c:\work\Jor\vol781_1 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5766-5770

The Effect of Threatened Abortion on Fetal Growth and
Premature Rupture of Membrane
Yehia Abd El Salam Wafa, Ashraf Hamdy Mohamed, Alsaied Ahmed Abo El Kamal Abd Allah
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
*Corresponding author: Alsaied Ahmed Abo El Kamal Abd Allah, Mobile: (+20) 0102301208,
E-Mail: Saeedbadwy2019@gmail.com

The diagnosis of threatened abortion is frequently made in clinical practice as a result of taking a history of
vaginal spotting and the finding of a closed cervix at subsequent vaginal examination in first 20 weeks of gestation.
Objective: This study was conducted to evaluate the incidence and relation between threatened miscarriage and preterm
premature rupture of membranes (PROM) and also its effect on fetal growth.
Patients and methods: The current study was conducted during a period of 8 months starting from 1st June 2019 till 31st
August 2019. The patients were divided into two groups. First group: Included one hundred women presenting with threatened
abortion at or below 20 weeks of gestation (case group). Second group: Included one hundred women who didn't have any
symptoms of threatened abortion (control group). All patients were recruited from the Outpatient Clinics and Casualties of the
Obstetrics and Gynecology Department, Al-Hussein and Bab Al-Sharia, Al-Azhar University Hospitals.
Results: Our study showed that there were significant differences regarding abortion, preterm labor and intrauterine growth
restriction in the case group compared to the control group. There was a relative increase in the incidence of premature rupture
of membranes, hypertensive disorders, placenta previa and the rate of cesarean section in the case group compared to the
control group.
Conclusion: There was a relation between threatened abortion and adverse pregnancy outcomes.
Keywords: Threatened miscarriage, Fetal Growth and Premature Rupture of Membranes.


Threatened abortion is defined as bleeding before 20
rupture of membranes (PROM) refers to rupture of the
weeks of gestation, and occurs in around 20% of
fetal membranes prior to the onset of labor irrespective of
recognized pregnancies (1). Approximately one-fourth of
gestational age (can occur even at 42 weeks of gestation).
all pregnancies are complicated by bleeding before 20
Premature rupture of membranes may occur at term or
weeks of gestation, and 12 to 57 percent of these
immediately preceding labor, or it may be an unexpected
pregnancies end in abortion (2).
complication during the preterm period, when it is
The diagnosis of threatened miscarriage is frequently
referred to as preterm premature rupture of membranes
made in clinical practice through taking a history of
vaginal spotting in first 20 weeks of gestation and the
Preterm Premature rupture of membranes (PROM)
finding of a closed cervix at subsequent vaginal
is a frequent obstetrical incident (3%) which can result in
examination. A definitive diagnosis of threatened
maternal and fetal complications such as infection and
abortion should be made following ultra-sonographic
prematurity (7).
examination, confirming the presence of fetal heart
Pre-term, premature rupture of the membranes
activity in an intrauterine pregnancy (3).
(PPROM) is the most common cause of pre-term labor (30-
Bleeding during pregnancy can cause maternal
40%) (8).
anxiety and emerging evidence suggesting that it may be

associated with poor fetal and maternal outcomes (4).
It is hypothesized that first-trimester bleeding may
The aim of this work was to evaluate the effect of
indicate an underlying placental dysfunction, which may
threatened abortion on fetal growth, premature rupture of
manifest later in pregnancy causing adverse outcomes
membranes and on other adverse pregnancy outcomes.
such as increased risk of pre-eclampsia, preterm delivery,

preterm premature rupture of membranes (PPROM),
placental abruption and intrauterine growth restriction
The current study was a prospective case-control
(IUGR) (5).
study which was conducted during a period of 8 months,
While spontaneous rupture of membranes (ROM) is
starting from January 1st, 2019 till August 31st, 2019.
a normal component of labor and delivery, premature

Full Paper (vol.781 paper# 1)

c:\work\Jor\vol781_2 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5771-5775

Disorders of Sexual Development in Proximal Hypospadias in Children
Amin M. Abokifa, Refaat I. El Badawy, Hesham W. Anwar, Yahia E. El Sagheer
Department of General Surgery, Faculty of Medicine, Al-Azhar University

Hypospadias is seen in around one in 300 live births, making it the most prevalent congenital
penile abnormality. Objective: to evaluate of the incidence and diagnosis of disorders of sexual development in
proximal hypospadias. Patients and Methods: This prospective study was conducted on 44 children attending
the Pediatric Surgery Department, Al-Azhar University Hospitals during the period from Dec 2018 to Nov 2019.
Detailed history taking; including complete physical examination, examination with special focus on external
genitalia and gonads; routine and specific laboratory investigation as genetic karyotyping, serum testosterone
(T), dihydrotestosterone, dehydroandrostenedione,17 OH progesterone, HCG stimulation test, serum levels of
luteinizing hormone (LH) and follicle-stimulating hormone (FSH), Adrenal hormones "serum cortisol & plasma
adrenocorticotropic hormone (ACTH) "to exclude congenital adrenal hyperplasia. Ultrasound abdomen and
pelvis was routinely done to assess the internal genital organs " uterus, fallopian tubes " and gonads " testis,
ovaries ". Results: there are (5) patients diagnosed as DSD: Three cases (6.8 %) have Karyotyping (46, XX),
diagnosed as CAH. One case (2.2%) has Karyotyping (46XY (70%)/45X (30) sex chromosome DSD (45, X/46,
XY PGD) or "mixed gonadal dysgenesis". One case (2.2%) has Karyotyping (46, xy), diagnosed as complete
Androgen insensitivity syndrome. Conclusion: Patients presenting with proximal hypospadias and one or more of
the co-existing anomalies of micro penis, undescended/impalpable testes, and penoscrotal transposition/bifid
scrotum should warrant DSD evaluation. Presence of bilaterally descended testes in scrotum does not preclude
the possibility of DSD.
Keywords: DSD, Proximal Hypospadias, Children.


Hypospadias is a common penile anomaly
hormone and follicle-stimulating hormone. If DSD was
occurring in 1 of 200 to 300 live births. Most cases
diagnosed, affected patients had 46, XX DSD, or 46, XY
encountered in clinical practice are distal hypospadias
DSD, or Sex Chromosome DSD (4).
while minorities of patients have proximal

hypospadias (1). Most cases of hypospadias are
considered as an isolated anatomical defect. In a small
The aim of this study was to evaluate the incidence and
group of patients, however, hypospadias may be a part
diagnosis of disorders of sexual development in proximal
of the presentation of a more complex anomaly of a
hypospadias in children.
disorders of sex development (DSD) (2).

The birth of a child with ambiguous external
genitalia is highly distressing to families. The first
This is a prospective single arm clinical trial for
question parents ask about their newborn is whether it
evaluation of the incidence and diagnosis of disorders
is a boy or a girl. The birth of a newborn with
of sexual development in proximal hypospadias in 44
ambiguous genitalia comes as a surprise for the
Child attending the Pediatric Surgery Department, Al-
parents and doctors alike (3).
Azhar University Hospitals. The duration of the study
DSD are defined as congenital conditions
is one years (Dec 2018- Nov 2019).
The study included all patients with proximal
chromosomal, gonadal, or anatomical sex (4).
hypospadias, with or without micro penis,
DSD is associated with micro penis, scrotal anomaly and undescended testes, scrotal transposition and bifid
undescended/ impalpable testis. A previous study reported scrotum aged 1 day till 14 years. While patients with
that chromosomal abnormalities were noted in 32% of ages more than 14 years or suffering from distal
patients with proximal hypospadias and undescended testis, hypospadias were excluded from the study.
in contrast to zero among those with distal hypospadias and
All patients included in this study were subjected to
undescended testis (5).
history taking including personal patients including age
Experts opinions recommended that hypospadias
and sex of rearing. In addition, parents were also
associated with undescended testis or bifid scrotum
inquired about consanguinity and a family history of
should be evaluated for DSD (6).
similar conditions or other types of DSD.
The most consistent investigations are karyotype
The patient's mothers were asked for previous intake of
analysis, serum levels of testosterone (T) and
hormonal therapy shortly before or during pregnancy.
Dihydrotestosterone (DHT) at baseline or following
They were also inquired about any manifestations of
HCG stimulation test, serum levels of luteinizing
hormone secreting tumors or surgery for excision of

such tumors.


Full Paper (vol.781 paper# 2)

c:\work\Jor\vol781_3 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5776-5783

Serum Level of Matrix Metalloproteinase 3 and Hydroxyproline in
Patients with Early Rheumatoid Arthritis
Adel Abbas El Beialy, Hemmat Ahmed Elabd, Asmaa Fouad Ibrahim Abd El-Rahman*
Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine for Girls, Al-
Azhar University, Cairo, Egypt
*Corresponding author: Asmaa Fouad Ibrahim Abd El-Rahman, Mobile: (+20) 1113670833,
E-Mail: asmaafouadibrahim@gmail.com

Rheumatoid arthritis (RA) is an autoimmune disease that results in a
chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks
flexible (synovial) joints.
The aim of this study was to estimate serum level of Matrix metalloproteinase 3 and hydroxyproline
in early rheumatoid arthritis.
Patients and methods: This study included a total of 40 patients with early RA (disease duration < 3 yrs.) and
20 normal volunteers of matched age and sex served as the control group, attending at Department of Physical
Medicine, Rheumatology and Rehabilitation, Al-Hussein University hospital. A disease evaluation was done
by DAS 28 for all subjects.
Results: In this study, there was a significant positive correlation between matrix metalloproteinase 3 (MMPs)
with all studied parameters of disease activity (MS, SJC, GH, ESR, DAS 28) p-value <0.05 and a significant
positive correlation between MMP3 and TJC p-value <0.001. There was also a significant positive correlation
between hydroxyproline with (TJC, SJC, DAS28) p-value <0.05. Results showed a significant positive
correlation between matrix metalloproteinase 3 and hydroxyproline. (P-value <0.001).
Conclusion: It could be concluded that in RA there is an evidence of elevated serum MMP3 and HP levels
that reflects disease activity and could be used as a specific marker for joint damage.
Keywords: Metalloproteinase 3, Hydroxyproline, Rheumatoid arthritis.


The initial presenting features of early RA
gelatinases (MMPs-2 and -9), stromelysins
do not substantially differ from other inflammatory
(MMPs-3, -10, and -11), matrilysins (MMPs-7 and
arthritis. So prior to definite diagnosis, patients
-26), membrane-type metalloproteinases (MT1-6-
with early RA are usually classified as
MMPs, also referred to as MMPs-14, -15, -16, -17,
undifferentiated arthritis which difficultly can be
-24, and -25), and other MMPs (MMPs-12, -18, -
discriminated from other inflammatory arthritis.
19, -20, -21, -22, -23, -27, and -28 (4).
Up to now, early RA was denoted to patients with
Matrix metalloproteinases (MMPs) are
disease duration of less than 2 years (1).
responsible for the homeostatic tissue repair and
The onset of disease is not similar in all
degradation of collagens (5).
patients but varies in regard to type, number, and
Previous studies have described the
the pattern of joint involvement. The course of
disease may be also different according to the
collagenolytic MMPs, which cleave interstitial
presence or absence of several variables including
collagens at a distinct site within their triple-helical
genetic background, frequency of swollen joints,
region, resulting in 3/4- and 1/4-length fragments.
autoantibody in the serum and the severity of
These fragments are thought to readily denature
inflammatory process (2).
and to be further degraded by the gelatinases,
The degradation of articular cartilage and
MMP-2, MMP-9, and other proteases (6).
the impairment of joint function are characteristic

Collagen turnover is crucial during normal
findings of both Rheumatoid arthritis (RA) and
physiological processes including wound healing,
osteoarthritis (OA) (3).
organogenesis, cell migration, and various

inflammatory processes. Overexpression of
MMPs are a family of zinc-dependent
collagen degrading MMPs results in an excessive
endoproteases with multiple roles in tissue
ECM degradation that can lead to a variety of
remodeling and degradation of various proteins in
pathologies such as rheumatoid arthritis (7).
the extracellular matrix (ECM). MMPs are

Mahmoud et al. (8) showed elevation of
commonly classified on the basis of their substrates
serum MMP1 in Egyptian patients with RA and
and the organization of their structural domains
OA, elevation of serum MMP3 levels in patients
into: Collagenases (MMPs-1, -8, and -13),
with RA but not in those with OA (9).


Full Paper (vol.781 paper# 3)

c:\work\Jor\vol781_4 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5784-5794

Adherence of Patients with Insulin Dependent Diabetes to Therapeutic Regimen
Hanan Elsayed Ali Abdu EL- Aal*, Mervet Abdelfatah Mohamed, Amna Yehia Saad
Department of Medical Surgical Nursing, Faculty of Nursing, Alexandria University
*Corresponding author: Hanan Elsayed Ali Abdu EL- Aal, Mobile: (+20) 01001737446,
E-Mail: hanan.mehanaa@yahoo.com

Diabetes mellitus is a metabolic disorder with varied etiologies characterized by chronic
hyperglycemia and carbohydrate, fat and protein metabolism disorders caused by insulin secretion defect, insulin
action or both. People with diabetes also have an increased risk of other diseases, including heart, peripheral, arterial
and cerebrovascular disease.
Objective: This study aimed to identify adherence of patients with insulin-dependent diabetes to therapeutic
Patients and methods:
A descriptive research design was used to accomplish the aim of the present study. A
convenience sample of 150 adult patients who were admitted to the study. The study was conducted at the Diabetic-
Outpatient Clinic at Shark El Madina Hospital in Alexandria. Outpatient clinic was working 6 days per week from
Saturday to Thursday from 9 am to 1 pm.
Results: There was a highly statistical significant relation between patient's age, sex, level of education, monthly
income and overall adherence to therapeutic regimen (p < 0.05). The highest percentage of the studied patients
who had good adherence to therapeutic regimen were aged 40 -50 years old, female patients, university educated
and had enough income (63.9%, 52.7%, 62.1%, and 75% respectively). Overall adherence barriers were moderate
in the patient's age group of 50-60, male, manual occupation, divorced, secondary educated and who hadn't have
enough income (65.4%, 55.9%, 71.1%, 71.4%, 70% and 63% respectively).
Conclusion: Based on the study findings, it can be concluded that, more than half of the studied patients were fair
adherent to diabetic diet, and more than two thirds of them were good adherent to medication.
Keywords: Adherence of Patients, Diabetes mellitus, Insulin, Congestive heart disease.

(4). Variables that have been considered to be correlates
Diabetes may be categorized as Type 1, Type 2,
of various adherence behaviors in diabetes can be
gestational diabetes and specific types of diabetes due
organized into four clusters: treatment and disease
to other causes, e.g. monogenic diabetic syndromes
characteristics; intra-personal factors; inter-personal
[such as neonatal diabetes and maturity-onset diabetes
factors; and environmental factors (5).
of the young (MODY)], exocrine pancreatic diseases
Ejeta et al. (6) stated that non-adherence to the
(such as cystic fibrosis) and drug- induced
patients typically follow a self- therapeutic regimen
or chemical-induced diabetes [such as glucocorticoid
leading to inadequate metabolic function, contributing
use, for HIV / AIDS treatment, after surgery or after
to acute and long term complications. There are four
transplantation of the organ (stress diabetes)] (1).
main acute complications of diabetes involved with
Burnier and Vrijen (2) defined adherence to the
short-term imbalances in blood glucose levels, which
therapy as the extent to which an individual's behavior
include hypoglycemia, diabetic ketoacidosis (DKA),
in taking medication, following a diet, and/or
hyperglycemic nonketotic coma or hyperglycemic
undertaking lifestyle changes, compatibles with
hyperosmolar syndrome (HHNS) and metformin
accepted recommendations from a healthcare
associated lactic acidosis (MALT).
provider. Also Ganiyu et al. (3) added that adherence
Long-term diabetes complications can influence
is described as the patient's active, voluntary, and
nearly all body systems. The general categories of
collaborative involvement in a mutually satisfying
chronic diabetic complications are macrovascular and
course of behavior to achieve a therapeutic outcome.
microvascular diseases. Chronic micro vascular
includes nephropathy, retinopathy and neuropathy.
management regimen that includes frequent self-
Diabetes ' macro-vascular diseases include congestive
monitoring of blood glucose (SMBG), dietary
heart disease (CHD), peripheral vascular disease and
modifications, physical activity, education, medication
stroke. To improve the quality of diabetic
administration, and foot care to maintain
treatment, including better metabolic control and diab
adequate glycemic control. Collaboration and
etic selfmanagement, it is necessary to determine barr
negotiation with health care providers, family
iers to diabetic management (7).
members, and others are important to ensure that
The goal of management is to control hyperglycemia,
such behavioral changes are optimally supported and
to maintain general health, psychological and
encouraged the numerous lifestyle modifications that
emotional satisfaction, and to prevent acute and
are of vital importance in the management of diabetes
chronic complications. The aspect of management

Full Paper (vol.781 paper# 4)

ABSTRACT The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5795-5803
Study of Central Venous Cut-Down Versus Percutaneous Central Venous
Catheterization in Neonates and Infants
1Mohamed Mohamed Ellithy, 2Ashraf Abdelhameed Abdelmonem,
1Ahmed Abdelghaffar Hamed Helal, 1Ibrahim Abu Zeid Ibrahim El Gohary
1Department of Pediatric Surgery, 2Department of General Surgery,
Faculty of Medicine -Al Azhar University
Corresponding author: Ibrahim Abu Zeid Ibrahim El Gohary, Mobile: 01144636947

Several more access routes of have been described. Umbilical artery catheters (UACs), and umbilical
vein catheters (UVCs). CVCs can be placed in numerous sites, including the internal jugular vein (IJV), the
subclavian vein, the femoral vein, peripheral veins leading to central access, and other surgical access sites.
Objective: To compare central venous cut-down catheterization versus percutaneous central venous
catheterization in neonates and infants regarding technical feasibility, indications, operative time and
Patients and Methods: This is a prospective study on two different methods for central line insertion in neonates
and infants. This study was done at Al-Azhar University Hospitals, in Pediatric Surgery Department, Neonatal
Intensive Care Unit and Pediatric Intensive Care Unit. One hundred patients who required central venous
catheterization were included in this study, during period between December 2018 and October 2019.
Results: The present study reported that the ultrasound guided CVC was more useful in placement of CVC in
infants and neonates, and decreasing complications. The ultrasound technique not only clarified the relative
position of the vein and its surrounding structures but also helped in identifying the course of the central vein
and its caliber and provide confidence to the operator
Conclusion: The present study reported that the ultrasound guided CVC was more useful in placement of CVC
in infants and neonates, and decreasing complications. Cost is one of the limiting factors in the availability of
ultrasound device in many clinical applications.
Keywords: Central Venous Cut-Down, Percutaneous Central Venous Catheterization, Neonates and Infants.

A central venous catheter (CVC), also
The need for vascular access in the
known as a central line, central venous line, or
pediatric patient is frequent (1). However,
central venous access catheter, is a catheter placed
placement of a peripheral line may not be feasible
into a large vein. Catheters can be placed in veins
or appropriate especially in neonates and infants.
in the neck (internal jugular vein), chest
The options available to clinicians have increased
(subclavian vein or axillary vein), groin (femoral
over the years.
vein), or through veins in the arms (also known as
The history of cannulation of a central
a PICC line, or peripherally inserted central
venous structure can be traced back to 1929, when
catheters). It is used to administer medication or
Forssmann described advancing a plastic tube
fluids that are unable to be taken by mouth or
near the heart by puncturing his own arm (2). In the
would harm a smaller peripheral vein, obtain blood
1950s, Aubaniac used the subclavian vein to insert
tests (specifically the "central venous oxygen
a central venous catheter (CVC) (3).
saturation"), and measure central venous pressure
Since then, several more access routes have
been described. Umbilical artery catheters (UACs),

and umbilical vein catheters (UVCs). (CVCs) can be
placed in numerous sites, including the internal
The aim of this study is to compare central
jugular vein (IJV), the subclavian vein, the femoral
vein, peripheral veins leading to central access, and
percutaneous central venous catheterization in
other surgical access sites (4).
neonates and infants regarding technical
Recently, mean good device is likely to
feasibility, indications, operative time and
focus on the material used in a central venous
catheter (CVCs), as well as on means of preventing

infection and occlusion. Ultrasonography is
becoming an increasingly useful adjunct in the
This is a prospective study on two different
placement of percutaneous central lines (4).
methods for central line insertion in neonates and
Pediatric and emergency medicine training
infants. This study was done at Al-Azhar
programs benefit from teaching and using
University Hospitals, in Pediatric Surgery
ultrasonography for central line placement (5).
Department, Neonatal Intensive Care Unit and
Pediatric Intensive Care Unit. One hundred

Full Paper (vol.781 paper# 5)

c:\work\Jor\vol781_6 AK E
The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5804-5816
In Vitro Evaluation of Antibacterial Potential of Cerastes Vipera
Venom against Gram-Positive and Gram-Negative Bacterial Strains
Samy A. Saber, Aly F. Mohamed, Abir A. El-Fiky, Hossam. H. Eldaly*
Department of Zoology, Faculty of Science, Al-Azhar University, Cairo, Egypt
*Corresponding author: Hossam Eldaly, Mobile: (+20)1114822801, Email: hossameldaly3@gmail.com

Venoms of the family Viperidae in particular are complex mixture of many substances. They
include many different proteins that possess significant bactericidal inhibition.
Objectives: The aim of the current work was to investigate the antibacterial profile of Sahara sand viper
(Cerastes vipera) snake venom against both gram negative Pseudomonas aeruginosa and gram-positive bacteria
Bacillus cereus.
Materials and Methods:
1. Identification of the venom was performed using assessment of total protein,
determination of the venom protein by SDS-PAGE electrophoresis and determination of the half lethal dose
(LD50) of venom. 2. Antibacterial activities of Cerastes vipera venom was examined by using disc diffusion
method. Microdilution method was used to determine the venom's minimum inhibitory concentration (MIC) and
the minimum bactericidal concentration (MBC). 3. The interaction between venom and bacteria was examined
by Electron microscope.
Results: The total protein of the venom was 1.047±0.1 mg/ml. The SDS electrophoresis showed there were four
clear bands of protein nearly at 25, 35, 48, 63 Kds and another band betweee 25, and 35 Kds. The LD50 was
18.3 µg/mouse (0.915 mg/kg body weight). Concerning the antibacterial effect of tested venom, disc diffusion
test showed a ring of inhibition zone of about 12 mm in the case of Pseudomonas aeruginosa and of about 0.8
mm in the case of Bacillus cereus. The Microdilution test showed that the MIC of the venom for Pseudomonas
was 12.5 mg/ml and that for Bacillus cereus was 25 mg/ml. The electron microscopic examination
supported the two previous tests, as it observed the presence of elongated, malformed, melted, no-membranous
and lysed bacterial cells when treated by the venom.
Conclusion: It could be concluded that Cerastes vipera venom is a potentially weak bactericidal, but can inhibit
antibiotic-resistant bacteria as Pseudomonas aeruginosa.
Keywords: Cerastes vipera venom, bactericidal, Bacillus cereus, Pseudomonas aeruginosa, MIC, MBC,
Electron microscopic examination.

responsible for the major toxic effects during snake
Egypt as a desert land comprises different
species of venomous animals including snakes. In
The aim of the current work was to investigate
the antibacterial profile of Sahara sand viper
envenomation per year with about 11­100 death
(Cerastes vipera) snake venom against both gram
cases annually (1). Cerastes vipera is one of the most
negative Pseudomonas aeruginosa and gram-positive
venomous snakes of Egypt. Sahara Sand Viper
bacteria Bacillus cereus.
(Cerastes vipera) is a venomous viper species
endemic to the deserts of North Africa and the Sinai
Ethical approval:
Peninsula (2).
The study was approved by the Ethics Board of
Antimicrobial resistance is an increasingly serious
Al-Azhar University.
worldwide threat associated with millions of illnesses
Snake venom collection: Lyophilized pure venom of
and deaths annually over the world. Antimicrobial
Sahara sand viper (Cerastes vipera) was obtained
resistance is predicted to cause ten million deaths in
from ANDI COE, VACSERA, where venom was
2050 (3). Given its vast ability as the source of
stored in brown vial at refrigerator (4C) till used.
therapeutics, it was found that viper venom has
Strains: Pseudomonas aeruginosa was obtained
antimicrobial activity against gram-positive and
from American Type Culture Collection number
gram-negative bacteria (4). The venom antimicrobial
27853(ATCC). Bacillus cereus was obtained from
activity was due to enzymes such as L-amino acid
the microbial chemistry department, National
oxidase (5).
Research Center.
The antimicrobial potential of snake venom
Inoculums Preparation: A loopful from the
enzymes is widely investigated. PLA2 and L-amino
overnight growth was transferred to 50 ml Tryptone
acid oxidases (LAAOl and LAAO2) are among the
Soya Broth (TSB) medium and was incubated at
best studied enzymes associated with antibacterial
37°C with vigorous shaking (150 rpm) for 18 h; cell
properties (6). Both PLA2 and LAAO are usually
growth was checked purity by Gram stain.


Full Paper (vol.781 paper# 6)

c:\work\Jor\vol781_7 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5817-5824

Homeostasis Model Assessment of Insulin Resistance in Obese Children as A
Predictor for Metabolic Syndrome
Habiba Ahmed Abdelsalam1, Soheir Bahgat Fayed1, Amal Gaber Mohamed2, Gehan Foad Ahmed1
epartment of Pediatrics Facul
ty of Medicine for Girls Al
- zhar University D
, epartment of Pediatric
Nutrition, National Nutrition Institute, Cairo, Egypt
*Corresponding Author: Habiba Ahmed Abdelsalam, Phone Number: (+20) 1008925256,
Email: habibaahmed454@yahoo.com


Background: Obesity has emerged as one of the most serious public health concerns in the 21st century. HOMA-
IR scores are useful indicators of insulin resistance for research purposes.
Objectives: This study was aimed to evaluate HOMA-IR for insulin resistance in obese children, to correlate
between HOMA-IR and metabolic syndrome in obese children and also to assess relation between insulin resistance
and morbidity. Subjects and Methods: This cross-sectional study included a total of ninety overweight and obese
children, aged 4-8 years, attending at El-Zahraa University Hospital and National Institute of Nutrition. This study
was conducted between from January 2018 to January 2019. All studied children were subjected to anthropometric
measurement, blood pressure measuring, skin finding as acanthosis nigricans. Lab investigations including
measurement of HBA1C, fasting serum glucose, total cholesterol, HDL-C, LDL-C, triglycerides and insulin were
done. Results: Mean and median values of HOMA-IR were significantly higher among patients with large birth
weight than low and average birth weight and among patients with positive family history of obesity than negative
ones. Participants illustrated a significant positive correlations between HOMA-IR and weight and BMI, SBP, DBP
and serum cholesterol Conclusion: It could be concluded that homeostasis model assessment of insulin resistance
index HOMA-IR in obese children is increased with increased body mass index, waist circumference systolic,
diastolic blood pressure, serum cholesterol, LDL-C, large birth weight, patients with positive family history of
obesity and among patients with acanthosis nigricans.
HOMA -Insulin Resistance - Overweight and Obese children.


This study was aimed to evaluate HOMA-IR for
Obesity has emerged as one of the most serious
insulin resistance in obese children, to correlate
public health concerns in the 21st century. The
between HOMA-IR and metabolic syndrome in
worldwide prevalence of childhood obesity has
obese children and also to assess relation between
increased strikingly over the past 3 decades (1).
insulin resistance and morbidity.
Obesity is a proinflammatory state that increases the

risk of several chronic diseases encompassing
diabetes, hypertension, dyslipidemia, cardiovascular
This cross-sectional study included a total of ninety
disease, asthma, sleep apnea, osteoarthritis and
overweight and obese children, aged 4-8 years,
several cancers in adults (2).
attending at El-Zahraa University Hospital and
Measuring insulin resistance (IR), is therefore a
National Institute of Nutrition. Written informed
useful tool to allow early intervention to prevent or
consent from all the parents of the subjects were
delay the development of the disease. The gold
obtained. This study was conducted between from
standard method to measure IR is by
January 2018 to January 2019.
hyperinsulinemic euglycemic clamp. However, the

complexity and high cost of the test has prevented its
Ethical consideration:
use in daily clinical practice and in epidemiological
Approval of Research Ethics Committee of
studies (3).
Pediatric Department and Al-Azhar Faculty of
Homeostasis model assessment for insulin resistance
Medicine for girls was obtained.
(HOMA-IR) index is widely used as a measure of

insulin resistance in adults and has also been
Inclusion criteria
validated in children and adolescents. However, the
Both sexes were included.
HOMA calculations require measurement of plasma
Body mass index (BMI) z score exceeded
fasting insulin and glucose. Due to the instability of
2 or 3 standard deviation according to WHO
insulin, blood collected for insulin measurement has
BMI chart recruited for the study (5).
to be kept cold, immediately processed and plasma
Exclusion criteria
frozen as soon as possible (3).
Age less than 4 year and more than 8 years.
HOMA-IR scores are useful indicators of insulin
obese children with:
resistance for research purposes (4).

Full Paper (vol.781 paper# 7)

Sohag University The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5825-5833

Role of Magnetic Resonance Imaging (MRI) In Abnormal Uterine Bleeding
Mohammad Tharwat Mahmoud Solyman1 ,Abdou Saeed Ait-Allah2, Mohammad Alaa Alsaid Mohammad1,
Mohammad Hasan Alam-Edeen1, Yasser Abdel-kareem Amin1
1Department of Radiodiagnosis, 2Department of Obstetrics and Gynecology,
Faculty of Medicine - Sohag University
*Corresponding author: Yasser Abdel-kareem Amin, Mobile: (+20) 01006875117, E-Mail: yasserrad476@gmail.com

Abnormal uterine bleeding (AUB) is not always reported by women experiencing symptoms.
Because of this, 3% to 35% of women worldwide may have abnormal uterine bleeding.
Objective: MRI examination of women with AUB to detect any organic cause not detected with transvaginal
ultrasonographic examination and if MRI add any advantage more than transvaginal ultrasound.
Patients and methods: This study had been conducted at the department of diagnostic radiology-Sohag University
Hospital at the period from September 2016 to September 2018. 50 women with abnormal uterine bleeding were
referred from the Department of Obstetrics and Gynecology or from the Outpatient Clinic for this study.
Results: Our study revealed a sensitivity of transvaginal ultrasonography (TVS) was 100% and specificity was
95.56% in detecting uterine pathology. For uterine myoma; the current study showed that MRI had a sensitivity of
100%, specificity 100%, PPV 90.9% NPV 100% and accuracy 98%. Our MRI sensitivity and specificity for
endometrial carcinoma were high may be because endometrial carcinoma was one case only and we used DW
image for her diagnosis. The need for histopathological evaluation of endometrial lesion couldn't be totally
excluded. In our study TVS had a sensitivity for endometrial carcinoma 100% and specificity 100%
Conclusion: Role of MRI in abnormal uterine bleeding as equal as that of (TVUS) but still TVUS has the upper
hand as the first imaging choice, real time imaging.
Keywords: MRI, Abnormal Uterine Bleeding, DWI, TVUS.


Any significant deviation from a woman's
tool and in most instances, should be performed early
established menstrual pattern may be considered
in the course of the investigation. Ideally, the
abnormal uterine bleeding, and several factors direct
ultrasonography system must be of adequate quality
evaluation of a patient with such bleeding.
to clearly display both myometrial and endometrial
Premenopausal disorders include endometriosis,
features, and the examiner should have the ability to
adenomyosis, and leiomyomas. A positive pregnancy
operate the scanning device and interpret the images
test in a woman of childbearing age prompts a search
displayed. Regardless, TVUS is not 100% sensitive
for an intrauterine pregnancy. Possible complications
even in ideal circumstances because polyps and other
that may contribute to bleeding include ectopic
small lesions may elude detection even in the context
pregnancy, placental factors including position,
of a normal study (2).
trauma and infection, gestational trophoblastic
Diffusion-weighted MRI (DW MRI) is a non-
disease, preterm labor and postpartum complications.
enhanced imaging technique that facilitates the
Atrophic changes, hormonal status and carcinoma are
display of tissue characteristics based on the
considerations in the postmenopausal patient with
difference in diffusion motion of water molecules.
abnormal uterine bleeding (1).
Several recent studies have reported DWI to be useful
The International Federation of Gynecology and
to detect and differentiate endometrial cancer from
Obstetrics (FIGO) has approved a new classification
normal endometrium or a benign lesion (3).
system (PALM-COEIN) for causes of abnormal
DWI is a method to visualize the three-
uterine bleeding in nongravid women of reproductive
dimensional microscopic movement of water
age. The classification system is stratified into nine
molecules within the intra- and extracellular
basic categories that are arranged according to the
compartments. DWI visualizes the variability in
acronym PALM-COEIN: polyp, adenomyosis,
water mobility due to changes in tissue cellularity,
cell membrane integrity and fluid viscosity. The more
coagulopathy, ovulatory disorders, endometrial,
restricted the movement of water, the higher the
iatrogenic and not classified (2).
signal intensity generated on DWI. The apparent
Evaluation for structural abnormalities affecting
diffusion coefficient (ADC) can provide quantitative
the endometrial cavity is performed to identify
degree of diffusion. Restricted diffusion is displayed
pathology including endometrial or endocervical
as low signal intensity on an ADC map. The
polyps and submucous leiomyomas that could
movement of water molecules is typically restricted
contribute to AUB. Transvaginal ultrasonography
within the tumor microenvironment due to increased
(TVUS) is an appropriate and important screening
cellularity. Due to restriction in movement of water

Full Paper (vol.781 paper# 8)

c:\work\Jor\vol781_9 The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (1), Page 62-67

Protective Role of Royal Jelly Against Gamma Radiation Induced Oxidative
Stress, Cardio-Toxicity and Organ Dysfunctions in Male Rats
Hazem, K.A. Sarhan and Lilian, N. Naoum
Medical and Radiation Research Dept., Nuclear Material Authority, Cairo, Egypt

Oxidative stress is known to be a key factor in several diseases and was reported as a result of
radiation exposure in human and experimental animals. Royal jelly contains free amino acids, proteins, sugars,
fatty acids, minerals, and vitamins, which are reported as a preventive treatment of a wide range of disorders.
Aim: The present study was designed to determine the possible protective effects of royal jelly against gamma
(-) radiation-induced oxidative stress in male rats.
Materials and Methods:
Thirty two rats were divided into four groups (n=8), control, treated (rats were
administrated by RJ (250 mg/kg/day) by stomach tube for 15 days, irradiated (rats were exposed to (10 Gy)
whole body gamma radiations as a fractionated dose (2Gy X 5 times), treated irradiated, (rats were
administrated by RJ (250 mg/kg/day) by stomach tube for 15 days before exposure to whole body gamma
irradiation (10 Gy) as a fractionated dose (2X5). Serum reduced glutathione (GSH) content, superoxide
dismutase (SOD) activity and lipid peroxide [malondialdehyde (MDA)] levels were assessed as well as serum
total cholesterol (TC), triglyceride (TG), High density lipoprotein-cholesterol (HDL-C), low density
lipoprotein-cholesterol (LDL-C), creatinine kinase-MB (CK-MB) and cardiac troponin I (cTnI). Also,
histopathologic and histochemical changes were assessed. Results: The results showed that, GSH content, SOD
activity and HDL-C were highly significantly decreased, while there was marked highly significant increase in
MDA, TC, TG, LDL-C, CK-MB and cTnI due to irradiation. Numerous histopathologic changes were detected
in the heart tissue of rats of the irradiated group with altered cardiac muscle fibres of the radiation-exposed
group. These changes manifested good amelioration in the exposed groups that supplemented with RJ (250
Conclusion: Royal jelly has a beneficial role in reducing oxidative stress and cardio-toxicity induced by
radiation exposure.
Keywords: Royal jelly; -irradiation; Antioxidant; cardio-toxicity.

biological system at the molecular level before
other physiological or micro-anatomical changes
Ionizing radiation (IR) has attracted a lot of
occur. This hypothesis is based on the use of
attention due to its beneficial as well as possible
chemicals that prevent the development of radiation
harmful effects to human population. Most of the
injury in exposed organisms by mitigation of
toxic effects of ionizing radiation are due to
radionuclide absorption through activation of the
generation of reactive oxygen species (ROS) by
free radical scavenging system (5). An ideal radio-
radiolysis of water which triggers formation of
protective agent should be active, rapidly absorbed
several reactive intermediates (1). Therefore, to
and easily distributed in the body tissues. It must be
overcome this oxidant stress, the body is equipped
without side effects or at least with minimal
with defense system, including enzymatic and non-
toxicity which gives insurance that no cumulative
enzymatic radical scavengers that can either
consequences could be expected from their
directly detoxify ROS or indirectly regulate their
repeated usage (6).
levels (2).
Royal jelly (RJ) has received a particular
Over production of ROS leads to uncontrolled
attention because of studies that have reported that
chain reactions and lipid peroxidation, resulting in
it is a highly efficient antioxidant and has free
various pathological conditions that may include
radical scavenging capacity (7). RJ is a secretion
some body organ (3). Radiation exposure attenuates
produced by the hypopharyngeal and mandibular
endogenous antioxidant enzymes, which are
glands of worker honeybees (Apismellifera). It
considered to function as a part of the first line
contains many important compounds with
defense mechanism to maintain redox balance and
biological activity such as free amino acids,
proteins, sugars, fatty acids, minerals, and vitamins
supplementation of antioxidants to improve the
(8). So far, RJ has been demonstrated to possess
efficacy of radiotherapy is a current proposed
several physiological activities in experimental
strategy as antioxidants are capable to scavenge
animals, including vasodilative and hypotensive
free radicals from the radiolysis of water and to
activities (9), anti-inflammatory (10) and antioxidant
protect cells from damage(4). Radio-protectors aim
properties (8).
to control the initial damage induced in the

Full Paper (vol.781 paper# 9)

c:\work\Jor\vol781_10 The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (1), Page 68-76

Protective Role of Lycopene Extracted from Tomato (Tomato pomace) against
Gamma Irradiation or Carbon Tetrachloride-Induced Brain and
Liver Toxicity in Male Albino Rats
Hazem, K.A. Sarhan
Medical and Radiation Research Department, Nuclear Material Authority, Cairo, Egypt

Based on the effect of substance possessing antioxidant effect previously reported, it was
hypothesized that lycopene extracted from tomato (Tomato pomace), a substance possessing antioxidant
activity, might be able to protect against oxidative stress induced by either carbon tetrachloride or gamma
Materials and Methods:
A total of 72 experimental male albino rats were randomly divided into equal six
groups of twelve rats each. Group 1: served as the control group. Group 2: rats were administrated with (5 gm)
tomato extract/kg body weight by gastric lavage tube for 15 days. Group 3: rats were exposed to single dose (10
Gy) whole body gamma irradiation. Group 4: rats were administered with CCl4 only in groundnut oil (1:1) at a
dose of 3 ml/kg body weight by single intraperitoneal administration. Group 5: rats were treated with lycopene
extract for 15 days before exposure to single dose (10 Gy) whole body gamma irradiation. Group 6: rats were
treated with lycopene extract for 15 days before administered with CCl4 for 15 days.
Results: showed highly significant increase in activities of alanine transferase (ALT), aspartate amino
transferase (AST) and alkaline phosphatase (ALP) in serum, 24 hours after CCl4 administration or radiation
exposure. Highly significant decrease in activities of superoxide dismutase (SOD), catalase (CAT) and
glutathione (GSH) content in the brain tissues. Meanwhile, highly significant increase in MDA content in the
brain tissues. Supplementation with lycopene before CCl4 intraperitoneal administration or radiation exposure,
exerted marked amelioration of CCl4 and ionized radiation induced disturbances in all the investigated
parameters. Histopathological evaluation of the tissues also demonstrated a significant decrease in cellular
degeneration and infiltration parameters after lycopene administration. Therefore, lycopene could have a
beneficial role in modulating oxidative stress by improving the natural antioxidant mechanism.
: Administration of lycopene by using suitable stomach tube pre-CCl4 intraperitoneal
administration or gamma irradiated has significantly ameliorated the disturbances induced in all the
investigated parameters.
Oxidative stress, Brain, Ionizing radiation, CCl4, lycopene extract, Antioxidant enzymes.


Carbon tetrachloride (CCl4) is a clear,
which produces damage to membranes and
colorless, volatile, heavy and non-inflammable
industrial liquid, reportedly used to induce free
radical toxicity in different tissues of experimental
decomposition reaction of water producing a variety
animals. It can bio-transformed to tri-chloromethyl-
of reaction oxygen species (ROS) (5). ROS such as
free radical (CCl3 or CCl3OO), thus initiating the
hydroxyl radicals (OH), super-oxide anion radicals
chain reaction process (1) which is the most
(O -) and hydrogen peroxide (H2O2) are extremely
prominent mechanism of CCl4 in the generation of
reactive and react with the molecule of cell
tissue damage (2). This free radical and related
membranes that are composed of a double layer of
reactive species lead to oxidative stress, which
lipids with proteins dispersed throughout (6). Under
produces major interconnected changes of cellular
normal conditions, there is a balance between the
metabolism, increases the serum marker enzymes,
generation of ROS and the cellular antioxidant
and lipid peroxidation (3).
systems (7). Exposure to ionizing radiation produces
Injury produced by CCl4 seems to be
significant alterations in the oxidant activity in
mediated by reactive metabolite-tri-chloromethyl
tissues and causes overproduction of ROS leading
free radical (.CCl3) formed by hemolytic cleavage
to oxidative damage of the lipids, proteins and
of tri-chloromethyl per-oxy free radical (Cl3COO.)
DNA. The oxidation of polyunsaturated fatty acids
formed by the reaction of CCl
3 with O2
, which
in membrane induced by ROS is called lipid
attach ionic fatty acids in the membranes of
peroxidation (LPO). However, organisms have
endoplasmic reticulum, leading to secondary free
protective systems against ROS, like endogenous
radicals, which are subjected to attack by oxygen,
antioxidant enzymes. Superoxide dismutase (SOD),
and subsequent process, termed lipid peroxidation,
glutathione peroxidase (GSH-Px) and catalase

Full Paper (vol.781 paper# 10)

c:\work\Jor\vol781_11 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5847-5852

Role of Diagnostic Musculoskeletal Ultrasound in Assessment of Gouty Arthritis
Amira Ibrahim Sabra, Ali Eid Eldeeb, Alsiagy Ali Salama, Salwa Elmorsy Elsayed
Physical Medicine, Rheumatology & Rehabilitation, Faculty of Medicine, Tanta University
Corresponding author: Amira Ibrahim Sabra,email: amirasabra2015@yahoo.com

Gout is a chronic heterogeneous disorder of urate metabolism results in deposition of monosodium
urate crystals in the joints and soft tissues, with accompanying inflammation and degenerative consequences.
Aim of work:
Assessment of the role of musculoskeletal ultrasound (MSUS) in detecting changes in gouty arthritis
patients under anti hyperuricimic treatment. Patients and methods: 30 patients with gouty arthritis treated with
febuxostat 80 mg once daily for 3 months and 20 (age, sex & body mass index "BMI") matched controls were
included. Patients were assessed by clinical examination, pain by visual analogue scale (VAS), tenderness by Ritchie
index, functionally assessed using lower extremity functional scale & examination of joint effusion and tophi by
palpation. MSUS findings in knee and first metatarsophalangeal "1st MTP" joints of patients and controls were
reported before and 3 months after treatment. Results: BMI mean in patients group was 28.18 ± 1.49 (25-31) and in
controls was 27.67 ± 1.56 (25-31). VAS, tenderness & lower extremity functional scale in patients before treatment
in knee & 1stMTP joints significantly improved after treatment (p < 0.001). There was a significant improvement in
ESR, CRP, serum uric acid, double contour sign & knee effusion in patients after treatment compared to before
Conclusion: Ultrasonography can detect changes related to treatment of gout with febuxostat. Febuxostat is a safe
and efficient anti hyperurecemic drug and is effective in treatment of gouty arthritis. Ultrasound is more sensitive in
detecting findings & changes of disease than clinical examination.
Keywords: gout, ultrasonography, gouty arthritis, double contour sign, tophi, febuxostat.


Gout is a chronic heterogeneous disorder of urate
Musculoskeletal Ultrasound (MSUS) has recently
metabolism resulting in deposition of monosodium
been identified as a promising new imaging modality
urate crystals in the joints and soft tissues, with
for gout, which would help provide an early, non-
invasive diagnostic tool. MSUS visualizes tissues as
consequences. It is the most common form of
acoustic reflections. Crystalline material reflects US
inflammatory joint disease in men aged 40 years )1(.
waves more strongly than the surrounding tissues, such
Gout is associated with group of conditions
as unmineralized hyaline cartilage or synovial fluid.
which may be characterized by an elevation of serum
This enables distinction of monosodium urate (MSU)
uric acid (usually), recurrent attacks (flares) of an acute
crystal deposition from the less echogenic surrounding
inflammatory arthritis with monosodium urate crystals
soft tissues. Monosodium urate (MSU) crystals are
demonstrated in synovial fluid, bone and joint
found in the cartilage, tendon sheaths, synovial fluid
destruction in some cases and aggregates of uric acid
and subcutaneous tissue. Ultrasound detects deposition
crystals (tophi) in and around joints, soft tissues and
of monosodium urate (MSU) crystals on cartilaginous
various organs. Tophus in bone leading to erosions in
surfaces, as well as tophaceous material and typical
some cases )2(. The primary goal in management of
erosions )5(.
gout is reduction and maintenance of serum uric acid in
The aim of this study was to assess the role of
a sub-saturating range (usually < 6.0 mg/dl). The two
musculoskeletal ultrasound (MSUS) in detecting
pharmacological methods currently employed for urate
lowering in gout are reduction of urate production by
antihyperuricimic treatment.
use of the xanthine oxidase (XO) inhibitor (allopurinol)

and enhancement of urinary uric acid excretion with a
uricosuric agent )3(.
This study included 30 patients with primary gout
Febuxostat is an orally-active, potent, non-
fulfilled "2015 Gout Classification Criteria: an
purine, selective xanthine oxidase inhibitor. It is
American College of Rheumatology/European League
indicated in adults for the treatment of chronic
against Rheumatism Collaborative Initiative" )6(. They
hyperuricemia in conditions where urate deposition has
were selected from the Outpatient Clinics of Physical
already occurred. Febuxostat 40-120 mg/day rapidly
and sustainably reduces serum uric acid by 25-70% in
Department of Tanta University Hospitals. In addition
uric acid underexcretors and overproducers )4(.
to 20 apparently healthy volunteers with matched age,

Full Paper (vol.781 paper# 11)

c:\work\Jor\vol781_12 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5853-5857
Study of Serum Uric Acid level in Thyroid Disorders
Mohamed Nabil Rafat1, Mohammad Mossaad Alsayyad2, Magdy Zaky El Ghannam3
and Mahmoud El Sherif Rafat*2
1Department of Internal Medicine; Faculty of Medicine, Al-Azhar University (Cairo)
2Department of Internal Medicine; 3Department of clinical pathology; Damietta Faculty of Medicine, Al-
Azhar University
*Corresponding author: Mahmoud El Sherif Rafat, Mobile: (+20) 01002861451, E-Mail: mahmoud.2005@yahoo.com

Background: Thyroid dysfunction affects hundreds of millions globally, serum uric acid (UA) elevation has been
found to be related to thyroid dysfunction according to some studies. Thyroid dysfunction affects the purine
nucleotide metabolism that may increase uric acid concentration, which is the end-product of purine metabolism
and is a primary risk factor for development of gout.
AIM OF THE WORK: The aim of this study was to estimate the frequency of hyperuricemia in patients with
thyroid dysfunction whether hypothyroid or hyperthyroid.
Patients and methods: This is a case control clinical study that was conducted in Internal Medicine Outpatient
Clinic and Inpatient Department of Internal Medicine at Al-Azhar University Hospital, Damietta.
The population of the study were classified into 50 hypothyroid patients (group I), 50 hyperthyroid patients (group
II) and 50 normal as control (group III). All were subjected to full history, clinical examination and laboratory
tests including, complete blood count, serum urea, serum creatinine, estimated glomerular filtration rate, lipid
profile, thyroid stimulating hormone, free triiodothyronine and free thyroxine. Investigations included
echocardiography, electrocardiography and thyroid ultrasound.
Results: There was significant elevation of body mass index, blood urea, createnine, VLDL, TG, cholesterol, Uric
Acid, TSH in group I as compared to group II & III. Additionaly, there was statistically significant elevation of
estimated glomerular filteration rate, FT4, FT3 in group II in comparison with groups I & III. Also, there was
significant increase in IHD, pericardial effusion, in group I and statistically significant increase in pulmonary HTN
in group II.
Conclusion: The uric acid level was elevated in both hypothyroidism and hyperthyroidism, the elevation was
more in hypothyroidism concomitant with the elevation of other parameters that characterize chronic kidney
disease such as creatinine, estimated glomerular filtration rate and blood urea indicating that the decreased
excretion of uric acid was the leading pathogenesis to this elevation in hypothyroidism
Keywords: Hyperuricemia, Thyroid dysfunction, Gout, VAI.

the risk of all mortality causes but can also affect the
Thyroid dysfunction affects the purine
management and prognosis of the disease (5).
nucleotide metabolism that may increase uric acid
During the last few years, a growing attention
concentration, which is the end-product of purine
has been paid to uric acid due to its involvement in
metabolism and is a primary risk factor for
development of gout. Uric acid has been considered
epidemiological studies reported a relation between
as a non-specific finding, unless it is complicated by
serum UA levels and traditional cardiovascular risk
gout or renal stones (1).
factors, including hypertension (HTN), metabolic
syndrome and diabetes mellitus (DM), suggesting a
stimulating hormone, tri-iodothyronine and free
possible pathophysiologic link between these
thyroxine being essential for the optimal functioning
conditions (6).
of almost all body tissues, play a critical role in

growth, cell differentiation and cellular metabolism
(2). Therefore, abnormal production of thyroid
The aim of this study was to estimate the
frequency of hyperuricemia in patients with thyroid
abnormalities leading to increased risk of metabolic
dysfunction whether hypothyroid or hyperthyroid.
syndrome, cardiovascular and musculoskeletal

disorders (3).
Similar to thyroid dysfunction, the increased
This study is a case control clinical study that was
serum uric acid (SUA) levels are also associated with
carried out on one hundred and fifty
other co-morbid conditions including hypertension,
individuals attending to Internal Medicine Outpatient
metabolic syndrome, chronic kidney disease and
Clinic and Inpatient of Internal Medicine
type 2 diabetes mellitus (4). The concurrence of
deranged SUA levels in patients suffering from
Azhar university hospital, Damietta. The population
primary thyroid dysfunction may not only increase
of the study were classified as follow:

Full Paper (vol.781 paper# 12)

Review of the literature The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5858-5865

Management of Football Players Injuries at Dakahlia Governorate
"Analytical Study"
Mohammed Ali Abd Elhamid Ali*, Mohamed Ahmed Yehya, Faisal Ahmed Hashem Elsherief
Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Azhar University
*Corresponding author: Mohammed Ali AbdElhamid Ali, Mobile: (+20) 01008998030,
E-Mail: asem.eisa.@gmail.com

: No research on the medical specialty of soccer injuries in Egypt, despite its importance for
injury prevention designing in a country with restricted football medicine resources. The aim of this study was to
evaluate the incidence and pattern of injuries in soccer players.
Objective: The aim of this analytical study is to evaluate the incidence, severity and pattern of injuries and follow
up of outcome results of the management procedures done for football players at Dakahlia Governorate season 2017
Patients and Method: A prospective study was conducted during season 2017-2018 which a complete of 154
players with associating age vary of 18­35 years. Physiotherapists recorded team exposure and injuries.
Participants: Five teams of 2nd Egyptian league at Dakahlia.
Results: A total of 350 injuries occurred during season 2017-2018 giving an injury incidence of 9.4 injuries/1,000
hours, on average 31 players per team. The average player participated in33 ± 4 matches and had 170 ±15 training
sessions each season. Of all included injuries 250 (71.4%) were acute injuries, where as 100 (28,6%) were overuse
injuries, with 212 (60.6%) occurring during matches and 138(39.4%) during training. On average, a player sustained
2.3 injuries per season. The single most common injury subtype was hamstring strain, representing 14.8% of all
injuries, severe injuries constituted 12%, ankle injuries represent 10.9%, fractures represent 2.8%, dislocations
represent 1.7%, ACL injury represent 1.2%, medial meniscal injury represent 2.3% and tendon Achilles rupture
represent 0.6%, concussion accounted for 1.7% of all injuries. Re-injuries constituted 9% of all injuries.
Conclusions: The overall incidence of injuries among players in Egypt is high because of lack of medical personnel
and medical care, lack in documentation of injuries and there is no rules or programs for injury prevention provided
by Egyptian Football Association. a lot of studies are required to completely perceive the pattern of injuries and
establish prevention programs.
Keywords: Football Injuries, Dakahlia Governorate, Sport injuries.


Football is one of the most popular sports in the
player. An injury can occur during the match (match
world (1-2), as many as about 200 million individuals
exposure), or during the training session(8).
playing that game, including about 200.000
Injuries can be classified by location, type, part
professional players(3).
of the body interested, and mechanism of injury, such
The Egyptian Football Association is the
as traumatic or overuse (8, 10). The main locations of
governing body of football in Egypt. It was founded
injuries are: head and neck (head, face, neck, cervical
in 1921, joined FIFA in 1923.The documented
spine), upper limb (shoulder, clavicle, hand/fingers,
Football player in Egypt around 750,320 players in all
elbow, wrist), trunk (pelvis/buttock, abdomen,
ages, genders, degrees all over Egypt(4).
lumbar spine, thorax and chest) and lower limb (hip,
Football players are at a high risk of injuries (5,
groin, thigh, knee, lower leg, ankle, foot and toes) (11).
6). Every elite male football player is supposed to be
The main types of injury are: traumatic, such as
exposed to injury at least once in a year, which affects
fracture, contusion or hematoma, laceration, muscle
his performance (2, 6).
or tendon strain and joint or ligament sprains or
Several classification systems for soccer injuries
overuse injuries (8).
have been developed (7). When a same type of injury
An overuse injury is caused by repeated micro-
re-affected the player, at the same sites, is considered
trauma without a single, identifiable event
responsible for the injury. A traumatic injury refers to
In terms of physical complaint, the injury can be
an injury resulting from a specific, identifiable
defined as: mild, if the loss of activity day is less than
event(10). Finally, two different circumstances can
1 week; moderate, if the rest period ranges between 1
lead to an injury: contact or non-contact with another
and 4 weeks; and Severe, if the loss of activity day is
player or object (12).
more than 4 weeks(9).
The diagnosis of injuries is based on clinical
Therefore, the injury severity is defined
medicine, fundamentally on symptomatology and
according to the number of days of activity lost by the
especially on the anamnesis of the injury mechanism

and physical examination. Imaging studies through

Full Paper (vol.781 paper# 13)

INTRODUCTION The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5866-5872

Can Hyponatremia Play a Role in Morbidity and Mortality in Chronic
Hepatic Patients in ICU at Aswan University?
Mohammed Zein Eldeen Hafez, Wael Abd El Gwad Abd Elaziz, Walaa Shazly Moustafa*
Department of Internal Medicine, Faculty of Medicine - Aswan University
*Corresponding author: Walaa Shazly Moustafa, Mobile: (+20) 01110098687, E-Mail: tantawy_wael@yahoo.com

Hyponatremia is a frequent complication of advanced chronic liver diseases related to an impairment in
the renal capacity to eliminate solute-free water that causes a retention of water that is disproportionate to the retention
of sodium, thus causing a reduction in serum sodium concentration and hypoosmolality.
Objective: The aim of this study is to evaluate the role of hyponatremia on morbidity and mortality in chronic liver
diseased patient in ICU unit at Aswan University Hospital. Matients and methods: This study included 90 patients
who were suffering of hyponatremia with chronic liver disease and selected from patients in Aswan University
Hospital. The patients were 61 males (67.78%) and 29 females (32.22%). Results: About (40%) of patients were
discharged and (60%) of patients died. First group: patients with mild hyponatremia about (67.71%) were discharged
and about (35.29%) died. Second group: patients with moderate hyponatremia about (65.7%) were discharged and
about (34.21%) died. Third group: all patients with severe hyponatremia (100 %) died.
Conclusion: hyponatremia play important role in mortality rate of patients with chronic liver disease.
Keywords: Hyponatremia, Morbidity and Mortality, Chronic Hepatic diseases, ICU.


Chronic liver diseases (CLD) and its
had serum sodium concentration below the normal
complications are the major health problem, due to big
level (4). Bernardi et al. (8) reported that hyponatremia
burden of hepatitis C virus and hepatitis B virus in the
was in 30% of CLD cases and hyponatremia can
community. It is very common reason of admission to
induce or aggravate hepatic encephalopathy, leading to
hospitals (1). In the decompensation condition, cases
disease progression like seizures, coma and even brain
having CLD are generally presented with ascites,

hemorrhage, spontaneous bacterial peritonitis (SBP)
and hepatic encephalopathy (2). About 30% of patients
The aim of this study is to evaluate the role of
with CLD usually die due to portosystemic
hyponatremia on morbidity and mortality in chronic
encephalopathy (3).
liver diseased patient in ICU unit at Aswan University
The clinical course of patients with CLD is
frequently complicated due to increase in the renal

function abnormalities and imbalance of electrolytes
(4). The body disturbance of the water is the main sign
This study included 90 patients who were
of advance cirrhosis (5), this phenomenon of
suffering of hyponatremia with chronic liver disease
disturbance of water is linked to the existence of ascites
and selected from patients in Aswan University
and is characterized by the development of dilutional
hyponatremia, which is a frequent complication and

sequel of chronic liver disease (4). One study indicated
Inclusion criteria:
that hyponatremia is a key prognostic factor in patients
1. Both genders were included.
with CLD (6). The prevalence of hyponatremia [serum
2. Chronic liver disease of any etiology presented by
Na < 130 mEq/L] in patients with cirrhosis with ascites
hepatic encephalopathy, hematemesis, melena,
is approximately 30% (7).
refractory ascites and SBP.
The relationship between hyponatremia and
Exclusion criteria:
severity of cirrhosis is associated with the development
1. Patients with hepatocellular carcinoma.
of complications. Hepatic encephalopathy, hepatorenal
2. Heart failure.
syndrome and spontaneous bacterial peritonitis (SBP)
3. Chronic kidney disease (CKD).
are more presented in cases having serum

concentration < 130 mEq (6).
Furthermore in cases having ascites, those
The patients were 61 male (67.78%) and 29
having hyponatremia have a lower diuretics response,
female (32.22%).
higher frequency of refractory ascites, and frequent
The study is a cohort study and was conducted
requirement of the therapeutic paracentesis (8). A study
at Aswan University Hospital (ICU unit). The study
from Pakistan demonstrated that 51.6% of CLD cases
was hospital-based clinical study on chronic liver


Full Paper (vol.781 paper# 14)

c:\work\Jor\vol781_15 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5873-5875

Platelet Rich Plasma in Repeated Implantation Failure in Women with
Thin Endometrium Thickness
Mahmoud A. El Hamedi1 and Hesham A. Salem2*
Department of Obstetrics and Gynecology
Faculty of Medicine, 1Zawia University, Libya and 2Tanta University, Egypt
*Corresponding author: Prof. Hesham A. Salem, E-Mail: prof.hesham_salem@hotmail.com, Mobile: +201223488672

repeated implantation failure (RIF) is a major challenge in reproductive medicine. Platelet rich plasma
(PRP) was able to promote the endometrial growth and improve pregnancy outcome of patients with thin endometrium.
Aim of the study: it was to evaluate the effectiveness of intrauterine infusion of PRP in treatment of thin endometrium
in frozen-thawed embryo (FTE) transfer.
Patients and Methods: the study included 10 infertile patients with thin endometrium (<7mm) in Frozen Embryo
Transfer (FET) program. Estradiol valerate 12 mg/d was started on day 3 of menstrual cycle. PRP was prepared from
autologous blood and infused into the uterine cavity. Endometrial thickness was re-assessed and if the endometrial
thickness wasn't satisfactory infusion of PRP was repeated 2-4 times. Cleavage stage embryos were transferred on the
3rd day after progesterone administration, and blastocysts were transferred on the 5th day after progesterone
Results: the endometrial thickness increased after PRP infusion in all the patients, and reached >7mm on the day of
progesterone administration. Sixty percent of the patients became pregnant; 83.3% continued pregnancy and 16.7%
experienced missed abortion.
Conclusion: intrauterine PRP may be effective in promoting endometrial growth, endometrial thickness, and improving
pregnancy out come in repeated implantation failure.
Keywords: Platelet Rich Plasma, Repeated, Implantation Failure, Endometrial Thickness


Repeated implantation failure (RIF) is a major
However, a number of women with thin
challenge in reproductive medicine. Despite several
endometrium remain non responsive even with the use
methods that have been described for management, still
of these strategies (9).
no universal agreement about any of these methods. The
Intrauterine infusion of platelet rich plasma
endometrium is one of the main factors in pregnancy
(PRP) is a new approach that had been suggested for the
during Assisted Reproductive Technology (ART)
treatment of thin endometrium (10).
treatment some cycle are cancelled due to inadequate
PRP is blood plasma prepared from fresh whole
endometrial growth. The pregnancy rate is increased
blood that has been enriched with platelet. It is collected
with growing endometrial thickness. In several studies
from peripheral veins and contains several growth
the minimum endometrium thickness for embryo
factors such as vascular endothelial growth factors
transfer was reported to be 7mm (1).
(VEGF), epidermal growth factors (EGF) and other
Platelet rich plasma (PRP) was able to promote
cytokines that stimulate proliferation and growth (11).
the endometrial growth and improve pregnancy outcome
Recently, PRP has been used in several medical
of patients with thin endometrium (2).
condition in ophthalmology, surgery and wound healing
Thin endometrium, non-responsive to treatment,
is still a challenge in assisted reproductive technique
(ART), which usually result in cycle cancellation and
The aim of this study is to evaluate the
unplanned embryo cryopreservation (3).
effectiveness of intrauterine infusion of PRP in treatment
Various strategies have been developed to
of thin endometrium in FTE (frozen-thawed embryo)
improve endometrial growth, uterine blood flow and
increase endometrial thickness. These strategies include

extended use exogenous estrogen, aspirin, vitamin E,
vaginal sildenafil citrate, electroacupuncture, and
Study design:
application of granulocyte colony stimulation factor (1,2,4-
This study is a non-randomized, non-controlled,
clinical trial.

Received: 3/11/2019
Accepted: 5/12/2019

Full Paper (vol.781 paper# 15)

c:\work\Jor\vol781_16 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5876-5882

Comparative Study between Endoscopic Transcanal Myringoplasty Versus
Microscopic Myringoplasty in middle age group (20-40 years)
Wael Hassan Abo-Elwafa, Mohammed Kamel Ibrahem Alawady, Hossam Mohammed Esam
Otorhinolaryngology- Faculty of Medicine - Al Azhar University
Corresponding author: Hossam Mohammed Esam,email: hossamesam49@gmail.com

The surgical goals of myringoplasty are the closure of the tympanic membrane perforation and
improvement of the hearing levels.
Aim of the work: To compare the results, advantages and disadvantages between endoscope and microscope in
PATIENTS AND METHODS: This study was carried out in the Otorhinolaryngology Department at Alhussin
and Bab-Alsharia University Hospitals. The study included 40 patients with a diagnosis of chronic suppurative
otitis media of tubo-tympanic type, divided into two groups and each group contained 20 patients. All patients
were operated by one surgeon.
Results: The difference in age, sex, side of diseased ear and size of perforation between the two groups was not
significant. In group (A) the circumference of the perforation was clearly visualized in all patients (100%). While,
in group (B) the circumference of the perforation could not be visualized in 7 patients (35%), 5 patients (25%)
required external auditory canal curettage and 2 patients (10%) required endoscope-assisted microscopic
myringoplasty to evaluate the ossicular chain. The difference between the 2 groups was significant (P.value =
0.004). In group (A) the graft was uptaken in 85% of patients while in group (B) the graft was uptaken in 80% of
patients with no significant difference between the two groups (p = 0.677).
Conclusion: The ability to easily negotiate through EAC, Panoramic, wide angle, and magnified view provided
by the endoscope and uninterrupted picture overcomes most of the disadvantage of the microscope.
Key words: chronic suppurative otitis media - endoscope ­ microscope.


Myringoplasty is mainly the treatment of choice
for the tympanic membrane perforations, whether
associated or not with non-suppurative chronic otitis
Otorhinolaryngology Department at Alhussin and
media (1). The surgical goals of myringoplasty are the
Bab-Alsharia University Hospitals. The study
closure of the tympanic membrane perforation and
included 40 patients. The age of all patients was > 20
improvement of the hearing levels (2).
years old with a diagnosis of chronic suppurative otitis
There has been an increase in the use of
media of tubo-tympanic type. The patients were
endoscopes in ear surgery in the last decade, not only
divided into two groups, each group contained 20
as an adjunct method, but exclusively (3). The use of
the endoscope for myringoplasty has a significant
- Group A: 20 patients were operated on using the
advantage because it is simple to use, not only for ear
endoscope-assisted myringoplasty.
examination, but also for repairing of the tympanic
- Group B: 20 patients were operated on using
membrane perforation. This provides a magnified
microscopic myringoplasty.
vision and enables the surgeon to change from a close
Inclusion Criteria:
up to a wide angle view rapidly, just by going closer
1) Patients having small, medium and large
or by withdrawing the endoscope. Further, it provides
(subtotal) dry perforation of tympanic
an all-round view to the surgeon, who can rotate the
angled endoscope to visualize the deep anterior canal
2) Patients having chronic suppurative otitis media
wall, anterior marginal perforations, anterior recess,
of tubo-tympanic type.
sinus tympani, fascial recess, hypotympanum and the
3) No evidence of infection in nose, paranasal
attic (4). Microscope gives binocular vision and allow
sinuses, nasopharynx and throat.
the surgeon to free his both hands for the operative
4) Fit for surgery.
work. The main advantage of the microscope is that
Exclusion criteria:
it provides a magnified view along a straight line (5).
1) Patients less than 20 years old or older than 40
The view during microscopic surgery is defined and
years old.
limited by the narrowest segment of the ear canal,
2) Wet ears.
while the endoscope can bypasses the narrow part of
3) Revision Myringoplasty.
the ear canal and provides a wide view, even by using
4) Patients with chronic suppurative otitis media of
a 0° endoscope (6).
attico-antral type (cholesteatoma).

Full Paper (vol.781 paper# 16)

c:\work\Jor\vol781_17 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5883-5892
Effect of Monocular Intravitreal Anti-Vascular Endothelial Growth
Factor Injection on the Fellow Eye
Samah R. Abd El-Moniem*1, Ahmed I. Abou El-Enin2, Afaf H. Rashwan1
1Department of Ophthalmology, Faculty of Medicine for Girls, Al-Azhar University, 2Department of
Ophthalmology, International Medical Center, Armed Forces, Cairo, Egypt.
*Corresponding Authors: Samah Reda Abd El-Moniem; Tel.: (+20) 1009686203;
Email: samahsemsema92@gmail.com

The contralateral effect of intravitreal Anti-Vascular Endothelial Growth Factor (anti- VEGF) on the
fellow eye is still controversial.
The aim of the current work was to evaluate the contralateral effect of anti-VEGF injection on the fellow
eye in patients with bilateral diabetic macular edema (DME).
Patients and Methods:
This prospective interventional study included a total of 30 female patients with bilateral DME
aged from 30 to 70 years, attending at Department of Ophthalmology, International Medical Center, Armed Forces.
This study was conducted to assess the effect of unilateral intravitreal injection of anti-VEGF on the fellow eye. It was
conducted between 2018 to 2019.
Results: The mean age ± SD was 61.0 ± 7.8 years and duration of DM was 17.50 ± 9.797 years. All patients were
obese with mean body mass index (BMI) 37.3 ± 3.5. 21 cases were hypertensive, 2 patients had albuminuria.
Statistically significant decrease in central retinal thickness (CRT) in both eyes were found with mean ± SD reduction
83.07 ± 31.67 µm in injected eye and 11.30 ± 12.78 µm in the untreated eye from baseline, no significant improvement
in best corrected visual acuity (BCVA). There was no significance correlation between hypertension and improvement
in CRT, while the patients with albuminuria showed worsening in CRT in untreated eye.
Conclusion: It could be concluded that ranibizumab can escape into the systemic circulation and reduce contralateral
CRT and the systemic condition could affect the outcome of the treatment.
Keywords: DME, anti-VEGF, fellow eye.


The incidence of diabetic retinopathy including
eye in patients with bilateral diabetic macular edema
diabetic macular edema (DME) which is the most
common microvascular complication of DM, increased

to alarming level and it considered the major causes of
severe visual impairment in DM along with (1).
This prospective interventional study included a
Vitreous VEGF levels which is an important
total of 30 female patients with bilateral DME aged from
mediator in DM has been observed to be high in DME,
30 to 70 years, attending at Department of
using VEGF inhibitors (anti-VEGF) was believed to be
Ophthalmology, International Medical Center, Armed
beneficial in reversing the loss of vision caused by
Forces. This study was conducted to assess the effect of
macular edema. Trials have handled the efficacy and
unilateral intravitreal injection of anti-VEGF on the
safety of different types of anti-VEGF in the treatment
fellow eye. This study was conducted between 2018 to
of DME, including Pegaptanib, ranibizumab,
bevacizumab, and aflibercept (2).

However, the observation of fellow eye effects,
Ethical approval:
along with the pharmacokinetic studies showing
concentrations of the agents in the bloodstream
obtained.Written informed consent from all the subjects
correlating with reduction in circulating free VEGF
were obtained.
levels, provide biologic possibility of potential systemic
The inclusion criteria were diabetic patients with
effects of these agents (3).
bilateral diabetic macular edema. The exclusion criteria
So, it is suggested that anti-VEGF agents reach the
were previous history of cataract surgeries in last six
untreated eye through the systemic circulation (4), but the
months, eyes with optic nerve pathology, previous
potential effect of unilateral injection of anti- VEGFs in
macular edema treated by laser or anti-VEGF injections,
the fellow eye is still doubtful in spite of some case
previous history of subtenon or intraocular steroid
reports of therapeutic effects after monocular injection
injection, Presence of other retinal diseases and previous
of anti-VEGFs in the fellow eye (5).
history of vitreo-retinal surgeries.
The aim of the current work was to evaluate the

contralateral effect of anti-VEGF injection on the fellow
Full ophthalmic and medical history were taken.

All patients were subjected to Full ophthalmological

examination, visual acuity by snellen chart, pupils

Full Paper (vol.781 paper# 17)

c:\work\Jor\vol781_18 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5893-5899
Effect of Aging on Left Ventricular Function by Real Time
Three-Dimensional Speckle Tracking Echocardiography
Youssef Fathy Nosseir1, Mahmoud Hassan Taha El Arousy2, Mohamed Moanes Mohamed
Mohey El Din1, Muhammad Mahmoud Sameh Muhammad Mahmoud1
1Departemnt of Cardiology, Faculty of Medicine, Al Azhar University,
2Departemnt of Cardiology, Islamic Centre of Cardiology, Al Azhar University

Three-dimensional echocardiography (3D-Echo) has been incorporated into routine clinical practice in
many echocardiography laboratories, as it provides many advantages in the evaluation and study of heart diseases.
Objective: To estimate the maximum normal systolic reference value of AS in a sample of healthy subjects. Patients
and methods:
This study was conducted in the Islamic Cardiology Centre in Al Azhar University, Real Time 3D
Speckle Tracking Echo data set was acquired over 24 months in 90 healthy subjects divided into 3 main groups
according to their age: 1- First Group 16-30 years old, 2- Second Group 31-50 years old and 3-Third Group 51-65
years old. Results: II and age group III were -22.07 ± 1.48%, -19.40 ± 1.98% and -17.67 ± 1.52% respectively. Our
study showed that the mean Global Longitudinal Strain at age group I, age group II and age group III were -19.2 ±
1.52%, -18.9 ± 1.96% and -17 ± 0.99% respectively. The present study showed that the mean Global Area Strain at
age group I, age group II and age group III were -29. 1±1.31%, -28.5 ± 1.76% and -28.1 ± 1.65% respectively. Our
present study showed excellent intraobserver reproducibility of the results and an overall acceptable interobserver
reproducibility of strain measurements.
Conclusion: Global area strain derived from three-dimensional speckle-tracking may be applied clinically as a
supplementary diagnostic method since strain imaging can identify LV dysfunction earlier than conventional methods.
This opens a new perspective in heart failure prophylaxis and primary prevention with institution of therapeutic
measures before the patients develop symptoms and irreversible myocardial dysfunction.
Aging, Left Ventricular Function, Real Time Three-Dimensional Speckle, Tracking Echocardiography.


fractions, (2) investigate the effect of drug therapy on
echocardiography (STE) is an emerging technology
LV mechanics, and (3) evaluate LV function during
used to quantify left ventricular (LV) function.
serial follow-up studies (2).
However, the accuracy and normal values of LV strain
3D STE derives several parameters, including
and twist using 3D STE have not been established in a
longitudinal, circumferential and radial strain, as well as
large group of normal subjects. The aim of this study
a combined assessment of longitudinal and
was to establish age-related normal values of LV strain
circumferential strain, termed area strain. 3D STE can
and torsion using real-time 3D echocardiographic
also quantify LV rotational movements such as rotation,
(RT3DE) images (1).
twist, and torsion. 3D STE provides a better insight on
global and regional myocardial deformation. Main
allows the quantification of left ventricular (LV) global
and regional function, which provides clinically useful
applications include detection of subclinical myocardial
information in different clinical scenarios (2).
involvement in heart failure, arterial hypertension,
Because of inherent limitations of two-
dyssynchrony, and ischemic heart disease (4). Three-
dimensional (2D) speckle-tracking for the analysis of
dimensional STE is a new technology used to quantify
LV mechanics, recent investigational efforts have
LV global and regional function (5). Theoretically, 3D
shifted to speckle-tracking analysis using real-time
STE should be more accurate than 2D STE, because the
three-dimensional (3D) echocardiographic (RT3DE)
speckles are confined within the pyramidal volume scan.
data sets. 3-10 Validation of 3D STE has been performed
In this manner, 3D STE should eliminate the
in animal studies using sono micrometry as the reference
confounding effects of through-plane myocardial
standard and in simulated models and in vitro as well (3).
motion, which may affect the accuracy of LV strain
However, the validity of 3D STE in human subjects has
measurements using 2D STE (6). However, the lower
yet to be determined because of the lack of a noninvasive
temporal and spatial resolution of RT3DE could
reference standard. Also, the establishment of normal
adversely affect the accuracy of 3D speckle-tracking
values of 3D speckle tracking echocardiographic
parameters over a wide range of ages is important before
echocardiographic measurements in patients with data
using this new technology in clinical investigations, to
sets at the lower range of frame rates (7).
be able to: (1) detect subtle LV dysfunction in patients
Area Strain (AS) stands out as a particularly
with normal LV ejection
novel method with a high potential for clinical

applications. This new parameter combines an analysis
of both the longitudinal and circumferential deformation

Full Paper (vol.781 paper# 18)

The Effect of Probiotics on Reducing Duration of Hospitalization in Infants with Indirect Hyperbilirubinemia The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5900-5905

The Effect of Probiotics on Reducing Duration of Hospitalization in
Infants with Indirect Hyperbilirubinemia
Amira Mohammed Mohammed Hamed1, Mona Mohamed Abdelmeguid2,
Shehab Ahmed Abdel Maksoud Omar*1
1Department of Pediatric, 2Department of clinical pathology, Faculty of Medicine, Al-Azhar University
*Corresponding author: Shehab Ahmed Abdel Maksoud Omar,
E-mail: shihabahmed2017@gmail.com, Mobile: (+20) 01156276379

: In recent years, the tendency to use drugs has been increasing in the treatment of neonatal
jaundice. Several drugs have been used since then, but the effect of probiotics on serum bilirubin level (SBL)
is not so clear. This study was conducted to evaluate the effect of probiotics on SBL and the duration of
phototherapy in term neonates with hyperbilirubinemia.
Objective: The aim of this study was to evaluate effects of probiotics on neonatal jaundice in reducing
hospitalization duration.
Patients and Methods: In this randomized clinical trial, we studied 100 term neonate with jaundice
hospitalized for phototherapy in AL Azhar Hospital, during August 2017 till January 2018. Eligible neonates
were randomly divided into two groups; probiotic group and control group. Both groups received standard
conventional phototherapy, but the intervention group received sachet on 10 ml of probiotic containing
formula until hospital discharge. The outcome variables were SBL and the duration of phototherapy.
Results: The 1st group had a significantly lower hospitalization stay in comparison to the 2nd group. The first
group showed 3.34 ± 0.70 days and the second group showed 3.7 ± 0.74.
Conclusion: Oral probiotics in neonates with jaundice have significant effect on SBL and the duration of
phototherapy. Further studies are needed with longer time follow up.
Keywords: Bilirubin, Jaundice, Newborn, Phototherapy, Probiotic.


General data: Jaundice is a yellow
and preventing its complications is phototherapy,
discoloration of the skin and mucus membrane.
which has been applied for decades as a safe
Jaundice is not a disease, but is a symptom of an
method (7).
elevated blood bilirubin level. Jaundice is a
Probiotics are defined to be non pathogenic
marker used to identify those infants who may be
strains of organisms that are incorporated into the
at risk for developing severe hyperbilirubinemia.
diet to modify gut microbial ecology leading to
Severe hyperbilirubinemia can be toxic to the
beneficial structural and functional changes in the
nervous system of infants, potentially causing
gut. Probiotics are microorganisms, which can
brain damage (1).
decrease the transit time of materials in the
One of the most prevalent clinical conditions in
intestines (8). A few studies assessing the eff ect of
probiotics on decreasing bilirubin levels have
hyperbilirubinemia, which is a common clinical
reported decreases in the required length of
problem encountered during the neonatal period,
phototherapy (9 & 10). In addition, some may carry
especially in the first week of life (2).
metabolic functions such as helping the
Hyperbilirubinemia is the most common cause of
fermentation of non-digestible fibers, and storing
hospitalization in infancy. Physiological icterus is
energy in the form of short-chain fatty acids.
a common cause of infantile hyperbilirubinemia,
Bifidobacteria and Lactobacilli are considerd the
which is diagnosed by ruling out other important
two most essential bacteria beneficial to human
etiologies such as hemolysis, infections and
health (11). The role of probiotics in human body
metabolic disorders (3).
has been explained by different pharmacological
Hyperbilirubinemia is the most common cause
mechanisms. For example, they can rapidly
of readmission in early infancy (4 & 5). In 2% of
increase the number of anaerobic bacterial
mature infants, bilirubin levels can reach more
colonies, promote the recovery of intestinal
than 20 mg/dL, which requires therapeutic action
microflora balance, and resist infections in some
and may result in complications such as
cases (12).
kernicterus and neurological damage (6). The aim
of managing hyperbilirubinemia is to prevent
The aim of this study was to evaluate
neurological damage. The most prevalent
effects of probiotics on neonatal jaundice in
therapeutic method form an aging infantile icterus
reducing hospitalization duration.

Full Paper (vol.781 paper# 19)

c:\work\Jor\vol781_20 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5906-5910

The Prevalence of Thyroid Cancer in Patients with Multinodular Goiter
Mansour Mohamed Kabbash, Hassan Ahmed Abdallah, Anwar A. El Shenawy,
Mostafa Mohamed Sayed Mohamed*
Department of General Surgery, Faculty of Medicine, Aswan University, Egypt
*Corresponding author: Mostafa Mohamed Sayed Mohamed, Mobile: (+20) 1144376088, Email: tantawy_wael@yahoo.com

Thyroid cancer is the most common endocrine carcinoma, as it accounts for almost 90% of all endocrine
malignancies. The incidence of thyroid carcinoma is about 1-3 cases in every 100,000 population. During the last 30
years, the rate of thyroid cancer incidence has increased worldwide.
Objective: The aim of this work was to determine the frequency of thyroid carcinoma in multinodular goiter in
patients undergoing thyroidectomy to make a strategy to perform total thyroidectomy (TT) as a rule of treatment.
Patients and methods: This retrospective study included the medical charts and surgical data of a total of 50 patients
who underwent surgery for goiter at General Surgery Department, Aswan University Hospital between 2015 and 2018.
Results: The present study showed that the frequency of papillary carcinoma was 6% of all thyroid diseases (from 50
patients), 60% of incidental thyroid carcinoma as the frequency was high in the 4th decade of life. The present study
showed that the frequency of follicular carcinoma was 2% of all thyroid diseases (one case), 20% of ITC. Patient was in
the 4th decade. The present study showed that the frequency of undifferentiated thyroid cancer was 2% of all thyroid
diseases. Conclusion: It could be concluded that, according to the finding of this study, total thyroidectomy is the
preferred method in benign thyroid disease for which surgery is indicated. The advantages of TT include reduction of
recurrence rate, achieves a permanent cure of thyroid disorders.
Keywords: Thyroid Cancer, Multinodular Goiter, CT, MRI, PET scan.


Multinodular goiter (MNG) is defined as an
increasing prevalence of incidental thyroid carcinoma
enlarged thyroid gland with multiple nodules. Patients
(ITC) among these patients but also the incidence of
with MNG may undergo surgery to address goiter
TC in recurrent goiter. Total thyroidectomy is the clear
enlargement, which can cause compressive symptoms
procedure of choice for the treatment of most TCs;
or cosmetic concerns; thyrotoxicosis; indeterminate
cytology and suspicious or diagnosed malignancy (1).
recommendation for MNG management that takes into
According to the National Cancer Institute
account the prevalence of ITC (5).
Surveillance, Epidemiology, and End Results (SEER)
Optimal oncologic treatment for thyroid cancer
Program, TC represents 3.4% of all cancers diagnosed
involves preoperative lymph node evaluation with
yearly. By 2030 TC, would become the fourth leading
ultrasound and compartment-oriented dissection of
cancer diagnosis, following breast, prostate and lung
pathologically cancerous nodes. Hence, there are clear
carcinomas (2).
advantages to having a cancer diagnosis prior to
The more frequent use of sensitive diagnostic
proceeding with any surgery as a second operation
obviously carries additional risks, costs, and stress for
examination, imaging techniques like CT scan, MRI or
the patient (6).
PET scanning, and biochemical markers, has increased
The aim of this work was to determine the
the detection of many types of cancer (3).
frequency of thyroid carcinoma in multinodular goiter
Ultrasound-guided fine needle aspiration
in patients undergoing thyroidectomy to make a
(FNA) is used to evaluate the thyroid nodule.
strategy to perform total thyroidectomy as a rule of
This technique of good sensitivity is simple,
treatment in any patient with multinodular goiter
minimally invasive, rapid, and the complications are
planned to be operated.
rare and minor (hematoma at the point of puncture,

pain, vagal discomfort). It has improved the selection
of patients who are candidates for surgery (4).
This retrospective study included the medical charts
As far as the thyroid is concerned, ultrasound
and surgical data of a total of 50 patients who underwent
and cytology examinations have identified an
surgery for goiter, attending at General Surgery
increasing number of small, asymptomatic thyroid
Department, Aswan University Hospital between 2015
cancers. Finally, the incidental discovery of preclinical
and 2018.
thyroid tumors at pathology examination may be more

frequent because of the increased use of enlarged
Ethical consideration:
surgical excision (total or subtotal thyroidectomy) for
This study followed all regulations of the Ethical
non-malignant thyroid diseases (3).
Committee of Faculty of Medicine, Aswan
The optimal surgical procedure for MNG
University. Written informed consent of all the subjects
patients remains a subject of debate, due to not only the

Full Paper (vol.781 paper# 20)

c:\work\Jor\vol781_21 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5911-5921

Is Laparoscopic Appendicectomy an Acceptable Approach in
Management of Patients with Acute Appendicitis?
Ehab Motawa Eisa El-Houseini*, Hussein Ali Abdelmoteleb, Mahmoud S. Ahmed
Department of General Surgery, Faculty of Medicine, Aswan University
*Corresponding author: Ehab Motawa Eisa El-Houseini, Mobile: (+20)01113647949, E-Mail: motawea84@gmail.com

Appendicitis is the most common cause of acute abdomen and appendectomy is the most
frequent surgical procedure performed in the world in recent times. In the last few years the number of
laparoscopic appendectomies performed around the world has dramatically increased.
Objective: The aim of the work is to study the acceptance and satisfaction of the patients as regards the
laparoscopic approach for management of acute appendicitis and evaluation the results.
Patients and methods: It was a comparative study included 100 consecutive patients with acute appendicitis.
They were given the options to accept the approach for appendectomy whether open or laparoscopic after
discussion the advantages and disadvantages of each approach and the last decision were left to the patient.
The study was approved by the medical ethics committee of Aswan University Hospital and a written informed
consent was obtained from all patients.
Results: The consecutive patients of age ranging from 15-45 years with features suggestive of acute
appendicitis were divided into laparoscopic appendectomy group (LA) 70 cases and open appendectomy group
(OA) 30 cases, after taking informed consent. LA was done with the help of three trocar/cannulae creating
pneumoperitoneum with CO2 whereas OA was performed by McBurney incision. The operating times in OA
and LA were 20-70 minutes (mean 30) and 25-95 minutes (mean 55) respectively. Increased doses of
analgesics, antibiotics and antiemetics were required in OA, as compared to LA. The mean postoperative
hospital stay in LA group was 1.4 days (range 1-3 days) whereas it was in OA group, it was 3.5 days (range 2-
6 days).
Conclusion: LA is safe and has major benefits like less postoperative pain, decreased wound infection, early
hospital discharged, early return to work and a better cosmetic scar than OA.
Keywords: Appendicitis, Appendectomy, Laparoscopic appendectomy.


In 1983, Semm(1) introduced the new
postoperative days (POD) 5 was reduced in
laparoscopic technique which replaced the open
patients undergone LA compared with that of OA.
procedure as the standard practice for several

surgical procedures. With the increased interest
with this laparoscopic technique, many researches
complication rate, including surgical wound
have been studying the outcomes of both the
infection and incision dehiscence was noted in
laparoscopic and open appendectomies in order to
patients with LA compared with OA (3).
establish a comparison between the two techniques
Diagnostic laparoscopy and laparoscopic
appendectomy are advisable in case of pregnancy
Laparoscopic appendectomy showed to be
up to 24 weeks. Woman should be under
less significantly associated with lower wound
observation of obstetrician-gynecologist in
infection and post-operative complication rate.
preoperative period to prevent premature birth and
Surgical time was considered as a hallmark of
abortion (4).
technical challenge and resulted diminished in the
Reduced adhesion formation is a
laparoscopic group. Intra-abdominal abscesses
substantive long-term advantage of laparoscopic
formation rate was higher in the open
appendectomy. The adhesion rate after open
appendectomy group, although slightly above the
appendectomy is more than laparoscopic
statistical significance threshold. Laparoscopic
appendectomy which noticed by following up of
approach seemed to show relevant advantages
the patients for three months after surgery (5).
compared to open appendectomy (2).
The laparoscopic approach
The patients with LA experienced prompt
to decrease the risk of adhesion formation by 45%
postoperative gastrointestinal function recovery in
after appendectomy
comparison with patients with OA. Furthermore,
appendectomy was associated with a 57%
the immunologic and inflammatory variable white
reduction in overall morbidity in all the obese
blood cell (WBC) and C-reactive protein (CRP) on
patients. The length of stay was 1.2 days shorter for


Full Paper (vol.781 paper# 21)

c:\work\Jor\vol781_22 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5922-5929
Effect of Both Bisphenol - A and Liquorice on Some Sexual Hormones in
Male Albino Rats and Illustration of the Effect of
Stem Cell Enhancer on Their Actions
Eman G.E. Helal1, Dina Alsayed Zaki2, Mohamed A. Abdelaziz 3, Abeer Zakaria1,
1Zoology Department, Faculty of Science (Girls), Al-Azhar University-Cairo, Baterij Medical College-KSA,
3Physiology Department, Faculty of Medicine, Al-Azhar University-cairo.
*Corresponding Author: Eman G.E. Helal, E-mail: emanhelal@hotmail.com, Mobile: 00201001025364,

Background: Xenoestrogens are a type of xenohormone that imitates estrogen. They can be either synthetic or
natural chemical compounds. Synthetic xenoestrogens include some widely used industrial compounds, such
as PCBs, bisphenol A (BPA) and phthalates. "Dietary estrogen" is also called phytoestrogen, which is a plant-
derived xenoestrogen not generated within the endocrine system, but consumed by eating phytoestrogenic plants.
Stem cell enhancer (SCE) (StemEnhance®) is a novel mobilizer of bone marrow adult stem cells that was shown
to increase the number of circulating stem cells.
The aim of the current work was to clarify the effect of both BPA and liquorice together on some sexual
hormones and illustration of the effect of stem cell enhancer on their actions.
Materials and methods: Thirty male albino rats were used and were divided into three groups: Group I: control
(untreated group), group II: rats treated with BPA and liquorice and group III: rats treated with BPA and anise oil
in addition to stem cell enhancer. Blood samples were collected for different biochemical investigations.
Results: There was a highly significant increase (p < 0.01) in the level of ALT and AST activities, urea, creatinine,
FSH, prolactin, total cholesterol, triglycerides, LDL-C, VLDL, LDL/HDL and TC/HDL. While, there was highly
significant decrease (p < 0.01) in HDL-C, total protein, albumin, globulin, testosterone and LH. These results
turned back to the normal values after receiving the SCE as compared to normal group.
Conclusion: It could be concluded that phytoestrogen and xenoeostrogen have undesirable effects and it is
recommended to minimize the utilization of these compounds to protect people from its hazardous effects.
: BPA, Liquorice, Stem Cell Enhancer, Hormonal assay, Biochemical parameters.


constrituents. Licorice, from the dried roots of
The impact of endocrine disrupting chemical
Glycyrrhiza Glabra L (Fabaceae), is one of the
exposure on human health is receiving increasingly
common herbal medicines that are grown and used
focused attention especially bisphenol A (BPA). BPA
broadly in different regions of the world. Several
is one of the manufacturing compounds that are used
countries have used extracted licorice as a sweetening
in production of different plastic compounds and
additive in candies, tobacco and beverages. Licorice
polycarbonate and become universally used in the
has many components, including chalcones,
production of paper, food and beverage containers,
flavonoids, glycyrrhizic acid and glycyrrhizin, which
consumer goods and in many other industrial
is considered the major biologically active one.
applications (1). Researches showed that BPA has
Previous studies have reported that licorice root has
ability to leach out some products including
many medical activities such as antimicrobial, anti-
tableware, plastic lining of cans used for food, white
atherosclerotic, antiulcer, anticancer, anti-viral, anti-
dental fillings sealants and polycarbonate babies'
inflammatory, antioxidant effect and free-radical
bottles. The leaching occurred by exposure of the
scavenging activities. It has been used as a medical
plastic to high temperatures (2). The adverse effects of
raw material to reduce weight gain because of its
BPA are mostly due to its estrogenic activity. Their
diuretic effect. Also, it was used to increase white
actions are mediated by endocrine signaling
blood cell count, as an antidote, as a relaxant and as
pathways resulting in large changes in the cell
an expectorant (4). It is proved that licorice is effective
functions even at very low concentrations. These
in the detoxification and protection of the liver.
changes have deleterious effects on health including
Moreover, licorice root contains liquiritin apioside,
prostate and breast cancer. It has been reported that
which is a potent antitussive compound.
BPA induces oxidative stress in different body
Stem cell enhancer is a natural stem cell
organs. Furthermore, other effects of BPA have been
mobilizer that can trigger the release of millions of
recorded such as mitochondrial-mediated apoptosis
adult stem cells from bone marrow into the
in the hepatic tissue and inflammatory cytokine
circulation, and its considerable safety allows for a
dysregulation (3).
sustained oral daily intake over long periods of time
The herbs chosen for this study contain
(4). The product we carry is a blend of many
phytoestrogens as shown from their chemical
compounds extracted from the cyanophyta

Full Paper (vol.781 paper# 22)

c:\work\Jor\vol781_23 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5930-5946

Histological and Immunohistochemical Study of The Effect of Cyclophosphamide
on Testis of Male Adult Albino Rats and The Possible Protective Role of Vitamin E
Gamal S. El Gharabawy, Ezz El-Dein E. Abd Allah, Ibrahim M. Amr, Mohammed Elmitwalli*
Histology Department - Faculty of Medicine, Al-Azhar University
*Corresponding author: Mohammed Elmitwalli, Mobile: +20- 01094972119

cyclophosphamide is not only used as anticancer chemotherapeutic drug in adult and childhood
malignancies, but also used as an immunosuppressive agent for organ transplantation. Aim of the work: this work
was planned to evaluate the histological, immunohistochemical and ultrastractural changes in the testis of adult
male Albino rats after administration of cyclophosamide and the possible role of vitamin E supplementation and
drug withdrawal were explored.
Materials and Methods:
50 healthy male Albino rats weighted 200gm were categorized into 5 groups, (ten rats
each group). At the end of the experiment, the animals of all groups were anaesthetized by ether inhalation. Their
testes were dissected out carefully and processed for light and electron microscope examination. The testes were
immediately dissected out and the samples for light microscope were fixed in 10% neutral buffered formaldehyde
(pH 7.2) for 24-72 hours. Sections (5um thick) were obtained and stained with H&E, Mallory's trichrome, PAS
stains and immunohistochemicaly for detecting bcl-2 protein were used. Minute specimens were double fixed in
glutaraldehyde and processed to obtain semithin sections stained with toluidine blue and ultrathin sections (70nm)
for TEM.
Results: testes of the cyclophosphamide-treated adult rats and cyclophosphamide withdrawal group revealed thick
tunica albuginea, distorted and shrunken seminiferous tubules with wide interstitium in between. These tubules had
marked reduction in the thickness of the germinal epithelium which appeared detached from irregular thick
basement membrane and wide empty lumina were devoid of spermatozoa. The germinal epithelium in these tubules
appeared degenerated with vacuolated cytoplasm and pyknotic nucle; the interstitium showed acidophilic hyaline
material, congested thickened blood vessels and numerous interstitial Leydig cells with pyknotic nuclei. Cross
sections of the middle and principle pieces of sperms showed disturbed axoneme. Cross sections in the sperms
detected the middle, principle and end pieces. In the middle pieces, the axoneme was surrounded by fibrous and
abnormal mitochondrial sheaths. The mitochondria in their sheath showed mild swelling, vacuolization and
distortion. Leydig cells had large oval euchromatic nuclei with widened perinuclear space. The cytoplasm contained
numerous mitochondria and dilated SER. using vitamin E with cyclophosphamide relatively improved the testicular
Conclusions: cyclophosphamide treatment produced marked changes in the histological structure of the testes
especially the germinal epithelium and sperms. This may lead to serious problems such as infertility or even sterility.
The histological affection of cyclophosphamide on testis persisted after stoppage of treatment which is an indication
of its cumulative effect. Supplementation of vitamin E with cyclophosphamide relatively improved the testicular
tissue. So, administration of vitamin E in patient received cyclophosphamide is mandatory to reduce its side effects.
Keywords: histological, immunohistochemical, clophosphamide, Albino,testis, ultrastructure.

benign diseases such as nephritic syndrome, multiple
Infertility is one of the most common public health
sclerosis and systemic lupus erythromatosis (2). The
problems that occur as a result of disturbance of
same authors added that CP is effectively maintained
spermatogenic process. This process (spermatogenesis)
remission of nephritic syndrome in patients who are
is characterized by complex sequential stages of
resistant to steroid and have frequent relapses. Emadi
et al. (3) reported that CP is an alkylating
chromatin remolding. The male germ cells are highly
agent and nitrogen mustard family of medications and
susceptible to genotoxicants. Some of these toxic
works by interfering with the duplication of DNA and
agents cause alteration of spermatogonia with
the creation of RNA. First, CP in the liver is
consequent decreased production of spermatozoa.
metabolized to 4-hydroxycyclophosphamide by
However, the others are quite toxic to cells of the
cytochrome P450 and then enters into cells and
spermatogenic lineage causing death of those cells and
spontaneously degrades to phosphoramide-mustard and
sterility (1). Cyclophosphamide (CP) is a class of
acrolein(4). Phosphoramide-mustard alkylates DNA
oxazaphosphorines. It is considered as an important
through alkyl groups is attaching to DNA and prevents
component of many drug regimens. It is not only used
its replication and inhibits tumor cells growth.
as anticancer chemotherapeutic drug in adult and
However, acrolein exerts toxic effects on the body's
childhood malignancies, but also used as an
healthy cell because it produces (ROS) and nitric oxide
immunosuppressive agent for organ transplantation.
and leads to production of peroxynitrite that destroys
Also, it is used for treatment of many acute and chronic
intracellular proteins, lipids and DNA (5).

Full Paper (vol.781 paper# 23)

c:\work\Jor\vol781_24 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5947-5953

Real Time 3-D Echocardiography for Evaluation of Left Ventricular Systolic
Function in Patients with Liver Cirrhosis Caused by Hepatitis C Virus
*Asmaa Ahmed Ali Hasan, *Nessren Mohamed Baha El Deen Mohamed
Cardiology Department and Tropical Medicine Department ­ El Zahraa University Hospital,
Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
Corresponding author: Asmaa Ahmed Ali Hasan, E-mail: dr.aahmedali@gmail.com, Mobile: 01281253583

Background: C
ardiovascular changes are associated with Liver cirrhosis so, it is important to assess its function in
cirrhotic patients. Child-Pugh scoring system is the simplest clinical method used for classifying liver cirrhosis. 3D echo
and 2D speckle tracking echocardiography (2D-STE) are the most recent imaging modalities able to evaluate LV systolic
function accurately. Aim: To assess LV systolic function in patients with chronic liver cirrhosis caused by HCV by
different echocardiographic modalities including 3D and STE and correlation of the results with the severity of cirrhosis
based on Child-Pugh score. Material and methods: A prospective study was done in Cardiology Department, Al-
Zahraa University Hospital including a total of 75 subjects; 45 cirrhotic patients and 30 subjects as a control. 2D, 3D LV
volumes and EF and 2D-STE of the LV were measured. Then, the patients' group was divided into 3 subgroups
according to Child Pugh score then LV systolic function were assessed with different echo modalities (2D, 3D and MM,
TDI (Sm) and, 2D STE). Results: The LVEF increased significantly in patient group by M-mode and 2D but decreased
by TDI, 3D echo and STE. Increased systolic velocity (Sa) by TDI in group III of cirrhosis but lowered systolic function
by using STE. Also, there was a significant correlation between severity of liver cirrhosis and LVEF by 2D STE, 3D and
2D. Conclusions: The recent noninvasive 3D echo and 2-D STE techniques are a promising methods for early detection
of LV systolic dysfunction in asymptomatic patients with viral liver cirrhosis. Also, the LV systolic dysfunction is related
to the extent of severity of liver cirrhosis.
Keywords: Liver cirrhosis ­ real time 3D - Ventricular function - Speckle tracking echocardiography- Child pugh score.


Echocardiography is considered a noninvasive
\conditions of stress (7). The relationship between the
method to assess cardiac function; however,
severity of liver disease and cirrhotic cardiomyopathy
conventional echo-Doppler technique has some
is not proved yet and it is still a matter of debate. The
limitations in its accuracy [1]. So, tissue Doppler
Child-Pugh scoring system is the most common clinical
imaging (TDI), speckle tracking imaging (STI), and
method used for assessing severity of liver cirrhosis. So,
real time 3 dimensional echocardiography (RT3DE)
we used it in this study [8, 9].
can be applied to overcome these limitations for the

quantitative assessment of regional myocardial
function. The recently developed 2D-STE modality has
This study enrolled a total of seventy five
an angle-independent in evaluation of the LV
subjects, forty five clinically stable (i.e. had not been
deformation which was from the spatial gradients of
hospitalized or undergone any interventions due to
myocardial velocities when using TDI or from the
cirrhosis within the previous 6 months), patients with
relative position of "speckles" within a myocardial
viral cirrhosis caused by HCV who were followed up at
region when using speckle tracking [2]. So, this modality
the Tropical Department of Al-Zahraa University
is considered more sensitive and accurate than
Hospital, between May 2017 and December 2018 and
conventional one in detecting any subtle ventricular
were referred to our echocardiography laboratory for
changes in function [3].
the assessment of LV systolic function. Thirty healthy
Heart failure, which related to cirrhotic
persons as a control group, age and sex-matched,
cardiomyopathy is considered the third leading cause of
selected from individuals who had no history of
death [4, 5]. So, it is important to evaluate cardiac
cardiovascular disease and who underwent a routine
function in patients with cirrhosis. Liver cirrhosis is also
physical examination with normal ECG and 2D-TTE
associated with many cardiovascular changes as
findings. The hypertensive or diabetic patients, pre-
hyperdynamic circulation due to increased cardiac
existing cardiac disease as RHD, congenital heart
output and decreased systemic vascular resistance [6].
disease, ischemic heart disease, myocarditis whether
Liver cirrhosis also is associated with normal systolic
due to infection in its etiology or whatever cause,
function at rest, systolic dysfunction under special
primary heart muscle diseases like cardiomyopathies,

poor image quality, any metabolic or systemic diseases

Full Paper (vol.781 paper# 24)

Introduction The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5954-5957

Surgical Intervention in Adhesive Intestinal Obstruction
Mansour Mohamed Kabbash, Abd.El-Aal Ali Saleem, Osama Abdallah Abdel Rheem,
Mohammed Abdel Raouf Adly Abd El-Rahman*
Department of General Surgery, Faculty of Medicine, Aswan University, Egypt
*Corresponding author: Mohammed Abd El-Raouf Adly Abd El-Rahman, Mobile: (+20) 1097404476,
Email: mohammedraouf111@gmail.com

Adhesive small bowel obstruction (ASBO) is a common cause for admission to surgical wards in
developed countries, particularly following colorectal and pelvic surgery. Despite advances in diagnosis and treatment,
the operative intervention rate is between 15 and 30%, the recurrence rate is up to 30% following surgery and the
mortality is between 2 and 8%.
The aim of current study was to report the time of surgical intervention of patient with adhesive intestinal
Patients and Methods: This study included a total of 50 patients with clinical diagnosis of adhesive SBO, attending
at Surgical Department, Aswan University Hospital. This study was conducted between January 2018 to December
2018. After clinical and radiological diagnosis of adhesive SBO, all patients were promptly hydrated with Ringer
lactate solution and their electrolytes and acid base imbalances were corrected.
Results: Successful conservative treatment was noted in 28 patients (66%) with discontinuation of nasogastric
decompression within an average period of 2 days followed by discharge on fourth day of admission. 22 Patients (44%)
underwent surgery, safe conservative management needed the pre- requisite of having ruled out any possibility if
strangulation of the bowel as the first step of management. As for hospital stay patients who underwent conservative
therapy have less durations of hospital stay (3-6 days) than those who underwent surgical intervention (7-14 days).
Conclusion: ABO remains a common clinical problem. Patients presenting with symptoms and signs consistent with
ASBO should undergo plain abdominal X-ray. If this confirms the diagnosis, and there is no clinical suspicion of
strangulation, a water soluble contrast agent should be administered by Nasogastric tube.
Keywords: Surgical, Adhesive Intestinal Obstruction, Management.


Acute intestinal obstruction occurs when there is
after operative trauma, resulting in intestinal contents to
an interruption in the forward flow of intestinal contents.
not pass smoothly (3).
This interruption can occur at any point along the length
Pelvic adhesions that follow trans-abdominal
of the gastrointestinal tract, and clinical symptoms often
gynecological surgery have long been implicated in
vary based on the level of obstruction. Intestinal
causing pain and infertility. Similarly, patients
obstruction is most commonly caused by intra-
presenting to the general surgeon display a spectrum of
abdominal adhesions, malignancy, or intestinal
adhesion related problems or morbidity. The treating
herniation. The clinical presentation generally includes
surgeon often faces difficulties with access and obscured
nausea and emesis, colicky abdominal pain, and a failure
normal anatomy which may lead either to an inability to
to pass flatus or bowel movements. The classic physical
apply minimal access surgery, prolongation of operative
examination findings of abdominal distension, tympany
time or result in potentially serious organ injury such as
to percussion, and high-pitched bowel sounds suggest
inadvertent enterotomy). Adhesions are estimated to
the diagnosis (1).
account for about a third of all bowel obstructions and
Many regions and countries have denoted
two-thirds of small bowel obstructions in the western
different tendency towards etiologic spectrum of
word (4).
intestinal obstruction, in the past few years adhesive
Managing adhesions and adhesion related
intestinal obstruction and malignant bowl obstruction
complications is expensive in terms of time , effort and
have replaced hernia. Intestinal obstruction accounts for
finance and impacts not only on the patient and the
approximately 15 percent of all emergency department
treating physician but also the health care system at
visits for acute abdominal pain. Complications of
large. The prolongation in hospital stay, re-admissions,
intestinal obstruction include bowel ischemia and
repeated surgical interventions and litigation impose an
perforation. Morbidity and mortality associated with
enormous burden on the health care systems globally,
intestinal obstruction have declined since the advent of
making adhesion prevention an important area of health
more sophisticated diagnostic tests, but the condition
care intervention research (5, 6). As once established,
remains a challenging surgical diagnosis. Physicians
adhesions follow an unpredictable temporal course,
who are treating patients with intestinal obstruction must
which is attended by a lifetime risk of recurrent
weigh the risks of surgery with the conservative way (2).
symptoms, complications, re-admissions and repeat
Postoperative adhesion is defined as biochemical and
surgery, prevention seems to be the most viable strategy
cellular response that happens to repair the peritoneum
yet. Peritoneal injury, the attendant inflammation,

Full Paper (vol.781 paper# 25)

INTRODUCTION The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5958-5964

Laparoscopic versus Open Repair of Perforated Peptic Ulcer
Mansour Mohamed Kabbash, Osama Abdallah Abdel Reheem, Abd El Rahman Mohamed Hussein
Department of General Surgery- Faculty of Medicine, Aswan University

H. pylori infection and nonsteroidal anti-inflammatory drug (NSAID) usage contribute to a great
majority of cases. Thus, non-operative management of the disease is indicated in nearly all cases, with the exceptions
of hemorrhage, perforation, obstruction, and refractory disease.
Objective: Comparison between laparoscopic and open repair of perforated peptic ulcer as regards postoperative
advantage and complication. Patients and methods: 279 identified published observational studies (randomized
control trials and clinical control trials) after search strategy. Participants were patients that had done repairing of
perforated peptic ulcer. Laparoscopic versus open repair of perforated peptic ulcer.
Results: There was no significant difference in the operating time between the two groups (p Z 0.618). Overall, the
laparoscopic group had fewer complications compared to the open group (14.3% vs. 36.8%, p Z 0.005). When
reviewing specific complications, only the incidence of surgical site infection was statistically significant
(laparoscopic 0.0% vs. open 13.2%, p Z 0.003). The other parameters were not statistically significant. Although
total hospital costs were similar (P = .465), the median intraoperative costs were greater for LR than for OR patients,
at U6772 and U5626, respectively (P < .001). The median cost of ward stay tended to be U865 less in the LR group
but was not statistically relevant.
Conclusion: Laparoscopic surgery had upper hand over open procedure because of less intraoperative blood loss
and postoperative pain, less postoperative complications, shorter hospital stay, surgical site infection rate, shorter
nasogastric tube duration.
Keywords: Laparoscopic, Open repair, Perforated peptic ulcer, H. pylori.


Direct Helicobacter treatment and eradication is
laparoscopy is a surgical approach to therapeutic
paramount because complete mucosal healing occurs
option (6).
less than 0.5% of the time with persistent infection.
In this context, Mouret et al. (7) published in
Other notable sources implicated in benign disease
1990 the first results on the performance of
include smoking, steroid usage, and Zollinger-Ellison
laparoscopy for correction of perforated peptic ulcer.
syndrome (1).
The conclusion of the study showed that laparoscopy
Decades ago the practice of elective surgeries
is a good choice of surgical approach and it has the
to correct this type of ulcer was common. However,
advantages of reduction of problems with respect to
with the advancement of conservative clinical
the surgical wound and adhesions (5, 7). Besides,
treatment from the eradication of H. pylori and acid
improved and expanded view of the lesion, minor
control, mainly through the use of H2 blockers and
surgical incision, less pain during the post-operative
proton pump inhibitors (Ppis), the rate of performing
and faster return of patient activities compared to post
these surgeries decreased considerably in the last three
laparotomy findings (1, 8).
decades and the clinical management became enough
Despite, the development of laparoscopic
to treat (2). So, the surgical approaches current
surgery for peptic ulcer disease, no consensus
therapies are directed to cases of refractory peptic
conclusion favoring its application has been reached.
ulcer, perforated and bleeding (PUP) (3). The
Some research showed that laparoscopic surgery has
fundamental goals treat or prevent complications of
substantial advantages over open abdominal surgery
ulcer, reduce the secretion of acid to allow healing of
for peptic ulcer disease, including less postoperative
the ulcer and tempering their recurrence and minimize
pain and postoperative complications and shorter
postoperative sequelae related to operation (1).
hospital stay. However, the other research showed that
Although good results in clinical management of
laparoscopic repair is not superior to open abdominal
peptic ulcer disease, emergency surgeries have
surgery for peptic ulcer disease, and may even have
increased drilling (1, 4). It is estimated that 2% to 10%
worse outcomes including longer operative time.
of patients with gastric or duodenal peptic ulcer
perforation in the course of their lives have greater
confounding whether laparoscopic surgery have better
mortality risk in the elderly (1).
advantages than open abdominal surgery for
Currently the standard surgical treatment for the
perforated peptic ulcer (9).
PUP is the laparotomy (5). However, there are number
of deficiencies in this procedure with regard to a larger
To compare between laparoscopic and open
incision, considerable pain during the post-operative
repair of perforated peptic ulcer as regards
period and slow recovery. By these implications,
postoperative advantages and complications.

Full Paper (vol.781 paper# 26)

c:\work\Jor\vol781_27 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5965-5972

Treatment of Open Comminuted Diaphyseal Fracture of the Tibia by Ilizarov
Hany Zaki Saied1 , Wael Shaaban Mahmoud1,Kareem Samir Arafa2
1 Orthopaedic Surgery Faculty of Medicine for girls Al-azhar University,2Faculty of Medicine, Al-azhar University
*Corresponding author: Kareem Samir Arafa, Email: drkareemgms@gmail.com, Mobile: (+20) 1003252480

Management of open diaphyseal tibial shaft fractures can be comminuted due to lack of soft tissue
coverage and blood supply of the tibial shaft. Open reduction and internal fixation [ORIF] with plates and screws
achieves stability, allows joint mobilization but does not allow early weight bearing which as a stimulus is a must
for early union. Closed reduction and intramedullary fixation compromise the intramedullary blood supply and
increases the risk of infection in open fractures. Ilizarov is considered safe in treating these open injuries, at the
same time it has the advantages of easy application, minimal invasive, and convenient subsequent soft tissue repair.
Objective: The aim of current study was to evaluate treatment of open comminuted diaphyseal tibial fracture by
ilizarov external fixator; its effective, availability, outcomes and complications.
Patients and Methods: This prospective study included a total of 10 patients with comminuted tibial diaphyseal
fractures managed with early Ilizarov external fixator, attending at Alharam Hospital. This study was conducted
between Feb 2018 and July 2019. General assessment indicators included pain, complete union, deformity in
comparison to healthy limb, infection, leg limb discrepancy, stiffness and activity of the patients were analysed.
Results: Follow-up of all participants for analysis was done. The follow-up time was 17 months. Three cases
developed ankle stiffness. The average total range of knee motion in our cases was 130.5 (range 125-140). A
significant limp occurred only in 3 cases. NO persistent limp persisted in our cases. Fifteen patients had minimal
pain at the site of fracture. Signicant pain occurred in three cases. Pin site infection occurred in 7 patients. All the
patients achieved full union and activity. Excellent results were obtained in 4 cases (40%). Good results were
obtained in 3 cases (30%) with overall good to excellent results were about (70%). Fair results were obtained in 3
cases (30%).
Conclusion: It could be concluded that the Ilizarov external fixator is a golden horse for orthopedic surgeons. It
holds wonderful promise in the management of open diaphyseal tibial shaft fractures.
Keywords: open diaphyseal tibia , Ilizarov tibia comminuted fractures.


Tibial fractures are the most common long
External fixators have been used for fracture
bone fractures, with around 25% being open
treatment. Since the introduction of the Ilizarov
fractures. The majority of open comminuted
method, these fixators have gained the widespread
diaphyseal tibial fractures result from high velocity
use [6]. However, the basic principles of fixation
trauma such as road traffic accidents and falls from
techniques have not been changed, although intensive
height. management of open diaphyseal tibial shaft
technologic developments have been recorded. Even
fractures can be comminuted due to lack of soft tissue
though the circular fixators are not the first choice for
coverage and blood supply of the tibial shaft [1]
the treatment of simple fractures. They are often
.Prognosis depends on displacement, comminution,
preferred for complex fractures associated with soft
and soft tissue injury. Advanced bone reconstruction
tissue damage. One of the greatest cones of the
and soft tissue coverage is required to poses bone and
circular fixators are their application to various
soft tissue healing. Thus, the rate of complications
traumatic extremities with a reduction in infection
associated with open comminted diaphyseal tibial
rates. The most important disadvantages of the
fractures is high [1] .When conservative treatment is
method are patient psychological trauma during the
several methods
follow up, patient compliance modifications are
management can be used [2] .Open reduction and
needed, and external fixation devices are more
internal fixation [ORIF] with plates and screws
difficult to learn compared to other methods of
achieves stability, allows joint mobilization but does
fixation [6]. Frequent need for secondary operations,
not allow early weight bearing which as a stimulus is
prolonged healing duration and pin site infections are
a must for early union [3] .Minimally invasive
ingrained problems in external fixation [7] .Ilizarov
percutaneous plate osteosynthesis [MIPPO], shows
has revolutionized the management of open
high rate of healing and low rate of soft-tissue
comminuted diaphyseal tibial fractures which are
complications. Close reduction and intramedullary
more susceptible to the infection by allowing more
nailing saves extra osseous blood supply, doesn't
union rates and early mobilization of the extremity
disturb fracture hematoma and maintains soft tissue
and other advantages which include wound
envelope, allows early weight bearing [4], but it
management, and deformity correction and limb
compromises the intramedullary blood supply and in
lengthening, among others. The tensioned wire
open fractures increases the risk of infection [5].

Full Paper (vol.781 paper# 27)

c:\work\Jor\vol781_28 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5973-5982

Knowledge and Attitude Assessment of Medical and Nursing Female Students at
Al-Azhar University in Cairo; For their Anticipated Breastfeeding Support
Esraa A. Mofied*, Reda M. El-Belbasy and Hanaa Abo Al-Hassan
Community and Occupational Medicine Department, Faculty of Medicine for Girls, Al-Azhar University
* Corresponding author: Esraa A. Mofied, E-mail: obidaghonaim@yahoo.com, Mobile:01026013567

Breastfeeding is a critical first step on a child's path to a healthy future. Despite its benefits, breastfeeding
is no longer a norm in many communities. Inadequate support and lack of information by healthcare professionals were
risk factors affecting breastfeeding failure. Although many studies identified knowledge and attitudes towards
breastfeeding among mothers, little is known about knowledge and attitudes towards breastfeeding among medical and
nursing students in Egypt.
Aim: This study is aiming to assess knowledge, attitude and anticipated practices of medical and nursing female
students at Al-Azhar University to provide breastfeeding support.
Participants and methods: A cross sectional study, conducted at Al-Azhar University in Cairo during the academic
year (2018-2019) on a sample of 440 female students from faculty of medicine and faculty of nursing.
Results: Regarding knowledge, the finding of the study revealed very good level of knowledge (mean percent score of
knowledge was 75.23%±7.37) and most of studied groups had neutral attitude (78.4%). Mean score of anticipated
practices among them was 63.97±6.64 indicating average level.
Conclusion and recommendation: This study reflects very good level of knowledge, neutral attitude and average
anticipated practices level among undergraduate female students in medical and nursing faculties at Al-Azhar University.
So, it is crucial to focus on students' education and training as a fundamental aspect in improving future health care
providers' knowledge, skills and experience needed in clinical practice. This will affect students' attitudes towards
breastfeeding and will reflect on their anticipated practices.
Keywords: breastfeeding, medical students, nursing students, knowledge, attitude and practices.


(5). Despite widespread efforts to encourage
Breastfeeding is a critical first step on a child's
breastfeeding, the rates in Egypt have remained low (7).
path to a healthy future. It should begin within the first

hour of a baby's life, should be exclusive for the first
There is declining trend of exclusive
six months and continue until the child complete two
breastfeeding from 68% in 1995 to 28.6% in 2018 (8, 9).
years (1, 2).
Physicians and nurses are considered important
Numerous benefits of breastfeeding are
health care members as they are one of the largest health
documented and new benefits continue to be identified.
care providers who are involved in different levels of
Extensive research indicates stronger associations
health care and represent the frontline for health care
between longer duration of exclusive breastfeeding and
services (10). Medical and nursing students are
enhanced maternal and infant health(3). Despite its
considered future role models or advocates of
established benefits, breastfeeding is no longer a norm
breastfeeding through evidence-based breastfeeding
in many communities (4). Globally, rates of
education and clinical training (11). Inadequate support
breastfeeding are far lower than what is needed to
and lack of accurate information by healthcare
optimally protect the health of women and their
professionals were reported among risk factors
children. Only 42% of newborns begin breastfeeding in
affecting breastfeeding failure (12). World Health
the first hour and 41% of infants less than six months of
Organization recommended preparing medical and
age are exclusively breastfed which is still far short of
allied health profession students to promote infant and
the 2030 global target of 70% exclusively breastfeeding
young child feeding(13). Although many studies in Egypt
(5). In addition, over 66% of those who exclusively
identified the knowledge and attitude about
breastfed continue breastfeeding for at least one year
breastfeeding among mothers, little is done among
while by two years of age, breastfeeding rates drop to
medical and nursing students (14,15).
45 % (6).

In the Middle East/North Africa initiation of
breastfeeding in the first hour was 65% and
continuation of breastfeeding up to two years was 20%

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c:\work\Jor\vol781_29 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5983-5988

Comparative Study between Slow Conventional Freezing and
Cryoprotectant-Free Vitrification of Human Spermatozoa in Large Volume
Mohammed M. Farid Rayea1, Medhat Kamel Amer1,
Ahmed Abdelhady Mousa2, Mohammed Gamal Farghaly1*
1Department of Andrology, Sexology and STDs, Faculty of Medicine, Cairo University,
2Department of Andrology, Sexology and STDs, Faculty of Medicine, Bani Suef University
*Corresponding author: Mohammed Gamal Farghaly, Mobile: (+20) 1003656609,
Email: drmohamedgamal93@yahoo.co
Cryopreservation is the collection, freezing, and long term storage of sperm, and is a highly effective
method of protecting male fertility. Cryopreservation of semen has been widely used as a vital method for fertility
preservation of male patients before undergoing chemotherapy, radiotherapy, and/or surgery that may lead to
testicular failure or ejaculatory dysfunction.
Objective: The aim of this study was to compare the aseptic technology of cryoprotectant-free vitrification of human
spermatozoa in large volume, to conventional freezing protocol as regards post thawing motility, vitality and sperm
DNA fragmentation.
Patients and methods: This study included a total of 20 male patients seeking seminal fluid analysis, attending at the
andrology laboratory of a specialized IVF center (ADAM International Hospital for Fertility and Sterility, Giza,
Egypt. Patients were presented with the diagnoses of normozoospermia, oligozoospermia (either isolated or combined
with asthenozoospermia or teratozoospermia).
Results: Motility of (in a large volume (300 µl) in the absence of permeable cryoprotectants displayed significant
statistically lower levels as compared to conventional Sperm Freezing. It was shown in different groups at different
times (post thawing and 1-hour and 24-hour) of assessment that motility of vitrified spermatozoa decreases in
comparison with slow conventional freezing as we go from the baseline. DNA fragmentation of vitrified spermatozoa
showed higher levels as compared to conventional slow freezing but there is no significant statistical difference
between vitrification and conventional slow freezing in DNA fragmentation.
Conclusion: It could be concluded that vitrification technique was quite far away from comparison with slow
conventional freezing protocol, and still need for further modifications and wide scale of study to achieve the good
Keywords: Slow Conventional Freezing, Cryoprotectant-Free Vitrification, Human Spermatozoa in Large Volume.


Many advances in reproductive medicine in the
During cryopreservation cells and tissue undergo
past five decades have made cryopreservation of human
dramatic transformation in chemical and physical
spermatozoa an invaluable tool for the clinical
characteristics as the temperature drops from +37 to -
management of infertility and sperm banking. The
196°C. The cells can lose up to 95% of their intracellular
advent of in vitro fertilization (IVF) and
water. The concentration of solutes increases
considerably, triggering the possibility of osmotic
microsurgical sperm handling techniques along with
advances in female gamete acquisition have resulted in
crystallization and mechanical deformation by
an increased demand for the cryopreservation of semen
extracellular ice may cause significant injury leading to
and tissue samples, often containing a very limited
cell death. Furthermore, if cells survive freezing, they
number of spermatozoa. Sperm cryopreservation also
might sustain additional damage during the thawing
makes it possible for cancer patients to preserve their
process due to osmotic shock, uncontrollable swelling
fertility prior to gonadotoxic chemotherapy or radiation.
and ice re-crystallization (2).
Applications of sperm banking are not limited to cancer
Recently scientists (3, 4, 5) have begun to re-
patients but extend to patients undergoing certain types
investigate the utility of ultra- rapid freezing in the
of pelvic or testicular surgeries; those who suffer from
degenerative illnesses such as diabetes or multiple
cryopreservation. Slow freezing of sperm utilizes
sclerosis; spinal cord disease or injury; and persons in
cooling rates of 1­10°C/min, while the rapid freezing, or
occupations where a significant risk of gonadotoxicity
vitrification, technique allows for cooling rates to reach
prevails (1).
more than 40-1000°C/min in order to avoid intracellular
A conventional slow freezing protocol has been in
ice formation. As new techniques are perfected, there is
use for many years and very little has changed in terms
a potential for sperm cryopreservation to greatly
of methodology and reagents. While freezing aims to
improve in the future (3, 4, 5).
preserve cells it can also easily destroy them if certain
The aim of this study was to compare the aseptic
precautionary steps are not taken into consideration.
technology of cryoprotectant-free vitrification of human

spermatozoa in large volume, to conventional freezing

Full Paper (vol.781 paper# 29)

c:\work\Jor\vol781_30 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (6), Page 5989-5994

Oxidative Stress and Apoptosis Biomarkers in Neonate Rats' Brain
Exposed to Diquat during Lactation
Nahas, A. A.1, Reem, M. Ziada1, Gamila, A. M. Kotb1, Ahmed, A. Gh. Farag2
1 -Mammalian and Aquatic Toxicology Dept., Central Agricultural Pesticides Lab. (CAPL),
Agriculture Research Center (ARC), Giza,
2 -Plant Protection Dept., Faculty of Agriculture,
Zagazig University, Egypt.
Corresponding author: Nahas, A. A.,email: zorosonds@yahoo.com

Toxic chemicals compete with biological macromocules and other small molecules that construct brain
structure in their natural function. Interruptions in development of the brain caused by toxic compounds, both before
and after birth, can lead to defects that occur quickly after exposure, or much later in life.
Objectives: This study aimed to throw light on the effect of diquat (DIQ) on the development of neonates, brain by
determination of oxidative stress and apoptosis markers during lactation period.
Materials and methods: Twenty pregnant female rats from the breeding facility of the Mammalian Toxicology
Department, the Central Agricultural Pesticides Laboratory, Agriculture Research Center were included in this study.
The lactating dams and their pups were constructed into two experimental groups (10 dams each). The first saved as
a control group and received distilled water daily during the breast-feeding period. The second group was intubated
with 5.12 mg/kg DIQ as 1/80 of LD50 (according to preliminary trails) from the 1st postnatal day (PND1) to the 10th
postnatal day (PND10) and served as treated (study) group. Brain samples of neonates were collected after treated
period and the 21th postnatal day (PND 21). The oxidative stress biomarkers (SOD, GPx, GST, GSH and Protein
carbonyl) and gene expression of BAX and BCL2 as apoptosis markers were estimated.
Results: The results indicated disruption in both oxidative stress and apoptosis biomarkers as evidenced by increased
in GST, GPx activities, gene expression of BAX and protein carbonyl level. Also, results showed a decline in SOD
activity, BCL-2 gene expression and GSH content declined.
Conclusion: The results of this study showed that exposure to DIQ increases the generation of free radicals and can
cause oxidative stress and induce neuronal programed cell death
Key words: Diquat, Oxidative Stress, Apoptosis, Gene expression, Lactation, Neonates.

development of newborn babies [2]. Completely
The herbicides of bipyridylium are a group of
different toxic substances can be transported from
herbicides. DIQ is mainly seen as an aquatic herbicide,
body stores and/or blood to a breastfeeding mother's
and is also widely used for irradiation in only certain
breast milk and thus lactating young children can be
crops; including cabbage, grain sorghum and soy
subjected to toxic chemicals that can pose a health risk
beans. Furthermore, DIQ has some formulations
[3]. The rapid development of the central nervous
designated for tree and fruit crops targeted sprays, and
system occurs both in the uterus and after child's birth
other areas where there is a need for non-control.
and usually requires an appropriate environment. It
Laboratory studies suggest that DIQ by ingestion and
depends entirely on a complicated relationship
dermal absorption is mildly toxic. In addition, serious
between different dynamical factors. Developmental
harmful effects that are not characteristic of paraquat
disturbances can be affected by genetic, external and
exposure are reported on the central nervous system.
internal factors acting during any of the phases of
Such neurological effects, including nervousness,
development [4]. The normal development of the
irritability and restlessness, disorientation and failure
central nervous system requires precise neuronal
to recognize family members or friends are the most
obvious symptoms of DIQ injury. Normally, diquat
causes kidney damage compared to paraquat [1].
programmed cell death [5]. Neurotoxic agents can cause
In human breast milk, a wide range of
brain injury, particularly if direct exposure actually
insecticides and toxic chemical pollutants have been
occurs during most of the early period of growth. If the
identified, because there is widespread concern that
development of immature embryos in the nervous
increased exposure to pesticides even during the earlier
system is impaired, the effects tend to be long-lasting
postnatal timespan may endanger the normal
and possibly permanent [6]. It is progressively

Full Paper (vol.781 paper# 30)