace
accidents, and 160 million work-related
factors with a potential for harm in terms of
diseases occur worldwide each year (1).
injury or ill health. Hazards are classified in five
categories: physical (noise, radiation, extremes
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 1036 1048
The Potency of Some Natural Products on Dimethyl
Benz(A)antheracene(DMBA) Induced Hepatotoxicity in Rats
Wafaa El Kholy, Hanaa Serag, Asharf zakaria and Aziza El Metwaly
Zoology department ,Faculty of Science,Mansoura University, Egypt.
Aim of the work:the present study was carried out to investigate the possible ameliorating effects of
three herbs: hops(H) 1.5g/kg diet , rosemary(R) 5g/kg diet and cat's claw (C C) 1.7g/kg diet on
hepatic toxicity induced by 7,12-Dimethyl benz(A)antheracene , a hydrocarbon involves various
negative consequence for human health and ecosystems conversation .Results:in this work,48 female
rats at 50 day of age were divided into 8 groups; control ,hops(H), rosemary(R), cat's
claw(CC),DMBA, DMBA+H,DMBA+R and DMBA+CC groups.Results:the results indicated that a
single intraperitonial (i.p) dose of DMBA (30mg/Kg b.W) caused significant decrease in the
percentage of body weight gain, but an increase in the hepatosomatic index. In addition , the results
illustrated an increase in the liver malondialdehyde (MDA) contents and hydrogen peroxide levels
(H2O2) accompanied by significant decrease in reduced glutathione (GSH) content and superoxide
dismutase (SOD) and glutathione-S-transferase (GST) activities.The results, also reported significant
decrease in serum total proteins, total albumin , globulin and liver total protein but serum total
bilirubin was significantly elevated in the DMBA intoxicated group. Furthermore, aspartate
aminotransaminase (ASAT), alanine aminotransaminase (ALAT) , -glutamyltransferase (GGT) and
alkaline phosphatase (ALP) activities were significantly increased in serum but significantly
decreased in the liver.
On the other hand, intake of hops, rosemary and cat's claw minimize the disturbances observed in
most of the tested parameter's resulted from DMBA administration and improve the liver functions
mostly in the following order, rosemary hops cat's claw. Conclusion: it can be concluded that
intake of such herbs (hops , rosemary, cat's claw)may be effective in reducing DMBA toxicity.
Key words: natural products, hepatotoxicity,rats.
7,12-Dimethylbenz[a]anthracene (DMBA) has
cellular function and structure. There is now a
been recorded to be one of the most widely
growing body of evidence to support the
used polycyclic aromatic hydrocarbons
concept that spices, such as Humulus lupulus
(PAHs), since it is recognized as one of the
hops (H) have medicinal properties and may
most potent carcinogens, when compared with
not only alleviate symptoms, but also help to
other members of this class of chemicals(1)
prevent diseases, which belongs to the hemp
.DMBA is well known as cytotoxic,
family ,which has grown wild since ancient
times in Europe, Asia, and North America(6).It
immunosuppressive agent(2), it supressed both
used as chemopreventive, antiproliferative, an
antibiotic , antifungal agent and cytotoxic
responses(3) .Acute treatment of mice by
effects in human cancer cell lines(7). It also
DMBA resulted in a profound hypocellularity
promoting healthy kidney functions, treating
in the marrow(4).DMBA is a potent carcinogen
urinary tract infections , reducing painful
which is selectively active in sites such as
urination and tone up liver(8).Alternatively,
kidney and liver, and has been widely used as
rosemary (R) belongs to lamiaceae family
a prototype carcinogen in experimental animal
(labiatae) is a woody , perennial herb with
models. Exposure to DMBA induces
fragrant, evergreen, needle-like leaves(9) . It is
pathological changes through toxicity occurred
a flowering plant that grows in Mediterranean
to liver and kidney characterized by induction
countries, southern Europe and in the littoral
of parenchymal hepatocellular damages
region through Minor Asia areas wildly. It has
including hepatic lesions tumors and cancer
been proposed that rosemary and its
constituents have a therapeutic potential in
Recently, much attention has focused on the
treatment or prevention of inflammatory
role of natural food additives or spices in
diseases, hepatotoxicity, renal toxicity and
various disorders reflecting alteration in
heart diseases (10).Additionally, cat's claw (CC)
Hematological and immunological studies on the effect of hepatitis B virus vaccination in hepatic and non hepatic, iron chelating dependent or independent Egyptian thalassemic patients
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 1049 1063
Hematological and Immunological Studies on the Effect of Hepatitis
B Virus Vaccination in Hepatitis and Non-Hepatitis, Iron Chelating
Dependent or Independent Egyptian Thalassemia Patients
Eman G. Helal*, Ali F.M. El-Sayed**, Noran Abu- Ouf* , Nahla G. Mohamed** and
Mona A.M. Ahmed**
*Al-Azhar University, Faculty of Science (Girls) and ** Virology Sector Research Unit,
Background: Regular transfusion in thalassemia major patients increases life expectancy and
improves quality of life. Blood transfusion is the main sources for viral transmission to Thalassemia
patients. So, detection of viral antigens using more than one technique must be adopted. Iron and its
binding proteins have immune regulatory properties and shifting of immune regulatory balance by iron
excess or deficiency may produce severe deleterious physiological effects. Thus, the aim of this study
was to assess the efficacy of immunization and determine the immune response of beta-thalassemia
patients. Also, to evaluate the effects of iron overload chelating therapy and hepatitis B virus (HBV)
vaccination on some immunological and hematological parameters in hepatitis and non hepatitis
Egyptian thalassemia patients.
Methods: Forty homozygote Thalassemia patients attending blood bank, therapeutic unite,
Holding company for Biological production and Vaccine, VACSERA were chosen for this study (age
range 4-30years, mean 14 years, 18 females 46% and 22 males 54%).
Results: There was no significant correlation between HBs Ab level in control and non vaccinated
groups that include Thalassemia, hepatitis, non hepatitis, either iron chelating therapy dependent or
independent patients. In the same time, there was no significant correlation between Ab level in
vaccinated control and Thalassemia groups. HbF and HbA2 % showed significant and highly
significant increases respectively, in most of groups especially, Thalassemia, hepatitis and iron
chelating independent, vaccinated or non vaccinated groups. While HbA may be present in small
amount or completely absent. RBCs count, Hb%, Hematocrit and MCV values were decreased
significantly in all patient's groups vaccinated or non vaccinated compared to control group, while
MCH and MCHC were not changed in patient' groups compared to control group. Platelets count was
increased significantly in most patient' groups (except non vaccinated, Thalassemia, hepatitis, iron
chelating dependent) compared to control group. Also, WBCs count was increased significantly in
most groups (except non vaccinated, Thalassemia, hepatitis or non hepatitis, iron chelating dependent
or independent) in comparison with the control group. All patients (hepatitis, vaccinated or non
vaccinated) had high significant increase in gamma globulins compared to control group.
Conclusion: Hematological and immunological measurements for hepatitis Thalassemia patients are
important to monitor and treat the disease.
Key words: Blood transfusion, Thalassemia patients, iron excess, HBs, gamma globulins.
The thalassemias are classified according to
Thalassemia ( is also known as Cooley's
which chain of the hemoglobin molecule is
anemia) is a group of inherited hemoglobin
affected. In - thalassemias, production of the
disorders characterized by reduced synthesis of
globin chain is affected, while in - thalassemia
one or more of the globin chains leading to
production of the globin chain is affected.
imbalanced globin synthesis which is the major
Thalassemia is the most common type of
factor in determining the severity of the disease
hemoglobinopathy transmitted by heredity. The
in the Thalassemia syndromes. In Egypt, -
decrease or loss of or chain has unfavorable
thalassemia is the commonest cause of chronic
effects on the production and the survival of red
hemolytic anemia and it represents a major
blood cells (RBCs) and may cause a decrease in
genetic disease and a public health problem
the concentration of the globin chain and of
which engulfs a large portion of the country's
hemoglobin, resulting in microcytosis and
plan(1,2) and the rate of new birth with
The management of thalassemia major
Thalassemia per year is 1000/1.5million(3).
essentially comprises of regular "safe blood
transfusion" and a life long iron-chelation
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 1064 1071
Therapeutic Efficacy of Conventional Treatment Combined with Manuka
Honey in the Treatment of Patients with Diabetic Foot Ulcers: A
Randomized Controlled Study
Mohamed Al Saeed
Department of Surgery, Taif University and Head of Surgical Department of king Abdul Aziz
Specialist Hospital, Taif, Saudi Arabia, Email:firstname.lastname@example.org
Background and aim of the work: Foot ulcers are a major problem of diabetes for which
conventional treatment modalities alone have had limited success in promoting complete wound
closure; however, there are large amounts of evidences that exist for the effectiveness of manuka
honey as a wound dressing especially in diabetic foot. The aim of this study was to compare the
efficacy of Manuka honey combined with conventional modalities to that of conventional treatment
alone in the treatment of diabetic foot ulcers.
Patients and Methods: This was a prospective double-blind, randomized clinical trial conducted at
the King Abdul Aziz Specialist Hospital in Taif, Saudi Arabia. Fifty-nine patients, enrolled from
January 2011 to January 2013, were randomized to receive conventional treatment plus manukahoney
impregnated dressings (honey treatment group) or conventional treatment alone (control group).
Outcomes were; time to eradicate infection, length of hospital stay, percentage of completely healed
ulcers after six weeks and six months.
Results: The mean time to eradicate infection and the hospital stay were significantly reduced in the
honey treatment group compared to control group (51.1% and 53.8% respectively, P<0.05).
Percentages of ulcers that were completely healed were significantly greater in the honey group than
the control group, at six weeks (61.3% vs. 11.5%; P <0.05) and at six months (87.1% vs. 42.3%;
P<0.05). There were less toe amputations in the honey-treated group (9.7% vs. 34.6%; P<0.05).
Conclusion: Combination of conventional treatment with manuka honey impregnated dressings is
superior to conventional treatment alone in controlling wound infection, promoting the complete
healing of diabetic foot ulcers, and decreasing the rate of minor amputations.
Keywords: Manuka, honey, Diabetic foot, Taif, Saudi Arabia.
Diabetes affects about 30% of the population
antibacterial properties (7-9). Manuka honey
of the Kingdom of Saudi Arabia and its
also contains phenolic derivatives of benzoic
complications, if uncontrolled, can be very
acids, cinnamic acids and flavonoids, which
serious (1, 2). The global lifetime risk of foot
are the same as those found in propolis with its
ulcers for patients with diabetes (type 1 or 2)
known antimicrobial activity (7).Honey
may be as high as 25% and due to cultural,
enhances wound healing by accelerating
social, educational, and climate factors, the
slough separation, promoting the growth of
incidence of diabetic foot ulcers is estimated to
be higher in the KSA, however, the actual
epithelialization (10). Therefore, the aim of
burden is not exactly known (3). In high
this study was to compare the efficacy of
altitude regions like Taif, the challenge is
manuka honey combined with conventional
compounded by hypobaric hypoxia and
modalities to that of conventional treatment
polycythemia with possible increased risk of
alone in the treatment of diabetic foot ulcers.
vascular occlusion (4, 5).Moreover, in rural
areas, patients usually present in advanced
Patients and methods: This prospective
stages, and prefer to treat foot ulcers with
double-blind, randomized clinical trial was
natural products which actually useful if used
performed at the King Abdul Aziz Specialist
properly by medical professional (6).
Hospital,Taif, Saudi Arabia. The study was
approved by the ethical committee of the
especially, manuka honey are increasingly
hospital.Adult patients of both sexes with a
being used as a wound dressing in light of
diagnosis of diabetic foot ulcers with a Wagner
evidence suggesting that it provides a moist
classification of stage two, three, or four were
wound environment with potent anti-
enrolled from January 2011 to January 2013.
PROTECTIVE EFFECT OF NIGELLA SATIVA AGAINST DIABETIC COMPLICATIONS ON THE LIVER AND THE TESTIS IN WHITE MALE RATS
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 1072 1082
Protective Effect of Nigella Sativa Against Diabetic Complications
on The Liver in White Male Rats
Nassar Ayoub Abdellatif
Department of Anatomy, Faculty of Clinical Pharmacy, Taif University, Saudi Arabia
andFaculty of medicine, Sohag University, Egypt.
Corresponding author: Nassar Ayoub Abdelatif Omar,00966508772881. Zip code: 2197 E-mail address:
Aim of the work: The effect of diabetes on the liver is associated with histological changes.
The aim of the present study was to evaluate the histological changes following
administration of nigella sativa (NS) in the streptozotocin (STZ) induced diabetes mellitus in
Materials and Methods: Thirty six male white rats (n=36), weighing (180230 g) were taken
for this study. The animals were divided into 3 groups: 1- Normal control group. 2- Diabetic
group. 3- Diabetic group treated by Nigella Sativa (N.S) oil. Diabetes was induced in the
experimental rats via intraperitoneal injection of streptozotocin (45 mg/kg body weight) in a
single dose. The fasting blood glucose was estimated, 5ml\kg of body weight of N. sativa oil
was given orally for three weeks. After an overnight fast, the animals were sacrificed. The
livers were identified, weighed and observed for any gross appearance and color changes and
tissues were preserved for histopathological studies using hematoxylin & eosin (H&E) and
periodic acid Schiff (PAS) stains.
Results: In streptozotocin treated animals, the body weight was significantly decreased
compared to normal rats, while treating diabetic rats with N. sativa oil showed significant
increases in the body weight. Administration of nigella sativa oil to diabetic rats resulted in a
significant decrease in blood glucose after three weeks compared to untreated diabetic rats. In
untreated diabetic group, there was a significant decrease in the liver glycogen. Light
microscopic examination of the liver of diabetic rats revealed profound histological changes.
Nigella sativa consumption could reverse most of these histological and biochemical changes
in the liver of the diabetic group owing to its hypoglycemic and antioxidant effect.
Conclusion: The Nigella Sativa due to its antioxidant role may be helpful in reversing the
changes in the liver in diabetes mellitus.
Keywords: Liver, Diabetes mellitus, Streptozotocin, Streptozotocin diabetes, Nigella Sativa.
Streptozotocin (STZ): Diabetes mellitus
insulin from ß-cells in pancreas, may
(DM) is one of the most common lifestyle
prove to be useful for prevention and
diseases. Type 2 diabetes had global
control of diabetes mellitus. Most of these
prevalence estimate of 2.8% in the year
actions have been shown by seeds of
2000 and is projected to be 4.4% in 2030
nigella sativa and their constituents in
. Prevention and control of DM is a
animal experiments and at the same time
major challenge and requires molding
have not exhibited adverse effects .
lifestyle towards more physical activity
Streptozotocin (STZ) is a naturally
and less calorie intake avoiding sedentary
occurring nitrosourea with molecular
habits. However most people find it
weight of 265 and empirical formula of
difficult to change their lifestyle and look
C14 H27 N5 O12 . It is widely used to
for a less cumbersome alternative. A
induce insulin-dependent diabetes mellitus
traditional component of food that can
in experimental animals because of its
reduce appetite, glucose absorption in
toxic effects on islet beta cells [4&5]. The
intestine, hepatic gluconeogenesis, blood
diabetogenic action of STZ is the direct
glucose level, body weight, and can
result of irreversible damage to the
stimulate glucose induced secretion of
pancreatic beta cells resulting in
degranulation and loss of capacity to
secrete insulin . The effects of STZ on
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 1083 1105
Effect of Noise Stress on Lung and Heart of the Adult Albino Rats and the
Possible Protective Role of Sulpiride.
Tamer M. M. Abu-Amara1*, Gamal S. Elgharabawi1, Moustafa E. E. Motawee1, Salah E.
Mourad2, Neama M. Taha3.
1Histology&Cytology Department,College of Medicine, Al-Azhar University, Egypt.
2 Anatomy Department, College of Medicine, Al-Azhar University, Egypt.
3 Physiology Department, College of Medicine, Umm Al-Qura University, KSA.
*Corresponding author: Tamer M. M. Abu-Amara, Lecturer of Histology & Cytology Department, College of
Medicine, Al-Azhar University, Egypt, E-mail: email@example.com
Exposure to noise stress is associated with increased respiratory system morbidity; however the
underlying mechanisms are unclear. Thus there is a need for more study about this harmful effect.
Sulpiride had been shown to have a protective role against noise stress on other systems but this role did
not studied well on respiratory system.
Aim of the work: To investigate using histological, histochemical and morphometric methods the
possible harmful effects of noise on adult female albino rats' lung, heart and the possible protective role
of combined sulpiride treatment.
Material and Methods: The present study was carried out on 24 adult female albino rats which were
randomly divided into Group 1(C, untreated negative control), Group 2 (N, noise exposed or
positive control) where rats were exposed to noise ">90 decibel/3h/day" for 1 month, Group 3(D,
sulpiride treated) where rats were exposed to sulpiride "0.028 mg/B.W./day" and Group 4 (N+D,
noise+ sulpiride exposed). Paraffin sections were prepared for histological, histochemical and
morphometric study. Also statistical analysis was done.
Results: Rats exposed to noise only or sulpiride only showed highly significant damaging changes on
lung such as thickening in the interalveolar septa and obliteration of the alveoli, inflammatory cells
infiltration within the pulmonary interstitium, peribronchiolar infiltration and fibrosis, thickening of the
pulmonary blood vessels walls, interstitial collagen fibres deposition and apoptotic cellular changes. On
the level of heart, highly significant decrease in the diameters of the myocardial muscle fibres with focal
areas of necrosis and apoptotic changes was detected. Also, increased collagen fibres deposition was
marked in sulpiride group. When noise and sulpiride treatment was combined, the damaging effects
were maximized on the lung and to a lesser extent on the heart.
Conclusion: These results provide evidence that noise stress cause obvious lung and heart tissue
damages. No protective role for sulpiride was proofed. This is as using sulpiride alone or in combination
with noise showed marked damaging effects on the lung and heart tissues.
Keywords: Noise, Sulpiride, Albino rats, Lung, Heart, Stress, Histology and Histochemsitry.
Achieving targets in secondary prevention of hyperlipidaemia in patients with coronary artery disease
The Egyptian Journal of Hospital Medicine (October 2013) Vol. 53, Page 1106 1109
Achieving Targets in Secondary Prevention of Hyperlipidaemia in
Patients with Coronary Artery Disease.
Dr Walid Sawalha , Dr Ashraf Ahmad Abu Alsamen , Dr Laith Saad Obaidat , Dr Ramzi
Queen Alia Heart Institute King Hussein Medical Centre Amman Jordan.
For correspondence: Dr Walid Sawalha. Jordan. Amman 11814. Bayader Wadi Alseer PO BOX 143388.
Email firstname.lastname@example.org. Tel 00962-777419331.
We set our study to assess how good are we at achieving targets of lipid profile in patients with
coronary artery disease at Queen Alia Heart Institute King Hussein Medical Centre Amman
This was a retrospective analysis of the lipid profile of patients who are being followed up for
coronary artery disease at Queen Alia Heart Institute. Lipid profile (total cholesterol, LDL
cholesterol, HDL cholesterol and triglycerides) of patients who are legible for secondary prevention
was collected and compared to the targets set by the Adult Treatment Panel (ATP) III guidelines.
Demographic data and risk factors for coronary artery disease (CAD) were collected. The type and
dose of lipid lowering drug was recorded.
Lipid profiles of 1250 patients were looked at. Their age ranged from 29 76 years with a mean
age of 59.6 years (±12.8). 27% of our study were females. The mean age for females was 64.2 years
(±11.4) and for males was 57.4 years (±13.1). The prevalence of diabetes was 48.5%, hypertension
59.2%, hyperlipidaemia in 30%, family history of premature CAD 28% and 44% were smokers.
Target total cholesterol was achieved in 67% of patients, and target LDL in 54% and HDL in 49% of
patients. Almost all patients were on statins or fibrates (94%). 52% were on Simvastatin (84% of
them on 20mg) and 38% on Atorvastatin (88% of them on 20mg).
Target lipid profile in our patients has only been moderately achieved in patients with coronary
artery disease. Only modest doses of statins are used. More efforts with better follow up is needed.
Key word; coronary artery disease, lipid profile, Jordan.
streaks is derived from LDL cholesterol. The
Over the past several years many studies
second stage consists of fibrous plaques in
have emphasized the importance of
which a layer of scar tissue overlies a lipid
hyperlipidaemia as a major risk factor for
rich core. Other risk factors contribute to
coronary artery disease (CAD), and the
plaque growth at this phase. Thus in our daily
impact of treating it (1,2,3,4). Cholesterol is a
practice we try to achieve the target lipid
fat-like substance (lipid) that is present in cell
blood levels, not forgetting other modifiable
membranes and is a precursor of bile acids
risk factors for CAD.
and steroid hormones. It travels in the blood
stream as particles of lipid and protein
We set our study to assess how good we are
(lipoprotein). This has three main classes
at achieving targets of lipid profiles in
named Low Density Lipoprotein (LDL),
patients with coronary artery disease at
High Density Lipoprotein (HDL) and Very
Queen Alia Heart Institute King Hussein
Low Density Lipoprotein (VLDL). The first
Medical Centre Amman Jordan, as set by
stage of atherogenesis is the fatty streak,
the National Cholesterol Education Program
which consists largely of cholesterol-filled
(NCEP) Expert Panel on Detection,
macrophages; most of the cholesterol in fatty
Evaluation, and Treatment of High Blood