c:\work\Jor\vol62_1 The Egyptian Journal of Hospital Medicine (Jan. 2016) Vol. 62, Page 1- 8

Assessment of Asthma Control in a Sample of Asthmatic Patients
in Taif City, Saudi Arabia
Nesriene El Margoushy, Sahar Musarri Alkhald, Nawal Zewaid Al Khaldi,and
Nihad El Nashar
Department of Medicine, Faculty of Medicine, Taif University, Saudi Arabia

asthma Control Test (ACT) Questionnaire is developed to meet the guidelines internationally
accepted for asthma management by measuring adequacy and any alteration in control of asthma, occurring
spontaneously or after starting asthma management. Objectives: to assess control of asthma in a sample of
patients diagnosed as asthmatics in Taif City based on Asthma Control Test (ACT) Methods: fifty
asthmatic patients, from those attending the out patients clinic in King Abdul Aziz Specialized hospital and
chest hospital in Taif city, were included in this study in the period from July to December, 2013. Patients
were subjected to: full clinical history and examination for clinical classification of the disease and to
recognize controlled from uncontrolled patients; review for the treatment plan for each patient; (ACT)
questionnaire was used to identify patients with poorly controlled asthma. Results: clinical classification of
asthma showed that 20% of patients had intermittent asthma, 24% had mild persistent asthma, 32 % had
moderately persistent asthma and 24% of patients got severe persistent asthma. According to ACT only
24% of patients were controlled, while the rest of patients 76% were considered uncontrolled. Conclusion:
ACT was found to be a reliable tool for assessment of uncontrolled asthmatic patients when implemented in
Taif city. Recommendations: conduct more studies in different geographical areas to assess effectiveness
of the AST questionnaire in different situations and different asthmatic patients.
Keywords: Asthma, Asthmatic Patients ,Taif City.


Asthma is an inflammation in the lung airways
triggers include; air pollution, a contact with a
affecting the sensitivity of the nerve endings
pet, tobacco smoke, sulfite-containing foods,
leading to easy irritation in these airways. During
certain drugs as aspirin and non-selective beta-
the attack, swelling of the airway linings occur
blockers. If triggering factors were avoided and
leading to narrow airways and reduction in air
the patient still has symptoms, drug therapy must
entry to and from the lungs. (1) Asthma could start
be started. Asthma management is planed
in any age but it usually starts in childhood. The
according to the type and degree of asthma. (6)
disease is manifested by episodes of shortness of
Clinical classification of severity of asthma is
breath and wheezing varying in frequency and
done according to frequency of symptom,
severity from a patient to another. (2)
symptoms by night time, predicted %FEV1,
Asthma is not a curable disease, but it is can be
variability in FEV1 and frequency of short acting
controllable as regard symptoms. As asthma
beta two agonist usage in order to control
changes from time to time, it is mandatory to
symptoms as in table (1). (5). Lung function
adjust treatment to sign and symptoms of the
measurements together with bronchial hyper
disease. (3) Improving health status of asthmatic
responsiveness may play an important role to
patients require close monitoring by proper
evaluate the effect of inhaled corticosteroids
history taking, physical examination and repeated
(ICS) and other controller medications in
follow up by pulmonary function testing to
classify the degree of the disease. (4) Asthma is
Asthma Control Test (ACT) questionnaire is
classified according to severity into intermittent,
developed to meet asthma therapy guidelines; it
mild, moderate or severe persistent. (5) The best
measures both adequacy and any change in
management for asthma is by detecting the
control of asthma symptoms, whether occurring
triggering factors which precipitate an asthma
spontaneously or after drug therapy. The
attack and eliminating exposure to them. These
questions required to assess control of asthma
Received: 01/12/2015 DOI : 10.12816/0021408
Accepted: 25/12/2015

Full Paper (vol.62 paper# 1)

c:\work\Jor\vol62_2 The Egyptian Journal of Hospital Medicine (Jan. 2016) Vol. 62, Page 9 - 17

The Fundamental Role Played by Cell Cycle Proteins in Controlling Cell
Proliferation in Chronic Hepatitis C Virus Infection.
1Saadia Farid, 2Laila Rashed and 3Samya Sweilam
Department Of Tropical Medicine, Biochemistry, and Medical Biochemistry
National Hepatology and Tropical Medicine Research Institute and Faculty of Medicine, Cairo University

examining the alteration of cell cycle genes in early hepatitis C virus (HCV) found that altered
expression of mitotic checkpoint genes, MAD2L1, KNTC1, CDC16 and CDC34, KNTC1 known as "rough
deal protein" (ROD) is part of a complex involved in elaborating an inhibitory signal due to improper
chromosomal aligment during cell division.
Aim of the work: attempt for the identification of proteins (genes), which act as predictive factors to
identify patients with high risk of cell transformation and HCC development.
Patients and methods: fifty three patients with chronic HCV infection, age ranged between 18 and 58 years,
time of assessment was before starting therapy of hepatitis C at the National Hepatology and Tropical
Medicine Research Institute. Ten healthy individuals were included to serve as controls. All the patients and
controls were subjected to the following: history, clinical examination, abdominal ultrasonography, and
collection of blood samples for routine laboratory investigation; CBCs. Liver biopsy was done to all patients
and controls, patients revealed mild fibrosis (Metavir fibrosis scores from F1 to F3). Also, we used freshly
frozen liver biopsies mRNA levels with perspective protein levels of four genes: P27, P15, KNTC1,
MAD2L1. Results: significant association of P27, P15, KNTC1 and MAD2L-1 with the progression of liver
fibrosis in chronic HCV liver biopsy was found. Conclusion: there is altered gene expression in HCV-
associated liver disease. Recommendations: the emerging interest of hepatologists in the influence of
genetic factors in HCV. Evaluation of the expression of key proteins related to the cell cycle and apoptosis in
chronically infected patients with HCV would be of significance to understand disease pathogenesis, and
will help in identifying novel prognostic indicators.
Key words: Cell cycle proteins P27, P15, KNTC1 and MAD2L-1, cell division, mitosis, HCV.


HCV associated liver disease. Together these
Hepatitis C virus (HCV) infection is a
events keep the dividing hepatocytes susceptible to
national and global public health concern,

affecting up to 4 million individuals in the United
cellular insult and hence putting them at a greater
States and 200 million individuals worldwide.(1)
risk of acquiring mutations. Liver injury is
The role of genetic factors in spontaneous
generally believed to be initiated by the death of
clearance of HCV and fibrosis progression need to
infected afflicting problems of inflammation,
be identified. Documented evidence indicates that
regenerative hepatocyte proliferation and fibrosis
inter-individual genome variability contributes
in the surrounding. (4) The development of a
considerably to the observed differences in natural
subgenomic HCV RNA replicon capable of
resistance or susceptibility to specific micro-
replication in the human hepatoma cell line, Huh
organism and to the phenotype once infection is
7, was a significant advance. (5, 6) Further, complete
replication of HCV in cell culture has been
segregation are a common feature of liver tumor
achieved. (6-8)
cells suggesting a possible role of mitosis
The molecular events during proliferation
deregulation in the pathogenesis of hepatocellular
are related closely to the cycle and its regulation.
carcinoma HCC. (3)
When stimulated to proliferate, hepatocytes first
In chronic HCV infection, rounds of
enter the G1 phase of the cell division cycle which
hepatic cell destruction and regeneration along
is followed by DNA synthesis, or the S phase.
with fibrosis occur as a result of persistent
Progression through each phase of the cell cycle
inflammation. This phenomenon provides the
involves periodic activation of phase-specific
pathogenic basis of
protein kinase complexes comprising of cyclins
and cyclin dependent kinase (CDKs). Therefore,
Accepted:16/12/2015 DOI: 10.12816/0021409

Full Paper (vol.62 paper# 2)

c:\work\Jor\vol62_3 The Egyptian Journal of Hospital Medicine (Jan. 2016) Vol. 62, Page 18 - 27

Mitomycin-C Induced Genetoxic Effect in Lymphocytes and Histological
Alterations in Testes of Male Albino Mice
Nagla Zaky Ibrahim El -Alfy, Mahmoud Fathy Mahmoud*
and Ayman Mohammad Abdullah
Biological and Geological Sciences Department, Faculty of Education, Ain Shams University, Cairo, Egypt


Background:mitomycin-C (MC) is an anti-cancer drug against several tumor types, including colon,
breast and head and neck. In this demonstration, the genotoxic effects of mitomycin-C on DNA content and
testicular tissue of male albino mice Mus musculus were studied.Materials & Methods: mitomycin-C treated
animal was injected intrapretonialy with tested doses of mitomycin-C single time at the first day of the
experiment. Comet assay was used to detect the DNA damage in mice lymphocytes and the mean of total
comet score was increased by dose and time among all treated groups. Results:the histological alterations
caused in the testis of mice after mitomycin-C treatment displayed variable changes in both the seminiferous
tubules and the interstitial tissue. Changes in seminiferous tubules were represented by hypoplasia of the
germinal epithelium and spermatogenic arrest at various stages of spermatogenesis. The most prominent
changes reported in the intertubular tissue were represented by the presence of a homogeneous and intensely
eosinophilic ground substance in the interstitial areas, congestion of blood vessels as well as haemorrhage. The
histological changes were also significantly increased by time and dose.
Key words: mitomycin-C, chemotherapy, comet assay, DNA, testicular histopathological alterations.

mutagenic [8-10]. It produces sister-chromatid
Cytotoxic drugs are a unique therapeutic
exchange in bone marrow
class of fundamental importance in current

antineoplastic chemotherapy. They belong to
and testis of rats and mice. Also, mitomycin-C
different chemical and chemotherapeutic classes.
induces sister-chromatid exchange in human
Many of them are genotoxic, carcinogenic and
lymphocytes following in vivo treatment [11, 12].
teratogenic when tested in vivo and in vitro [1,
Mitomycin-C induces chromosomal aberration,
2].Mitomycin-C, also known as mutamycin or
dominant lethal mutation and DNA damage in the
mitomycin it is a commonly used as a
spermatogonia. Also mitomycin-C may have
chemotherapeutic agent, it is a naturally occurring
caused the spermatogenic apoptosis [10, 13].Since
antibiotic, originally has isolated from the Gram
mitomycin-C is still in use as a chemotherapeutic
negative bacteria Streptomyces Caespitosus which
agent in the treatment of cancer, so this study was
has been shown to have antitumor activity and
performed in order to evaluate the harmful effect of
growth inhibitor [3, 4]. Mitomycin-C was found to
different doses of mitomycin-C on male albino
combine with DNA in tumor cells and to inhibit
replication of DNA by cross-linking to double

strand DNA synthesis [5]; mitomycin-C or
metabolites of mitomycin-C alkylate the DNA
molecule [6]. So that mitomycin-C has been used for
solving several medical problems as neoplasia,
Fifteen mature male mice (CD1) of six to eight
tissue transplantation and it has beneficial in the
weeks old with an average body weight (28 2 g.)
treatment of many types of solid tumors and
were used in current investigation. Mice were
hematologic malignancies. According to Hawkins,
apparently normal, healthy, were kept in animal
(1991) [7] cytotoxic drugs may increase the risk of
houses under suitable conditions during the whole
predispose to malignancy and increase mutations in
period of experiment and were fed on standard
offspring; cytotoxic drugs that used in cancer
rodent pellet diet and supplied with water. Animal
treatment interrupt nucleic acid and protein
care and use was approved by the relevant ethics
synthesis. Several studies have shown that
committee and guide line for the care and use of
mitomycin-C to be cytotoxic, teratogenic and
experimental animals.
Received: 01/12/2015
Accepted: 15/12/2015 DOI: 10.12816/0021410

Full Paper (vol.62 paper# 3)

c:\work\Jor\vol62_4 The Egyptian Journal of Hospital Medicine (Jan. 2016) Vol. 62, Page 28 - 36

Histopathological and Immunohistochemical Changes Induced by
BisphenolA in Reproductive Tissues of Female Rat
Alazzouni A. S.*, Hassan B. N.*, Al Jalaud N. A.**
*Department of Zoology, Faculty of Science, Helwan University
**Department of Biology, Faculty of Science, University of Dammam, Saudi Arabia

Bisphenol A (BPA) is an environmental chemical that has beenwidely used in the
manufacture of polycarbonate plastics andepoxy resins for many years. Due to its major applications
inthe production of plastic food or beverage containers andthe coating of food cans, people of different
ages are inevitably exposed to BPA in daily life. It is a contaminant with increasing exposure to it and
exerts both toxic and estrogenic effects on mammalian cells. Aim of the work: the present study was
designated to evaluate the histopathological and immunohistochemical effect of BPA on the
histoarchitecture of pituitary ,adrenal,ovarian and uterine axis of female albino rats and the ameliorative
effect of antiestrogen drug and stem enhance Experimental model and methods: 20 female albino rats
weighing 100 120 g. were kept under observation for about 15 days before the onset of the experiment
for adaptation, then the rats were classified into 4 groups 5 rats for each , the first group was left
without any treatment for 30 days as negative control group , the second group was administered with
20 mg/kg.bw of BPA for 15 consecutive days as positive control, the third group administered with 20
mg/kg.bw of BPA for 15 consecutive days and then treated withantiestrogen drug as 0.1 mg/100gm.bw
for 15 day, the fourth group administered with the same dose for the same period and the treated with
stem enhance (4.5 mg/100.bw) for 15 days.All rats are scarified and organs were histologically examined
after processing
Results:the results showed thatPA has a histopathological effects on vital organs (pituitary,
adrenal,ovary,oviduct and uterus) even for a short period with minimal ameliorative effect of
antiestrogen drug and stem enhance.
Keywords :bisphenol A xenoestrogen antiestrogen stem enhance.

anastrozole, exemestane, and selective estrogen
Bisphenol A. could be polymerized to make
receptor modulators likeraloxifene, tamoxifen(5)
polycarbonate plastic, a miraculous cheap

product that is lightweight, transparent,
Lonning et al .,2004.Stem Cell Enhancers
colorable, resistant to impact, heat, and
acilitate and trigger the mobilization of bone
chemicals, inalterable with time, and easy to
marrow stem cells to the injured tissue needs for
mold and thermoform. BPA rapidly became one
repairing(6)Drapeau et al.,2009.
of the most produced and used chemicals
Aim of the work:The present study was
worldwide, even though it was a recognized
designed to investigate the effect of
antiestrogenic drug and stem enhancer on
Exposure to BPA is almost universal: most
female rat exposed to BPA.
people have measurable amounts of BPA in

both urine and serum(2)Mileva et al.,2014. BPA
is composed of two phenol groups which have
Twenty female albino rats of Sprague Dawely
structural homology with b-estradiol, it is
strain, weighing around 100-120g, at the age of
suspected that it mimics estrogenic actions (3)
6-8 weeks were purchased from Theodore
Baba et al.,2009.BPA is capable of inducing
Bilharz Research Institute, Giza, Egypt. They
toxic effect on nonreproductive vital organs;
were kept under observation for about 15 days
several studies in the literature have reported
before the onset of the experiment for
absorption of large amounts of BPA through
skin which has been shown to cause extensive
Experimental design:
damage to the liver and kidney in humans(4)Eid
Experimental animals were divided into four
et al.,2015.
groups(five/Each) as follows:
Antiestrogen drugs classified into aromatase
Group I (Control group): Normal young
female rats (without any treatment) for 30 days.
Received: 01/01/2016
Accepted: 15/01/2016 DOI:10.12816/0021411

Full Paper (vol.62 paper# 4)

c:\work\Jor\vol62_5 The Egyptian Journal of Hospital Medicine (Jan. 2016) Vol. 62, Page 37 - 50

Relation between Serum Levels of Vitamin D and Echocardiographic Determinants of
Systolic and Diastolic Functions in Patients with and without Cardiorenal Syndrome
Ahmed Ibrahim El-Desoky Khalil*, Ramzy Hamed El-Mawardy, Haitham Galal
Mohammed, Mohammed Ahmed Abdel Rahman, and Tarek Rasheed Mohamed
Department of Cardiology, Faculty of Medicine, Ain Shams University
*Corresponding author, Ahmed Ibrahim El-Desoky, e-mail:desokyalex@gmail.com,Phone: 01090229797

vitamin D is a fat-soluble vitamin; it has skeletal and non-skeletal functions. The effect of
Vitamin D on CV disease had several mechanisms including elevated PTH and Calcium-phosphate
metabolism. It decreases the pro- remodeling of Angiotensin II on the cardiomyocytes.
The Objectives: to study relation between serum levels of vitamin D and echocardiographic
determinants of systolic and diastolic functions in patients with and without cardio-renal syndrome.
Patients and Methods:
prospective study was conducted on 90 patients of all age groups and both
sexes, admitted to Ain-Shams University hospital. The study included 3 groups of patients: Group 1:
systolic dysfunction and renal insufficiency (30 patients), Group 2: systolic dysfunction only (30
patients). Group 3: renal insufficiency only (30 patients), in addition 10 healthy controls were taken as
controls. Patients were subjected to full comprehensive echocardiography and KFT with estimation of
creatinine clearance, and Vitamin D level that was statistically studied against echocardiographic
parameters of cardiac systolic and diastolic function. Results: our study found that, compared to patients
with normal vitamin D level, patients with vitamin D deficiency (defined as having vitamin D level <20
ng/ml) had significantly higher ventricular thickness (IVS, PW and mean wall thickness) (P value <
0.001), and higher LV mass which seems to be linked eventually to worse outcomes with no significant
impact on worsening Diastolic dysfunction. A ROC curve was done revealing a sensitivity of 80% for
the mean wall thickness ( 10 mm) to identify patients with vitamin D deficiency.
Conclusion: Vitamin D deficiency was associated with ventricular hypertrophy with worsening
outcomes with no impact on diastolic function.
Key words: Vitamin D deficiency, Systolic heart failure, Diastolic dysfunction.


Vitamin D is a fat-soluble vitamin. The classic
role of vitamin D for maintaining bone health
was recently extended by reports linking vitamin
promotes cardiac hypertrophy. (3)
D deficiency to various other diseases, including
However, despite the suggested relation between
arterial hypertension and diabetes mellitus.(1) It
vitamin D deficiency and cardiac function, the
also turned out that the myocardium is an
relation between vitamin D deficiency and the
important target tissue for vitamin D-mediated
echocardiographic predictors of cardiac functions
effects on a genomic and non-genomic level .(2)
in patients with heart failure, to the best of our
Recent scientific evidence showed that vitamin D
knowledge, has not been studied yet.
has 3 major potential protective mechanisms;
Accordingly, we aim to study the relation
First, experimental studies indicated that 1,25
between serum 25-hydroxy vitamin D levels and
(OH) vitamin D could directly suppress renin
parameters of cardiac systolic and diastolic
gene expression. Second, the presence in the
function in patients with LV systolic heart failure.
cardiac muscle cells of vitamin D receptors, a

calcitriol-dependent Calcium binding protein and
calcitriol-mediated rapid activation of voltage-
Patients: The study included 90 patients of all
dependent calcium channels. Third, vitamin D
age groups and both sexes, admitted to Ain-
Received: 01/01/2016 DOI : 10.12816/0021412
Accepted: 15/01/2016

Full Paper (vol.62 paper# 5)

c:\work\Jor\vol62_6 The Egyptian Journal of Hospital Medicine (Jan. 2016) Vol. 62, Page 51- 56
Radiofrequency Catheter Ablation of Premature Ventricular Beats
among Egyptians: Predictors of Success and Recurrence
Mustafa Mohamed Abdelmonaem*, Wagdy Abdelhamid Galal, Hayam Mohamed
Eldamenhoury, Mohamed Amin Abdelhamid, Rania Samir Ahmed, Haitham Abd El
Fattah Badran
Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author:Mustafa Mohamed Abdelmonaem, 01020139399, Mostafaabdelmonaem@yahoo.com

Background: Premature ventricular beats (PVBs) are early depolarization of the myocardium
originating in the ventricle, the prognosis in patients with frequent PVBs and no obvious organic
heart disease is usually very good. However, many patients are severely symptomatic with impaired
quality of life.
Aim of the study: We aimed at our study to assess the success of radiofrequency catheter ablation
of monomorphic PVB and its impact on improvement of left ventricular (LV) systolic functions.
Patients and Methods: The current study was conducted on 40 patients with frequent symptomatic
monomorphic PVBs, candidate for PVB radiofrequency catheter ablation in cardiology department,
Ain Shams University, between 2013 and 2015. All patients were subjected to thorough history
taking, complete general and local examination, conventional 2D echocardiography and pre-
procedural Holter ECG monitoring. Patients were divided to two groups (20 patients in each group)
according to the presence or absence of structural heart disease. Electrophysiological mapping and
ablation was done for all patients, and their clinical, electrophysiological and procedural aspects
were analyzed. Follow up echocardiography and Holter ECG monitoring was done 3-6 months later
to assess recurrence and impact on LV internal dimensions and systolic functions.
: Acute success was achieved in 35 patients (87.5%), and long term success was achieved in
30 patients (75%), with elimination of PVBs and distressing symptoms among group of patients
with procedural success. Presence of structural heart disease was not related statistically to
procedural failure or long term recurrence. Magnitude of reduction of PVB burden had significant
correlation with improvement of systolic functions (P=0.04). Significant improvement of
echocardiographic parameters was witnessed among group with baseline LV systolic dysfunction.
Conclusions: Radiofrequency catheter ablation is an effective and safe therapeutic tool for frequent
monomorphic PVBs and should be addressed as 1st line option for reversal of PVB induced LV
systolic dysfunction.
Keywords: PVB, electrophysiology, radiofrequency ablation.


Premature ventricular beats (PVBs) are early
or abnormal automaticity mechanisms have
depolarization of the myocardium originating
also been postulated.2 Beta blockers or
in the ventricle. They are often seen in
Verapamil usually show only limited
association with structural heart disease and
effectiveness in controlling this type of PVB.
represent increased risk of sudden cardiac
Radiofrequency ablation can be effective, but
death (SCD), yet they are ubiquitous, even in
is hampered by the fact that this PVB has
the absence of identifiable heart diseases.
limited and unpredictable inducibility.3
They may cause troubling and sometimes
Aim of the study: To assess the efficacy of
incapacitating symptoms such as palpitation,
chest pain, pre-syncope, syncope, and heart
mapping techniques in presence or absence
PVBs originating in the ventricular outflow
of structural heart diseases.
tract usually appear in patients without

structural heart disease. They may present in
the form of isolated or incessant PVBs, or as
This study was prospective comparative
tachycardia (up to 80% of idiopathic
study conducted on fourty patients with
ventricular tachycardia). The main causal
symptomatic monomorphic PVBs; patients
mechanism is triggered activity, but re-entry
were divided into two equal groups
Received: 01/01/2016 DOI : 10.12816/0021413
Accepted: 15/01/2016

Full Paper (vol.62 paper# 6)

c:\work\Jor\vol62_7 The Egyptian Journal of Hospital Medicine (Jan. 2016) Vol. 62, Page 57- 64
The Impact of Transradial versus Transfemoral Approach for Percutaneous
Coronary Intervention on the Outcome of Patients Presenting with Acute
Coronary Syndrome
Ahmed Ibrahim Nassar, Ahmed Mohamed El Mahmoudy,
Ahmed Mohamed El Missiry, Shehab Adel El Etriby*
Department of cardiology, Faculty of Medicine, Ain Shams University
*Corresponding author Shehab Adel El Etriby, e-mail:etribyz@gmail.com Phone: 01001717943

the transfemoral approach (TFA) has been until presently the main-stay for arterial access PCI
in the setting of acute STEMI, while the transradial approach (TRA) is gaining ground in elective as well as
primary procedures.
Objectives: to assess the impact of transradial versus transfemoral approach for PCI on the outcome of
patients presenting with acute coronary syndrome.
Patients and Methods: prospective study was conducted on 100 patients presenting to Ain Shams
University Hospitals Coronary Care Unit (CCU) with recent onset acute coronary syndrome (whether
unstable angina (UA)/nonST-segment-elevation MI (NSTEMI) or ST-segment-elevation MI (STEMI))
undergoing revascularization via percutaneous coronary intervention (PCI). Patients were randomized into 2
equal groups, for the first group PCI was performed via TFA while for the second group via TRA.
Results: our study found that, with TRA we get less bleeding, less local vascular complications [8 (16%) vs
2 (4%), p=0.045] & less amount of dye used (169.60 21.28 versus 187.00 37.65 ml, p=0.006) without
significant increase in fluoroscopy time (10.86 4.88 versus 9.76 4.74 mins, p=0.256) or radiation
exposure. Although there was no significant difference in mortality and morbidity, TRA offers the patient a
more simple procedure with less hospital stay (3.4 0.948 versus 3.86 0.808 days, p<0.01).
Conclusion: radial artery access is a safe and effective approach for management of ACS. If performed by
experienced operators, TRA should be the standard access in managing ACS specifically in STEMI.
Keywords: Acute coronary syndrome, transfemoral approach, transradial approach.


Acute coronary syndromes (ACS) with and
reported on percutaneous entry into the distal
without ST-segment elevation are most commonly
radial artery for selective coronary angiography in
caused by rupture of an atherosclerotic plaque,
100 patients.7,8
leading to thrombin generation, platelet activation,
The main complications of femoral artery access
and thrombus formation.1
are hematoma, arteriovenous fistula, arterial
Although there have been improvements in
pseudoaneurysm, and retroperitoneal hemorrhage.
outcome in recent years, these patients remain at
These complications are responsible for most of the
high risk for ischemic events, both early during the
bleeding that occurs in invasive procedures,
initial hospitalization and long term.2
especially in ACS and they are influenced by
In patients with ACS, major bleeding is as
common as recurrent myocardial infarction and
occurs in about 5% of patients. A substantial
The transfemoral approach (TFA) has been until
proportion of the bleeding occurs at the vascular
presently the main-stay for arterial access
access site.3,4
percutaneous coronary intervention (PCI) in the
More recently, there has been increasing
setting of acute STEMI, while the transradial
awareness that bleeding is associated with an
approach (TRA) is gaining ground in elective as
increased risk of adverse outcomes, including MI,
well as primary procedures.10
stroke, and death.5
The current study aimed to assess the impact of
In 1948, Radner6 first described transradial
transradial versus transfemoral approach for PCI on
catheterisation using radial artery cut-down. In
the outcome of patients presenting with acute
1989, Campeau8 revisited Radner's idea and
coronary syndrome.

Accepted:15/12/2015 DOI:10.12816/0021414

Full Paper (vol.62 paper# 7)

c:\work\Jor\vol62_8 The Egyptian Journal of Hospital Medicine (Jan. 2016) Vol. 62, Page 65 -76

Anticancer Potential of Bee Venom and Propolis Combined Treatment on
Human Breast Adenocarcinoma Cell Line (MCF-7)
Eman G. E. Helal*, Nora Abdulaziz Al Jalaud **,
Islam M. El-Garawani*** and Anwaar Alkamel Kahwash****
*Departments of Zoology Faculty of Science - Al-Azhar University,
**Department of Biology, Faculty of Science, University of Dammam, Saudi Arabia,
***Department of Zoology, Faculty of Science, Menofia University, Menofia,
****Departments of Basic Science - College of Dentistry - Sinai University.

Natural remedies were used for cancer treatments, particular breast cancer. Also, the
consumption of food products containing high amount of flavonoids and antioxidants had reported to
lower the risk of various cancers. Bee venom (BV) and propolis were produced by honey bee. They
were characterized by naturopathic formulation, affordability and containing high amount of
antioxidants. Moreover, they were used safely since ancient times globally. Although that, there is no
information about the synergistic or antagonistic anticancer effects of their combination. This study was
designed to evaluate cytotoxic and pro-apoptotic effects of BV, propolis, and their combination on
breast cancer (MCF-7) cells. Materials and Methods: As preliminary study, MCF-7 cells were treated
with BV (5, 10, and 20g/ml) and propolis (50, 150, and 450g/ml) to specify the desired combination
doses of each treatment with no anticancer effect individually. Consequently, doses of (5g/ml BV+
50g/ml propolis and 5g/ml BV+ 150g/ml propolis) were chosen to evaluate the possible synergistic
anticancer potential between them. All groups in this study were examined at 2, 4, and 12 hours
intervals. The morphological changes were evaluated by acridine orange/ ethidium bromide dual
fluorescent staining and Giemsa staining to reveal the formation of apoptotic bodies or nuclear
condensation and cytoplasmic blebbing, respectively. DNA fragmentation assay was also carried out to
record the reduction in DNA content and apoptosis. Bcl-2 expression, cytoplasmic anti-apoptotic
marker, was used to prove the apoptotic properties, and autophagic cell death by florescent microscopy
was evaluated also. Results: Morphological observation by inverted and florescent microscopy revealed
apoptotic cell death under exposure to BV (10 and 20g/ml) and propolis (450g/ml). On the other
hand, the results of combined treatments revealed significant morphological alterations after fluorescent
and Giemsa staining. Apoptotic DNA fragmentation was clearly observed and Bcl-2 recoded significant
down regulation which proved the apoptotic properties of combined treatments. Additionally,
autophagic degradation results also supported the occurrence of stress on treated cells leading finally to
cell death. All results of powerful anticancer potential were obvious among all combined-treated groups
in dose and time dependent manner. This clear that, the combined treatments have possible synergistic
effect which, propose it as potential candidates to be used in development of chemotherapy.
Keywords: Bee venom, propolis, combination, MCF-7, autophagy, and apoptosis.

Cancer is the most common causes of
Despite the presence of numerous
mortality and creates many economic and
clinical and traditional therapies which may be
health issues. The most common malignant
chosen according to the several factors and the
tumors afflicting women worldwide is breast
curative role of chemotherapy in treatment of
cancer (1) and ranked in the second place in
various cancers, most of them are not precise
mortality among cancer types (2).MCF-7, one of
enough to distinguish between neoplastic and
the breast cancer cell lines, is the acronym of
healthy cells which result in many serious side
Michigan cancer foundation-7(3). It is a primary
effects and others have hampered limited
tumor (1), invasive breast ductal carcinoma (4).It
success on treatment(9). So that, there is an
is characterized by the presence of estrogen
imperative need to new safer and more
(5)and progesterone receptors (6), proliferative
successful type of cancer treatment.
response to estrogens(7)and its phenotype is
Several studies reported that, many
luminal epithelial(8).
natural treatments exert anti-carcinogenic

effects on different types of cancer. Up to 80%
Accepted:15/12/2015 DOI: 10.12816/0021415

Full Paper (vol.62 paper# 8)

c:\work\Jor\vol62_9 The Egyptian Journal of Hospital Medicine (Jan. 2016) Vol. 62, Page 77 - 88

Role of Hypovitaminosis D in the Incidence and Complications of
Diabetes Mellitus in Rats
Hanaa H. EL-Sayed1; Ayman E El-Adawy2; Areej A Yassin 1and Soad H Mostafa2
1 National Nutrition Institute - Biochemical Nutrition and Metabolism Dep. Cairo, Egypt
2 Faculty of home Economics, nutrition and food science Dep., Menofiya University

Diabetes mellitus continues to be a public health concern. Vitamin D had sparked
widespread interest in the pathogenesis and prevention of diabetes. The aim of this study was to
investigate the effect of vitamin D (deficiency & treatment) with alteration in fasting plasma glucose,
insulin resistance in alloxan injected rat. Materials and methods: The experiment was carried out
using 40 male albino rats (Sprague Dawley) weighing 15010g. Animals were randomly divided into
three groups; first group fed standard diet as a negative control group. Diabetic group injected
subcutaneously by alloxan, and fed on standard diet. The third group fed standard diet without vitamin
D for two weeks. After that glucose and insulin were determined in each rat of all groups to insure
alteration in fasting plasma glucose, insulin resistance, Homeostasis model assessment insulin
resistance (HOMA-IR) was calculated. Then the third group was divided to two subgroups. The first
subgroup fed basil diet with required vitamin D; while the second subgroup fed standard diet with
double dose vitamin D. At the end experiment (4 weeks), glucose, insulin, lipid profile, liver and renal
functions were determined in blood and serum, while (HOMA-IR) and LDL were calculated for
normal, diabetic group and both treatment subgroups. Results: Vitamin D deficiency group had the
nearest results to the diabetic group injected with alloxan group in: insulin, glucose and HOMA-IR.
Other groups had lower level than the other two groups in the same parameter. Our data explained the
improvement in glucose level after feeding with vitamin D. Diabetic group injected with alloxan had
increased in liver enzymes, renal function and lipid profile compared with other groups and showed
variable changes in histopathological examination. Conclusion: Vitamin D deficiency status is
associated with a higher risk of type 2 diabetes. Vitamin D improves glucose tolerance and insulin
sensitivity. Vitamin D has also been shown to reduce the risk of diabetes associated complications.
Keywords: Alloxan Diabetic- glucose tolerance- Insulin sensitivity .Vitamin D


Diabetes mellitus is a metabolic disease that
Vitamin D is the most important regulator of
can affect nearly every system in the body .1
calcium homeostasis in the body by increasing
Low vitamin D status can be caused by number
absorption of calcium from food and reducing
of factors, including insufficient cutaneous
urinary calcium loss. It exerts important
synthesis (due to limited sunlight exposure or
functions in skeletal development and bone
aging), inadequate intake and absorption of
mineralization elaborated that by Holick 5. Yet,
vitamin D, obesity or darker skin. Low blood
vitamin D has no hormone activity itself. Once
levels of its main metabolite, 25(OH) D, have
it enters the blood circulation, either
been linked to poor health outcomes such as
synthesized in the skin or ingested, it is bound
fractures, poor physical function, diabetes,
by the vitamin D binding protein and
neurodegenerative, autoimmune and infectious
metabolization. To become biologically active,
diseases .2
vitamin D needs two successive hydroxylations
Lips3 explained that vitamin D and especially
in the liver (at carbon 25) and in the kidney (at
its activated metabolite 1, 25-dihydroxyvitamin
a position of carbon 1). In the kidneys, 25-
D3 (1,25D3), are involved in controlling the
hydroxyvitamin D (25[OH] D) is converted to
normal function of the endocrine pancreas, and
an activated (1, 25-dihydroxyvitamin D; 1,
particularly insulin secretion. Whereas Bourlon
25[OH] 2D) as well as an inactivated (24, 25-
et al., 4 indicated that vitamin D deficiency
dihydroxyvitamin D; 1, 25[OH] 2D) form. The
inhibits rat pancreatic secretion and turnover of
vitamin D hormone, 1, 25(OH2) D, exerts its
insulin, leading to impaired glucose tolerance,
effects mainly by activating the nuclear vitamin
while replacement therapy with 1,25D3, and is
D receptor (VDR), a member of the nuclear
able to reverse these abnormalities.
receptor super-family of ligand activated
Received: 01/01/2016
Accepted: 15/01/2016

Full Paper (vol.62 paper# 9)

c:\work\Jor\vol62_10 The Egyptian Journal of Hospital Medicine (Jan. 2016) Vol. 62, Page 89 - 94

An Audit Evaluating Anticoagulation Clinic Managed by Clinical
Pharmacists in Jordan
Nadia A. Al-Omari 1, Nairooz H. Al-Momany 1, Ruba B. Ayesh 2,
Hana A. Al-Sarayreh 3, Hiam S. Al-Haqesh 4, Diana A. Ibrahim 1

1: Clinical Pharmacy, Queen Alia Heart Institute, 2: Clinical Pharmacy,
Dirocterate of Royal Medical Services, 3: BCs in Diet Therapy, Queen Alia Heart Institute,
4: Clinical Pharmacy, King Hussein Medical Center.
Corresponding author: Nadia Ahmad Al-Omari. E-mail:alomari.nadia@yahoo.com.
Phone Number: 00962798593375


Background and Objectives :Warfarin is the most widely prescribed oral anticoagulant; it is highly
effective for the treatment and prevention of venous and arterial thrombosis. The beneficial outcomes of
warfarin therapy are dependent upon achieving and maintaining an optimal international normalized ratio
(INR) therapeutic range. The aim of this study was to evaluate the impact of our newly established clinic
at Queen Alia Heart Institute (QAHI) in the Royal Medical Services (RMS), Jordan.
Patients and Methods:An observational prospective study was carried out in a newly established
anticoagulation clinic managed by two clinical pharmacists and one nutritionist in QAHI since September
2013 until June 2014. The patients (no= 250) who were on warfarin for at least two months referred to the
clinic were included in our study. All patients or their care givers received a 45 minutes educational
session and a warfarin booklet. Then they were followed up regularly for achieving and maintaining the
target INR and developing any adverse events related either too high or low INR (>4.5 or <1.5,
respectively).Results:The age range of this group of the patients who were referred to t he clinic was
wide, 5-81 years. 65% of them were males, with the most common indications for Warfarin were aortic
and mitral valves replacement, and atrial fibrillation.72% of the patients were not achieving therapeutic
(T) INR 43% of them achieve the TINR within the first week, 28% within the second week, 17% within
the third, 4% within the fourth and 8% exceeded 4 weeks. The proportion of time within TINR for all the
patients during the whole period was 75%. Only 7% of the patients had low INR, <1.5 and 5% had high
INR, >4.5 for one visit. No major thromboembolic or hemorrhagic events were reported.
Conclusion:The newly established clinic had achieved a considerable encouraging results and feedbacks
in the short period of time since it had been established.
Keywords: Warfarin, international normalized ratio (INR), atrial fibrillation (AF), thrombosis,


Warfarin is the most widely prescribed oral
anticoagulant; it is highly effective for the
hospitalizations/emergency visits due to adverse
treatment and prevention of venous and arterial
events related to anticoagulation, compared with
thrombosis. Warfarin use in clinical practice is
standard community care (usual care/health
extremely challenging because of narrow
maintenance Organization care).(1-5) Our institute
therapeutic range, its pharmacokinetics and
identified the need to establish such clinics to
pharmacodynamics is affected by genetic
improve warfarin management and provide safe
variables, drug interactions, comorbidities,
and effective care for patients on warfarin.
patient age and diet, so individualized
The protocol was prepared in consensus
therapeutic approach is needed. As the majority
between the managing clinical pharmacists and
of studies examining treatment setting in regards
the referring physicians and approved by the
to the quality/safety of oral anticoagulation
Full term (RMS) higher medical committee.
The proposal included the goals of the clinic,
anticoagulation clinic services are associated
the work flow of the clinic (referral form, patient
with better international normalized ratio (INR)
initial visit, patient standard visit, and
Received: 1/11/2016 DOI : 10.12816/0021417
Accepted: 10/11/2016

Full Paper (vol.62 paper# 10)

Hepatoprotective And Antidiabetic Effects of Apple Cider Vinegar on The Liver of Male Rats Nassar Omar et al

Full Paper (vol.62 paper# 11)

c:\work\Jor\vol62_12 The Egyptian Journal of Hospital Medicine (Jan. 2016) Vol. 62, Page 105 - 108

Role of Ginseng as Hepatoprotective, Antioxidant and Anti-Inflammatory
against Methotrexate Induced Liver Injury in Rats.
Gehan A. Youssef
Physiology Department , Faculty of Medicine (Girls), Al-Azhar University.

Ginseng, an ancient and famous medicinal herb in the Orient, has been used as a
valuable tonic and for the treatment of various diseases including hepatic disorders. Ginseng extracts
and individual ginsenosides have shown a wide array of beneficial role in the regulation of regular
liver functions and the treatment of liver disorders.
Objective: This study tries to determine the hepatoprotective , antioxidant and anti-inflammatory
effects of ginseng on Methotrexate (MTX)-induced hepatotoxicity
Materials and Methods: forty rats (weigh 150-180 g) were used. The rats were kept in animal
house for one week and had access to water and food . Temperature was kept at 37 C. After one
week, the rats were randomly divided into four equal groups: Group (A) (control) received normal
saline ; group (B )received Ginseng(1.8 ml/kg/day) orally ; group( C) received MTX (100 g/kg)
intraperitoneally and group (D) received MTX (100 g/kg) intraperitoneally with ginseng (1.8
ml/kg/day) orally. After six weeks, the rats were decapitated and evaluation of liver function was
Results: Ginseng treatment markedly suppressed the serum alanine aminotransferase (ALT) ,
aspartate aminotransferase (AST) and serum gama glutamil transpeptidase (GTP) activiteis .
Ginseng was attributed to stimulate anti-oxidant protein contents, such as glutathione peroxidase
(GPX). The marked increase of proinflammatory cytokines ( TNF ) in MTX treated rats group
was additionally attenuated by ginseng,
Conclusion : Ginseng effectively prevent liver injury, mainly through down regulation of oxidative
stress and inflammatory response.
Key words: Ginseng ,methotrexate, liver, anti-inflammatory activity, antioxidant.


The pharmacological effects of ginseng can be
The present work was to introduce the
understood in the light of their polyvalent
multifaceted pharmacological effects and
actions as demonstrated by ginseng saponins
related mechanisms of ginseng on hepatic
with their positive anti- mutagenic, anticancer,
protective action against mammalian tumors

cell lines , anti-diabetes and.1,2 Ginseng has an
immune-stimulatory, anti-inflammatory effects
The present study was carried out on forty
and antihepatoxicity effects.3 It is well known
adult male albino rats, weighing 150-180 gm.
strong antioxidant effect, for its antioxidant
They were housed in clean properly ventilated
property due to its ability to scavenge free
cages under the same environmental condition,
radicals and to neutralize, ions-induced
with free access to food and water throughout
the period of the experiment which was ten
Methotrexate (MTX) is a potent hepatotoxic
days. The animals were divided equally into
agent. The hepatic malfunction is probably due
four groups:
to a direct toxic action of the methotrexate,
Group I: Control group.( received normal
since most reaction is dose dependent.5
Liver diseases represent a major health
Group II: Ginseng group. Animals received a
burden worldwide, with liver cirrhosis being
daily oral dose of ginseng extracts for 6 weeks,
the ninth leading cause of death in Western
used in a soft gelatin capsules each capsule
countries.6 Therapies developed along the
contain ginseng extracts 100mg provided by
principles of western medicine are often limited
Arab Co. for Pharmaceutical & Medicinal
in efficacy, carry the risk of adverse effects.7
plant. The experimental dose daily prepared by
Therefore, treating liver diseases with plant-
100mg of ginseng extract dissolved in 0.5 ml
derived products which are accessible and do
olive oil , according to Paget and Barnes given
not require laborious pharmaceutical synthesis
each rat about (1.8 ml/kg/day) by oesophygeal
seems highly attractive.8
Received: 19/12/2015
Accepted: 25/12/2015 DOI:10.12816/0021419

Full Paper (vol.62 paper# 12)

c:\work\Jor\vol62_13 The Egyptian Journal of Hospital Medicine (Jan. 2016) Vol. 62, Page 109 - 126

Sodium Chloride Stress Induced Morphological Changes in Some Halotolerant
Mona S. S. Al Tamie
Qassim University College of Science
Email: d.mst3@hotmail.com

Materials and methods: Nine fungal isolates namely Emericill anidulans, Mucor racemosus , Alternaria
pluriseptata Penicillium canescens, Syncephalastrum racemosum, Aspergillus fumigatus, Alternaria
chlamydospora, Aspergillus parasiticus
and Ulocladium atrum were isolated from AL SHEGA area at
AL- QASSIM region. Results: The influence of different sodium chloride concentrations on the growth
rate, morphological and ultrastructure were studied. Considerable differences in their growth rate and
morphology were detected on medium containing different concentrations of sodium chloride (NaCl). Low
growth rates were obseved on high NaCl concentrations . At 15 % NaCl, low growth of Emericill
anidulans, Penicillium canescens, Syncephalastrum racemosum, Aspergillus parasiticus
and Mucor
was detected , whereas all fungal isolates were failed to grow at 20% NaCl. Scanning Electron
Microscope (SEM) revealed that all fungal asexual reproduction organs were metamorphosed at higher NaCl
concentration, fungal heads and sporangia were speculated or elongated. Sporangiophores and conidiophores
were shortened and dwarfed ,little number of conidia or spores were detected.
Key words : halotolerant fungi ,salt stress ,SEM.sodium chloride, morphology


Follow fungi in desert region the strategy of
concentrations of salts.[8] Its balance between a
fungus strain and representing growth of stressful
rigid and a dynamic structure influences the
environments, lack of food and low humidity,
shape of cells .[9] and enables growth and hyphal
drought and high temperature or osmophilic ] [1.
branching .[10]
Organisms living in environments with high
Some studies have focused on the role of the
concentrations of salts are challenged by osmotic
fungal cell wall in chemical sensing and
stress and by the toxicity of specific ions [2].
processing of environmental signals that control
Most fungi differ from the majority of halophilic
growth and cell morphology of microorganisms
prokaryotes .[3] they tend to be extremely
and synthesis and secretion of extracellular
halotolerant rather than halophilic and do not
enzymes.,[11], [12], & [13]
require salt to the survival, .[4] and especially the
Little is known about their mechanisms of
growth of microorganisms in highly saline
adaptation to high salinity. To investigate the
environments requires numerous adaptations, [5].
effects of low and high NaCl concentrations on
The fungal cell wall is a supramolecular structure
cell morphology, with particular emphasis on cell
that offers strength to the cells, determines their
wall ultrastructure.[14]
shape, protects them against mechanical damage
The dominant representatives and the most
and mediates the cell-to-cell communication and
thoroughly investigated halophilic fungi in
their interaction with the environment. Physical
hypersaline waters of the salterns are the black
and biological properties of fungal cell walls are
yeasts, [15] and particularly the model organism
determined by the composition and the
arrangement of their structural components.[6]
An important level of adaptation of the black
The fungal cell wall is the first line of defense
yeasts to high salinity is seen in their
extremophilicecotype , which is characterized by
adaptation at the cell wall level is expected to
a special meristematic morphology and changes
have one of the most important roles for
in cell wall structure and pigmentation .[17]
successful growth at a highly saline [7]
This work aims at investigating the effect of salt
The cell wall is essential for maintaining the
stress on growth of some halotolerant fungal
osmotic homeostasis of cells, since it protects
isolates, also representing the effect of salt stress
them against mechanical damage as well as high
on their morphology by (SEM).
Received: /12/2015 DOI : 10.12816/0021420
Accepted: 25/12/2015

Full Paper (vol.62 paper# 13)