c:\work\Jor\vol671_1 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 285- 293

Systematic Review: The Burden of Post-operative
Complications Following Colectomy for Ulcerative Colitis
Bandar Kamal MufrehAlsirhani1, MasadMasaeedMasadAlmutairi2 , SaadMunawwikh
Alshammari3 ,Abdulraouf Mohammad Altaleb4 , Othman RushdyFilfilan 5, Mohammed Abdulaziz
Othman4 , Mohammed Seror Bawahal6, Abdullah Hussain Muzaffar5 , ZiyadNawafAljazi 7,
Yasameen Abdul Qayoom Esmail8 , Maram Mohammed Al-Lahyani5 , Salman Quaid Alanazi9,
Mohammed YaseenAzher4, ZuhairMohmmad Al Aarbi10, Hussain Ali A Alaidarous5, Omar
Abdulkarim O Alkathiri11, Amirah Ali Alshammari12 ,

Ali Jassim A Alnasser
1-University Of Gezira , 2-University Of Gezira, 3-Lublin Medical University ,4-King Abdulziz
University , 5-Umm Al-Qura University ,6-King Abdullah Hospital , 7-Prince Mutaib Bin Abdulaziz
Hospital- Aljouf , 8-Taiz ­ Universaty- Yemen ,9-Warsaw Medical University , 10-Makkah University ,
11-Batterjee Medical College , 12-Hail University , 13- king Faisal University .

Ulcerative colitis (UC) patients failing medical management require colectomy.
Literature search in MEDLINE , CINAHL andEmbase, targeting studies reporting the outcomes of
colorectal procedures (from 2002 to 2016 with total and subtotal colectomy postoperative complications in
adults with ulcerative colitis as an endpoint. Texts and authoritative Web sites were also reviewed then
identification of papers according to the inclusion and exclusion criteria and data extraction were performed
by two independent researchers.
Results:Following data extraction and synthesis,we identified 24 articles for review. Reporting outcomes
from procedures conducted from 2002­2016. Most frequent short-term complications: infectious
complications and ileus (mean incidence 21% and 19%), while most frequent long-term complications:
pouchitis, fecal incontinence and small bowel obstruction (mean incidence 31%, 22% and 18%). Post-
operative early complications (30 days) occurred in 18­63% of patients with ulcerative colitis while late
complications (>30 days) occurred in 19­58% of patients. Rates of early infection and late pouch failure
decreased significantly from 2002 to 2015 (22% to 2% respectively).
Conclusion:although Colectomy remains an appropriate therapeutic strategy for specific groups of patients-
it is not the optimal cure for UC. Clinicians need to fully understand the various postoperative
complications and comorbidities that are highly prevalent with over a third of patients expected to
experience long-term or late arising post-operative complications. Thus, while surgical procedures are
recommended as an appropriate therapeutic strategy for a specific group of patients, the post-operative
complications associated with these surgical procedures should not be underestimated.
Keywords:Ulcerative Colitis, post-operative complications, colectomy ,pouchitis, colon surgery.

Even for patients who initially present with a
The global burden of Ulcerative Colitis(UC) is
limited extent of disease, such as those with
significant and continues to rise, even in western
proctitis or proctosigmoiditis, UC will progress to
countries where historical prevalence was already
a greater extent of disease extension in about one-
high1.The natural history of UC suggests that in
third of patients, with 10­20% developing
the years following diagnosis, only half of all
extensive colitis.3
patients achieve remission, with the remainder
Colectomy for UC is a technically demanding
continuing to experience disease burden; this
operation associated with morbidity and mortality
results in an increasing proportion requiring
4,5 .Patients undergoing elective procedures have
colectomy. After 10 years of treatment, over one-
lower risk of postoperative mortality, ranging
third of patients still have active disease and 20%
from 0.0% to 1.0%6. In contrast, mortality in
will undergo colectomy.2
those requiring emergent colectomy was as high
as 6.9% 7 .Other factors that have been shown to
Received: 09 / 01 /2017 DOI : 10.12816/0036639
Accepted: 15/ 01 /2017

Full Paper (vol.671 paper# 1)

c:\work\Jor\vol671_2 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 294- 304

A Systematic Review ofthe Safety of Nipple Sparing Mastectomy
Ayman Mohammed Al-Jehani1 ,SaadSalehAlgarni2, Nada KhalafAlOdhilah3,
AsalSuweid Abdullah Aldosari4, Shaykhah Ali Almalki5, SumayyahRuddaAlthalhi1,
Abrar Hassan Alqahtani5, Yazeed Ahmed L Asiri6, Mohammed Abdullah M Alfaya6 ,
Fahad Abdullah M Alfaya6 , Salman Quaid Alanazi7, Sarah Mohammed Alzayer5 ,
MeshalFahad Khan 5, SurakaJaffarRummani1, Mohammed AbdulwahabAbalkhail9,
AbdulmohsinAlmulhim8, KholoodEmbarak D Alharbi1
1IbnSina College , 2Security Forces Specialized Polyclinic ,3King Saud University ,4King
Saud Hospital City , 5Um Alqura University , 6King Khalid University , 7Royal Commision
Hospital , 8AlemamAbdulrahman Bin Faisal University ­Dammam ,9 Imam Muhammed ibn
Saud Islamic University-Riyadh.

Breast cancer is a complex disease, and local recurrence and cancer-related death is likely
multifactorial.Over the past three decades there has been a move towards breast conservation and a focus
on aesthetic outcomes while maintaining oncological safety. For some patients, mastectomy is the
preferred option. There is growing interest in the potential use of nipple sparing mastectomy (NSM).
However, oncological safety remains unproven, and the benefits and indications have not been clearly
A Systematic search in the scientific database ( Medline, EMBASE , Google Scholer and Ovid )
from 1980 to 2016 was conducted for all relevant retrospective studies including; randomized controlled
trials, cohort studies and case­control studies involving women undergoing either NSM were analyzed and
included based on the preset inclusion criteria.
Results:The search yielded 1193 articles, of which 55 studies with 9053 patients met our selection criteria.
After a mean follow up of 41 months (range, 7.1­78 months), the overall pooled locoregional recurrence
rate (LRR) was 3.25%, the overall complication rate was 21.8%(1309 of 6003) , and the overall incidence
of nipple necrosis, either partial or total, was 6.6 % (561 of 8438 ). Significant heterogeneity was found
among the published studies and patient selection was affected by tumor characteristics.
Conclusion:There is growing evidence that NSM has been marked as oncologically safe in women with
small, peripherally located tumors, without multicentricity, or when performed as a prophylactic
mastectomy. Hence, NSM has been recommended only if carefully selected for a particular group of
Keywords:Mastectomy,Recurrence, NSM , NAC.


undergo a masterctomy. This is due to various
Breast carcinoma is the leading cause among
reasons (size or position of the tumour,
women in most developed countries 1. It is not a

single disease, which comprises of many
anticipating a bad cosmetic result, small breast,
biologically different entities with distinct
multifocal tumour, a woman's request, etc.) 5.
History of Mastectomy goes back in time to
Halsted's radical mastectomy which had been the
suggested that breast cancers with different
standard of care for patients since its inception in
histopathological and biological features exhibit
1894 up to the 1960s. Patey described the
distinct behaviors that lead to different treatment
modified radical mastectomy, which achieved a
responses and should be given different
local recurrence rate of 10% after 10 years6. Skin
therapeutic strategies 3 .Thus, accurate grouping
sparing mastectomy (SSM) was first described in
of breast cancers into clinically relevant subtypes
1991 by Toth and Lappert; it involves removing
is of particular importance for therapeutic
the entire breast and nipple-areola complex
decision making and thus urgently called for
(NAC) while maintaining the skin envelope and
it4.There is evidence that 40% of breast cancer
the native inframammary fold (IMF)7. A
Received: 15 / 01 /2017 DOI : 10.12816/0036640
Accepted: 20/ 01 /2017

Full Paper (vol.671 paper# 2)

c:\work\Jor\vol671_3 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 305- 313

Chronic Hepatitis C Treatment: A Systematic Review
1Aishah Mohammed Alenezi, 2Abdulaziz Hassan Mohammed Al-Fakih,3
Sultan Mohammed Al-Afif,3Abdulkarem Mohammed Al-Afif, 5Bashayer Abbas Habib,
Mooj Abdullah Alghofaili, Shaykhah Ali Almalki, 6Shahad Dhafer Adraj,
7Mada Khaled Arfaj, 4Waad Musayid Alsadi, 4Lama Hamed Almazroei, Amjad Meshal Allhyani, 4
Hanof Abdulrhman Bakri, 9 Bandar Aedh Alyami, 10 Ola Ali Alsaihati, 11 Zahra Issa A Al Ali, 12Altalhi,
Abdulrahman Salem D, 13Abdualrhman Ali Al-Amri , 14Arwa Ibrahim Y Ramel
1 Northern Border University, 2 First Clinic, 3 Hadhramout University, 4 Ibn Sina College, 5 Almaarefa
Colleges, 6 Um-Alqura University, 7 Ibn Sina College Dent,8 Batterjee Medical College, 9 Imam Muhammad
Ibn Saud Islamic University, 10 Shariqa University, 11 Maternity And Children Hospital- Dammam, 12 Taif
University, 13 King Khalid University-Abha , 14 East Jeddah General Hospital

Chronic hepatitis C (CHC) infection affects almost 3% of the global population and can lead to
cirrhosis, liver failure, and hepatocellular carcinoma in a significant number of those infected. Thus, there is a
complelling need to develop and introduce new therapeutics with a direct-acting antiviral effect in order to
target various stages of the HCV lifecycle for HCV eradication without concomitant interferon.
Study Objective:
to provide treatment recommendations for chronic HCV for specialists and generalists
based on published evidence.
A literature search of Web of Science, Scopus, Embase, Agricola, Cochrane Library, Cinahl Plus,
Google Scholar, and Oaister was conducted from 1990 to 2016, records were filtered according to the
Inclusion criteria and 27 hits were yielded.
Results: Hepatitis C virus genotype 1 is more difficult to cure than genotype 2 or genotype 3. Patients with
HCV genotype 1 should receive treatment with sofosbuvir + pegylated interferon + ribavirin because of the
shorter duration of therapy and high rates of SVR (89%-90%). Simeprevir + pegylated interferon + ribavirin
is an alternative for patients with HCV genotype 1 (SVR, 79%-86%). Patients with HCV genotypes 2 and 3
should receive therapy with sofosbuvir + ribavirin alone (SVR for genotype 2, 12 weeks' duration: 82%-93%;
SVR for genotype 3, 24 weeks' duration, 80%-95%). Patients with HIV-HCV coinfection and patients with
compensated cirrhosis (ie, cirrhosis but preserved synthetic liver function) should receive the same treatment
as HCV-monoinfected patients. Conclusion: A growing body of evidence suggests that recently developed
HCV combined treatment modalities have transformed chronic HCV into a routinely curable disease being
relatively available and well tolerated ,which can potentially reduce the need for liver transplantation and
reduce HCV-related mortality. Treatment protocol for genotype1 is based on a combined regimen of
Pegylated interferons with ribavirin and sofosbuvir or simeprevir while Sofosbuvir with ribavirin alone
should be used to treat patients infected with HCV genotypes 2 and 3. Patients coinfected with human
immunodefiency virus and HCV genotype 1 should be treated for HCV with pegylated interferons, ribavirin,
and sofosbuvir by a physician with experience in treating this particular group of patients and familiar with
potential drug interactions.
Keywords: Hepatitis C, Treatment, SVR , HCV genotype, Simeprevir, Ribavirin.


Hepatitis C virus (HCV) is a globally

prevalent pathogen and a leading cause of death and
HCV is now the most common cause of death in
morbidity1 .The most recent estimates of disease
HIV-positive patients on highly active antiretroviral
burden show an increase in seroprevalence over the
therapy 4 .
last 15 years to 2.8%, equating to >185 million
HCV infection may present different geographical
infections worldwide 2 . Acute HCV infection turns
characteristics, which may be associated with
into chronic infection in 70%­80% of cases, and
ethnical / race and environmental factors such as
20%­25% of those with Persistent HCV infection is
HCV genotype and coinfection with other
associated with the development of liver cirrhosis,
pathogenic agents 5 . The prevalence of hepatitis C
hepatocellular cancer, liver failure, and death3 ,and
is particularly high in subpopulations of
Received: 13 / 01 /2017 DOI : 10.12816/0036641
Accepted: 19/ 01 /2017

Full Paper (vol.671 paper# 3)

c:\work\Jor\vol671_4 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 314- 321

Histological and Histochemical Studies on The Alimentary Canal of Spur-
Winged Lapwing Vanellus spinosus
Fatma M.A. Taki-El-Deen
Department of Biological and Geological Sciences, Faculty of Education,
Ain Shams University ­ Egypt

Aim of the work: The present study aims to describe and compare between the different parts of
the alimentary canal of Spur-winged lapwing Vanellus spinosus from the histological and histochemical
Materials and methods: This animal was caught from its natural habitat (Nile Delta in Egypt);
dissected and the alimentary canal was fixed in the suitable fixatives for histological and histochemical
Results: Histological findings revealed that the alimentary canal wall in different parts under
investigation is consisted of four main layers which are; serosa, muscularis, submucosa and mucosa.
The serosa is composed of simple squamous epithelium. The muscularis is formed of outer circular and
inner longitudinal muscle fibers. The submucosa is showing green colour with Masson's stain due to its
content of connective tissue. The mucosal folds of oesophagus are characterized by stratified squamous
epithelium. At the base of these folds, oesophageal glands which secrete acid mucopolysacchride are
located. The stomach composed of two parts; cardiac (glandular) and pyloric (muscular). The gastric
glands of glanular portion are differentiated into deep and superficial gastric glands. The deep gastric
glands are of compound-branched alveolar and have neutral mucopolysacchride secrections. While, the
superficial gastric glands are of compound tubular type and secreting acid and neutral
mucopolysacchride since they give blue and red colours with Alcian PAS stain. The gastric glands in
muscular portion of stomach, are compound tubular type and have acid and neutral
mucopolysaccharides. The mucosal villi of duodenum and ileum are characterized by tubular glands
(crypts of Leiberkhün), which contain acid and neutral mucopolysaccharides. The mucosal layer of
rectum is covered by simple columnar epithelium containing goblet cells in addition to the rectal
glands. This layer nature is acid and neutral mucopolysaccharides. The histochemical results showed
differences in the stainability and distribution of polysaccharides, acid and neutral mucopolysaccharides
in different parts of alimentary canal of investigated animal.
Keywords: bird, Spur-winged lapwing, alimentary canal, histology, histochemistry.


Spur-winged lapwing (Vanellus spinosus) is
intestine, many studies on birds have been
belonging to order, Charadriiformes, family,
reported 3,4,5.
Charadriidae. It feeds on insect, plants,
The aim of this investigation is to study the
invertebrates, which are picked from the
microscopic structure with histochemical
reference of oesophagus, stomach, duodenum,
Many studies has been concerned with the
ileum and rectum of Spur-winged lapwing
microscopic structure of the gastrointestinal
(Vanellus spinosus).
tract of vertebrates. The mucous membrane of

avian stomach showed neutral glycoproteins,
sialo and sulphosaccharides1. A comparative
Histological and Histochemical preparations:
histological and histochemical study was

Tissue samples of the alimentary canal
carried out on the stomach of few numbers of
from Spur-winged lapwing (Vanellus spinosus)
vertebrate species belonging to classes
were immediately excised, fixed in 10%
Amphibia, Reptilia, Aves and Mammalia2.
neutral formalin solution, dehydrated in
Certain differences in the histochemical
ascending series of ethyl alcohol, cleared in
reactivities of mucopolysaccharides in the
terpineol and embedded in paraffin wax.
histochemical structure of their alimentary
Sections of 4-6 µm thick were stained with
tracts1,2. With special reference to
haematoxylin and eosin, microscopically
oesophageus, stomach, small and large
examined and photomicrographs were made as

Received: 15 / 01 /2017 DOI : 10.12816/0036642
Accepted: 21/ 01 /2017

Full Paper (vol.671 paper# 4)

The effect of the antibiotic amoxicillin on the fetuses of albino mice The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 322- 329

The Effect of Amoxicillin on The Fetuses of Albino Mice
Sahar A. Sabry and Heba I. Rashad
Department of Biological and Geological Sciences,
Faculty of Education, Ain Shams University

The present study was carried out to evaluate the effect of the beta-lactam antibiotic
amoxicillin on the fetuses of albino mice from the morphological and skeletal points of view.
Material and methods: Twenty four adult pregnant mice were used in the present study. They were
allocated into 3 groups (8 mice each). The first group served as a control and were injected
intraperitoneally (i.p.) with the solvent of the drug and the second and third groups were treated with 205
and 820 mg/kg body weight of amoxicillin for 8 days (gestation days 7-14), respectively.
Results: The morphological examination of the fetuses of treated groups showed growth retardation of
mice fetuses as represented by the conspicuous decrease in the average body weight and body length in
the two treated groups. No external malformations were recorded among fetuses maternally treated with
the low dose of the drug. On the other hand, the fetuses maternally treated with the high dose showed
mild external morphological malformations. In addition, the skeleton of the two treated groups exhibited
incomplete ossification in most skeletal elements.
Conclusion: The beta-lactam antibiotic amoxicillin had exerted mild morphological malformations and
skeletal abnormalities in mice fetuses maternally treated during organogenesis period of gestation.
Keywords: Amoxicillin-Morphology-Skeleton-Fetuses of albino mice.


The beta-lactam antibiotic drugs are useful

agents used for the treatment of many cases of
recorded skeletal anomalies in rat fetuses
urinary tract infections 1, acute otitis media2
maternally treated with adriamycin in GDs 6-9.
and pneumonia 3.
There is even less information concerning
They were classified into four categories
the most common generation of beta-lactam
according to their chemical structure4 . The first
antibiotics, amoxicillin. Few reports have been
category was the penicillin derivatives like
presented on the effects of amoxicillin on fetuses
amoxicillin, cephalosporis like cefprozil,
covering the gestation days of organogenesis
monobactams like aztreonam and carbapenes
(GDs 7-14). In the present study we aim to
like meropenem. -lactam antibiotics are
investigate the potential teratogenic effects of
bacteriocidal, and act by inhibiting the synthesis
amoxicillin on morphology and skeletal
of the peptidoglycan layer of bacterial cell walls.
structures of mice fetuses maternally treated
The peptidoglycan layer is important for cell
during gestation days 7-14.
wall structural integrity being the outermost and

primary component of the wall4 . In spite of the
beneficial role of -lactam antibiotics5 . reported
The beta-lactam antibiotic drug used in the
that amoxicillin crosses the human placenta
present investigation is amoxicillin which is
readily during the first trimester. Also, growth
available in the form of vials, each containing
retardation and malformations of the skeletal
1000mg of the active ingredient . It was obtained
elements were observed in mice fetuses
from 1 A Pharma. The low dose and the high
maternally treated with 8mg/kg of Doxycycline
dose of this drug for mice were calculated
6. Delaying in development of skull bone and
according to Paget and Barnes 11 .The chosen
cartilage calcification due to the administration
doses were nearly comparable to the human
of carbamazepine were also reported by
effective therapeutic dose (ETD). Two doses of
Gerenutti et al. 7
amox were used in the present study; 205 and
Higher incidence of bone developmental
820 mg / kg body weight and were considered as
variations was seen in rats fetuses whose
the low and high doses, respectively. The doses
mothers were treated with D-penicillamine in
were estimated according to weight of the mouse
GD15-19 8 . Xia, et al. 9 observed bone
and injected intraperitoneally(i.p.).
malformation in rat fetuses maternally treated
The present investigation was carried out on
with adriamycin in gestation days (GDs) 8-9.
mature albino mice of pure CD-1 strain with an
Kotsios et al.10
average body weight 21-23g obtained from the
Received: 16 / 01 /2017 DOI : 10.12816/0036643
Accepted: 22/ 01 /2017

Full Paper (vol.671 paper# 5)

c:\work\Jor\vol671_6 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 330- 335

Assessment of the Physiological Changes Induced by Sodium Nitrite,
Annatto or Mono Sodium Glutamate in Male Albino Rats
Eman G.E. Helal, Rasha A.A. El-Sayed, Mariam S. El-Gamal
Department of Zoology, Faculty of Science (Girls), Al-Azhar University, Egypt
*Corresponding author Eman Helal, emanhelal@hotmail.com

Background: food additives are added to most junk and fast foods, especially those for kids. Sodium
nitrite is an inorganic salt with widespread applications in the food industry as a color fixative and
preservative in meat and fish. Annatto extract is a natural food color obtained from the outer coatings of the
seeds of the Annatto tree (Bixa orellana L.). Monosodium glutamate (MSG), the sodium salt of amino acid
glutamate, is a food additive that popularly used all over the world as "flavor enhancer". Aim of the work:
this study was aimed to determine the hazardous effects of sodium nitrite, annatto and monosodium
glutamate on some physiological parameters in male albino rats. Materials and methods: this study had
been done on fourty male albino rats with an average body weight 100-145 g. The animals were divided
into four groups; Group 1: control (untreated group), Group 2: sodium nitrite treated group, Group 3:
annatto treated group and Group 4: monosodium glutamate treated group. Blood samples were collected,
sera were separated and used for estimation of some biochemical parameters (liver enzymes, kidney
functions, glucose, protein profile and lipid profile) and hormonal levels [testosterone, T3 (triiodothyronine)
and T4 (thyroxine)]. Results: the biochemical results showed an increase in the activities of liver enzymes
[aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT)], and the levels of glucose,
kidney functions (urea, and creatinine), lipid profile [total cholesterol, triglycerides, low density lipoprotein
(LDL-C)] and thyroid hormones [thyroxin (T4) and triiodothyronine (T3)] in all treated groups when
compared to the control group. A drop in protein profile (total protein, albumin, globulin and A/G ratio),
testosterone hormone and HDL level were observed in the treated groups as compared to the control rats.
it could be concluded that some food additives like sodium nitrite, annatto, and monosodium
glutamate have extreme effects on liver and kidney functions, protein and lipid profiles and also on thyroid
and testosterone hormones. So, it is recommended to minimize the use of these additives to protect young
children and mature people from these destructive effects.
Keywords: sodium nitrite, annatto (Bixa orellana), monosodium glutamate (umami), liver and kidney

compounds in the solution (4). This pigment is
Humans are continuously exposed to different
obtained from the seed coat of the tropical shrub
kinds of chemicals such as food additives. Many
Bixa orellana L. This tree is native to tropical
of these additives have been increasingly
South America, where it has been a traditional
recognized as potentially hazardous to human
ingredient of some foods for centuries (5). Bixin
health. Sodium nitrite is a food additive that is
and nor-bixin are the main pigments of annatto
used, because of its role in inhibiting the growth
seeds that are carotenoids of huge importance in
of Clostridium botulinum spores in the
the food, pharmacological and cosmetic
refrigerated meats (1). Meanwhile, large amounts
industries. In food industries, these natural
of sodium nitrite can be toxic to animals,
pigments are used in cheeses, sausages, meats
including humans. The cytotoxicity and
and candies (6). Lately, FDA (Food and Drug
detrimental effects of nitrite can be attributed to
Administration) of United States of America,
its oxidative properties (2). The reactive nitrogen
classified annatto as a color additive exempt
species that are produced by exposure to nitrite
from certification that is safe for human
have many toxic effects including hepatotoxicity,
revealed that annatto is not carcinogenic neither
inflammatory responses and tissue injury (3) .
maternally toxic nor embryotoxic (7).
Food colorants may often be considered simply
Monosodium L-glutamate (MSG) is a common
cosmetic in nature, but its role is very significant.
glutamic acid salt that contains 78% glutamic
Both food quality and flavor are closely
acid, 22% sodium salt and water (8). MSG is the
associated with color. Annatto is a natural
commonest food additive that has been used as a
colorant that imparts colors ranging from yellow
flavor enhancer in the home as well as in food
to red due to the concentration of color
industry since 1907 (9).
Received: 16 / 01 /2017 DOI : 10.12816/0036644
Accepted: 22/ 01 /2017

Full Paper (vol.671 paper# 6)

c:\work\Jor\vol671_7 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 336- 343

Protective Effect of Morin against Flutamide-Induced
Hepatotoxicity in Mal Wister Rats
Mazhar F. M., Kadry S. M., Hala F. Abd-Ellah, Hend A. Sabry and Saleh A. S.
Department of Zoology, Faculty of women for Arts, Science & Education,
Ain Shams University, Cairo, Egypt

Aim of the work: The aim of this work was to investigate the protective role of morin against the
hepatotoxic effect of flutamide (FLU) that is widely used drug for treatment of metastatic prostate
adenocarcinoma. Administration of FLU to male rats in a dose of 100 mg/ kg b.w. daily for 4 weeks
resulted in serious hepatic injury.
Materials and Methods: Male Wistar rats were equally divided into six experimental groups (n = 10):
Group I (control group) received appropriate vehicle (carboxy methyl cellulose, CMC) for 8 weeks,
Group II (CM group) received CMC for 4 weeks then morin for another 4 weeks, Group III ( M group)
were treated with morin for 8 weeks, Group IV (CF group) received CMC for 4 weeks then FLU for
another 4 weeks, Group V (CMF group) received CMC for 4 weeks then morin for another 4 weeks
then received morin associated with FLU for additional4 weeks and Group VI (MMF group) was
pretreated with morin for 4 weeks then treated with morin simultaneously with FLU for additional 4
Results: In FLU treated rats, highly significant increases in each of serum ALT, AST, direct and total
bilirubin as well as hepatic MDA were observed relative to the control group. Moreover, highly
significant decrease in hepatic SOD, GSH and GST activities were observed. On the other hand,
administration of morin with FLU resulted in mild and marked reduction in the elevated serum ALT,
AST, direct and total bilirubin and hepatic MDA levels induced by FLU intoxication, respectively
(regardingco-treatment and pretreatment with FLU).
Conclusion:These data showed protective effect of morin against FLU-induced hepatic damage,
especially when administered prior to and concomitantly with FLU.
Keywords: Flutamide; Morin; Hepatotoxicity; Lipid peroxidation and Antioxidatant activity.


cancer (3) . FLU also inhibited mitochondrial
(trifluoromethyl) phenyl]-propanamide, is a non-
steroidal antiandrogen compound which is
formation(6). The metabolism of FLU by the
devoid of estrogenic, progestational or
androgenic activities. This drug is used for
microsomal enzymes results in the formation of
reactive metabolites which can lead to lipid
adenocarcinoma(1). FLU is mainly metabolized
peroxidation and consequently to hepatocytic
in the liver and its metabolites are excreted in the
urine (2) .After oral administration, FLU is well
absorbed and its circulating form is almost
excluded despite the absence of fever or rash (7).
Flavonoids are polyphenolic compounds that
hydroxyflutamide (3).In the prostate cancer,
can be found in dietary components such as food
tumor cells need testosterone to proliferate. FLU
products, beverages and herbal medicines with
and its active metabolite 2- hydroxyflutamide
different health benefits shown in several
compete with testosterone to bind to androgen
studies(8).Most flavonoids have an antioxidant
receptors leading to impairment of testosterone
activity (9, 10). Morin hydrate, or simply morin
signaling and modulation of the testosterone-
dependent pathways (4).Despite its therapeutic
light yellowish pigment)is a kind of flavonoid
benefits, treatment with FLU has been associated
belonging to the group of flavonols, found in
with idiosyncratic liver injury and therefore
almond hulls (11),mulberry figs (12), onion (13)and
received a black box warning label (5). Also of
guava leaves (14).Over the years, numerous
interest is the observation that FLU can
activities have been assigned to this flavone.
influence the metabolism of estradiol in
Morin has been shown to exhibit antitumor (15),
particular the 2-and 4-hydroxylation of this
antioxidant (16), antidiabetic (17) and anti-
essential hormone in patients with prostate
Received: 16 / 01 /2017 DOI : 10.12816/0036645
Accepted: 22/ 01 /2017

Full Paper (vol.671 paper# 7)

c:\work\Jor\vol671_8 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 344- 351

Adverse Effects of Two Kinds of Food Additive Mixtures
(Flavor Enhancer, Food Preservative or Food Coloring Agent) on
Physiological Parameters in Young Male Albino Rats
Eman G.E. Helal1, Rasha A.A. El-Sayed, Mohamed A. Mustafa2, Mariam S. El-Gamal1
1Department of Zoology, Faculty of Science (Girls), Al-Azhar University, 2Basic Centre of Science,
Misr University for Science and Technology, Egypt
*Corresponding author Eman Helal, emanhelal@hotmail.com

food additives are substances used in food industry in order to improve the food's
taste, appearance by preserving its flavor and preventing it from souring. Food additives are added to
the most junk and fast foods, especially food for kids.
Aim of the work: this work was aimed to investigate the adverse effects of some food additives on the
biochemical parameters in addition to study the side effects of these food additives in male albino rats.
Materials and Methods: this study was performed on twenty four young male albino rats with an
average 120-145 g body weight. Animals were divided into four groups (6 /cage); Group I (Control
untreated group), Group II (administered orally with sodium nitrite (0.1 mg/kg b.wt./day) and annatto
(0.065 mg/kg b.wt./day)), Group III (administered orally with sodium nitrite (0.1 mg/kg b.wt./day)
and monosodium glutamate (MSG) (15 mg/kg b.wt./day)) and Group IV (administered orally with
annatto (0.065 mg/kg b.wt./day) and monosodium glutamate (15 mg/kg b.wt./day)). Blood samples
were collected on the last day of experiment, for biochemical estimations which included levels of
serum glucose, total protein (TP), albumin, creatinine, urea, testosterone , thyroid hormones (T3 and
T4), activities of AST and ALT in addition to lipid profile.
Results: showed marked elevation in levels of fasting glucose, activities of AST, ALT, urea,
creatinine, total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-C),
VLDL and ratios of TC/HDL-C and LDL-C/HDL-C (risk factors) as well as albumin / globulin ratio
and serum thyroid hormones (T3 & T4) accompanied with marked decline in levels of serum total
proteins, albumin, globulin, albumin/ creatinine ratio, testosterone and HDL-C in all treated groups in
comparison to the control group. There was a significant reduction in the body weight in groups that
received (NaNO2 with annatto) and (MSG with NaNO2) while treated rats with (MSG and annatto)
showed a significant increase in body weight as compared to control rats.
Conclusion: Due to the harmful effects of food additives, the use of these compounds must be limited
as it resulted in a vehement disturbance in the biochemical and physiological parameters that was
grievously pronounced on many hormones.
Key Words: Food Additives, Thyroid hormones, Monosodium Glutamate, Biochemical parameters,
Coloring agent.


Food additives are substances intentionally added
there is a world-wide interest generated in the
to food that changes its characteristics, maintain
development of natural dyes (4). Annatto pigment
and improve safety (preservatives), improve or
is one of the most important natural colorant
maintain nutrient value and also improve taste,
agents that is derived from Bixa orellana L. (B.
texture and appearance (1). Food additives are
orellana) and used in food industries, textiles,
divided into five broad categories according to
cosmetic and pharmaceutical products (5). Bixa
their function: 1) Taste enhancers, 2) Antioxidants,
orellana L. (B. orellana) is an evergreen tree
3) Preservatives, 4) Stabilizers and emulsifier and
belonging to family Bixaceae that growing in
5) Coloring agents (2). These additives may come
several tropical countries of the world(6) and
from natural or synthetic origin (1).
recognized for its medicinal applications as an
Synthetic dyes and textile finishing agents have
antioxidant, analgesic, wound healer, homeostatic,
come under severe criticism for their high
hypoglycemic, as an antidote in snake bite, cough
environmental pollution effects at the stage of
treatment, and diuretic among others (7). As far as,
manufacturing as well as application (3). Therefore,
it is commonly used by urologists for prostate
Received: 17 / 01 /2017 DOI : 10.12816/0036646
Accepted: 23/ 01 /2017

Full Paper (vol.671 paper# 8)

c:\work\Jor\vol671_9 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 352- 358
Biochemical and Genetic Studies on Inhibin as a Hormonal Candidate in
Prediction and Diagnosis of Premature Ovarian Failure in the Egyptian Women
Azza M. El-Wakf 1*, Amal K. Selim2, Abdel Aziz El-Refaay3,
Hosam Abdel- Fatah3, Shimaa M. Saad1
1Zoology Department, Physiology Division, Faculty of Science, Mansoura University, Egypt;
2Biochemistry Department Faculty of Medicine, Mansoura University, Egypt; 3Obstetrics and
Gynecology department, Faculty of Medicine, Mansoura University, Egypt.
*Corresponding author: Prof. Dr. Azza El-wakf, Zoology Department, Physiology Division, Faculty of Science,
Mansoura University, Egypt. Tel: +20 01001760744(mobile); E-mail address: drazza_elwakf@yahoo.com;
: Recent studies have implicated a role for inhibin alpha (INH) gene abnormalities in the
etiology of premature ovarian failure (POF).The present study aimed at demonstrating the possibility that
-16C>T polymorphism of INH gene may enhance susceptibility to this disease among Egyptian women
undergoingt in-vitro fertilization(IVF) technique.
Methods: A total of 50 POF Egyptian women at age (31.5±7.3) and 50 control women at age (29.1 ± 6.8)
were included in this study. Genotyping of INH-16C>T gene was performed by restriction fragment
length polymorphism. Levels of inhibin, activin, FSH and LH were also assessed.
Results: Serum levels of FSH and LH showed significant increase coupled by decrease in serum inhibin
and inhibin/activin ratio, however, levels of activin were within normal values in POF women comparing
to control ones. The frequencies of CC, CT and TT genotypes showed no significant changes in POF
women compared to control group. Moreover, there were no significant differences in frequency of C and
T alleles among the POF women in comparison to controls.
Obtained data indicated that -16C>T polymorphism of INH gene can not imply a
functional effect on the current decline of serum inhibin and hence the risk of developing POF in the
studied Egyptian women. Further studies on POF women are needed to expand the present data.
Keyword: Premature ovarian failure (POF); Inhibin; Activin; INH gene polymorphism.

Premature ovarian failure (POF), or poor
maturation/recruitment6. There may be a
ovarian response is a syndrome characterized by
number of contributing factors for POF,
amenorrhea for duration of 4-6 months or more,
including genetic abnormalities, pelvic surgery
hypo-estrogenism and elevated serum FSH
and chemotherapy or other medications 5, 7. In
concentration (FSH 40 IU/l) before age of 40
most cases, it would be logical to consider
years1.Women with POF can experience
reproductive hormones including FSH and LH
multiple consequences of hypo­estrogenism
as contributing factors dealing with oocyte
atresia 1,8 . Evidence is provided also for the role
cardiovascular and neurocognitive disorders2.
However, the major consequence of POF is
progesterone, anti-mullerian hormone (AMH)
lowered fertility, which in some cases, is due to
and activin in the diagnosis of menstrual
the inability of the follicles to respond to
irregularity and depletion of the primordial
hormonal stimulation, and in most cases due to
follicular pool9.
the actual absence of follicles3. Women with
In this line, recent studies have implicated
POF are suffering from clinical symptoms like
inhibin as a hormonal candidate in the
those observed with the onset of menopause,
mechanistic determinants of POF disease.
such as hot flushes, dyspareunia, vaginal
Inhibin is a hormonal product of granulosa cells
dryness, vaginitis, insomnia, mood swings, heart
10,11that serves as marker of ovarian function
palpitation and headache4. Depression may also
and/ or follicular development due to its role in
occur when women recognized that fertility and
negative feedback control of FSH12. Inhibin
the femininity are possibly to be lost 5.
structure is closely related to the multi-
POF may arise through different events
functional transforming growth factor (TGF)-
including: 1) reduction of primordial follicle
pool; 2) acceleration of follicular atresia; or 3)
heterodimer glycoprotein consisting of two
subunits (18 kDa-alpha) and (14 kDa- beta)
Received: 19 / 01 /2017 DOI : 10.12816/0036648
Accepted: 25/ 01 /2017

Full Paper (vol.671 paper# 9)

c:\work\Jor\vol671_10 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 359- 365

Comparative Microscopic Study on the Tongue, Oesophagus and Stomach of
Two Different Birds in Egypt
Fatma M.A. Taki-El-Deen
Department of Biological and Geological Sciences, Faculty of Education
, Ain Shams University ­ Egypt

Aim of the work: The present investigation aims to compare between the tongue, oesophagus and
stomach of two birds in Egypt having different food habits.
Materials and methods: The animals under investigation are Whimbrel (Numenius phaeopus) and
domestic duck (Anas platyrhnchos). These birds were caught from Abou-Rawash Constituency and Nile
Delta in Egypt. The birds were dissected the tongue, oesophagus and stomach were fixed and stained for
the microscopic comparative study.
Results: Histological results of this study found that the tongue of each bird (Whimbrel and domestic
duck) is composed of three layers; mucosa, submucosa and muscularis. No lingual papillae are observed.
The mucosal layer consists of stratified squamous epithelium. This layer in Numenius phaeopus is thicker
than in Anas platyrhnchos. The submucosa is constructed from connective tissue. The muscularis is
represented by bundles of muscle fibers extending in different directions. The lingual glands of Anas
are of compound alveolar type and have neutral mucopolysacchride content.
The muscularis of the oesophagus consists is consisting of outer circular and inner longitudinal muscle
fibers. This layer is thick and well represented in Anas platyrhnchos than in Numenius phaeopus. The
mucosal folds have stratified squamous epithelial cells. Oesophageal tubulo alveolar glands have acid
mucopolysacchride content in Numenius phaeopus and neutral mucopolysacchride content in Anas
. The stomach in each bird (Whimbrel and domestic duck) is differentiated into glandular
and muscular portions. The gastric glands of the glandular portion are differentiated into deep and
superficial gastric glands. The muscularis of the muscular portion in the investigated birds is composed of
circular and longitudinal muscle fibers. This layer in Anas platyrhnchos is thicker than in Numenius
. The mucosal layer in Anas platyrhnchos has thick tough keratin-like layer (cutica gastrica).
The mucosal glands in the investigated birds have acid and neutral mucopolysacchride content.
The histological and histochemical results showed differences in the tongue, oesophagus and stomach
between the investigated birds.
Keywords: bird, whimbrel, domestic duck, tongue, alimentary canal, histology, histochemistry.

which is in contact with the lumen. They noticed
Whimbrel (Numenius phaeopus) belongs to
that the
order, Charadriiformes, family, Scolopacidae. It

feeds on small invertebrates, which are picked
microscopic structure may differ according to the
from soft mud.
nature of food habits of the different birds5.
Domestic duck (Anas platyrhnchos) belongs to
With special reference to tongue, oesophageus
order, Anseriformes, family, Anatidae.
and stomach, many studies on birds have been
It feeds mainly on grains.
reported 6. The purpose of this investigation is to
Microscopic studies have been achieved to
investigate the digestive system of vertebrate
animals1. Also, morphological studies of Birds'
oesophagus and stomach of two birds with
tongue such as budgerigar have been reported2.
different food habits. These birds are;
The histological studies mentioned that the
Whimbrel (Numenius phaeopus) and domestic
tongue layers are; mucosa, submucosa and
duck (Anas platyrhnchos).
muscularis. The mucosal layer is constructed

mainly from several rows of epithelial cell3.
Histological studies of gastrointestinal tract were
Histological and Histochemical preparations:
established that the main layers of alimentary

The investigated birds were trapped alive,
canal are; serosa, muscularis, submucosa and
anesthetized and carefully dissected. Tissue
mucosa4. The serosa represents the outermost
samples of the tongue, oesophagus and stomach
layer while the mucosa is the innermost one
were obtained, fixed in 10% neutral formalin
solution, dehydrated, cleared and embedded in
Received: 19 / 01 /2017 DOI : 10.12816/0036649
Accepted: 25/ 01 /2017

Full Paper (vol.671 paper# 10)

c:\work\Jor\vol671_11 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 366- 376
Histological and Ultrastructural Studies on the Effect
Amoxicillin on the Stomach of Mouse Fetuses
Sahar A. Sabry
Department of Biological and Geological Sciences, Faculty of Education, Ain Shams University

Introduction: B-Lactam antibiotics are widely used because of their lack of toxicity in humans. However,
during pregnancy, exposure of the fetus is likely to occur due to b-lactam antibiotics cross the placenta. The
potential adverse effects of amoxicillin were examined in stomach of mice fetuses.
Material and Methods: This study was aimed to evaluate the possible side effects produced by
amoxicillin prenatal administration on the stomach of fetuses.
Twenty pregnant mice were used in this study; and were divided into two groups: the first group served as a
control group and injected by saline solution (the drug solvent); the second group treated with amoxicillin
dose of 205 mg/kg body weight. The treatment was daily administered interperitoneally, from the 7th day of
gestation till the 14th day of gestation (GDs 7-14). The developing 19-days old fetuses were examined
histologically and ultrastructurally to determine any disorders in the stomach.
Results: This study illustrated marked deleterious consequences in the gastric wall of 19 day old fetus,
following the treatment with amoxicillin, ranging from marked vacuolations and erosions in the epithelial
and glandular cells of the gastric mucosa to conspicuous necrosis of glandular (parietal and zymogenic)
cells. The electron microscopical examination of the gastric mucosal cells of fetuses maternally treated with
amoxicillin, revealed conspicuous alterations, in the cytoplasmic organelles of gastric mucosal cells
(surface epithelial, peptic and parietal cells). The cisternae of RER were dilated and fragmented. The
mitochondria displayed gradual devastations.
Conclusions: Therefore, the destructive impacts of amoxicillin on the stomach of mice fetuses indicated
that it should be used under restricted precautions in the medical fields to protect the pregnant women from
its hazardous impact.
Keywords: Amoxicillin, Stomach, Histology, Ultrastructure, Mice fetuses.


B-Lactams are the widely spread group of
therefore indicating that their absolute lack of
antibiotics used for the treatment of many cases
because of their low toxicity which has been
demonstrated (7,8,9). Hemorrhagic colitis is a rare
reported in the adult (1,2). They also, are
but well-recognized complication with ampicillin
prescribed during pregnancy because of their
or penicillin derivative treatment (10) . Also, the
safety and the absence of known fetal toxicity
author reported a patient who developed colitis
(2,3). B-lactam antibiotics cross the human
after amoxycillin therapy in whom 111Indium
placenta and so that fetuses exposed to these
leucocyte scan demonstrated right-sided colitis.
drugs (4,5). However these drugs are not
Blanchi and Pariente (11) recorded acute
teratogenic, the absolute lack of toxicity of b-
hemorrhagic colitis after ingestion of amoxicillin.
lactam antibiotics to the fetuses remains to be
Even if it is not teratogenic, amoxicillin may
determined. The period of organogenesis, is
induce histological and ultrastructural disturbance
considered the greatest concern because of any
during organ formation. Yun et al. (12) in their
adverse effect of these drugs on developing tissue
study on the effects of amoxicillin treatment of
may impair its formation (6). Thus, the present
piglets on the prevalence of hernias and
work was constructed to assess and evaluate the
abscesses, growth and ampicillin resistance of
possible toxic effects induced by treatment with
intestinal coliform bacteria in wanted pigs
one of these B-lactam antibiotics on stomach of
reported that the amoxicillin treatment of new-
fetuses maternally treated during the period of
born piglets produced statistically significant
organogenesis. However, none of these drugs has
effect in some studied parameters. The authors
been classified in the class A of Food and Drug
added that these effects were only minor and they
Administration fetal risk drug categories,
did not find grounds to recommended preventive
Received: 21 / 01 /2017 DOI : 10.12816/0036650
Accepted: 27/ 01 /2017

Full Paper (vol.671 paper# 11)

Partial Coherence laser interferometry VS Conventional ultrasound biometry in axial length measurement in pseudophakic The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 377- 381

Optical Biometry versus Applanation Ultrasound Biometry in
Axial Eye Length Measurement in Pseudophakia
Hayam Sayed Kamel
Ophthalmology Department, Faculty of Medicine (for Girls) , Al ­ Azhar University, Cairo, Egypt.

: to compare axial eye length (AEL) measurement in pseudophakic eyes by optical biometry
and applanation ultrasound (u/s) biometry.
Methods: a prospective, case controlled and comparative study was performed at Al-Zahraa
University Hospital clinic from (January 2016 ­ December 2016). In total 45 eyes were enrolled; 24
pseudophakic eyes were attending the clinic for routine post operative follow up; and 21 eyes with
clear crystalline lens as a control group. AEL was measured in both groups using both optical biometry
and applanation u/s biometry.
Results & Conclusions: both optical biometry and applanation u/s biometry show no significant
difference in AEL measurement in pseudophakic eyes as well as the control group.
Key words: Pseudophakia, Ultrasound biometry,


This prospective, case controlled and
AEL plays a main role in determining
comparative study included 45 eyes, in which 24
postoperative refraction and is responsible for
eyes were pseudophakic and 21 eyes with clear
54% of the actual refractive error. AEL error of
crystalline lens (as a control group). The patients
100m translates to a postoperative refraction
were selected from outpatient clinic of Al-Zahraa
error of 0.28 D(1). The advent of new premium
University Hospital from (January 2016­
implant technologies has increased patient
December 2016) who attended for routine
expectation for exceptional postoperative vision,
examination. All the eyes were examined by slit
in turn decreasing the acceptable margin for error
lamp (S/L) first to assess the anterior segment
in Intra ocular lens (IOL) power calculation(2).
(Cornea, tear film) and state of the lens. B- scan
Until recently, AEL was measured by using
was performed in pseudophakic eyes with
applanation technique, which involves contact
insufficient clear media to be excluded from the
with the cornea and can result in corneal
study. Other exclusion criteria include inability
epithelial injury, infection, and patient
to fixate, head tremors, tear film abnormalities
discomfort(3). To overcome this limitation, a
and previous ocular surgery rather than cataract
partial coherence interferometer (PCI) was
extraction. AEL measurement was carried by
introduced (optical biometry). AEL measured by
Mentor AdventTM A/B system equipped with 7.5-
this method was comparable to that of other
15 MHz real-time high frequency probe with the
methods in precision. Especially considering that
contact method for applantation u/s biometry
the method is of the non-applanation type, it has
technique and NIDEK-AL-Scan biometer for
the advantage of giving the patient less
optical biometry technique. The eyes were
discomfort and has a low interobserver error(4).
classified according to AEL into hypermetropic
Currently, the AEL can be obtained by using
eyes with AEL less than 22.50 mm, emmetropic
either the applanation u/s biometry or the optical
eyes with AEL 22.50-24.50 mm and myopic
biometry. Optical biometry has been gaining
eyes with AEL more than 24.50 mm. Optical
popularity due to the fact that it offers an easy,
biometry was always performed first followed by
contact- free method to quickly and accurately
applanation u/s biometry to avoid the
assess the AEL(5). Optical biometry is also
confounding effect of potential corneal
superior to applanation u/s biometry in the
indentation by the probe which may decrease
measurement of pseudophakic and silicone oil-
A.C. depth with subsequent decrease in AEL
filled eyes(6). The current study focused on the
measurement. Statistical analysis was performed
accuracy of optical biometry in AEL
for both measurements. The study was
measurement in pseudophakic eyes and
approved by the Ethics Board of Al-Azhar
comparing these measurements with applanation
University and an informed written consent
u/s biometry to help later in IOL power
was taken from each participant in the study.
calculation in eyes necessitating IOL exchange.
Received: 23 / 01 /2017 DOI: 10.12816/0036651

Full Paper (vol.671 paper# 12)

c:\work\Jor\vol671_13 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 382- 391

Therapeutic Effects of an Ethanolic Olive Leaves Extract or Bone Marrow
Mesenchymal Stem Cells against Liver Injury Induced by Gamma Radiation
Samir Attia Zahkouk1, Hanan Ahmed El-kabany2 and Eman Mohammed Hassona Dawoud3
1Department of Zoology, Faculty of Science (for boys), AL-Azhar University
2National Centre for Radiation Research and Technology, Atomic Energy Authority (AEA),
3 Department of Zoology, Faculty of Science (for girls), AL­Azhar University, Cairo, Egypt.

Background: Ionizing radiation absorption causes immediate biochemical, sub cellular and cellular damage,
while its morphological expression and organ dysfunction are often considerably delayed. This study was
aimed to investigate the possible therapeutic effects of ethanolic olive leaves extract or bone
marrow derived-mesenchymal stem cells (BM-MSCs) transplanted in the liver of rats exposed to
gamma radiation. For this purpose, hematological and biochemical parameters were determined
Materials and methods: 50 adult male albino rats (Sprague dawely strain) were used in this study.
They were divided into 5 groups (C group: Untreated control rats; R group: rats exposed to a
single dose of gamma-radiation (6 Gy), OLE group: rats treated with olive leaves extract (15 mg
/kg body weight / day for 30 days), R+OLE group: animals of this group were irradiated with
6Gy then treated with OLE(15 mg /kg body weight/ day) after 3 hours post irradiation for 30
days. and R+MSCs group: Mesenchymal stem cells-irradiated animals (MSCs +R): animals of this
group were irradiated with 6Gy then injected after 6hours post irradiation with (BM-MSCs) 3×106
cells/ml suspension through caudal vein . All these groups were subjected to hematological and
biochemical investigations.
Results: Hematological and liver function changes were shown in gamma irradiated rats, these
changes included a significant depression in hematological parameters of blood such as (RBCs, Hb,
Hct and WBCs)and a significant increase in liver parameters (ALT,AST and ALP) at different
intervals of the experiment in comparison with the control group. These changes manifested good
amelioration in the exposed groups by using either olive leaves extract (OLE) or bone marrow
mesenchymal stem cells (BM-MSCs). Conclusion: Ethanolic olive leaves extracts and mesenchymal
stem cells have ameliorated hematological and biochemical parameters changes in liver of the
irradiated group. their actions may be due to their anti-inflammatory and antioxidant properties.
Keywords: gamma radiation - liver- Ethanolic olive leaves extract (OLE) - Bone marrow
mesenchymal stem cells (BM-MSCs).


Ionizing radiation is high-energy radiation that
considerably in finding naturally occurring
has the ability to break chemical bonds, cause
antioxidant for use in foods or medicinal
ionization and produce free radicals that can
materials to replace synthetic antioxidants,
result in biological damage[1]. Low dose of
which are being restricted due to their side
gamma rays could have dangerous on the
effects such as carcinogenicity[6]. Natural
some hematological parameters (RBCs &WBCs)
antioxidants can protect the human body from
for blood of female rats exposed to ionizing
free radicals and retard the progress of many
radiation .It is necessary to review the dose
chronic diseases as well as retard lipid
limits recommended by the ICRP-60for
oxidative rancidity in foods [7] .Olive leaves
radiation workers [2] .Exposure to whole-body
extract (OLE) or its constituents, especially
gamma radiation causing physiological and
oleuropein are tissue protective as an
histological changes in liver this can progress
antioxidant when administered therapeutically.
to fibrosis, cirrhosis and liver failure [3].
Although individual phenolic compounds in
Medicinal plants play a key role in the
OLE have strong antioxidant activities, the
human health care. About 80% of the world
antioxidant activities of the combination of
population relies on the use of traditional
phenolics are better than the individual
medicine which is predominantly based on
phenolics [8] .
plant material[4].Many antioxidant compounds,
Most of the cells in the human body are
naturally occurring from plant sources, have
differentiated and possess a particular function.
been identified as free radical or reactive
Stem cells (SCs) are unique cells with the
oxygen scavengers [5]. It has increased
exceptional ability to renew them indefinitely
Received: 24 / 01 /2017 DOI : 10.12816/0036652
Accepted: 31/ 01 /2017

Full Paper (vol.671 paper# 13)

c:\work\Jor\vol671_14 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 392- 396

Assessment of Endovascular Management of Extracranial
Internal Carotid Artery Stenosis
Ayman H. El Sudany1, Amira A. Zaki, M. Ossama Abdulghani, Azza Abdel Naser,
Salma H. Khalil and Ahmed El Bassiouny
Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
1Corresponding author: Ayman Hassan Othman El Sudany.
Email: Aymanhsudany@gmail.com,Telephone: 01004174777

carotid artery stenting (CAS) had become widely used as an alternative to carotid
endarterectomy (CEA) in revascularization therapy of carotid artery stenosis, especially in some high risk
patients for surgical intervention.
the purpose of this study was to evaluate the outcome and follow up of cases that undergo
extracranial CAS at the Neuroendovascular Unit of Ain Shams University Hospital.
during a 30 month period, 50 cases were enrolled and underwent carotid artery stenting with open
cell (Protégé® - EV3) or closed cell (Wall stent® - Boston scientific) stents. A filter device for embolic
protection (Spider filter® - EV3) was used. Clinical assessment with the National Institute of Health Stroke
Scale (NIHSS) together with post procedural diffusion-weighted magnetic resonance imaging (DW-MRI)
was used to determine cerebral embolization.
CAS was performed in 50 cases; 40 (80%) symptomatic and 10 (20%) asymptomatic . A similar
number of open-cell and closed-cell stents were used. New acute cerebral emboli were detected with DW-
MRI in 12% (6/50) of cases after the procedure. Three (3/50) cases (6%) showed corresponding clinical
deterioration in NIHSS; two cases developed minor stroke and the third case developed a major stroke.
CAS at Ain Shams Neuroendovascular Unit showed a high technical success rate and good
short term clinical outcome.
Carotid artery stenting (CAS), brain DW-MRI, NIHSS.


practices, quantification of microembolization
measures in preventing stroke and death among
using DW-MRI may be used as surrogate end-
patients with significant carotid stenosis1.
points of cerebral embolization during CAS4. The
Although carotid endarterectomy (CEA) has been
goal of this study is to evaluate the outcome and
the primary treatment option for carotid stenosis,
follow up of cases with symptomatic and
carotid artery stenting (CAS) is currently an
equivalent alternative especially in patients with a
undergoing CAS at the Neuroendovascular Unit,
high risk for CEA2. The Carotid Revascularization
Ain Shams University Hospital.
Endarterectomy versus Stenting Trial (CREST)

did not reveal any significant differences between
CAS and CEA among standard risk patients based
During a 30 month period, 44 patients
on a composite primary end point of peri-
with significant carotid stenosis were enrolled and
procedural stroke, myocardial infarction, or death
underwent CAS with open-cell or closed-cell
and ipsilateral stroke thereafter, although a higher
stents. Indications for CAS were either
risk of stroke with CAS and a higher risk of
symptomatic (50% or greater) or asymptomatic
myocardial infarction with CEA were observed
(80% or greater) carotid stenosis. This was
during the peri-procedural period3. Diffusion
determined with duplex ultrasound scan and
weighted magnetic resonance imaging (DW-MRI)
confirmed during the procedure with digital
is an imaging technique frequently used to detect
angiographic carotid stenosis (percentage by
interventions. Because adverse neurologic events
diameter) was performed according to North
after CAS are rare events in high-volume
American Symptomatic Carotid Endarterectomy
Received: 26 / 01 /2017 DOI : 10.12816/0036653
Accepted: 03/ 02 /2017

Full Paper (vol.671 paper# 14)

c:\work\Jor\vol671_15 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 397- 406
Fecal Lactoferrin as a New Marker of Disease Activity
in Inflammatory Bowel Diseases
Mohammed Nabil Rafat 1, Atef Abo Al-fotouh Ibrahem1, Abd-ELgawad Saied Mohammed1,
Mohammed Al-Shahawey1, Mohammed Salah Ali 1, Wael Refaat Hablus2, Amr Abd El-Aziz

1Internal Medicine Department,2Clinical Pathology Department, Faculty of Medicine - Al-Azhar
University (Cairo). Corresponding Email: dr_msalahali@azhar.edu.eg

Inflammatory bowel diseases (IBD) including ulcerative colitis (UC) and Crohn's disease
(CD) are organic inflammatory diseases, caused by chronic mucosal inflammation of the gasrtointetinal
tract. As the presenting manifestations of IBD and other diseases are similar, obtaining a clinical diagnosis
can be difficult, and further invasive diagnostic procedures may be required in order to obtain a confirmed
diagnosis. The aim of this study is to evaluate the diagnostic utility of measuring fecal concentrations of
lactoferrin as a simple and noninvasive indicator of disease activity in patients IBD and to be correlated with
endoscopic findings and disease activity index and acute inflammatory response including leucocytic count,
high sensitive CRP, ESR. Methods: This study was carried on 40 patients with IBD; 24 patients with
active IBD (16 UC patients and8 CD patients) and 16 patients with inactive IBD (10 UC patients and 6
CD patients) versus 40 healthy controls. All patients underwent blood and stool sampling as well as an
interview to assess the disease severity utilizing UC activity measured by the Truelove and Witts Severity
Index and Crohn's Disease Activity Index. Measurement of FLA levels at different stages of inflammatory
bowel disease activity to detect its role in assessment of disease severity. Results: This study showed that
FLA levels were highest in patients with IBD in comparison with healthy group. FLA levels also correlated
significantly with disease severity in patients with IBD where higher levels of FLA were found in patients with
severe UC or Crohn`s disease. At cutoff value 9.68 ug/ml FLA showed 100% sensitivity and specificity in
identification of patients with IBD from healthy subjects.
FLA is a sensitive and specific biochemical marker of inflammation for use in the diagnosis
of suspected IBD cases, and its level correlates well with both clinical disease activity indices.
Keywords: Inflammatory Bowel Disease, Ulcerative Colitis, Crohn's Disease, Fecal lactoferrin.


Inflammatory Bowel Disease (IBD)

includes Crohn's Disease (CD) and Ulcerative
practice 3. Initial attempts to noninvasively
Colitis (UC). These are chronic idiopathic
gauge disease activity had employed serologic
conditions, marked by recurrent episodes of
inflammation of the gastrointestinal tract,
such as C-reactive protein (CRP) and
interspersed with periods of remission 1.
erythrocyte sedimentation rate (ESR).These
Determining disease activity in IBD is
markers have been more recently thought to be
difficult, as patients might have a concurrent
less sensitive and specific than fecal makers 4.
source of gastrointestinal symptoms, such as
Biological markers are a noninvasive
irritable bowel syndrome (IBS) or infection.
way of objectively measuring inflammation and
Attributing certain clinical symptoms to IBD has
can play an adjunctive or primary role in the
traditionally been accomplished either by
assessment of disease activity. These markers
examining biopsy specimens or by using
can be classified into serological and fecal
radiologic imaging. However, these methods are
categories 5. Among the various serological
not without risks 2 and there is much interest in
biological markers available, erythrocyte
assessing disease severity in a noninvasive
sedimentation rate (ESR), C-reactive protein
fashion. The gold standard for assessing
(CRP), anti-neutrophil cytoplasmic antibodies
intestinal damage is fecal excretion of
(ANCA), and anti-Saccharomyces cerevisiae
111indium-labeled leukocytes, but because this
antibodies (ASCA) stand out. However, these
process involves patient exposure to radiation as
systemic markers have low sensitivity and
well as prolonged collection of feces, it is rarely
specificity for intestinal inflammation and
used in clinical
correlate poorly with symptoms and disease

Received: 03 / 01 /2017 DOI : 10.12816/0036654
Accepted: 10/ 01 /2017

Full Paper (vol.671 paper# 15)

Full Paper (vol.671 paper# 16)

c:\work\Jor\vol671_17 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 415- 424
Assessment of Left Ventricular Diastolic Function in
Nonalcoholic Fatty Liver Disease
Mohamed Elhussein Mohamed Ali Elnahas1, Mohamed Amin Kamal 1, Wael Refaat
Hablas2, Raed Elsayed Hamed Mansour3, Ayman Elsaid Sadek 1
Departments of Cardiology1, Clinical Pathology2, Tropical Medicine 3,
Faculty of Medicine, Alazhar University
*Corresponding author, Mohamed Elhussein Mohamed Ali Elnahas,
e-mail: mohamedalnahas@yahoo.com, Phone: 01095245260

Background: nonalcoholic fatty liver disease (NAFLD) is a spectrum of fat-associated liver conditions
that can result in end stage liver disease. NAFLD patients when compared to control subjects have a higher
prevalence of atherosclerosis which is independent of obesity and other established risk factors. Recent
studies have identified NAFLD as a risk factor for early subclinical abnormalities in myocardial
metabolism as well as in cardiac structure and function. In particular, it has been shown that NAFLD is
associated with left ventricular hypertrophy and impaired diastolic function.
The Objective: the aim of this study is to assess left ventricular diastolic function in NAFLD patients.
Patients and Methods: the study included thirty Egyptian NAFLD patients their age between 20 and 45
years old, and twenty healthy control subjects who were age and sex matched. Full medical history,
complete physical examination and laboratory tests were done in form of ALT, AST, total cholesterol,
LDL, HDL, triglyceride, hemoglobin A1C, creatinine, urea and CBC. Abdominal ultrasonography and
transthoracic echocardiography also were done.
Results: NAFLD patients had higher diastolic blood pressures, increased body mass indices, ALT, AST
and glycated hemoglobin A1C more than controls. Also in our study the mean of E, E/A ratio, DT, lateral
E/e and septal E/e is significant higher in NAFLD patients than control group. The mean of lateral e and
septal e is lower in NAFLD patients than control group.
Conclusion: patients with NAFLD had significant impairment on diastolic function in the non-diabetic
and normotensive NAFLD patients compared to the controls as measured by two-dimensional
echocardiography Doppler imaging in addition to tissue Doppler imaging.
Keywords: Left ventricular diastolic function, nonalcoholic fatty liver disease, echocardiography, tissue


Nonalcoholic fatty liver disease (NAFLD) is a
NAFLD is attributable to cardiovascular as well
spectrum of fat associated liver conditions that
as liver related deaths3.
can result in end stage liver disease and the need
More recent work has identified NAFLD as a
for liver transplantation. Simple steatosis or fatty
risk factor for early subclinical abnormalities in
liver occurs early in NAFLD and may progress to
myocardial metabolism as well as in cardiac
nonalcoholic steatohepatitis (NASH), fibrosis
structure and function4.
In particular, it has been shown that NAFLD is
hepatocellular carcinoma1.
associated with left ventricular hypertrophy and
NAFLD patients when compared to control
impaired diastolic function5.
subjects who do not have hepatic steatosis,

patients with NAFLD have a higher prevalence
of atherosclerosis which are independent of
The study included thirty Egyptian NAFLD
obesity and other established risk factors2.
patients diagnosed by evidence of hepatic
Studies have reported that the increased age
steatosis by abdominal ultrasound and their age
related mortality observed in patients with
between 20 and 45 years old, and twenty healthy
Received: 02/ 03 /2017 DOI : 10.12816/0036656
Accepted: 12/ 03 /2017

Full Paper (vol.671 paper# 17)

c:\work\Jor\vol671_18 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 425- 435
Comparison of Usefulness of Percutaneous Coronary Intervention Guided by
Angiography plus Computed Tomography versus Angiography Alone and its
Impact on Instent Restenosis
Tarek Mounir Zaki, Yasser Gomaa Mohamed, Alaa Mahmoud Roshdy,Ahmed Mohamed Onsy,
Mohamed Abdel Kader Abdel Raheem,*Mahmoud Maher Abdou Ibrahim
Department of Cardiology, Faculty of Medicine, Ain Shams University
*Corresponding author: Mahmoud Maher Abdou Ibrahim, email:mahmoudmaher501@yahoo.com, Phone: 01006502097

: optimal stent selection and placement would be expected to improve clinical outcomes.
Coronary computed tomography angiography (CCTA) may permit better preprocedural planning.
Objectives: to assess the impact of incorporating coronary computed tomography angiogaphy guidance in
defining reference value for stent length and diameter on angiographic and clinical outcomes in comparison
to quantitative coronary angiography and its effect on incidence of instent restenosis.
Methods: the study was conducted on 153 diabetic patients with stable coronary artery disease. Patients
were divided into two groups: group A and group B according to PCI guidance either with quantitative
computed tomography angiography (QCTA) datasets or quantitative computed tomography (QCA) datasets
respectively. Follow up clinically for six months to assess incidence of major adverse cardiac events
(MACE) and angiographically by coronary angiography at six months or before if clinically indicated to
assess incidence of instent restenosis (primary end point).
Results: QCTA was associated with longer lesions (p=0.001) and larger reference vessel diameter
(p=0.001) than that measured by invasive QCA in group A. No statistical significant difference between
group A and group B regarding restenosis rate, minimum lumen diameter at follow up and incidence of
Conclusions: CCTA guided percutaneous coronary intervention (PCI) is a safe and effective strategy for
treatment of coronary artery disease however it didn't add a beneficial role in reducing incidence of instent
restenosis or MACE in comparison to angiographic guidance alone.
Key words: CCTA, PCI, instent restenosis


Percutaneous coronary intervention (PCI)
It may provide a more accurate estimation of the
and stent selection are unique to each lesion
vessel wall diameter and lesion length, potentially
being considered, taking into account the true
allowing for more accurate stent size selection.
vessel size of the nearby normal reference
This could result in less size mismatch between
segments, the likely lesion length, as well as
the stent and vessel wall and allow optimal
plaque composition. The choice of stent diameter
placement of the stent margins in relatively
can be variable and somewhat forgiving, as
disease free segments. Although intravascular
smaller stents can, within reason, be dilated to a
ultrasound (IVUS) can also provide some of this
larger size. However, undersizing and oversizing
information, it is associated with increased cost, a
stent diameters may lead to instent restenosis or
small increased risk of adverse events, and longer
vessel rupture, respectively. Also, undersizing
procedural time, all of which limit its routine
stent length may lead to coronary dissection as
clinical use 2.
well as residual exposed plaque, both of which

Therefore, it seems reasonable that lesion
characteristics obtained with coronary CT
accompanied by the inherent increased risks
angiography, if available before invasive
associated with multiple stent implantations 1.
angiography, would be a surrogate for a

preprocedural IVUS examination and would help
angiography (CCTA) is able to visualize the
with PCI planning 3.
lumen in any dimension and can characterize

Instent restenosis is a common complication
plaque and the coronary artery wall morphology.
after implantation of coronary artery stents,
Received: 04/ 03 /2017 DOI : 10.12816/0036657
Accepted: 14/ 03 /2017

Full Paper (vol.671 paper# 18)

c:\work\Jor\vol671_19 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 436- 438

Axial Eye Length Assessment in Silicone Oil-Filled Eyes
Hayam S. Kamel* and Mona N. Mansour*
*Ophthalmology department, Faculty of Medicine (For Girls), Al Azhar University

to compare the reliability of axial eye length (AEL) measurement in silicone oil-filled
phakic eyes by conventional B-scan ultrasonography through the eyelid, after a correcting factor,
to partial coherence interferometry (PCI) measurement.
Methods: a prospective and comparative study was performed at Al-Zahraa University Hospital
clinic from (January 2016 - December 2016). In total 13 phakic eyes of 13 patients who
underwent vitrectomy and silicone oil filling were enrolled into the study. AEL was measured
by B-scan and compared to measurement by PCI.
Results & Conclusions: there was no significant difference in AEL measurement by either
B-scan ultrasonography through the eyelid, after a correcting factor, and PCI.
Key words:
Silicone Oil, Optical biometry, B-scan ultrasonography.

the AEL in SO-filled eyes. However, the
Silicone oil (SO) has become increasingly
AEL obtained with B-scan is much longer
useful as a tamponade in the vitreous cavity
than the actual value if not adjusted(10). In
for complicated retinal surgery. The low
comparison, the PCI may be a good
sound velocity of SO can result in
solution for the measurement of the AEL in
SO-filled eyes because of its optical
difficulty in identifying the retinal spike.
The sound velocity of SO varies depending
measurement using a conversion factor of
on the particular SO used (e.g., 987 m/sec
0.71 multiplied by the AEL measured in
[1,000 centistokes (cs)] & 1,040 m/sec
the presence of SO has also been suggested.
[5,000 cs])(3). The optical and sound
The ratio of vitreous cavity diameter with
attenuation properties of SO make AEL
oil to that without oil was 0.62. However,
measurement difficult. SO leads to the
this was done for SO of 1,300 cs only. Oils
following artifacts in ultrasonography:
of different viscosity may have different
1. Longer eye due to slower sound speed,
constants that must be determined(5). Many
2. Multiple fluid interfaces,
siliconized eyes are highly myopic with
3. Sound absorption by the oil, leading to
posterior staphyloma, adding to the
poor penetration(5). In eyes that have SO as
challenge of identifying the silicone­retinal
a tamponade agent, there is an apparent
interface at the macula and resulting in
increase in AEL, as measured by B-scan.
inaccurate calculation of IOL power(7). The
This is because the velocity of sound in SO
current study focused on the reliability of
is slower than in vitreous humour, being
AEL measurement in SO-filled phakic eyes
987 m/s in SO of viscosity 1000 cS,
by conventional B-scan ultrasonography
compared to 1532 m/s in aqueous and
through the eyelid, after a correcting factor,
vitreous. When the vitreous humour is
compared to PCI measurement.
replaced with SO, it takes approximately
1.5 times as long for an ultrasound pulse to
traverse the vitreous cavity(2). Accurate
This prospective and comparative study
determination of AEL in SO-filled eyes can
included 13 phakic eyes of 13 patients who
present a dilemma since the true AEL of
underwent vitrectomy and SO filling in
the eye is often unknown, and AEL of the
Al-Zahraa University Hospital. The
SO-filled eye measured by the conventional
patients were selected from the outpatient
B-scan is greater than the true AEL(6). Both
clinic from (January 2016 - December 2016)
PCI and B-scan could be used to measure
who attended for routine postoperative
Received: 11/ 02 /2017 DOI: 10.12816/0036658
Accepted: 18/ 02 /2017

Full Paper (vol.671 paper# 19)

c:\work\Jor\vol671_20 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 439- 443

A Case report: Aggressive Fibromatosis in a One-year Old Child
Mohammad T. Melibary 1 ,Talal Al-Khatib 2 , Saad Almuhayawi
3and Fadwa J. Altaf4
1 East Jeddah General Hospital, Jeddah, Saudi Arabia.
2, 3 Department Of Otolaryngology-Head & Neck Surgery, Faculty of Medicine,
King Abdulaziz University, 4 Department of Pathology , King Abdulaziz University.

Aggressive fibromatosis, also defined as desmoid tumor, is an uncommon tumor. A review of literature
detected less than 100 cases that have been reported of pediatrics aged 16 years or younger with
aggressive fibromatosis in the head and neck. In this study we report a 1-year old girl who presented with
an oral mass . The clinical , radiological, the histopathological features, and treatment are discussed .
Key words : aggressive fibromatosis, desmoids tumor, pediatric, and head and neck .


Aggressive fibromatosis, previously referred to
presented to the ORL clinic and a biopsy was
as desmoids tumor, is described as uncommon
taken and the preliminary diagnosis was
soft tissue tumor. It often rises from deep-seated
suspicion for leiomyoma. On examination, there
musculoaponeurotic structures [1, 2] .The tumor
was 3X4 cm oropharyngeal mass projecting on
the right side of the mouth. It was occupying
surrounding tissues, and have a high potential
most of the soft palate on the right and crossing
for local invasion and recurrence. Head and neck
the midline pushing the tonsil inferiorly and the
fibromatosis comprise around 12­15% of all
uvula medially (Figure 1A) .
cases [3]. In 1839, Dupuytren first described the
The mass had a smooth outer surface but firm to
features of fibromatosis, but it was not fully
palpation. Flexible nasopharyngoscopy showed
published until 1954 by Stout .
no intranasal involvement. There was no airway
The etiology of aggressive fibromatosis remains
compromise with only a small bulge on the right
unknown. However, other various etiologies
lateral pharyngeal wall at the level of the palate.
such as genetic predisposition, trauma, and
The patient had no palpable neck nodes and the
association with Gardner's syndrome, etc, have
rest of the head and neck examination was
been suggested in the literature [3] .In relation to
unremarkable. An MRI was performed and
a potential endocrine etiology, there have been
showed hypo-intense parapharyngeal tumor on
cases reported in the literature that have shown
T2 and Hyper-intense on T1 (Figure 2).
progression or regression in response to either
The patient was taken to the operating theatre
puberty or hormonal therapy. We report a 27
for resection of the parapharyngeal tumor. The
month old patient that has been diagnosed as a
patient's guardian was consented for transoral
case of aggressive fibromatosis, along with
and possible transcervical approaches. The
literature review of similar cases reported in the
tumor was resected transorally. Upon excision

posteriolaterally to the ptyregoid muscles.
Biposy from ptyregoid muscles, was taken as a
A 27 months old female presented with an oral
deep margin. The right tonsil was removed with
mass noticed by her mother since she was 3
reconstruction of the remaining soft palate
months of age. This mass was stable in size until
primarily. The patient was discharged after
a biopsy was taken at the age of 3 months. Since
recovery and was able to tolerate oral feeding
then, the mass started growing slowly. The
(Figure 1B).
mother noticed decrease in oral intake. The
Histologically, sections from oropharengeal
family seeked medical advice. The patient was
mass reveal multiple fragments of soft tissue

some of it composed of mucus secreting glands

in which there was spindle cell proliferation
Received: 17 / 01 /2017 DOI : 10.12816/0036659
Accepted: 22/ 01 /2017

Full Paper (vol.671 paper# 20)

c:\work\Jor\vol671_21 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 444- 454

Ameliorative Potential of Selenium against Bisphenol A- Induced
Hepatotoxicity in Rats
Hany A. Abdel Samie1*, Samir A.Nassar2, Youssef Hussein3
1. Dept. of Zoology, Faculty of Science, Menoufia University, 1. Dept. Clin Lab Sciences, College of
Applied Medical Sciences, Hail University, Kingdom of Saudi Arabia,2. Zoology Department, Faculty
of Science, Zagazig University, Zagazig, 3. Department of Human Anatomy and Embryology, Faculty of
Medicine, Zagazig University, Zagazig, Egypt
* Corresponding author e-mail: hanyabdelsamei@yahoo.com

: environmental pollutants affect various tissues. Bisphenol A, a compound used in making
epoxy resins and polycarbonate plastics, induces many hazardous effects. Aim of the work: this work
was designed to test the ameliorative potential of selenium against hepatotoxicity caused by bisphenol A.
Materials and Methods:
male rats were divided into four groups. Group 1 served as control, group 2
given sodium selenite, group 3 was administered with suspension of bisphenol A that is dissolved in corn
oil. Rats of group 4 were administered with selenium plus bisphenol A. Liver specimens and blood
samples were inspected after 3 and 6 weeks of treatment.
: there was no statistical difference between control and selenium -administered rats in all
parameters. Rats treated with bisphenol A suffered significant depression in weight whereas selenium
administration decreased the effect on rat's weight. Bisphenol A administration induced blood vessels
congestion, inflammatory infiltration, bile duct proliferation, cytoplasmic vacuolization and
macrosteatosis while selenium administration improved liver histopathological criteria either after 3 or 6
weeks. Bisphenol A treatment elevated nuclear PCNA and caspase-3 expression in the cytoplasm and
liver function enzymes (serum AST and ALT) and bilirubin. Again, selenium ameliorated these changes.
In conclusion, bisphenolA exerted deleterious impact on rats' hepatocytes and serum biochemical
parameters in a time-dependent manner. Selenium supplementation provides an extent of amelioration
against bisphenol A- induced hepatotocixity.
Keywords: Bisphenol A; Selenium; Histology; Immunohistochemistry; Biochemistry.


Environmental chemical contaminants
reactive oxygen species and decreased
expression of antioxidant genes in the liver by
accordingly cause injuries to body organs. Such
BPA. Selenium (Se), a nutritional supplement
contaminants disturb the hormonal regulation
is an important component of antioxidant
and affect other body's mechanisms [1]. Of these
defense system in cells and is engaged in the
pollutants is the estrogenic compound bisphenol
modulation of intracellular redox specially
A (BPA) applied in a range of products as
reusable drink and food containers and other
reductases [13]. Se protected liver against Cd [14],
products [2]. Under basic, acidic conditions or
aluminum [15], mercury chloride- induced rats
high temperature, BPA is hydrolyzed thus
liver and kidney damage [16] and efficiently
leaches into these containers [2]. A 95% BPA
inhibiting AFB1- induced liver carcinogenesis
was found in human urine samples in a United
[17]. This study aims at evaluation of the
States' reference population [3] , in plasma of
protective capability of selenium in combating
mothers and fetuses and in placental tissue at
BPA hepatic toxicityin albino rats by
delivery [4] and in human colostrums [5]. BPA
affects rat's spermatogenesis [6], decreasing the
caspase-3 immunoexpression and by measuring
sperm production efficiency in male rats [7] and
serum ALT, AST and bilirubin.
injures kidneys, brain, liver and other organs via

formation of reactive oxygen species [8, 9].
Moreover, association between elevated levels
Animals and experimental design
of free active BPA and obesity, diabetes and
cardiovascular diseases and low spermatozoa
norvegicus), weighing 130±10 g were obtained
count was recorded [10] and to rats brain damage
from the National Institute of Serum and
[11]. Hassan et al. [12] found generation of
Vaccination, Cairo, Egypt. Rats were kept under

laboratory conditions of 22­25oC and 12 h light/
Received: 21 / 02 /2017 DOI : 10.12816/0036660
Accepted: 26/ 02 /2017

Full Paper (vol.671 paper# 21)

Research article The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 455- 458
Imported Malaria in Egypt
Anwar H. Abo Hashim1, Mohamed Y. Saad2, and Tarek K. Zaalouk1
1Department of Parasitology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
2Department of Parasitology, Faculty of Medicine, Al-Azhar University, New Damietta, Egypt.

: With the dramatic increase in international travel among Egyptian people, the risk of
malaria importation from malaria-endemic regions threatens the achievement of the malaria elimination
goal of Egypt.
Patients and methods: Blood samples from 700 patients were collected from different medical
laboratories in Egypt from travelers to African endemic areas either Egyptians or foreigners coming to
Egypt within previous 8 weeks; during period from January to December 2016. All samples were done by
direct microscopic examination of the Giemsa-stained thick and thin blood smears ("gold standard"), as
well as the rapid diagnostic test (RDT) (Accurate MAL-w23, Polymed) for feverish cases as a
confirmatory test.
Results: A total of 25;3.57%(out of 700) imported malaria cases were recorded.P. falciparum (15
cases,60%) and P. vivax (14 cases, 56%) were the two predominant species as well as one case (4%)P
From them 4 cases had mixed P.falciparum and P.vivax and one case had P. falciparum and ovale,
The cases were coming from 11 African countries and their distribution was, Sudan,11; Nigeria, 5;
Ghana,3; Cameroon,1; Angola,1; Congo,1; Chad,1; Guinea,1; Togo,1; South Africa,1; and Eritrea,1case.
RDT was performed for feverish (300) patients and positive results were obtained among 27 cases.
Twenty five of them had parasitemia while the other two had history of past infection.
Conclusions: Imported malaria infections pose an increasing challenge to the malaria elimination in
Egypt. The risk of potential re-introduction of malaria into inland malaria free areas of Egypt should be
urgently addressed, also the rapid diagnostic tests (RDTs), offer a useful tool for rapid diagnosis in
suspected cases.
Keywords: Malaria, Imported, Epidemiology, Egypt, diagnosis.


results8.Microscopic blood
examination is
The international spread of infectious diseases
recognized as the "gold standard" for definitive
including malignant malaria has been accelerated
diagnosis, but requires experienced personnel and
by increasing human mobility and travel over
implementation of good quality control and
recent decades1, 2, 3.
assurance system9.
The importation from endemic regions and the
Serological methods for diagnosis of parasitic
threat of spreading drug resistance type remains a
problem for many eliminating or malaria free
immunofluorescence (IFA) do not detect current
countries due to the difficulty of diagnosis,
infection but refer to past exposure10. However,
substantial burden of treatment, relatively high
they are useful when applied in epidemiological
mortality rates, and potential secondary local
surveys for screening of potential blood donors
transmission4, 5.
and in providing evidence of recent infection in
The disease is considered as one of the most
immunocompromised individuals11, as well as
important parasitic infections that affect mankind
among hidden malaria carriers.
with a heavy burden where an estimated 3.3
Specific antigenic detection is considered a
billion people are at risk of being infected and
good diagnostic tool of malaria which can
developing disease6.
differentiate between Plasmodium species12.Also
In 2015, the World Health Organization (WHO)
the rapid diagnostic tests (RDTs), offer useful
set a new target of reducing the global malaria
alternative tools of diagnosis. However, before
burden by 90 % by 2030, and encouraged nation
these tests can be widely adopted, several issues
members to fulfill the goal of malariaelimination7.
remain to be addressed, including quality assur-
Clinical diagnosis of malaria based on patients'
ance of diagnostic performance and affordable
signs and symptoms, including fever, headache,
cost when applied in field conditions.
weakness, myalgia, chills, dizziness, abdominal
Hence, the present study was done to evaluate
pain, diarrhea, nausea, vomiting, anorexia, and
the present situation of imported malaria in Egypt
pruritus is nonspecific and provides variable
using (RDT) as well as microscopic examination.
Accepted:19/3/2017 DOI: 10.12816/0036661

Full Paper (vol.671 paper# 22)

c:\work\Jor\vol671_23 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 459- 464

The Effect of Hormone Receptor Status on Pathological Response
after Preoperative Therapy in Breast Cancer Patients
Iman Elsharawy1, Erich Solomayer2, Hesham Elghazaly1, Engi Elkholy1, Dalia Elsheikh1
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams
University. 2University hospital of Saarland, Homburg, Germany.

The pathological complete response of preoperative therapy in breast cancer patients
has been correlated with outcome and prognosis in terms of local and distant relapse. Response rates
vary according to clinical and pathological prognostic factors of patients including hormone receptor
status. This study was performed to assess response in terms of pathological response rates in relation
to Estrogen and progesterone receptor status.
Methods: This study analyzed 99 female patients with non metastatic breast cancer who received
neoadjuvant chemotherapy +/- targeted therapy during the period of April 2007 to March 2014.
Patients were treated at the university hospital of Saarland in Homburg, Germany. Records were
reviewed and correlation of response to Estrogen (ER) and Progesterone (PR) status was done.
Response was assessed and pathological complete response was defined as absence of invasive and in
situ disease in breast and axilla.
Results: Out of 99 patients, 29 (29.3%) patients achieved pathological complete response (pCR).
Forty two percent of tumors with negative Estrogen receptor status achieved complete response, versus
18% of ER positive tumors which was found to be of statistical significance (P value 0.009). Similarly
42.6% of tumors with negative Progesterone receptors showed pCR versus only 10% of PR positive
tumors which also showed high significance (P value 0.001).
Conclusion: This study confirmed that high pCR rates are achievable in ER and PR negative disease
using preoperative chemotherapy. It was concluded that each of the ER, PR status significantly impact
pCR rates where ER, PR negative status achieve higher pCR rates.
Keywords Neoadjuvant, Breast cancer, Preoperative, Pathological response.


Preoperative therapy refers to the systemic
patients with non-metastatic breast cancer as
treatment of breast cancer prior to definitive
shown by pathological complete response.
surgical therapy. The main objective of
Correlation of response to clinical factors and
preoperative therapy is to improve surgical
pathological factors was assessed. All
outcomes in patients for whom a primary
demographic and clinical data were obtained
surgery is technically not feasible and in
from patients' registry, electronic medical
patients with operable breast cancer who need
records and surgical pathology reports.
a mastectomy but desire breast conservation, or

in whom a partial mastectomy would result in a
Data selection
poor cosmetic outcome (1,2).
The study involved 110 female patients with
Neoadjuvant (preoperative) treatment can also
histologically diagnosed breast cancer who
be regarded as an in vivo test of sensitivity to
the used regimen (3) allowing for an early
chemotherapy +/- targeted therapy during the
evaluation of the effectiveness of systemic
period of April 2007 to March 2014. Patients
therapy. This can guide the clinician to
were treated at the university hospital of
discontinue the ineffective treatment (4) .
Saarland in Homburg,Germany.
The ER-negative genomic profile includes
Patients analyzed in the study were 99 patients
many subtypes, such as basal-like, claudin-low
after exclusion of 11 patients (9 with distant
(5), and interferon-rich (6), as well as others.
metastases, one with metastases and pregnancy
Being also PR negative and HER2 negative,
and one due to pregnancy). The patients were
most of these fall under the category of triple
considered as 99 subjects when analyzing the
negative breast cancers (7) .
patient related factors, however when
analyzing tumor related factors they were
Study design
analyzed as 104 tumors due to bilaterality in 5
This is a retrospective study to assess the
efficacy of primary systemic therapy in female
Received: 8 / 03 /2017 DOI : 10.12816/0036662
Accepted: 18/ 03 /2017

Full Paper (vol.671 paper# 23)

c:\work\Jor\vol671_24 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 465- 474
Behavioral and Educational Interventions to Improve Asthma
Outcomes in Children: A Systematic Review
Fawzya Aref 1, Abdulaziz Sulaiman B Emam2, Mohmed Salem Basalama3, Aljawharah
Mohammad Aljohani 4,Bandar Aedh Alyami 5, Ahmed Majed Alghamdi 6, Rayan Ali Barakat 6,
Bariah Yahya Drain 7, Mohammed Musleh Aljuaid 8,Rehab Abdulmohsen Al Ali 9, Esraa Hamza
Ahmad Abtini 7, Ghazi Waleed G. Serouji 10, Salah Mahmoud Alabbasi 10, Turki Mohammed
Alshehri, Rawan Yousef Alahmadi 11, Rahaf Mustafa Albensari 12, Faisal Ahmed M Abu
Shaigah13, Bayan Abdu G Alzubaidi7
1Maternity Hospital Jeddah, 2 Jeddah Center, 3King Fahad Hospital, Taibah University,
4Al Imam Muhammad Ibn Saud Islamic University,5Umm Al-Qura University, 6Umm Al-Qura University,
7Ibn Sina College, 8Batterjee Medical College, 9Alexandria University,
10 Primary Health Care, 11University of Hail,12 National Guard Hospital, 13 Dammam Medical Complex

Asthma, being a chronic inflammatory disease requires not only medical treatment but also
complimentary healthcare, self-management strategies and interventions for the appropriate management
and possible prevention of attack as well as reduction of school absences and days of restricted activity
and decrease emergency room utilization.
Methods:Randomized clinical trial (RCT) data reviewed for outcomes and processes associated with
asthma educational and behavioral interventions provided by different types of health professionals.
Thestudy group has synthesized studies that identified barriers and interventions to improve asthma
symptoms and management in children through searching in MEDLINE,Cochrane EMBASE, TOXLine
and CINAHL considering papers starting from 1999.
Results:Physician-led interventions were most successful for outcomes related to the use of health care.
Multidisciplinary teams were best in achieving symptom reduction and quality of life. Lay persons were
best in achieving self-management/self-efficacy outcomes. Components most frequently employed in
successful programs are skills to improve patient­clinician communication and education to enhance patient
self-management. Fifty percent of interventions achieved reduction in the use of health care and one-third in
symptom control. A combination approach including self-management and patient­clinician
communication involving multidisciplinary team members may have the greatest effect on most outcomes.
Conclusion: strong evidences suggest that the development of self-management and clinician­patient
communication skills are essentially required and considered as critical factors for Asthma patients
particularly children symptoms alleviation and outcomes improvement in the long term. This can be
achieved by appropriate self-care, awareness programs through effectiveeducational and behavioral
intervention which are crucial components associated with success across outcomes and providers.
Keywords:asthma,Health education,interventions.

drugs, and we know more about the
Asthma is the third-ranking cause of
pathophysiology and
hospitalization children1.Adolescents are at

particularly high risk for poor asthma outcomes,
treatment of asthma than ever before. However,
with asthma death rates twice as high for 11­17
prevalence and problems associated with the
year olds than 0­10 year olds2. Asasthma
disease (e.g., health care use, family disruption,
continues to be one of the costliest long-term
costs) have not dramatically decreased in kind.
disorders of childhood. Among chronic pediatric
This may in part be due to patients and families
conditions, it accounts for the highest number of
not following the recommendations of their
pediatric emergency department (ED) visits and
clinicians and effectively managing their
hospitalizations and the highest number of
disease. Studies have shown rates of adherence
missed school days for children and missed
to the medical regimen to be less than 50% 4.
work for parents. The resulting financial costs
An increasing amount of attention has been paid
are considerable3.There have been dramatic
to the roles of the patient and family in the day-
advances in the therapeutics of asthma,
to-day management of asthma. This has, in part,
evolved from recognition in the medical
inflammatory, combination, and long-acting
community of the need for partnership with
patients in the effective control of chronic
Received: 3/ 03 /2017 DOI : 10.12816/0036663
Accepted: 12/ 03 /2017

Full Paper (vol.671 paper# 24)

c:\work\Jor\vol671_25 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 475- 481

Common Dermatological Diseases in Saudi Arabia: A Literature Review
Abdulrahman M Albahlool 1, Bariah Yahya Drain2, Ghayda Ghazi Alqurashi2, Rehab
Abdulmohsen Al Ali 3 , Rawan Jabril Ahmad Khamaj2, Areen Jibreel Ahmad Khamaj2,
Shaden Falah Alharbi4, Nasir Fahad Alqurashi 5, Ghala Abdulaziz Yasin2, Sana
Abdulrazaq Alrebh6 , Esraa Jamel A Subahi2, Najd Fahad Aldakkan 7, Aeshah Abdullah
Mohammed, Ahdab Faisal Nono2, Asmaa Hussein Ageely8, Faisal Rabih Fatayerji9
1King Fahad Hospital, 2Ibn Sina College, 3Alexandria University, 4Hail University, 5BMC,
6King Faisal University,7 Dar Al Uloom University, 8Jazan University, 9King Abdulaziz University

Background: over the last two decades, only few dermatology research papers have been published in Saudi
Arabia provided the small number of experts -in this field -enlisted in higher education institutions. Hence a
compelling need to review the recent publications and define the current prevalence, status and interventions
Objective: To present an overview of the common dermatological diseases, particularly eczema and
dermatitis, in Saudi community as well as their effects and ways to mitigate them.
Methods: Review of Randomized Controlled Trials (RCTs) researches conducted and published in Saudi
Results: Empirical findings revealed that Acne, Eczema and Psoriasis are the most common dermatological
disorders among the Saudi community while Atopic Dermatitis was the most common mostly affecting
children. In the meantime, Vitiligo emerged to be the most rampant pigmentary ailment, also viral warts
appeared predominant covering up to 12% of the patients in the subject. On the other hand, dermatophytoses
occurred commonly among the fungal conditions, while psoriasis arose as the most recurrent papulosquamous
Conclusion: The prevalence of dermatological disorders in Saudi Arabia is rather high with the issue being
overlooked and deprioritized in favor of graver pathological conditions despite the significant social,
psychological and quality of life impact on the patients. Thus, we recommended that proper education and
awareness campaigns on skin diseases should be provided at all academic and social levels as one way of
prevention and alleviation of skin diseased in Saudi Arabia.

that skin conditions are usually allied with cheap
The kingdom of Saudi Arabia is a state
situated in Asia and comprises a population of

about twenty-seven million people. Despite the
and therapeutic measures and inadequate briefness,
noticeable growth in its infrastructure and industrial
these disorders continue to be one of the primary
sectors, Saudi Arabia remains to be one of the most
conditions that lead to ill health and disabilities in
affected nation on skin diseases and dermatological
the general public. Statistics of dermatological
conditions in general. Dermatology is habitually
conditions, from reliable researchers, mainly in the
perceived as an outpatient facility by the personnel
upcoming nations suggests that they are relatively
involved in its treatment and control. They mainly
common, fluctuating in the range of 25% to 81%,
tend to overlook and pay little devotion in the way
where most of them are as a result of contagions
they handle their patients. These conditions vary in
such as scabies, pyodermas, and Superficial
various aspects such as the medical exhibition,
Mycoses (3). The sequences of these type of
severity and the general epidemiology (1). This
disorders, among other factors remain to be
suggests that they are deadly illnesses which are
determined by the kind of the community
usually abrupt in their early stages and very much
development and the level of quality of the
troubling to the patients. Being one of the leading
provided attention. Every involved party, ranging
countries stricken by Dermatological disorders,
from the public, medical, scholarly and the
Saudi Arabia lacks the top expertise to offer proper
administrative bodies should therefore work and
description to their patients, thus a major
join their efforts to enhance the prime cautiousness
contributor to the disorders' spreading (2). Argues
and diminish the liability of these disorders in the
Received: 4 / 03 /2017 DOI : 10.12816/0036664
Accepted: 13/ 03 /2017

Full Paper (vol.671 paper# 25)

c:\work\Jor\vol671_26 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 482- 490

Thyroid Dysfunction andThyroid Autoantibodies in
Egyptian Patients with Systemic Lupus Erythematosus (SLE)
AymanAbd El-Aziz1, MostafaAbdElal Doma2,
Abdel Hamead A. Mohammed3, and Essam A. El-Moselhy4*
Internal Medicine1, Rheumatology, Physical Medicine &Rehabilitation2,Clinical Pathology
andCommunity Medicine3, Faculty of Medicine, Al-Azhar University
*Corresponding Author: AymanAbdl El-Aziz, Department of Internal Medicine, Al-Azhar University, Egypt.
e-mail: d.aymann.abdelaziz@hotmail.com
: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with many clinical
manifestations and immunological abnormalities. SLE and autoimmune thyroid disease are at the two
endpoints of a shared immunogenetic mechanism. Aim of the study: To evaluate the link between SLE
and thyroid disorders. Patients and Methods: Thirtypatients known to have SLE were recruited in this
study, with ageranged from 17 to 35 years. All patients were submitted to history taking, clinical
examination, and relevant laboratory investigation. Results: Thyroid disorderswere common (33.3%) in
lupus patients. Hypothyroidism was the commonest (16.6%) abnormality in SLE patients then euthyroid
(10.0%), and lastly hyperthyroidism (6.6%). The mean age of SLE patients was 26.1+1.5 year. Eighty
percent ofthe patientswere females. The most common SLEcharacteristics were malar flush (90.0%),
photosenstivity (80.0%), fever (70.0%), and arthritis (50.0%). Mean Hb level was 9.2±0.59 g/dL. While,
mean values of acute phase reactants were erythrocyte sedmentaion rate (ESR) at 1st and 2nd hour
(74.3±6.6 and 121.4±5.26 mm/h, respectively) and C-reactive protein (20±6.7 mg/L). The meansof FT3,
FT4, TSH, TG Ab, and anti thyroperoxidase (TPO) Abin SLE patiets were 136.6±14.1 ng/dL, 8.83±1.2
ng/dL, 4.15±1.27ng/dL, 15.12±11.15ng/dL, and 121±65.4 IU/mL, respectively. Meanwhile, 30.0% and
76.7% of SLE patients were +ve for rheumatoid factor (RF) and antineuclearAb, respectively. There
were 6.7% and 16.7% of the patients +ve for thyroglobulin Ab and anti TPO Ab, respectively. The
statistically significant differences parameters in SLE patients with normal and abnormal thyroid
function were ESR at 1 & 2 hours, RF, and antiTPO Ab (P=0.00, 0.00, 0.03, and 0.03, respectively). The
statistically significant differences parameters of demographic, clinical, and laboratory data in SLE
patients with normal and subgroups of abnormal thyroid function were age, SLE duration, Hb level,
RBC, WBC, PLT, and ESR at 1 & 2 hours (P=0.00, 0.00, 0.00, 0.001, 0.0001, 0.00, 0.00, and 0.00,
respectively). Conclusion and Recommendation: Thyroid disordersare common in SLE patients. The
most common form is hypothyrodism. Patients with SLE should be evaluated for thyroid disorders by
testing FT3, FT4, TSH, TG Ab, and anti PO Abfor early detection of thyroid abnormalities. Further
studies are needed to support and clarify the association between SLE and thyroid disorders.
Key words: Systemic lupus erythromatosus, Clinicalmanifistations, Thyroid dysfunction.


bodies. Thyroid autoantibodies may precede the
Autoimmune diseases can be divided
appearance of clinical autoimmune disease [7].
into organ-specific and systemic illness. The
Also, thyroiditis is very common in SLE [8].
systemic inflammatory autoimmune diseases are
Hashimoto's disease (HD) is the most important
such as systemic lupus erythromatosus (SLE),
autoimmune cause of thyroiditis all over the
rheumatoid arthritis (RA), etc [1]. SLE is
world. The patients often present with hypo-
prevalent throughout the world with manifold
thyroidism and a firm goiter. It is the most
clinical manifestations and immunological
common cause of goitrous hypothyroidism in
abnormalities. SLE is affecting primarily
areas of iodine sufficiency [9]. Thyroiditis and
women [2]. Its incidence varies from 40-100 per
consequent hypothyroidism can be the first
1, 00,000 populatio [3]. Also,thyroid disorders
manifestation of a variety of autoimmune
are quite common. They are the next common to
type 2 diabetes mellitus among the various
Scleroderma and SLE [6]. Pyne and Isenberg [10]
endocrine disorders [4]. Many studies had
showed that patients with SLE had a prevalence
showed the prevalence of thyroid disorders in
of hypothyroidism greater than that of the
SLE [5,6]. SLE Patients had a high prevalence of
normal population. The presence of either
symptomatic and significantly more subclinical
condition was associated with a higher
hypothyroidism and positive thyroid autoanti-
frequency of both antimicrosomal and anti-

thyroglobulin antibodies (anti TG Abs).
Received: 22 / 02 /2017 DOI : 10.12816/0036665
Accepted: 29 / 02 /2017

Full Paper (vol.671 paper# 26)

c:\work\Jor\vol671_27 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 491- 493

Rickets among Saudi Infants in Jeddah, Saudi Arabia
Ibrahim Hussain Muzaffar1, Mashael Abdullah Abdulsubhan2, Abdulrahman Mohammedsaeed
Baqasi1 Omar Badr Bawazir1, Renad Mousa Aljohani1, Yazeed Waleed O Alfadl3, Mohammed Taha
A Alnoor3, Akram Abdulwahed G Atbay3, Manar Ibrahim Y Sangoura3
Umm Alqura University1, Batterjee Medical College2, Ibn Sina National College3
Corresponding author: Ibrahim Hussain Muzaffar, Dr.Ibrahim.muzaffar@outlook.sa - 00966547771242

In most developing countries, nutritional rickets is a major health problem. The aim of this
study was to explore the magnitude of nutritional rickets among Saudi infants, and the various clinical
presentations, as well as to address the possible operating risk factors behind the disease.
Methods: Cross sectional study has been conducted among Infants, aged 4 ­ 24 months, who were seen
and evaluated, at King Abdulaziz Hospital and Oncology center, pediatrics endocrine clinic in Jeddah -
Saudi Arabia, during the period from January 2015 to December 2016, and confirmed to have rickets were
Infants under 2 years of age are liable to have vitamin D deficiency and rickets, if they are
exclusively breast fed and having inadequate exposure to sunlight. Delayed introduction of complementary
foods and malnutrition are also important contributing factors in nutritional rickets. Vitamin D deficiency
can present with variety of symptoms other than musculoskeletal symptoms like recurrent acute
respiratory, diarrhea and seizures.
Keywords: Rickets, Vitamin D Deficiency, Saudi infants.


delayed developmental milestones [9-11]. There
Vitamin D plays an essential role in
are many causes of rickets; include inadequate
calcium homeostasis, normal development and
dietary intake of calcium and vitamin D,
maintenance of human bones, and enhancement
malabsorption, inadequate exposure to sunlight,
of the immune system [1].
renal and liver diseases, and medications [12].
Rickets is a term signifying failure of
Other causes of rickets include calcium and
mineralization of growing bone or osteoid tissue
phosphorous deficiencies, inherited forms of
with characteristic changes of growth plate
hypophosphatemic rickets and Vitamin D
cartilage among infants before closure of growth
metabolism defects, including receptor mutations
plate [2]. Vitamin D deficiency rickets remains
[13-17]. Patients with rickets usually develop
prevalent in developing countries and ranks
among the five most common diseases in infants
characteristic changes of the growth plates and
[3-4]. In the Kingdom of Saudi Arabia, despite
metaphyseal bone, which include widening of
having economic affluence and adequate sunlight
wrists and ankles, bowing of the legs,
all year round, vitamin D deficiency is fairly
craniotabes, ricketic rosary and Harrison sulcus
common in infants, infants, adolescents, as well
as pregnant and lactating Saudi women [5-8]. It is
The aim of this study was to explore the
common cultural practice to keep infants and
magnitude of vitamin-D deficiency rickets
young infants indoors with minimal or total
among Saudi infants, and the various clinical
avoidance of direct sunlight. Although there is an
presentations, as well as to address the possible
awareness of the high prevalence of vitamin D
operating risk factors behind the disease and
deficiency in Saudi Arabia, a review of the
identify recommendations to prevent its
literature revealed a lack of data on the most
common presentations.

Rickets typically presents in the 1st 18
months of life with hypotonia and short stature in
169 Infants, aged 4 ­ 24 months, who
addition to widening of the ends of long bones,
were seen and evaluated, at King Abdulaziz
growth retardation, skeletal deformities and
Hospital and Oncology center, pediatrics
Received: 22 / 02 /2017 DOI : 10.12816/0036666
Accepted: 29 / 02 /2017

Full Paper (vol.671 paper# 27)

c:\work\Jor\vol671_28 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 494- 498

Clinical Presentation of Polycystic Ovary Syndrome among Saudi
Arabian Women ­ Jeddah ­ Saudi Arabia
Najla Abdullahh Alsibyani1, Mohammed A Malibary2, Ahmad Ayed Derham2, Abdulrahman
Abdulelah Almnabri3, Nuha Khalid Jazzar3, Rzan Waleed Melibari3, Reem Aaidh Alnefayi4,
Alanoud Saed Alnefaie4
Battarjee Medical College1, King Abdulaziz University2, Um Alqura University3,
Ibn Sina National College4
Corresponding author: Najla Abdullahh Alsibyani, Najla863@hotmail.com - 00966599848099

Polycystic ovary (PCO) is a highly variable condition with a wide array of
presentations. The Polycystic ovary syndrome should meet at least two of the following three criteria:
oligo- or anovulation; clinical and/or biochemical signs of hyperandrogenism; polycystic ovaries on
ultrasound. The prevalence of PCO is largely unknown in Saudi Arabia.
Objectives: The aim of this study was to investigate the reproductive hormones levels in patients
with polycystic ovary syndrome (PCOS) in addition to the effect of age and body mass index (BMI)
on the hormonal findings ,ultrasound and to determine the clinical, biochemical, and etiologic
features of hirsutism in Saudi females.
A cross sectional study has been conducted among total of 183 patients diagnosed
with PCOS had been assessed clinically along with measuring the level of reproductive hormones in
Obstetrics and Gynecology Clinic at King Abdul-Aziz hospital and oncology center in Jeddah, Saudi
Arabia, between June 2015 and June 2016.
Conclusion: Elevated levels of luteinizing hormone / Follicle stimulating hormone LH/FSH and
testosterone and reduced FSH, hormone-binding globulin (SHBG), and progesterone were predictors
of PCOS. This was independent of BMI or age. Future studies with larger sample size and data on
insulin levels are needed for greater understanding of the manifestations of PCOS in the Saudi
Keywords: Polycystic ovary syndrome - Polycystic ovary disease ­ PCOS.


Polycystic ovary syndrome and
However, polycystic ovary as
disease (PCOS/PCOD) is the most common
a phenomenon is very common in women
endocrinopathy in women of reproductive
with idiopathic hirsutism and oligomenorrhea
age, with a prevalence of up to 10%. It is a
complex condition that was first described in
Also a wealth of literature agrees that women
women who had PCOS as the underlying
may present an appearance of PCOS at
cause of hirsutism and chronic anovulation [1].
ultrasound without any sign of androgen
PCOS is a growing epidemic among Saudi
excess, although with indicators of ovarian
Arabian women, and women around the
dysfunction [5]. Similarly, PCOS is diagnosed
world although is a highly variable condition
by exclusion, and disorders having a
with a wide array of presentations. In study
phenotype related to that of PCOS must be
conducted on Saudi girls aged 18­28, the
ruled out; such as congenital adrenal
estimated prevalence of PCOS was observed
hyperplasia, Cushing syndrome and virilising
to be 53.7% which is strikingly higher [2].
tumors [6].
With the new guidelines for diagnosis
The principal findings in patients with
of PCOS, The European Society of Human
PCOS include irregular menstruation, acne,
Reproduction and Embryology/American
and excessive amounts of androgenic
Society for Reproductive Medicine criteria,
hormones. Obesity is a common finding of
often called Rotterdam, includes various
women with PCOS [7-8-9]. PCOS is not merely
phenotypes based on a combination of any
a disease of the reproductive system, since
type 2 diabetes, metabolic syndrome, and
hyperandrogenism, menstrual irregularity, and
sometimes cardiovascular disease have been
polycystic ovaries on ultrasound [3].
associated with this condition [9].

Received: 24 / 02 /2017 DOI : 10.12816/0036667
Accepted: 01 / 03 /2017

Full Paper (vol.671 paper# 28)

c:\work\Jor\vol671_29 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 499- 504
Adults Knowledge and Attitude of Family Medicine Practice in Saudi Arabia
Adil Ali N. Ayed
Outpatient Clinics, King Khalid University, Abha, Kingdom of Saudi Arabia
Corresponding author: Adil Ali N. Ayed,Senior registrar of Family Medicine, King Khalid University, Abha,
Kingdom of Saudi Arabia. Mobile: 00966556740004

suboptimal knowledge on medication practices, safety, and negative attitudes has some
negative impact concerning managing different types of diseases.
Objectives: the primary objective of this research work was to measure the public knowledge and to
identify their attitudes and practices on medication practices, with mainly focus on colorectal cancer and
diabetes. This is because they are ranked as the major diseases in the Kingdom of Saudi Arabia,
accounting for about 10.4% according to recent researches
Subjects and methods: the study was based on two cross-sectional surveys focusing on public support
and the internet based research.
Results: women constituted 55% of the cohort (n=420). The age of the participants ranged between 18
and 74 with the mean of 37 years. About a quarter of the respondents correctly identified colonoscopy and
FOBT as primary screening tools. Seventy percent of the respondents agreed with the statement that there
are misconceptions about the contraction of cancer and diabetes. Nearly forty participants reported that
they never combined traditional medicine in treating the epidemics with about 30 of them had a failure to
ask the community doctors on the need to be checked on the possibility of the having the disease.
Conclusion: majority of the adult had adequate knowledge and attitudes scores, but they were not
adhering to health promotion activities. Furthermore, misconceptions in knowledge, attitudes, and
practices on medication use were prevalent.
Keywords: Knowledge, Colorectal Cancer, Diabetes.


Colorectal cancer (CRC) is ranked as
CRC is more prevalent in adults aged 50
the second most common cause of female cancer
years and older. However, this epidemic can be
and the third most common cancer among males
controlled through CRC screening which detects
globally. This scenario is experienced mostly in
the disease during its early stages when the
developing countries; moreover, it is ranked as
survival rates are high. To create targeted
the fourth leading cause of many deaths after
messages and enlightening material aimed at
lung, stomach and liver cancer. According to
boost participation in testing, it requires that the
studies, CRC has higher rates in Australia, New
target population have a good knowledge and
Zealand, Europe and the USA, with moderate
attitudes of the condition. The lack of
rates found in Africa and south-central Asia [1].
knowledge is a significant CRC risk factor and
According to cancer statistics, it was estimated
is a potential barrier towards effective
that about 6% of the current population globally
campaigns [3].
would develop CRC anytime during their
It has been projected that in the next
lifetime and as per that study more than half of
twenty-five years, diabetes will become one of
them will die because of the disease [2].
the world's main killer [4], and the Kingdom of
In Asia, a review of literature has shown
Saudi Arabia is not left out. The increase in the
that that there is a gradual increase rate of CRC
prevalence of diabetes in countries such as Saudi
as well as mortality in many countries such as
Arabia can be attributed to increase in
Singapore, the Kingdom of Saudi Arabia, Japan,
urbanization, which has resulted in a continuous
and South Korea. In Saudi Arabia, the
generational paradigm shift of lifestyle from the
prevalence of CRC has progressively increased
customary Middle-Eastern model to a more
in the period between 2001 and 2006,
"western" standard. Furthermore, a majority of
irrespective of gender and age group [3].

conventional lifestyles that featured regular and
Received: 2 / 03 /2017 DOI : 10.12816/0036668
Accepted: 12 / 03 /2017

Full Paper (vol.671 paper# 29)

c:\work\Jor\vol671_30 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 505- 513
Human Myometrial Interstitial Cajal like Cell (Telocyte) in Preterm and Full
Term Labour: Histological and Immunohistochemical Studies
Hoda M. Elsayed1 and Yasser A.Helmy2
Department of Histology, Faculty of Medicine, Sohag University1
Department of GYN and OBS, Faculty of Medicine, Sohag University2
Corresponding author: Hoda Mohammed Elsayed,Email:hoda_abdelrasowl@med.sohag.edu.eg

Preterm labour is a common obstetric problem. The human myometrium is formed of two
types of cells namely smooth muscles and interstitial Cajal like cells or telocytes which express both
estrogen and progesterone receptors.
Aim of the work:
This study aimed to know how many telocytes are present in the pregnant uteri at time
of labour in the different gestational ages and the possible role of telocytes in preterm labour.
Patients and methods: 10 pregnant women were included in the study planned to do cesarean section.
They were divided into two groups: Group I: included 5 cases whose gestational age was less than 37
weeks (preterm). Group II: included 5 cases whose gestational age was more than 37 weeks (full term).
Specimens were obtained from the myometrium at the time of the operation and processed for
histological and immunohistochemical study.
H&E stained sections revealed hypertrophied smooth muscle fibers with different orientations.
Methylene blue stain revealed telocytes between the smooth muscle fibers as a branched cell with small
cell body and thin long processes. CD 117 (ckit) immunostaining revealed an apparent increase in the
number of telocytes in preterm cases (Group I) compared to full term cases (Group II). Morphometric
study revealed a significant increase in the number of ckit positive telocytes in preterm cases compared to
the full term one.
: telocytes are present in the pregnant uteri at different gestational ages with a significant
increase in their number in the preterm cases; they may have a possible role in preterm labour.
Keywords: Myometrim, telocytes, preterm, full term, c kit.


skeletal muscles, parotid gland and urinary
Preterm labour is a common obstetric
bladder [8-13].
problem associated with fetal and maternal
Regarding the female reproductive system,
complications. Many factors are involved in the
telocytes were found to be present in resting
regulation of uterine contractility, as mechanical
mammary gland stroma [14], human fallopian
stretch by the growing fetus, intercellular
tubes, normal human vagina [15] and pregnant
and non pregnant uteri [16&17].
signaling) or the presence of inflammatory cells
Telocytes were found to have contact with each
during spontaneous normal labour [1-5].
other and with the smooth muscle cells by gap
The human myometrium is consisted of two
junctions and also with the nerve bundles and
types of cells involved in its contractility:
blood vessels [7]. Furthermore, they express
smooth muscle fibers and interstitial cells that
estrogen and progesterone receptors in non-
are named telocytes (TCs) or interstitial Cajal
pregnant uterus and during the fertile period [18].
like cells [6]. Cajal cells were firstly described in
The presence of steroid hormone receptors
1911 by the Spanish neuroanatomist Cajal in the
suggested that telocytes could be responsible for
wall of gastrointestinal tract. Cells resembling
myogenic contractility modulation under
Cajal cells, but outside the gastrointestinal tract
hormonal control [16]. Most of the markers
they are named interstitial Cajal like cells or
expressed by the interstitial Cajal like cells are in
(TCs) [7].
common c-kit, CD34 and Vimentin [19].
It was reported that telocytes are present in many
Regarding the function of telocytes, it is
organs in the body: heart, lung, pancreas,
suggested to have different roles according to
their location. Horn et al. suggested that
Received: 24 / 02 /2017 DOI : 10.12816/0036669
Accepted: 01 / 03 /2017

Full Paper (vol.671 paper# 30)

c:\work\Jor\vol671_31 The Egyptian Journal of Hospital Medicine (Apr. 2017) Vol. 67(1), Page 514- 517

Prevalence of Hepatitis C Virus among Patients with Human
Immunodeficiency and Its Association with Intra-Venous
Drugs Addiction in Jeddah, Saudi Arabia
Alaa Mohammed Aldehry 1, Abdallah Mohamed Cheick 2, Sultan Mohammed Badri 1,
Shahad I. Faraj 1, Amjad Turki Fakieh 3, Majid Talat Tounsi 4,
Shatha Abdulrauf Yousef 1, Amna F. Ammar 1
1 Ibn Sina National College, 2 King Abdulaziz University, 3 King Khaled University,
4 Al Kaakya Primary Healthcare Center
Corresponding Author: Alaa Mohammed Aldehry - alaamohamed1@outlook.sa - 00966567574744


Background: Despite extensive research on HIV and hepatitis C (HCV), there remains a gap in
knowledge on the burden.
Objectives: to assess the prevalence of hepatitis C virus (HCV) among positive human
immunodeficiency virus patients and to study the relationships between these infections and
intravenous drug addiction.
Methodology: a cross sectional study has been conducted among total of 325 positive
immunodeficiency patients (HIV) diagnosed to have HCV infection in the gastroenterology clinic at
King Abdul-Aziz hospital and oncology center in Jeddah, Saudi Arabia between January 2015 and
January 2016.
Conclusion: The high prevalence of these major virulent infections among drug addiction is a sign of a
major public health problem. Other than complicating addiction illnesses of patients, they could play
major roles in spreading these infections to other intravenous drug addictors.
Keywords: Hepatitis C virus - Human immunodeficiency virus - Intra-venous Drugs addiction.


Hepatitis C virus (HCV) is a small
with human immunodeficiency virus (HIV),
enveloped positive strand RNA member of the
with rates of up to 30% in some regions [9].
Flaviviridae family [1]. Its infection is a major
Considering these viruses, blood borne
health issue as it often leads to chronic
infections are transmitted efficiently through
sharing of contaminated needles and other
carcinoma (HCC) and is the leading indication
injection paraphernalia [10-13]. In the United
for liver transplantation worldwide [2]. In
States, approximately 9-12% of new HIV cases
addition, the virus has also been implicated in a
and 50% of new HCV cases are associated with
number of extra-hepatic "autoimmune" disease
illicit injection of drugs [14].
manifestations [1]. HCV-related autoimmune
The diagnosis of HCV is based on
and lymphoproliferative diseases, including
detecting either anti-HCV antibody by enzyme
cryoglobulinemia and lymphomas, were
linked immunosorbent assay (ELISA) or HCV-
documented soon after HCV discovery [3]. The
RNA by polymerase chain reaction (PCR) [15].
current literature supports the view that risk of
A study has been done show that HCV core
antigen assays have been developed and they
hypercholesterolemia, insulin resistance, and
have a comparable sensitivity to that shown by
diabetes mellitus, is increased in HCV infection
the PCR-based assay, with a mean detection
difference of one to two days [16-18]. HCV
Chronic hepatitis C (CHC) is a global
infections in the Kingdom of Saudi Arabia
problem with a variable prevalence in different
(KSA) were usually acquired as an outcome of
countries [5]. It is estimated that 140-170 million
the transfusion of infected blood products,
individuals are chronically infected with the
before the implementation of blood donation
hepatitis C virus (HCV), and 3-4 million
screening programs [19]. However, the
individuals are infected annually [6]. In Eastern
prevalence of CHC in the KSA has been
Mediterranean countries there are about 21.3
diminishing steadily over the last decade as a
million HCV infected patients [7]. Blood donor
result of these programs [19-20] . Furthermore, the
screening data indicates prevalence rates of
use of polymerase chain reaction (PCR)
0.4%­1.1% [8]. Prevalence of hepatitis C virus
techniques for screening blood donors is
infection (HCV) is high among people living
Received: 5 / 03 /2017 DOI : 10.12816/0036670
Accepted: 14 / 03 /2017

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