The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 384-394
Cognitive Competency of Filipino Nurses Working in Some Hospitals of Taif
City, Kingdom of Saudi Arabia
Adnan Amin Alsulaimani*, Daisy A. Vicencio**, Fred B. Ruiz*** and Hatim A. Elsheikh****1
*Department of Pediatrics and ****Department of Clinical Pharmacology, College of Medicine, Taif
University, POBox 888 Taif 21974, Kingdom of Saudi Arabia, **Department of Quality Control, Al-
Ameen Hospital, POBox 685 Taif 21944, Kingdom of Saudi Arabia, ***Graduate School, College of
Nursing, Fatima University, Valenzuela, Philippines,
1Corresponding Author:Hatim A. Elsheikh,Department of Clinical Pharmacology, College of Medicine, Taif
University, POBox 888 Taif 21974, Kingdom of Saudi Arabia
Email address: email@example.com, Mobile phone: 00966502372191
Background:Nurses give care to diverse client population, which necessitates that, they should be
culturally competent. Competence in cross cultural practice is a process requiring experience and
continued interest in learning and in sharpening cultural assessment and communication skills.
Objectives: Toinvestigate the cognitive competency of Filipino nurses working in five hospitals at Taif
City, Kingdom of Saudi Arabia. The study evaluates strength of self-efficacy perception ofthenurses, on
the cognitive constructs and the difference among the strength of self-efficacy perception of the nurses
when grouped according to their demographic profiles.
Methods:Transcultural Self-Efficacy Tool (TSET) Kit was used to measure the cognitive competency of
three hundred and seven respondent Filipino nurses working in five hospitals of TaifCity.
Results:The strength of self -efficacy perceptions of the nurses within the cognitive constructs shows
that the five highest means score dealt with "safety", "hygiene", "Informed consent", "pain relief and
comfort" and "life support and resuscitation" while the five lowest scores dealt with "Health History and
Interview", "Sexuality", "Birth", "Pregnancy" and "Diagnostic Test". The differences among the strength
of self -efficacy perception of the nurses on the cognitive construct when grouped according to seven
demographic profiles shows that only three of the demographics were different in some of the cognitive
construct variables. These were work setting, department and preferred position
Implications:The findings of the present study suggest in-service educational training to all nurses on
transcultural nursing to enhance their cultural competencies.In addition, Arabic Language training is
recommended as one of the requirements for new nurse applicants.
Key words:Cognitive competency, cognitive construct, Filipino,nurses, transcultural self-efficacy.
At present nurses from the Philippines
and beyond the minimum requirements of an
have the reputation of qualified and respected
international standard. As proof of acceptability
workers with high work ethics, and are in high
and recognition increasing number of foreign
demand worldwide.(1)They are appealing as
students are enrolled in tertiary education,(2) and
immigrant workers because they had been
many countries send health science students to
trained in English, as the medium of
the Philippines.(5)In addition, Philippine colleges
instruction,(2)by teachers familiar with American
and universities, both private and public,
nursing practices.(3) This can be attributed to
through their own accreditation bodies, now
Philippine Education patterned against United
actively seek accreditation and recognize that it
States Curriculum wherein, the structure of the
is the most effective way to spur their
nursing training was academically and socially
very similar to the programs in the Unites
States,(3)and the mandate of the Commission on
professional is educated through a combination
Higher Education (CHED) to all nursing
of competency-based and community-oriented
schools to have an accreditation.(4) This was
BS Nursing curriculum, grounded in Liberal arts
intended to ensure that, their standards are in par
that strengthen the character andvalues of the
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 395-402
CD8+T Cell Activation Associated with Viral Replication in Chronic
Saadia Farid, Laila Rashid and Samya Sweilam
Department Of Tropical Medicine and Medical Biochemistry.National Hepatology and Tropical
Medicine Research Institute and Cairo University Faculty of Medicine
Background: PD-1 expression is controlled during T-cell activation. PD-1 has an important role in
regulating immune response as well as tolerance. During chronic hepatitis C virus (HCV) infection
there is high level of PD-1 expression on exhausted CD8+T cells. There is also reduced expression of
T-bet. T-bet is identified as a transcriptional repressor of Pdcd1.
Aim of the work: The study will attempt to find out the level of expression of PD-1 on peripheral
CD8 + T-cells, associated with chronic HCV infection.
Patients and methods: Fifty patients with chronic hepatitis C virus infection (CHCV), whose age
ranged between (16-59) years, were selected from the National Hepatology and Tropical Medicine
Research Institute were included in this study, before Interferon and ribavirin therapy, and fifteen
healthy individuals were included to serve as controls. All the patients and controls were subjected to
the following: history, clinical examination, abdominal ultrasonography and collection of blood
samples for routine laboratory investigations. CBCs and analysis of the expression of surface markers
on CD8+T cells and PD-1.
Results: Our results suggested that increased expression of PD-1 cells was an additional inhibitory
mechanism that contributed to virus-specific CD8 + T cell exhaustion in chronic hepatitis C virus
(CHCV) infected patients.
Conclusion: Our study concluded that there's significant increase in PD-1 expression of circulating
HCV-specific CD8 + T cells in CHCV patients. Recommendations: The blockade of the inhibitory
receptors (PD-1) programmed cell death is considered as a novel strategy for the treatment of chronic
Key Words: Hepatitis C virus, CD8 T cells, T cell dysfunction, PD-1.
HCV infection is a considerable public health
effector function in vitro. (6-10) However, HCV-
problem and an important cause of liver
specific CD8 T cells in the liver (the site of
disease.(1) The estimated worldwide prevalence
HCV replication) display markedly increased
of HCV infection is 2 % to 3 % which translates
PD-1 expression compared to peripheral blood
to an estimated 170 million infected individuals.
(6,9,11) and profound functional impairment that is
(2) HCV is highly persistent human pathogen
refractory to PD-1 blockade alone. (9) Similarly,
that infects the liver and causes significant
highly activated circulating HCV-specific CD8
morbidity and mortality due to chronic liver
T cells in acute evolving hepatitis C show
disease.(3) Control of HCV replication may
markedly increased PD-1 expression with a deep
depend on effective Th lymphocyte. (4,5) There is
functional impairment that is unresponsive to
also an enhanced Th2 response during CHCV
and high anti-HCV antibodies production which
The PD-1 molecules is expressed on
may partly be responsible for the persistence of
lymphocytes, especially on T and B cells, and is
an inducible inhibitory regulator of T cell
Patients with CHCV infection harbor
activation. (12-13) Dysfunctions of viral specific
dysfunctional antiviral T cells with increased
CD8 + T cell immune responses are closely
PD-1 expression in circulating blood. PD-1
associated with HCV replication.(14-16) It has
blockade can restore their antigen-specific
been proposed that unbalanced distribution of
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 403-417
Effect of Human Adipose-derived Mesenchymal Stem C on The
Differentiation of Monocytes
Sobh, M. A. *; Habbak, L. Z.**; Mansy S. E.**; El-Chennawi, F.A. ***; Zeed, S.M.**
* Stem cell, Urology and Nephrology Center, Mansoura University, Egypt.
** Zoology Department, Faculty of Science,Damietta University, Egypt.
*** Clinical Pathology Department, Faculty of Medicine, Mansoura University, Egypt.
Background: The ideal stem cell for use in functional tissue engineering needs to be abundantly
available, harvested with minimal morbidity, differentiated reliably down various pathways and able
to be transplanted safely and efficaciously. Adult human adipose tissue contains a population of
mesenchymal stem cells; adipose-derived stem cells, which seem to fulfil most, if not all, of these
criteria. In this work, we investigated the immunogenicity properties of human adipose-derived
mesenchymal stem cells (HAMSCs) and their effect on monocytes differentiation.
Materials and methods: The HAMSCs have been isolated and specified. Human peripheral blood
mononuclear cells (PBMCs) were isolated and passed through a column with magnetic beads coated
with anti-CD14 antibody. CD14+ ve cells were isolated and cultured independently or co-cultured
with HAMSCs in the presence of cytokines (IL-4, Granulocyte-macrophage colony-stimulating factor
(GM-CSF)) to induce their differentiation into dendritic cells (DCs). Their further maturation was
induced by LPS added on the 6th day of culture.
Results: The major part of the independently cultured cells (CD14+ ve) was found to express the
markers which are considered to be specific for the mature dendritic cells such as Human leukocyte
antigen-DR (HLA-DR) (40.44 %) and low percentage of cells (6.9 %). Nevertheless dendritic cells of
monocyte origin (mDCs) co-cultured with HAMSCs showed significant shifts in the pattern of
surface markers. The percentage of HLA-DR cells was much lower (6.44%) compared to control
cultures (p < 0.001). Similarly, the secretion of IL-10 by DCs was up-regulated in co-cultures of
HAMSCs and DCs.
Conclusion: The results show that human adipose-tissue mesenchymal stem cells (HAMSCs) could
inhibit the differentiation of the blood monocytes into dendritic cells.
Keywords: Human adipose tissue; mesenchymal stem cells; Monocyte differentiation; Allogeneic
Mesenchymal stem cells (MSCs) are
differences can be detected when studying
pluripotent cells that can be found in several
MSCs isolated from different sources.
adult and fetal tissues. Human mesenchymal
Although embryonic stem cells seem to exhibit
stem cells (MSCs) have the capacity to
unlimited differentiation potential both in vitro
differentiate into a variety of tissues including
and in vivo, they are subject to significant
bone, cartilage, stroma, fat, muscle, and
ethical, legal and political concerns and are not
tendon. The major properties of MSCs are
generally available in current medical practice
based on their plasticity, self-renewal and
or research. Stem cells from adult tissue, on the
differentiation capacity. These characteristic
other hand, suffer from few such restrictions.
features define MSCs as a very promising
Multipotent stem cells can be isolated from
means for the purposes of regenerative
various mesenchymal tissue sources in adults,
medicine. Mesenchymal stem cells are
most commonly bone marrow. The harvest of
morphologically symmetrical fibroblastoid
bone marrow stem cells (BMSCs) has practical
type cells. They express CD44, CD29, CD105,
constraints. These include pain at the harvest
CD73, and CD166 and lack markers that are
site, and harvest of only a small volume of
consistent with hematopoietic cells, in
bone marrow (and therefore a small number of
particular CD45 and CD34.
stem cells), Umbilical cord blood (UCB)
Adult mesenchymal stem cells have been
from the placenta of infants also contains
isolated from various adult tissues or peripheral
mesenchymal stem cells. The use of UCB has
blood. It has been reported that significant
been limited by the practical difficulties in
obtaining and isolating the mesenchymal stem
ADIPONECTIN LEVELS AS A MARKER OF INFLAMMATION IN PULMONARY TUBERCULOSIS
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 418-421
Assessment of Adiponectin as a Marker for Severity of Pulmonary
Elmargoushy N.M.*, Elnashar N.A.*, Mohammad S.M.**, Elnashar M.A.** Mohammad H.A*
Taif University*, Jazan University**
Background:To evaluate the serum levels of adiponectin in patients with both active and old
pulmonary Tuberculosis (TB) and their possible relation with the severity of the disease, forty patients
of both sexes suffering from pulmonary TB (20 cases active and 20 cases old) were matched with 20
healthy control volunteers in this study from February 2014 to June 2014. Body mass index (BMI) and
serum levels of adiponectin were measured in all subjects.
Results: Both BMI and serum levels of adiponectin were significantly different between active TB
patients and control. Comparing old TB patients with controls also have the same results. No
correlation between BMI and serum adiponectin level in old TB patients was found, while adiponectin
levels in active TB patients show a significant negative correlation.
Conclusion: Increased adiponectin in serum of TB patients may be a promising marker for severity of
the disease independent of BMI.
Key words: adiponectin pulmonary tuberculosis
Pulmonary tuberculosis (TB) occurs
Adiponectin (APN) is a secretory protein
synthesized by adipocytes and plays a potential
with Mycobacterium tuberculosis (MTB). It is
role in regulating the inflammatory response
a major health problem throughout the world
by many of autocrine or paracrine. Adipokines
and remains to be the single most infectious
have both pro-inflammatory and anti-
disease causing high mortality in humans. Cell
inflammatory properties. Adiponectin is a
mediated immunity can control the infection in
protein produced exclusively in adipose tissue
most of the cases. It is still a major health
that appears to play a critical role in mediating
problem, and although the disease seems to be
physiological effects such as insulin
limited in the developed countries, it still
sensitivity, inflammatory response, and cell
remains a major problem in developing
proliferation. Adiponectin levels are inversely
countries. It is a major infectious cause of
associated with obesity and are thought to
death around the world, with most of the 1.5
decrease in individuals with increased
million deaths per year attributable to the
disease occurring in developing countries.
Negative energy balance and wasting in
Adiponectin has an endocrine effect
chronic inflammation has been recognized as a
(as a circulating hormone acting on blood
prominent feature of TB and one of the major
vessels, liver and skeletal muscles) and an
obstacles to manage the patients. (1)
auto/paracrine effect (differentiation of
The early diagnosis and adequate
preadipocytes to adipocytes), adiponectin also
treatment of infected patients with pulmonary
with all of the known receptors for adiponectin
TB is considered necessary to reduce
such as AdipoR1, AdipoR2, T-cadherin and
transmission of Mycobacterium TB and to
calreticulin are expressed on multiple cell
achieve the goal of disease elimination and
types in the lung and APN has been isolated
diagnosis, also, treatment of individuals with
from Bronchoalveolar lavage fluids (BAL). (4)
latent TB infection, who are at high risk to
develop active infection, is crucial for disease
Patients with pulmonary TB disease
control. There is an urgent need for rapid and
often suffer from weight loss. Body mass
accurate diagnostic methods in order to
index is known to be inversely correlated with
achieve higher sensitivity and specificity
adiponectin. (5) Thus, increased adiponectin
compared to traditional methods i.e.,
may be a promising marker for severity of the
microscopic examination and culture of
disease independent of the BMI.
ANTI DIABETIC EFFECT ARTEMISIA ANNUA (KAYSOM) IN ALLOXAN-INDUCED DIABETIC RATS
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 422-430
ANTI-DIABETIC EFFECT OF ARTEMISIA ANNUA (KAYSOM) IN ALLOXAN-INDUCED
Eman G.E.Helal*, Noran Abou- Aouf*, ALsayeda Mohammed Khattab*, Mohammad
*Department of Zoology, Faculty of Science, Al-AzharUniversity( Girls)
**Department of physiology, Faculty of medicine, Omar Al-Mokhtar University, Albydaa,Libya
Background and Objective: Diabetes is the most common endocrine disorder affecting millions of
people worldwide. Nowadays, herbal drugs are gaining popularity in the treatment of diabetes and its
complications. The current study was aimed at evaluating the significance of supplementation of
Artemisia annua (Kaysom) extract in reducing the metabolic abnormalities accompanied with alloxan-
induced diabetes in male albino rats.
Material and Methods: Thirty male albino rats were divided equally into three groups including control,
diabetic and diabetic treated with Kaysom extract . A single dose of alloxan(120 mg/kg body weight)
was used to induce diabetes in rats. Diabetic rats were administered Kaysom extract orally twice daily for
30 days. At the end of the experimental period, level of serum fasting insulin and glucose in addition to
serum lipids profile such as total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL),
low density lipoproteins (LDL), and very low density lipoproteins(VLDL); serum proteins including
total proteins, albumin and globulin; renal markers (creatinine, urea and uric acid) and activity of certain
enzymes such as aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT) and gamma-
glutamyltransferase (GGT) was determined for all groups. In. addition, estimation of % change of body
weight, values of homeostasis model assessment of insulin resistance (HOMA-IR) and ratios of
albumin:globulin (A:G), TC/HDL, LDL/HDL (risk ratios 1 and2) were calculated for each group.
Results: Diabetic rats showed a marked decline (p<0.01) in the level of; serum insulin, body weight (4.98
%),total proteins, albumin, globulin and HDL accompanied with marked elevation (p<0.01) in level of;
fasting blood glucose, HOMA_IR, ASAT, ALAT ,GGT, urea, creatinine, uric acid, serum TC, TG, LDL,
VLDL and ratios of TC/HDL and LDL/HDL (risk factors) as compared to the corresponding of controls.
Supplementation of diabetic rats with Kaysom extract significantly ameliorated most of the estimated
Conclusion: These results demonstrate that Kaysom extract may be of advantage in inhibiting
hyperglycemia and ameliorating metabolic abnormalities induced by diabetes.
Key words: Artemisia annua (Kaysom), Diabetes, lipids, hyperglycemia, insulin resistance.
Diabetes mellitus (DM) is highly recognized as
the most common metabolic and endocrine
disorder worldwide. It is linked to disturbances
vegetables, culinary herbs, and medicinal plants
in carbohydrate, fat, and protein metabolism(1). It
are among the main choices in the management
is especially important because the global
of diabetes (4,5).
prevalence of diabetes is projected to escalate
According to the World Health Organization
relentlessly. At least 250 million individuals
(WHO) report, around four billion people (80%
worldwide suffer from diabetes and this number
of the world“s population) use herbal
will be doubled by 2030. Increases in
medicine(6), with eleven different bioclimatic
complications will undeniably follow increasing
regions and around 7,500 different plant species.
diabetes incidence rates.(2) More than 80% of
Artemisia Annua is considered as an important
diabetes deaths take place in low- and middle-
medicinal plant species with high content of
essential oils and flavonoids, and is thoroughly
practices, are considered responsible for an
studied(7).The plant is overexploited by
impartial role in primary health care despite
collection for folk medicinal uses, it has the
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 431-436
Frequent Dose of Peginterferon Alfa 2a Evaluation in Treatment-Naļve
Chronic HCV,Genotype 4 Egyptian Patients
Shendy Mohammed Shendy; Abdel Aziz Ali Saleem; Mohamed Darwish El-Talkawy; and
Hepatogastroenterology Department, Theodor Bilharz Research Institute, Giza, Egypt.
Introduction:More frequent dosing with decreasing time intervals between injections of pegylated
interferon in the treatment of HCV genotype 4, to our knowledge, was not tested before. The purpose
of reducing the intervals between doses particularly in the first 12 weeks is to decrease the
peak/trough ratio of the blood concentration of interferon in order to give no chance for the virus to
recover. Therefore, the aim of this study is to explore the effect of such frequent dosing in the first 12
weeks as a trial to increase the response rates of our Egyptian patients with HCV genotype 4.
Materials and methods: This study includes 28 Egyptian patients, discovered to have chronic
hepatitis C genotype 4 infection within 1-11 years before enrolling to study. They include 17 males
and 11 females with mean age 41.57. Patients with active HCV infection without any vascular or
parenchymatous decompensation were given pegasys 180µg every 5 days and ribavirin according the
weight (800-1400 mg/day) for the first 4 injections. PCR is then done. Those with RVR (negative
PCR after 4th injection) were treated in usual way with pegasys given every week. Those with
detectable HCV RNA continued in the same way as first month for 12 injections. PCR was then
repeated. Those showing EVR continued treatment in the usual way. Those with partial or slow EVR
(detected HCV but viral load decreased at least 2 logs) continued as first month for 24 injections.
Those with non EVR stopped treatment. All other patients continued treatment till 48 injections. Re-
evaluation was done at end of treatment and after 6 and 12 months of end of treatment.
Results: Rapid virological response with disappearance of HCV RNA after 4 injections of treatment
was detected in 14 cases (50%) in whom treatment in usual way continued till the end of 48 weeks.
Additional 8 patients (28.6%) showed disappearance of HCV after 12 weeks of treatment to reach
total of 22 cases (78.6%) in whom treatment in usual way continued till the end of 48 weeks. Three
patients showed 2 log reduction of viral load continue treatment per protocol while 3 patients showed
less viral load reduction were withdrawn from treatment. Additional 2 patients showed disappearance
of HCV RNA at 24 weeks of treatment to reach a total of 24 patients (85.7%) the patient showing
positive RNA stopped treatment. All those patients continuing treatment to 48 weeks remain negative
for HCV RNA at end of treatment. Therefore, the ETR is 85.7% using this frequent dose
administration of pegylated interferon. Only one patient relapse at week 72 (after 6 months of end of
treatment). Thus, the SVR occurred in 23/28 patient (82.14%). Dose reduction was done for Ribavirin
in 3 cases during treatment due to clinically significant decrease in the hemoglobin levels, all showed
SVR. No reduction of interferon dose was commenced. General side effects were as usual and
controlled with paracetamol.
Conclusion: It is concluded that the use of more frequent peginterferon is associated with the best
SVR in genotype 4, and whenever possible this strategy can be used particularly in patients with early
disease as indicated by absence of sever hepatic or hematological abnormalities.
Keywords: Chronic HCV, Genotype 4, Peginterferon Alfa 2a.
infection in the USA with a prevalence of
HCV is endemic in most regions of the
approximately 1.3%, leading to chronic liver
world and has an estimated global prevalence as
high as 3%, affecting up to 170 million people
individuals(4).Also, chronic HCV infection is a
worldwide(1). Although certain regions, such as
major source of liver-related morbidity and
northern Africa and the eastern Mediterranean,
mortality, resulting in progressive liver disease,
including Egypt, have a very high prevalence of
cirrhosis and HCC in many individuals and
HCV infection relative to other areas, it is
HCV-associated liver failure is the leading
currently the most common chronic blood-borne
indication for liver transplantation, accounting
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 437-443
Study of Nutritional Contents of PrunusAmygdalusBatsch Seeds
Seham S. El Hawary1, Nadia M Sokkar1, 2, Ali M. El Halawany1, 2,Helmi A. Mokbel1*.
1Department of Pharmacognosy, Faculty of Pharmacy,Cairo University, Cairo, Egypt.
2Faculty of Pharmacy, King AbdulazizUniversity,Jeddah, Saudi Arabia.
*Corresponding author:Helmi A. Mokbel,Telephone: 00201065696699,
E- mail: firstname.lastname@example.org
Background: Prunus amygdalus Batsch (Rosaceae) is one of the major tree crops of the
world.Inaddition to its nutritional value, almond also contains a number of phytochemicals that are
responsible for a variety of bioactivities, among which antioxidant activity which has been frequently
studied.Noprevious studies were done on Umm alfahm cultivar, this encouraged the authors to perform
the present study aiming to throw light on the nutritional profile of title plant.
Material and methods: Proximate analysis of the kernel Prunus amygdalus B. includes the
determination of moisture content, total ash, total protein, total fats, total carbohydrates and crude fibers,
study of vitamin E content by using HPLC, determination of the mineral content according to
Association of Official Analytical Chemists(A.A.O.C) and determination of amino acid contents in
Results: Almond were showed a total fat (52.083%) the protein constitute (22.83 %), carbohydrate
(16.9%) adequate low moisture content (4.37%) low ash content (3.82%), the content of vitamin E in
almond (77.67 mg/100gm), the mineral contents of almond were resulted Calcium (0.23%) Phosphorus
(0.53%), Potassium 6656 mg/kg, Magnesium 2864 mg/kg, Sodium 1072.5 mg/kg, Iron119.9 mg/kg,
Zinc 52.25 mg/kg, Selenium 68.71 mg/kg and Copper 13.55 mg/kg. The identified amino acids
amounted to (40.2%) calculated on dry basis, total non-essential amino acids percentage (70%) was
higher than the percentage of the essential amino acids (30%). Glutamic acid (5.02%) was the major
non-essential amino acid identified, whereas Cysteine (0.37%) was the minor component, concerning the
identified essential amino acids, Leucine was the major one (1.38 %), while methionine (0.16 %) was the
Conclusion: From the present study,it could be concluded that the kernels of Prunus amygdalus
Batsch"Umm alfahm" cultivated in Egypt are good for health and should readily be incorporated into
Keywords: nutritional, Prunus amygdalus, almond, Umm alfahm, amino acid
Almond area in Egypt occupies about (15944)
China, the Mediterranean region and
feddans yielding mainly (22292 tons/year)
according to Egyptian Ministry of
Almond seeds, whole nuts or with skin
Agriculture statistics , most of this acreage
peeled, are consumed as snacks or used as
is located in north Sinai, west Nubaria,
ingredients for processed foods such as
Matrouh, south Sinai and Alexandria. The
almond Prunus amygdalus, syn. Prunus
chocolates, whereas the inedible counterparts,
dulcis, or Amygdalus communis is a small
including hull, shell, and skin are discarded or
deciduous tree belonging to the subfamily
used as fuel material or livestock feed.
Prunoideae of the family Rosaceae. Almond
Almond fruit consists of three or correctly
is one of the major tree crops of the world,
four portions: kernel or meat, middle shell,
almonds are one of the oldest commercial nut
outer green shell cover or almond hull and a
crops of the world; from the middle and west
thin leathery layer known as brown skin of
Asia, it has diffused to other regions and
meat or seedcoat. The nutritional importance
continentswhich include the Middle East,
of almond fruit is related to its kernel. Other
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 444-449
Non leaking Cystoid Macular Edema
Mona Mohamad A. Farag
Ophthalmology Department, Faculty of Medicine(For Girls), Al Azhar University, Cairo, Egypt.
The current study was conducted to report the discrepancy in findings between Spectral Domain-
Optical Coherence Tomography (SD-OCT) & Fundus Fluorescein Angiography (FFA) examinations of
the macular area regarding Cystoid Macular Edema (CME) in patients with diabetic retinopathy (DR) or
retinal vein occlusion (RVO).
This was a retrospective observational case study, involved 205 eyes of 179 patients. Eyes with
diabetic retinopathy or retinal vein occlusion those underwent SD-OCT & FFAwere included in the study.
All eyes had SD-OCT detected CME.
In the current study, SD-OCT detected CME was associated with diabetic retinopathy in 56.1% of eyes
& with retinal vein occlusion in 43.9 % of eyes. CME associated with DR or RVO was undetected on FFA
examination in 12.2% and 7.3 % of eyes, respectively.
Both SD-OCT & FFA were complementary to each other in the detection of CME in eyes with DR or
RVO. The use of both SD-OCT & FFA aided in the diagnosis, the choice of the treatment option &the
final visual outcome.
Keywords: Cystoid, edema
Both FFA and OCT are highly sensitive in
The term cystoid macular edema (CME)
detection of macular edema (ME) of various
applies when there is evidence by slit-lamp
etiologies, with OCT superior to FFA according
biomicroscopy, fundus fluorescein angiography
to certain parameters. The noninvasive character
(FFA), and/or optical coherence tomography
of OCT compared with FFA makes it a much
(OCT) of fluid accumulation into multiple cyst-
more popular option among patients and among
like spaces within the macula. 
some clinicians. With the extensive use of OCT
It is the final common pathway of several
for the diagnosis of ME, there is a tendency
intraocular and systemic diseases. 
toward the less frequent use of FFA, especially
Common causes of CME are postsurgical
during frequent follow-up visits.
(cataract, glaucoma and laser surgeries),
The current study was conducted to report
intraocular inflammatory diseases, medications,
the discrepancy in findings between both OCT
diabetic retinopathy and retinal vein occlusions.
& FFA examinations of the macular area as
Treatments of CME vary from observation,
regard CME in patients with diabetic retinopathy
medical and surgical. The visual outcomes are
(DR) or retinal vein occlusion (RVO).
basically related to retinal structural changes of
the macula especially in the longstanding cases.
This was a retrospective observational case
On FFA, the appearance of CME is relatively
study, where the presence of CME was
well-defined as a petalloid, or honeycomb-like,
evaluated on both FFA &Spectral Domain-OCT
pattern of hyper-fluorescence as a result of dye
(SD-OCT) examinations in patients with
pooling in the cystoid spaces.
diabetic retinopathy or retinal vein occlusion
CME could be easily detected by OCT
(branch or central). This study involved 205
independent of the angiographic degree of
eyes of 179 patients, 115 eyes had diabetic
leakage, and OCT is at least as sensitive as FFA
retinopathy & 90 eyes had retinal vein
for identifying macular edema. 
occlusion. Inclusion criteria included; eyes
Pegylated Interferon alfa 2a and small dose Ribavirin in the treatment of HCV genotype 4 in End-stage renal disease
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 450-459
Pegylated Interferon Alfa 2a and Small Dose Ribavirin in The Treatment of
HCV Genotype 4 in End-stage Renal Disease
Shendy Mohammed Shendy1;Mahmoud AlAnsary1; Manar Raafat2 ; Malak Nabil 2;Abdel Aziz
AliSaleem1;Mohamed Darwish El-Talkawy1 and Ayman AbdelAziz1.
1Hepatogastroenterology department and2Nephrology department,Theodor Bilharz Research institute, Giza,
Background:As hepatitis C virus (HCV) infection is a major health problem in patients with end-stage
renal disease (ESRD).
Aim:explore the response rate and adverse effects of pegylated interferon and ribavirin in treating HCV
genotype 4 in patients withend stage renal disease (ESRD) waiting renal transplantation.
Patients &Methods:This study included 24 patients with ESRD and active HCV infection as detected by
clinical, sonographic, biochemical, serological, virological and histological examination with liver biopsy.
All patients were under hemodialysis with HCV antibodies positive > 6 months. Viral genotyping and
both qualitative and quantitative PCR were carried out before starting therapy. Treatment was continued
for 48 weeks using pegasys 135 µg weekly and ribavirin 200 mg daily. The biochemical and virological
responses were evaluated regularly during and after treatment. The sustained virological response (SVR)
being evaluated 24 weeks later. The side effects were monitored throughout the treatment period.
Results:Rapid virological response (RVR) after week 4 was achieved in 11/24 (46%) patients. The
sustained virological response (SVR) was achieved in 16/24 (66.7%) patients. No break through or
relapses were detected during and after treatment respectively. Correlation was found between the viral
load before treatment and that at week 4 with p < 0.001and at 12 weekand between the reduction of
hemoglobin and the reduction of viral load at week 12 with p < 0.045.
Conclusion:genotype 4 HCV patients with ESRD can be considered for therapy pre-operatively to
overcome all the morbidities associated with persistence of HCV after renal transplantation provided that
the general condition, the hematological parameters and all other factors of treatment allowed such
Key words: Pegylated Interferon alfa 2a, Ribavirin, HCV genotype 4, End-stage renal disease.
and contamination of dialysis machines[14-16].
Despite the introduction of blood-product
ESRD patients with chronic HCV infection
screening, the increased use of erythropoietin, as
well as the adoption of universal precautions and
usually have an apparent indolent clinical course
strict infection controls, hepatitis C virus (HCV)
with only mildly-elevated serum ALT level[16-18].
infection still remains a major health problem in
HCV infection is an independent risk factor that
patients with end-stage renal disease (ESRD)
increases the risk of death among dialysis patients
.The annual incidence of HCV infection in
up to 2.39-fold and increases mortality rates
these patients ranges from 0.2% to 6.2%, which is
approximately 1001000 times higher than that in
hepatitis C is also associated with mixed essential
the general population. The reported
prevalence rates of chronic HCV infection among
transplantation morbidity by enhancing the risk
ESRD patients ranges from 3.4%to 80% with
of de novo or recurrent HCV-associated
great geographic variation[3,8,1113].
glomerulopathies[70-74]. Recurrence of HCV-
The higher incidence and prevalence rates of
associated kidney disease can adversely affect
HCV infection among ESRD patients suggest the
graft survival and has been linked to higher
possible routes of nosocomial transmission, such
serum creatinine levels[71-75]. In addition, HCV
as contamination of the hands of staff members,
infection adversely decreases the heath-related
sharing items between patients, dialyzer reuse,
quality of life in these patients. Although ESRD
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 460-469
Quantification of Non-Calcified and Calcified Coronary Plaques Using 64-
Slice MDCT in Patients with Acute Coronary Syndrome
Wahid Hussein Tantawy, *, Mounir Sobhy Gerges*, Essam Mohamed Abd El-Hafez*
Radiodiagnosis Department*, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Purpose: To investigate the accuracy of 64-row MDCT to analyze and quantify coronary arterial plaques
in patients presented with acute coronary syndrome (ACS).
Patients and methods: Between April 2010 and December 2013, 50 patients presented with acute
cardiac chest pain were categorized into 2 groups according to their diagnosis based on clinical
evaluation, ECG findings and cardiac biomarkers; group A including patients with ACS and group B
including patients with stable angina (SA). Both groups underwent 64-row multidetector CT (MDCT)
coronary arterial imaging. For each plaque, stenosis percentage was evaluated and the plaque was
quantified using software (Sureplaque®) based on the density (HU) and percentage of its individual
components including lipid, soft tissue, and calcium density.
Results: Of the 50 patients; 24 and 26 were grouped into groups A & B respectively. The mean value of
stenosis percent of the proximal & middle coronary segments of group A patients = 77.2% ± 10.2% -
90.5% ± 58.4% and 79.5% ± 9.1% - 85.25% ± 11% respectively, while in group B = 54.1% ± 12.1% -
65.2% ± 18.4% & 53.3% ± 1.5% - 68.6% ± 11.7% respectively (p=0.00-0.001). Quantification showed a
mean value of lipid content percentage of group A = 15.4% ± 0.8% - 47.7 % ± 19.2 %, while in group B
= 7.2% ± 5.5% - 10.3% ± 8.2% (p=0.0080.001). The mean value of soft tissue content percentage in
group A = 15.4% ± 0.8% - 47.7 % ± 19.2 %, while in group B = 7.2% ±5.5% - 10.3% ± 8.2%. The
calcification content percentage in group A = 18% ± 8.7% - 35.1 % ± 16 %, while in group B = 66.4% ±
13.8% - 76.7% ± 16.5%.
Conclusion: 64-row MDCT angiographic quantification software provides a good basis for the future
attempts of proper risk stratification of patients with coronary artery disease especially those liable for
Keywords: Acute coronary syndrome, Stable angina, coronary plaques, coronary MDCT angiography,
Acute coronary syndromes (ACS), especially
of collaterals, or failure of the thrombus to
myocardial infarction and sudden cardiac death,
significantly impede blood flow (2).
are mostly caused by rupture or erosion of
Disrupted plaques provoke thrombosis in several
coronary atherosclerotic plaques. The plaque
ways. First, contact with collagen in the plaque's
itself does not have to be associated with lumen
narrowing. Coronary blood flow may be
activation. Second, tissue factor (TF) produced
obstructed by a thrombus forming at the site of
by macrophages and smooth muscle cells (SMCs)
plaque rupture. In fact, the majority of lesions
activates the coagulation cascade (3).
that cause acute coronary syndromes are not
A noninvasive technology gaining clinical
stenotic before the event occurs (1).
acceptance is computed tomography angiography
Hence, in acute coronary syndromes, the culprit
(CTA). It is used primarily for the detection of
lesion is often a plaque complicated by
calcium; however, it has been shown that it is
thrombosis extending into the lumen. Such
also useful in detecting the plaques that may be
plaques are termed "thrombosed plaques". In
responsible for ACS. Therefore, patients with
some cases, multiple thrombosed plaques may
coronary lesions exhibiting positive remodeling
exist, only one of which is acting as the "culprit"
and low attenuation on CT angiography were
lesion. A plaque may also develop thrombosis,
considered at higher risk for ACS compared with
which remains asymptomatic due to the presence
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 470-481
The Possible Rescue Effect of Vitamin E or Silymarin on Lung Tissue
of Male Albino Rats Exposed to Electro-Magnetic Field
Abir Khalil Mohamed
Department of Zoology, Faculty of Science, Al-Azhar University, Cairo, Egypt, E-mail:
Aim of the work: Investigation of the histological and histochemical changes in the lung of male albino
rats exposed to mobile phone radiation and the possible protective role of vitamin E or Silymarin.
Material and Methods: The present study was carried out on 36 adult male albino rats (Sprague
dawly); they were divided equally into 6 groups (C group: control rats; R group: rats exposed to 900
MHz (2h /day) of radiofrequency electromagnetic field (RF-EMF) radiation; S group: positive control
rats given Silymarin; E group: positive control rats given Vitamin E; R+S group: rats treated with
Silymarin post EMF irradiation and R+E group treated with vitamin E post EMF irradiation).
Results: Rats exposed to mobile phone radiation showed numerous histological and histochemical
changes; these changes were ameliorated by using vitamin E or Silymarin. Vitamin E showed anti-
damaging effect of lung tissue exposed to mobile phone radiation more than Silymarin.
Conclusion: The present study showed that the natural anti-oxidant Silymarin and vitamin E could
protect the lung tissue from the damage produced after the exposure to mobile phone radiation. Vitamin
E showed significant anti-damaging effect more than the anti-damaging effect of Silymarin.
Keywords: Mobile Phone, Radiations, Lung, Histology, Histochemistry, Albino rats.
Nowadays, the rapid development of new
3h / d) . Further, cancer could indirectly
technologies to support our modern life
develop after the exposure to EMF of mobile
increases the level of electromagnetic fields
phone radiation. The flow of continuous waves
(EMF) in our environment . The modern
into the cell causes severe damage to the
electromagnetic (EM) equipment became a
macromolecules that comprise the cell
frequent source of danger with non-ionizing
membrane and affects the cell functions; this
radiation . All wireless technologies emit
leads to cancer [6 & 13].
electromagnetic field (EMF) radiation that
Therefore, researchers are trying to deal with
spreads worldwide and affects the human health
the current problem using natural anti-oxidant
. Wireless technology includes personal
agents that can reduce the production of
computers, mobile phone, cordless telephone,
reactive oxygen species generated after the
local TV, and radio communication . There is
exposure to EMF radiation . Among these
an increasing concern about the bio-hazard
agents are vitamin E and Silymarin which are
effects of radio frequency (RF)-EMF radiation
effective anti-oxidant and free radical
on human health [5 &6]. The exposure to RF-
scavenger agent [14, 15 & 16].
EMF radiation could interfere with the body's
Vitamin E (-tocopherol) is found in virtually
own electromagnetic system and thus producing
all cell membranes, especially in the inner
a variety of biological problems on the tissues
mitochondrial membrane, the site of the
and organs; this was previously demonstrated
electron-transport system . Vitamin E is a
on the brain , tissues of the reproductive
lipid soluble chain antioxidant which
organs , liver , spleen , kidney  and
protects the biological membranes from lipid
pancreas . With regards the respiratory
peroxidation . Silymarin (silybin) is found in
system, humble studies were done to investigate
the seeds of Silybum marianum. Silymarin is
the probable harmful effect of RF-EMF emitted
natural flavonoids effective in preventing
from mobile phone. At the cellular level,
several diseases associated with environmental
Chinese hamster lung cells (CHLC) exposed to
toxin exposure such as radiation .
1800 MHz of RF-EMF radiation showed DNA
Thus, the present study aimed to investigate two
damage . Also, tight junction proteins (ZO-1,
parameters. The first parameter is to detect the
actin and occludin) were significantly decreased
histopathological and histochemical changes in
in their expression in the lung of rats when
lung tissues exposed to RF-EMF at frequency
exposed to electromagnetic pulse (200 kV/ m,
equals 900 MHz. The second parameter is to
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 482-493
Effects of Iron Chelating Therapy And/or HBV- Vaccination
On -Thalassemia Major Patients
Eman G. Helal*, Ali F.M. El-Sayed**, Nahla G. Mohamed**, and Mona A.M. Ahmed**,
Mohammad Abulhasan Zoair***
*Zoology Department, Faculty of Science, Al-Azhar University (Girls),** Virology Sector Research
Unit, VACSERA. Egypt,*** Department of physiology, Omar Al-Mokhtar University, Albydaa,Libya
Introduction: Thalassemia is a genetic inherited blood disorder in which the body makes abnormal
hemoglobin with excessive destruction of red blood cells, which leads to anemia. For many years,
hepatitis B virus was a major problem for patients with thalassemia substantially contracted from blood
transfusions. The development of effective vaccine has further reduced the magnitude of the problem of
hepatitis B. Iron chelators are used to remove excess iron that accumulates due to repeated blood
Aim of the work: To compare thalassemic patients either have or haven't HCV with healthy persons as
regards biochemical indices taking in consideration effect of vaccination against HBV or not and using
iron chelating therapy or not by the studied persons.
Methodology: A case control study in which 40 thalassemic, blood transfusion dependent patients were
chosen randomly to act as a case group from thalassemic patients attending the VACSERA Company.
The cases (40 patients) they were classified to patients having HCV, patients were HBV vaccinated
,other non vaccinated, using iron chelating therapyor don't use it. Another 10 healthy and non
thalassemic persons were chosen randomly among persons attending the same company as a control
group to be matched with the case group.
Results: 50% of studied thalassemic patients had HCV seropositivity. Biochemical blood indices which
were found to be significantly elevated among thalassemic patients than controls were ALT, AST, ALP,
GGT and LDH enzymes in addition to serum iron, ferritin and globulin mostly in HBV non-vaccinated
and iron chelating therapy non dependent patients while, other biochemical indices which were
significantly decreased among thalassemic patients compared to controls included: total cholesterol,
total protein, albumin and albumin/globulin ratio mostly in HBV vaccinated and iron chelating non
Conclusion: this study illustrated the effectiveness of iron chelators agentsand the importance of
vaccination for reduction of morbidity and mortality.
her Asians, and African
Thalassemia is a genetic blood disorder
Americans. Both alpha and beta thalassemia
passed down through families (inherited) in
include two forms: Thalassemia major
which the body makes an abnormal form
(homozygous) and thalassemia minor
of hemoglobin (the protein in red blood cells
(heterozygous). Beta thalassemia major is
that carries oxygen). The disorder results in
also called Cooley's anemia.(5)
excessive destruction of red blood cells,
Some surveys have also indicated that many
which leads to anemia.(1)
of the developing countries have no facilities
Hemoglobin is made of two proteins: Alpha
for the diagnosis, control, and management
globin and beta globin. Thalassemia occurs
of the common hemoglobin disorders.(6) In
when there is a defect in a gene that helps
short, the global situation regarding the
control production of one of these proteins.
control and management of these conditions
is extremely unsatisfactory and cannot
There are two main types of thalassemia:
continue to be ignored by the international
Alpha and beta that occur when a gene or
genes related to the alpha or beta globins are
missed or mutated respectively(3,4).
The thalassemic children become wasted and
Beta thalassemias are common in persons of
pot bellied due to hepatosplenomegally.
Mediterranean origin, and to a lesser extent,
Hypersplenism leads to worsening of anemia
with a greater tendency to infection and
hemorrhage because of granulocytopenia
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 494-512
Anastomotic Leakage After Gastrointestinal Surgery: Risk Factors,
Presentation And Outcome
Hamed Ahmed Abd El Hameed El-Badawy
Department of General Surgery, Faculty of Medicine for Girls,
Al Azhar University Cairo, Egypt
Background: Intestinal anastomosis is one of the most commonly performed surgical procedures,
especially in the emergency setting and is also commonly performed in the elective setting when
resections are carried out for benign or malignant lesions of the gastrointestinal tract. Anastomotic leak
after gastrointestinal anastomosis is one of the important postoperative complication that leads to
significant morbidity and adversely affects length of hospital stay.
Objective: To define the risk factors, presentation and outcome of anastomotic leakage after
Methods: Prospective data collection from patients who underwent small or large bowel resection and
anastomosis without fecal diversion in the surgical department in Al Zahraa University Hospital in the
period between November 2010 and April 2014. Demographic details of the patients as well as
preoperative, intraoperative and postoperative data were recorded. Leak found or not and on which
postoperative day leak found. How it was identified (clinical or radiological) and how it was treated.
Outcome of patients was recorded as mortality rate and postoperative hospital stay.
Results: There were 70 (63.64%) males and 40 (36.36%) female patients. Mean age was (44.23 15.78)
years. Anastomotic leak was occurred in 17 (15.4%) patients group I, while there was no leak in 93
patients (84.6%) group II. The mean postoperative period for diagnosis of anastomotic leakage was 9
days range (5-16) days.
Categorical variable found to be significantly affecting the outcome of anastomosis were age of
the patients (P0.001), smoker versus nonsmoker (P0.0001), preoperative chemotherapy, radiation and
anti T.B. (P0.001), type of surgery elective versus emergency (P0.05). Bowel preparation done in 73
versus not done in 37 (P0.05), level of anastomosis small bowel and choledocojejunostomy versus
gastrojejunstomy and large bowel (P0.001), left versus right side colonic anastomosis (P0.05).
Intraoperative blood loss (P0.0001). Blood transfusion >2 unit (P0.0001).
Mortality rate was (29.41%) 5/17 in group I, while it was (3.23%) 3/93 in group II. The postoperative
hospital stay was (24.7 5.92) days in group I, while for group II it was (12.83 3.8) days.
Conclusion: Postoperative gastrointestinal anastomotic leak is a very serious complication that has great
clinical impact on patients, putting surgeons in dilemmas of detection and management.
There is multiple risk and predictive factors associated with occurrence of leak were suspected in
this study such as: older patients, preoperative anemia, hypoalbuminemia, immunosuppressive therapy,
smoking, surgery performed in an emergency setting, without adequate bowel preparation, long operative
time, intraoperative blood loss and blood transfusion and low pelvic anastomosis, but many factors
remain unclear. The presentation of anastomotic leakage varying from severe peritonitis and leakage of
bowel content through the wound or from the drain to asymptomatic (small pelvic abscess).
Early detection and expediently treatment is very helpful to improve the patients outcome but
death after leak is most often a substitute for a critically ill patients and was infrequently the actual cause
of death and so every effort needs to be made to bring down the mortality rates and hospital stay
associated with anastomotic leak.
Key Words: Anastomotic leakage, gastrointestinal surgery, risk factors.
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 513-530
The Effects of Jasonia montana (Neheda) on Some Biochemical and
Histological Parameters of Diabetic Albino Rats
Eman G. E. Helal1*, Nouran Abou-Aouf1,Sayda M. Khattab1, Hassan S. Shaibah2, Hoda M.
Abu-Taleb3, Tamer M. M. Abu-Amara4*
1Department of Zoology, Faculty of Science (Girls), Al-Azhar University, Cairo, Egypt.
2Anatomy Department, Faculty of Medicine, Umm Al-Qura University, KSA.
3Department of Enviromental Research, Theodor Bilharz Research Institute, Cairo, Egypt.
4Histology and Cytology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
*Corresponding authors: Eman G.E. Helal - Tamer M. M. Abu-Amara,
E-mail: email@example.com - firstname.lastname@example.org
Diabetes mellitus is one of the common and widely distributed metabolic diseases all over the
world. This disease is characterized by hyperglycemia that results from defects in insulin secretion,
insulin action or both. In Asia, different medicinal plant species are used as a traditional treatment for
diabetes mellitus e.g. Jasonia montana (Neheda) was one of these plants that was used in a mixture to
treat diabetic patients long times ago.
Aim of the work: This work was aimed to investigate the antidiabetic, hypolipidemic and antioxidant
effects of the aqueous extract of Jasonia montana (Neheda) on the alloxan-induced diabetic male albino
Material and Methods: This study was performed on thirty male albino rats with an average 100-110 g
body weight. The animals were divided into three groups (10 /cage); Group I (Control untreated group),
Group II (Alloxan-induced diabetic group) and Group III (diabetic group treated orally with 28.5 mg/
kg body wt. twice/ day of the plant extract).
Results: The biochemical results showed marked decline (p<0.01) in levels of the serum insulin, body
weight, total proteins, albumin, globulin and HDL accompanied with marked elevation (p<0.001) in the
levels of fasting blood glucose, levels of HOMA_IR, AST, ALT, GGT, urea, creatinine, uric acid, serum
TC, TG, LDL, VLDL and ratios of TC/HDL and LDL/HDL (risk factors) in diabetic rats in comparison
with the control group. Daily management of diabetic rates with aqueous extract of Neheda showed
significant improvement in most of these parameters. Histologically, considerable improvement in the
morphological changes that was observed in diabetic groups had been detected after treatment with
Neheda in liver, kidney and pancreatic tissues in comparison to the control group.
Conclusion: It could be concluded that Jasonia montana (Neheda) can be used as an antidiabetic drug
that can lower blood glucose concentration and guard against the negative effects of diabetes.
Keywords: Diabetes mellitus, Alloxan, Hyperglycemia, Neheda, Jasonia montana.
and adjacent areas, including the Sinai
Diabetes mellitus is one of the most common
Peninsulain Egypt(4). This medicinal plant was
endocrine metabolic disorders that is usually
traditionally used to treat many diseases like
associated with micro- and macro-vascular
diarrhea, renal troubles, stomachache and chest
complications(1). The incidence of diabetes had
diseases(4). High content of essential oils such as
been increased worldwide in the last years(2).
According to the International Diabetes
chrysanthemol, intermediol, and 1,8-cineole
Federation, the estimated number of diabetic
were found in Jasonia montana(5). Also, many
patients was about 30 million in 1985, 150
reports confirmed that Jasonia montana is rich
million in 2000 and then 246 million in 2007(2).
in flavonoid and methoxylated flavonoids(6).
The International Diabetes Federation expects
Moreover, Jasonia montana contains high levels
increase in this number up to 380 million
of phenolic compounds such as cinnamic and
patients by 2025(2). Family Compositae
caffeic acids which have excellent antidiabetic,
(Asteraceae) [locally known as Neheda]
antioxidant and anticholestatic effects(7). These
include many plants such as Chiliadenus
polyphenols are more potent antioxidants than
montana or Jasonia montana and Chrysoco
vitamins C and E(8). Eighteen phenolic quercetin
montana or Varthemia montana(3). Jasonia
derivatives like glucuronidejaceidin, and
montana had been found in the Mediterranean
centaureidin were isolated from Jasonia
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 531-546
The Role of Different Photoperiods in the Activation of the Thyroid Gland
and Ovaries of Adult and Aged Rats ( Rattus norvegicus )
Gabry M.S., El-Hennamy R.E., Ibrahim M.A., and Fathalla A.S.
Zoology and Entomology Department, Faculty of Science, Helwan University, Egypt.
Back ground: Many animals use the length of the day (photoperiod) to predict and adjust to
seasonal changes in the environment through predictive changes in physiology and behaviour. The
present work is designed to study the effect of different photoperiod regimes, i.e., short photoperiod
10L:14D, long photoperiod 14L:10D and 12L:12D light-dark cycle (LD) on the structure and
hormonal secretion of the thyroid gland and ovaries in adult and aged female rats.
Material and methods: The rats were divided into 6 groups, each group contained 6 adults (6
months old) or aged rats (18 months old) and maintained for one month under different photoperiod
Results: Short and long photoperiods increased the activity of the thyroid gland of the adult
rats. This gland was full of small follicles lined with simple columnar epithelium. Serum thyroxin
levels were extremely higher in long photoperiod group than that observed in 12:12LD and short
photoperiod groups. In contrast short photoperiod induced an increase in serum thyroxin level in the
aged rats. Short photoperiod and 12:12 LD cycle enhanced gonadal activity of the adult rats. The
ovary contained clusters of primordial follicles, different stages of ovarian follicles, and, few
numbers of atretic follicles. In the groups of the aged rats all the stages of the ovarian follicles
exhibited signs of atresia in such groups. LH, FSH, progesterone and estrogen were increased mainly
in the control group in adult and aged rats compared to the photoperiod groups. From the present
result we could conclude that: 12:12 light dark cycle enhanced the structural and functional
activities of ovaries in adult rats, while aging decreased their activities. In contrast, long photoperiod
induced thyroid gland activities in adult rats while short photoperiods activated the gland of aged
Key words: Photoperiod, Thyroid gland, Thyroxin, Ovary, Female hormones, Rat.
Photoperiodism is the ability of plants and
circadian physiology to environmental light-dark
animals to measure environmental day length to
a certain time of year. In mammals, melatonin
The gonadotrophs (LH and FSH-secreting cells)
provides the hormonal signal transducing day
are an important link in the pituitary-gonadal axis
length. Duration of pineal melatonin is inversely
and thus in the regulation of reproduction.
related to day length and its secretion drives
However, these cells do not work alone. The
enduring changes in many physiological systems,
pituitary homeostasis and adaptation to
including the HPA, HPG, brain-gut axes, the
reproductive needs requires a coordinated action
autonomic nervous system and the immune
among cells that are part of different
hypothalamic-pituitary-target organs axes 4.
Many animals use day length (photoperiod)
Photoperiod affects reproduction in a
to predict and adjust seasonal changes in the
number of rodent species. The effects of
environment through predictive changes in
photoperiod in adults are manifested by
physiology and behavior 2. Most the
maintenance of reproductive function on long
physiological processes in mammals exhibit
photoperiods and regression of reproductive
daily rhythms generated by a system of cell
structures on short photoperiods. The pineal
autonomous circadian oscillators located in the
gland and its hormone melatonin have been
brain and in peripheral organs and tissues. A
implicated in the photoperiodic regulation of
reproduction in all mammals studied to date 5.
suprachiasmatic nucleus provides circadian
Studies of thyroid physiology in rats support
output signals that are essential for maintaining
the view that the pineal gland has an anti-
synchrony of oscillators within organs and
thyrotropic action. An inhibitory action of the
between organ systems and for coupling
pineal gland on hypothalamic -pituitary-thyroid
axis response to TSH in the presence of elevated
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 547-553
Correlation between the Level of Vitamin D and Bone Mass Index in Primary
Osteoporotic Patients in Taif-KSA
Nagy A. Seleem*, Azza A. Taha**, Amal A.Soliman***, Nehal M. Salama****
*Department of Orthopedic and Traumatology, Faculty of Medicine, Al-Azhar University.
**Department of Public Health and Community Medicine, Faculty of Medicine, Menoufyia University.
***Department of Clinical Pathology, Faculty of Medicine, Menoufyia University, Egypt.
****Department of Internal Medicine, Collage of Medicine, Taif University, Saudi Arabia.
Osteoporosis (OP) is considered as one of the commonest metabolic bone diseases in orthopedics,
characterized by a reduction in bone mass density and micro-architectural deterioration of bone tissue
leading to diminished material properties with an increase in bone fragility and susceptibility to minor
The aim of this cross sectional study was to detect the level of vitamin D in patients suffering from
primary osteoporosis and to correlate their levels with bone mass index. This work was performed - at
the Orthopedic Outpatient Clinic of King Abdul Aziz specialist Hospital, Taif, (KSA) - on 115 patients
(77 females and 38 males) fulfilling WHO revised criteria of 1994 for osteoporosis. The mean age of
patients was 67.5± 8.2. A medical history was taken and bony pains, fragility fractures, and loss of
height, were elicited, with Inclusion criteria in the form of a T-score -2.5 SD at the lumbar spine,
with exclusion of any patient with secondary osteoporosis. Full physical examination and investigations
were done including estimation of serum total vitamin D and X-ray of lumbar and thoracic spine.
Results indicate that the mean total vitamin D and T-score were 19.7±6.6 ng/dl and -2.9± 0.4
respectively. 88.7% of osteoporotic cases were complaining of bone pains, 47% of them complaining of
height loss and 47.8% of them had spine fracture in X-ray. Positive strong significant correlation
between total vitamin D and T-score (r=0.83, p value <0.0001) was found. It could be concluded that
there is a significant positive strong correlation between total vitamin D and bone mass index in primary
osteoporotic patients in Taif - KSA. It is recommended that adequate intake of calcium and vitamin D
during prophylaxis and treatment of osteoporosis is necessary.
Keywords: Vitamin D, BMI, Osteoporosis.
Osteoporosis (OP) is considered as one of
use of medications such as chronic use of
the commonest metabolic diseases in
orthopaedics, characterized by a reduction in
Osteoporosis develops due to imbalance
bone mass density and micro-architectural
between bone formation and bone resorption.
deterioration of bone tissue leading to
The main mechanisms by which osteoporosis
diminished material properties with an
develop are an inadequate formation of new
increase in bone fragility and susceptibility to
bone during remodeling, excessive bone
minor trauma fractures .(1)
resorption, and inadequate peak bone mass.
OP is a silent disease often under
Disturbances of these three mechanisms lead
recognized and undertreated. Fracture may be
to the occurrence of this metabolic bone
the first and only manifestation, making OP a
major contributor to morbidity and mortality
Risk factors for osteoporotic fractures
include advanced age, deficiency of fat-
Postmenopausal osteoporosis is a
soluble vitamins ,low dietary calcium ,
primary type 1, while primary type 2
phosphorus, iron ,magnesium, zinc , copper,
osteoporosis called senile osteoporosis and
fluoride, boron, proteins, under weight, lack
occurs after age of 75 years and is seen in
of weight bearing exercise, tobacco smoking,
both females and males at a ratio of 2:1.
female athletes, amenorrhea, heavy metals
Secondary osteoporosis can arise at any age
and soft drinks may increase risk of
and affects both men and women equally. (3)
osteoporosis, especially in women. (6)
Secondary osteoporosis may arise
The risk of osteoporotic fractures can be
secondary to chronic disease or prolonged
reduced by changing the life style of the
patient (diet, exercise, etc.). (7)
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 565-575
Cytotoxicity of Silver Nanoparticles in Mice Liver Cells: An Ultrastructure
Ola H. El-Habit a,b, Eman A. Mousa c, Basma N. Hassan a
a Faculty of Science, Zoology and Entomology Department, Helwan University, Egypt
b Faculty of Science, Zoology Department, King Saud University, Kingdom of Saudi Arabia
c Faculty of Science, Zoology Department, Kafr El-sheikh University, Egypt
Introduction: Nanoparticles of silver have many important applications and are among the most
commonly used nanomaterials. They are increasingly used in a variety of both medical and consumer
products which includes: spectrally selective coating for solar energy absorption and intercalation
material for electrical batteries, as optical receptors, polarizing filters, catalysts in chemical reaction and
bio-labeling. Nanosilver (Ag-NP) has both antibacterial and antiviral activity. Yet, the knowledge about
the systemic toxicity of nanosilver is relatively limited.
The aim of work: To evaluate the potential toxicity of small size 10nm silver nanoparticles using
two different doses (0.1 ml and 0.4 ml) focusing on the ultrastructural changes occurring in mice
The methods: This study was performed using three groups of mice. The animals of the first group
were given a daily intravenous injection of 0.1 ml of silver nanoparticles for 28 consecutive days. The
second group was treated with 0.4 ml of silver nanoparticles for 28 consecutive days. The third group
served as a control group in which the animals did not receive any vehicle. The study was focused on the
ultrastructure of the liver.
The results: Ultrastructure observations of liver cells of mice Treated with any of the two doses (0.1
and 0.4 ml) of 10 nm Ag-NP indicated severe accumulation of dark deposits of Ag-NP in the cytoplasm
and the cell organelles.
Conclusion: Our study revealed that nanosilver used in doses of 0.1 and 0.4 ml led to deposits in the
cells and induced damage of cell components especially the nucleus, mitochondria and chromatin.
Key words: nanosilver , cytotoxicity, liver, mitochondria
Silver nanoparticles (AgNPs) are one of the
Over the past few years, synthesis and
most commonly used nanomaterials. AgNPs are
characterization of nanoparticles have gained
increasing momentum due to their large surface
known to have antioxidant and antimicrobial
area to volume ratio because of which
nanoparticles exhibit novel and new properties
Silver nanoparticles (AgNPs) are presently the
than their macroscopic counterparts.(1)
most commercialized of all the nonmaterial.
Nanoparticles (NPs) are defined as
According to the Woodrow-Wilson database,
materials that measure between 1 and 100 nm.
about 24% of all consumer products - claiming
Given that the diameter of many cellular
to contain engineered nonmaterial - have nano-
macromolecules such as DNA (2 nm), ATP
silver. AgNPs have a wide range of applications
synthase (10 nm), and synaptic vesicles (40 nm)
in electronics, paints, clothing, food, cosmetics,
are also in this size range, it is perhaps
and medical devices that are contributed to their
unsurprising that NPs can exhibit bioactivities
catalytic, optic, magnetic and antibacterial
that are lacking in corresponding bulk materials.
NPs can be synthesized using a variety of base
A small minority of studies reported on the
materials in different sizes and shapes, with each
toxicity of supernatants or filtrates of AgNPs
parameter conferring specific physical and
solutions so that the toxicity of applied AgNPs
bioactive properties. (2)
can be evaluated separately from the toxicity of
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 565-579
Histpathological and Immunohistochemical Changes Induced by
Contraceptive Pills in the Cervix of Female Rabbits
Gabri MS**,Ibrahim MA**, Abd El-kader DH*, Hassan BN**
*Department of Histology, Faculty of Medicine, Cairo University
**Department of Zoology and Entomology, Faculty of Science, Helwan University.
Introduction: oral contraceptive pills (OCPs) are the most popular form of hormonal contraception
in young women.
Aim of the work: the present study focused on evaluating the effects of two different contraceptive
pills including combined pills (estrogen and progesterone) and mini pills (progesterone only) on the
cervix of female rabbit.
Material and methods: after three months of daily oral administration of these contraceptive pills
the animals were sacrificed. The excised organs were dissected, processed and stained with H & E,
PAS reaction and Masson's trichrome stain and orcein stain. This was followed by morphometric
measurements and statistical study. Results: this study revealed that contraceptive pills
administration - specially the combined one - caused marked alterations in the form of hyperplastic
cervical mucosal cells and hypertrophied muscular layer. Also, there was a significant increase in
collagenous and elastic fibres content in the muscular layer of the cervix. There was also a
statistically significant increase in PAS positive materials in the lumina of the mucosal glands of the
cervix. All these changes were less marked in the case of mini pill treatment
Conclusion: pills of progesterone only showed marked histopathological change, in the cervix as a
contraceptive mean, but in less manner than the combined pills (estrogen and progesterone).
Key words: combined pills mini pills cervix hyperplasia .
Combined oral contraceptive pills were
The introduction of the birth control pill
developed to prevent ovulation by
as an effective, coitallyindependent method
suppressing the release of gonadotropins.
of contraception was a public health milestone
Estrogen negative feedback on the anterior
of the last century.
pituitary greatly decreases the release of
The oral contraceptive pill (OCP) brought
FSH, which inhibits follicular development
to market over
and helps to prevent ovulation. 
50 years ago was designed around a 28-day
Progestagen negative feedback and the
cycle that included
lack of estrogen positive feedback on LH
a 7-day hormone-free interval to induce a
release prevent a mid-cycle LH surge.
withdrawal bleed. 
Inhibition of follicular development and the
The conventional dosing scheme was
absence of LH surge prevent ovulation.It
developed to mimic the physiological event of
is unclear whether ovulation suppression
monthly menstruation in non pregnant
occurs at the level of the hypothalamus, the
women and to provide the illusion of natural
pituitary or both.  .
. Progesterone only pills primarily rely
The hormone free interval reportedly has
on the induction of viscous cervical mucus,
no physiological benefit, but was initially
which hampers the penetration of sperm into
included to increase user acceptability.
the female genit
use changes in
A majority of oral contraceptive failures are
the endometrium, making it less suitable for
primarily because of one of two types of
compliance problems: (1) taking pills
For many women the pill provides a highly
incorrectly or (2) improper transition from one
reliable and acceptable contraceptive,
pill package to the next. About 2030% of
together with many benefits to generate
women taking oral contraceptives miss at least
health. Indeed it is often prescribed for its
one pill each month and that adolescents miss
non contraceptive benefits. These many
an average of three pills a month.
accompanied by some
disadvantages, which are small with a little
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 580-597
+Effect of Crowding Stress on Lung and Heart of the Adult Albino Rats
and the Possible Protective Role of Sulpiride
Tamer M. M. Abu-Amara1*, Wagih M. Abdelhay 1, Ayman F. Elsharawy1, Lotfy S. Mohamed1,
Salah E. Mourad2, Abdelghany H. Abdelghany3 and Neama M. Taha4.
1Histology&Cytology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
2 Anatomy & Embryology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
3Anatomy & Embryology Department, Faculty of Medicine, Alexandra University, Egypt.
4Physiology Department, College of Medicine, Umm Al-Qura University, KSA.
*Corresponding author: Tamer M. M. Abu-Amara, Lecturer of Histology & Cytology Department, Faculty
of Medicine, Al-Azhar University, Egypt, E-mail: email@example.com
Abstract: Exposure to crowding stress is associated with increased respiratory system morbidity,
However, the underlying mechanisms are unclear. Thus, there is a need for more study of this
harmful effect. Sulpiride had been shown to have a protective role against crowding stress on
other systems but this role was not studied well on the respiratory and cardiovascular systems.
Objectives: Investigating the possible harmful effects of crowding on adult albino rats' lung and
heart and the possible protective role of combined sulpiride treatment.
Materials and Methods: The present study was carried out on 24 adult albino rats of local strain
weighing 120±3 g which were randomly divided equally into Group 1(C, untreated negative
control), Group 2 (Cr, crowding exposed or positive control) where rats were exposed to
crowding in a cage (20x20x20 cm- 6 rats /cage) for 1 month, Group 3(D, sulpiride-treated)
where the rats were exposed to sulpiride "0.028 mg/B.W./day" and Group 4 (Cr+D, crowding +
sulpiride-treated). Paraffin sections were prepared for histological, histochemical and
morphometric studies. The data were statistically analysed.
Results: The rats exposed to crowding 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, significant decrease in the diameters of the
myocardial muscle fibres with focal areas of necrosis, apoptotic changes and increased collagen
fibres deposition was marked in sulpiride group. When crowding and sulpiride treatments were
combined, the damaging effects were maximized on the lung and heart.
Conclusion: These results provided evidence that crowding stress causes obvious lung and heart
tissue damages. No protective role for sulpiride was proofed. This is because using sulpiride
alone or in combination with crowding showed marked damaging effects on the lung and heart
Keywords: Crowding, Sulpiride, Lung, Heart, Stress, Histology and Histochemsitry.
Crowding stress is a type of psychosocial
temperature hypoxia, change of air
stress induced by an increased density of
humidity considered as a risk factor that
population. Population density may be
increases the mortality rate due to
raised either by increasing the number of
respiratory tract infection especially among
species living in the same area and/or by
infants(4). This interferes with personal
reducing their living space(1). Crowding
activities leading to antisocial behaviour(5).
stress induces complex changes at the
For instance, crowding was found as an
behavioural, physiological and molecular
important factor related to poor school
levels with subsequent serious social,
performance of children(6). Crowding could
medical, economic and environmental
be seen as a social condition of high
implications(2,3). Environmental changes
interpersonal situation where it involves an
related to crowding particularly in small
unwanted, unnecessary or interfering
limited spaces include increasing
potential or actual interaction without real
high density of population(7). Exposure to
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 598-611
Histological and Biochemical Evaluation of the Effects of Some
Antioxidants on Aged Testes
Maiada Moustafa, Ahmed Said Alazzounui, Mohamed Said Gabri
Department of Zoology and Entomology, Faculty of Science, Helwan University.
Background: Different studies have demonstrated that aging clearly affects male fertility which
may be attributed to the androgen deficiency. Reactive oxygen species play a central role in the
pathophysiology in the aged-related decrease in male fertility. Some antioxidants have ameliorative
effects on different aged organs.
Material and Methods: The present study aimed to evaluate the effects of some antioxidants on
aged testes. Ten adult and fifty aged male albino rats (Rattus albus) were divided into six groups.
Group I (control adult), Group II (control aged), Group III (Vitamin E-treated aged), Group IV
(Vitamin C-treated aged), Group V (Zinc sulphate-treated aged), Group VI (Vitamin E-, Vitamin C-
and Zinc Sulphate-treated aged). Vitamin E, Vitamin C and Zinc were administrated in doses 2.52
mg, 3.15 mg and 0.693 mg, respectively. Histological and ultrastructural evaluation of the testes
were examined as well as Follicle stimulating hormone (FSH), Luteinizing hormone (LH), total and
free testosterone levels in the serum were measured. Counting the number of litters per animal and
the teratogenic effects was noticed. Results: Giving zinc alone or combined with other antioxidants
gave better ameliorative effects on the testicular structure and hormonal levels in the serum. No
teratogenic effects of the aged animals`offspring were noticed.
Key words: aging, testis, zinc, vitamin E, vitamin C, combined antioxidants.
Aging is an extremely complex and
overcome by the use of in vitro fertilization
multifactorial process that proceeds with the
(IVF) and intracytoplasmic sperm injection
gradual deterioration in functions. (1) It can be
(ICSI) techniques. (4) It was found that semen
accumulation of molecular damage to cells
morphology, were not decreased with
and tissues in response to exposure to stress
advancing age, but there was age-dependent
associated with environment and lifestyle.(2)
decrease in semen volume. (5) Embryo quality
After maturity the signs of aging start to
at the cleavage stage (days 23) was not
appear, when optimal health, strength and
affected by increasing males' age, while it was
appearance are at the peak. After puberty, all
associated with a significant decrease in
the physiological functions gradually start to
blastocyst embryo formation, probably
decline (e.g. the maximum lung, heart and
reflecting male genomic activation within the
kidney capacities are decreased, the secretion
embryo. (4) Zinc (Zn) plays an important role
of sexual hormones is lowered, arthritic
in the reproductive system. (6) It is the only
changes, skin wrinkling, etc).(3) The precise
metal found in almost all classes of enzymes.
High concentrations of zinc in the testes and
responsible for the aging are not known, but
accessory sex glands show its pivotal role in
according to Fontana and Klein(3) who are
the reproductive system. (7) Zn deficiency has
likely to involve a constellation of complex
been linked to hypogonadism and impaired
and interrelated factors, including oxidative
sperm function.(8,9) Studies have showed that
stress-induced protein and DNA damage in
antioxidants have a far-reaching effect in
conjunction with insufficient DNA damage
andrology.(10) Vitamins A, E, D and C were
repair, as well as genetic instability of
reported to possess antioxidant functions.(11)
mitochondrial and nuclear genomes. Age-
Although efficient, the antioxidant enzymes
related decline in testicular function could be
and compounds do not prevent the oxidative
damage completely. A series of damage
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 612-629
The Effects of Ambrosia maritime, L. (Damsissa) on Some Biochemical
and Histological Parameters of Diabetic Albino Rats
Eman G. E. Helal1*, Nouran Abou-Aouf1, Sayda M. Khattab1, Abd EL Razek A.
Meselhy2, Tamer M. M. Abu-Amara3*
1Department of Zoology, Faculty of Science (Girls), Al-Azhar University, Cairo, Egypt.
2 Anatomy and Embryology Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
3Histology and Cytology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
*Corresponding authors: Eman G.E. Helal - Tamer M. M. Abu-Amara,
E-mail: firstname.lastname@example.org - email@example.com
Diabetes mellitus is one of the common and widely distributed metabolic diseases all over the world.
This disease is characterized by hyperglycemia that results from defects in insulin secretion, insulin
action or both. Different medicinal plant species are used as a traditional treatment for diabetes
mellitus e.g. Ambrosia maritima, L. (Damsissa) which is one of these plants that its extract was used
to treat diabetic patients long times ago.
Aim of the work: This work was aimed to investigate the antidiabetic, hypolipidemic and antioxidant
effects of the aqueous extract of Ambrosia maritima, L. (Damsissa) on the alloxan-induced diabetic
male albino rats.
Material and Methods: This study was performed on thirty male albino rats with an average 100-110
g body weight. The animals were divided into three groups (10 /cage); Group I (Control untreated-
group), Group II (Alloxan-induced diabetic group) and Group III (diabetic group treated orally with
28.5 mg/ kg body wt. twice/ day of the plant extract).
Results: The biochemical results showed marked decline (p<0.01) in the levels of the serum insulin,
body weight, total proteins, albumin, globulin and HDL accompanied with marked elevation (p<0.001)
in the levels of fasting blood glucose, levels of HOMA_IR, AST, ALT, GGT, urea, creatinine, uric
acid, serum TC, TG, LDL, VLDL and ratios of TC/HDL and LDL/HDL (risk factors) in diabetic rats
in comparison with the control group. Daily management of the diabetic rates with aqueous extract of
Damsissa showed significant improvement in most of these parameters. Histologically, considerable
improvement in the morphological changes that was observed in diabetic groups had been detected
after treatment with Damsissa in liver, kidney and pancreatic tissues in comparison to the control
Conclusion: It could be concluded that Ambrosia maritima, L. (Damsissa) can be used as an
antidiabetic drug that can lower blood glucose concentration and guard against the negative effects of
Keywords: Diabetes mellitus, Alloxan, Hyperglycemia, Damsissa, Ambrosia maritima.
Ambrosia maritima, L. (Damsissa) family
Diabetes mellitus is a metabolic disorder that
compositae (Asteraceae), widely grown in
is characterized by hyperglycemia associated
Egypt, especially in Sinai(5). It is a common
with impairment in insulin secretion and/or
folk medicine used in the treatment of
insulin action as well as aberrations in
intermediary metabolism of carbohydrates,
diabetes, stomachic, and renal troubles(6).
proteins and lipids(1). Diabetes mellitus
Alard et al.(7) revealed that no toxic signs
increased risk of developing cardiovascular,
were detected after oral administration of
dried leaves of such plant. Phytochemical
analyses on Ambrosia maritime extract have
cerebrovascular disease(2, 3). A wide variety
of medicinal plants are used in the treatment
pseudoguaianolide sesquiterpenes such as;
of diabetes. From these a large number of
neoambrosin, chloroambrosin, damsinic acid,
Egyptian herbs are known to be used in folk
hymenin(8). Two new sesquiterpene lactones,
medicine(4). One of these plants is the herb of
characterized as 1'-noraltarnisin and 13
The Egyptian Journal of Hospital Medicine (October 2014) Vol. 57, Page 630-
Influence of Maternal Anemia on Placental Volume with Study
of Uterine Artery Doppler
Fatma M. El-Sokkary *, MadihaM. Hanafy *, Hanan Abd Elmonem Mohamed *
Obstetrics & Gynecology Faculty of Medicine for Girls Al-Azhar university *
Objectives: To study the influence of maternal hematocrit(Ht) and hemoglobin (Hb) levelon
placental volumewithstudy ofuterine artery Doppler.
Subjects and Methods: In this prospective study 40 pregnant( singleton pregnancy) cases were
selected from the outpatient clinic of Alzahra university Hospital. They were divided into two
groups the study group (20 cases)were anemic( iron deficiency) and the control group( 20cases)
were healthy. For each case two scans for the placenta and fetal growth were performed, the first
at recruitment and the second 5 weeks later. Placenta volume was measured at each visit using
three dimensional ultrasound. The maternal Hb and ( Ht) were measured in each visit.
Results: It revealed a non statistical significance between maternal hemoglobin, hematocrit and
placental volume during the 1st visit and 2nd visit in anemic group compared to the control
group.As regards Doppler study of the uterine artery in the present study it was noted that the
pulsatility index and resistance index showeda non significant increase in the anemic group
compared to the control group.
Conclusion:Maternal iron deficiency anemia can affect placental growth and development.
Placental volume increased with mild anemia during the first trimester but has no significant
effect of fetal growth.The use of 3D ultrasound is more accurate and efficient safe technique of
great value in evaluating placental growth and volume. Also, the study of uterine artery blood
flow during the mid second trimester showed a nonsignificant increase of RI and PI with
maternal anemia. Further study are needed for the effect of anemia on fetal growth during
preconceptional, first,second,third trimester and the outcome of pregnancy.
Key words: Maternal anemia, Placental Volume, Uterine Artery Doppler.
Humberto Azpurua et al.(6) studied the use of
two-dimensional ultrasound (2DUS) for evaluation
Anemia is an important prevalent and
of placental volume , Placental location and shape.
preventable disease which may have considerable
Three-dimensional ultrasonography is shown to be
complications for mothers and fetuses. More than
an appropriate , safe , non-invasive and accurate
half of the women in the world experience anemia
technique for evaluating the placental volume (PV)
during pregnancy (1). Anemia in pregnant may
at the first trimester (7).
contribute to an increased nutritional insult to the
fetus, by further contributing to fetal growth
Uterine artery Doppler ultrasound found to be a
retardation (2). Iron deficiency is the cause of more
useful, non invasive method with which to assess
than 90-95% of anemia during pregnancy (3).
indirectly from the earliest stages of pregnancy
According to The World Health Organization (4) Iron
changes in the uteroplacental circulation. (8). When
deficiency anemia (IDA) is the most common cause
abnormal uterine artery Doppler velocimetry was
of nutritional anemia.
accompanied with maternal anemia the risk of
Fetal growth and well-being depend on the
adverse pregnancy outcome was increased(9)
functional and structural components of the
This work aimed to assess the influence of
placenta(5). Anemia has a tremendous effect on the
maternal hematocrit and hemoglobin percent on
placenta. Maternal anemia increases the volume of
placental volume, crown rump length and uterine
the placenta. Fetal hypoxemia usually develops as a
consequence of maternal anemia.
Patients and Methods