Correlation Of Plsma C The Egyptian Journal of Hospital Medicine Vol., 12 : 1 11 September 2003
I.S.S.N:
12084
1687-2002
Correlation of Serum Concentrations of Soluble Thrombomodulin, Soluble Vascular Cell Adhesion Molecule-1, Intracellular Adhesion Molecule -1 And E-Selectin In Patients With Systemic Lupus Erythematosus
Malak., A. Mohsen*, Magda.A.Gamil*,Maha. I.Shehata* Boshra.H,El Zawahry **and Salwa.S.I.Afifi***
Clinical Biochemistry,*Microbiology and**Physiology Departments.
Faculty of Medicine for Girls and *** Microbiology Department Faculty of Pharmacy,
Al- Azhar University, Cairo, Egypt.
Abstract: To date no specific serological parameters are available to assess disease activity in systemic lupus erythematosus (SLE). The objective of this study was to correlate serum levels of thrombomodulin (TM), intracellular adhesion molecule-1 sICAM-1, vascular cell adhesion molecule-1 sVCAM-1, and E-selectin with standard laboratory tests and clinical indices of disease activity in 40 patients with SLE and 20 apparently healthy persons as controls. According to British Isles Lupus Assessment Group (BILAG) disease activity index, the 40 patients were divided into two groups, the first consisted of 22 with active disease, and the second consisted of 18 patients with inactive SLE. Serum sTM, sICAM-1, sVCAM-I, and E- selectin were measured in their sera, using enzyme linked immuonosorbent assay (ELISA) technique.C-reactiv protein (CRP), Erythrocyte sedimentation rates (ESR) and serum creatinines were measured by standard laboratory tests. Total leukocytic count and hemoglobin concentration were detected by coulter counter. Levels of sTM and sVCAM were highly elevated in the group of patients with active SLE as compared to the inactive one (P<0.0005) while sICAM-1 levels were moderately elevated (P<0.005). E-selectin was poorly correlated with disease activity in SLE (P>0.05). In SLE, the BILAG disease activity index, ESR and serum creatinine correlated best with sTM, sVCAM-1 and E-selectin levels while there was a weak association between CRP levels and the adhesion molecules, and no correlation between CRP level and disease activity. In conclusion, sTM and sVCAM were the most important serological indices of disease activity in SLE and might be valuable serological parameters for monitoring therapy.
Introduction:-
Systemic lupus erythematosus (SLE)
to blood vessel destruction and organ injury
is an autoimmune disease of unknown
(e.g. glomerulonephritis and vasculitis).It
aetiology affecting multiple organ systems
has been suggested that expression of
.The role of vascular injury in the
adhesion molecules primes the vascular
pathogenesis of SLE has been well
endothelium for subsequent injury, as
described {Belmont et al ; 1999, Cronstein
reflected by increased release of thromb- et al;
1999}.
Circulating
immune
omodulin (TM) into the circulation
complexes of auto antibodies and self-
(Belmont et al; 1997 , Boehme et al ;2000).
antigens are deposited in the vascular walls
TM is a cell-surface glycoprotein
of SLE patients and activate the
located at the luminal surface of the
complement pathways .The resulting
vascular endothelium and acts as a
complement products stimulate leucocytes
membrane bound; high-affinity thrombin
to injure the vascular endothelium, leading
receptor (Dittman and Majerus; 1990).It
Refree: Prof; Dr. Azza Shawky Ghanem
1
Granulocyte macrophage-colony stimulating factor levels in bronchoalveolar lavage fluid from patients with chronic bronchitisThe Egyptian Journal of Hospital Medicine Vol., 13 : 14 21 Dec.2003
I.S.S.N: 12084
1687 -2002
Granulocyte macrophage-colony stimulating factor levels in bronchoalveolar lavage fluid from patients with chronic bronchitis Mona Hilmy Alrayes, MD* and Entesar Said Ahmad, MD**,
Department of Clinical and Chemical Pathology* and Department of Chest**.
Girls` Faculty of Medicine- Alazhar University
Abstract Background and objectives: Although inflammatory changes are found throughout the airways of patients with chronic bronchitis (CB), the mechanisms of the pathogenesis of CB are still unclear. The aim of this study was to investigate airways inflammation in patients with and without an exacerbation of CB. Granulocyte macrophage-colony stimulating factor (GM-CSF) levels in serum and bronchoalveolar lavage (BAL) fluid were assayed. Materials and methods: 40 CB patients and 10 never smoking, age and sex matched controls were studied. 20 of the CB patients were studied under baseline conditions (B), and 20 during an exacerbation (E) of CB. Bronchoscopy and bronchoalveolar lavage (BAL) with cytological analysis were performed for 7 males from CB(E) group, and 6 males from CB(B) group. The levels of GM-CSF were determined in sera and in BAL supernatants by a solid phase enzyme immunoassay. Results: There was high significant elevation of serum GM-CSF in both CB (E) and CB(B) groups in comparison with the control group (P<0.0001 & P=0.002 respectively). Both serum and BAL GM-CSF levels were elevated in CB(E) group in comparison with CB(B) group (P=0.0001 & P=0.009 respectively). Also there was significant elevation of BAL neutrophils, eosinophils and lymphocytes in CB(E) in comparison with CB(B) (P<0.05, P<0.01 and P<0.01 respectively). There was only significant positive correlation between BAL GM-CSF and BAL neutrophils count in CB(E) group, while no significant results were detected in CB(B) group. Conclusion: During exacerbations of CB there were changes in the cell populations in BAL of patients consistent with a recruitment of polymorphonuclear leucocytes, eosinophils and lymphocytes in the airway lumen. These recruited different inflammatory cells could work together toward the production of airway abnormalities and lung destruction. The locally elevated levels of BAL GM-CSF might be a cause and /or a result suggesting a role for this cytokine in the inflammatory processes of chronic bronchitis. The elevated levels of serum GM-CSF in chronic bronchitis may be due to the interference of other cytokines, microenvironmental factors in bone marrow and/or other factors.
Introduction Chronic bronchitis (CB) is a clinical
pathogenetic mechanism of chronic sputum
syndrome defined by cough and chronic
production is still unknown. CB is
sputum production occurring on most days
associated with intermittent exacerbations
of the month for at least 3 months a year
(chronic
bronchitis
with
acute
during the two years prior to the study.
exacerbations [CB(E)]) that present with
Sputum is defined as expectorated lower
worsening of the chronic symptoms of
respiratory tract secretions and is composed
productive cough and dyspnea. These
of fluid and cellular components, including
exacerbations cause considerable morbidity
macrophages, bronchial epithelial cells and
and in patients with concomitant airway
inflammatory cells (Seatta et al, 1997). The
obstruction are major causes of mortality.
major risk factor for the development of CB
CB(E) can have one or more of several
is cigarette smoking, but the precise
different etiologies
including
viral
14
"DEVELOPMENT OF PRIMARY HEALTH CARE BASED ON DISTRICT HEALTH SYSTEM STRATEGY IN EGYPT"The Egyptian Journal of Hospital Medicine Vol., 13: 22- 36 Dec.2003 I.S.S.N: 12084 1687-2002 "Development Of Primary Health Care Based On District Health System Strategy In Egypt"
Eltobgy A.1, El-Henawy A.2, El-Moselhy E .1, and Osman A.1
1Community Medicine Department, Faculty of Medicine, Al-Azhar University, Egypt.
2Urban Health Department, Ministry of Health and Population, Egypt
Abstract
The study aimed to improve the qualitative and quantitative aspects of primary health care (PHC) services within the context of the District Health System (DHS) approach in Egypt. A cross-sectional analytical research design was chosen to investigate the current research problem. The study samples included 9 health districts, 35 district hospitals and 201 primary health care facilities chosen randomly from eight governorates. The results revealed that the sampled districts (management level) are suffering from many administrative and technical problems. Analysis of district hospitals and PHC units' data showed that they have a severe defect in regarding to most of the studied essential elements. The researchers concluded that the concept of DHS based on PHC as proposed by the WHO is not very clear to the majority of directors but a very well infrastructure is present allover Egypt that will help in the process of system development and institution to a great extent if properly planned and organized.
Introduction:
Governmental health care systems are
programs were launched e.g. Extended
normally integrated into the national
Program of Immunization (1977); Selective
administration, thus being characterized by
Primary Health Care (1979); Child Survival
the centralized organizational structures.
and Development Revolution (1982); Safe
Three levels usually describe the providing
Motherhood Initiative (1986); and Better
structures. The Primary Health Care (PHC)
Health through Family Planning (1987).
level comprises basic promotive, preventive
Given that the vertical nature of these
and curative services. The secondary care
programs undermined the holistic idea of
level stands for referral hospitals with broad
the PHC concept, they were heavily
based
curative
services.
Specialized
criticized. They were considered as move-
services with high standards can be found
ments, of which "each has characteristics of
in national hospitals on the tertiary care
bordering
on
ideology
beyond
the
level. The paradigm of PHC forwarded
simplicity of a program or activity" (Chen,
different strategies e.g. establishment of
1988).
community based health care initiatives.
Currently the emphasis of health
These efforts turned out to be rather short
systems development aims at the district
lived due to the lack of a clearly defined
level as an intermediate level between the
framework (Matomora, 1995).
central national structures and the
Since the International Conference on
community based structures of the pure
PHC, held at Alma-Ata in 1979, the call of
PHC approach (WHO, 1987a).
health for all by the year 2000 through PHC
The term "district" denotes a clearly
has provided a motivational and unifying
defined administrative unit of local
concept in international health development
government, which commonly has a
(WHO, 1995a). Murray (1990) clarified
population of between 50,000 and 500,000.
that after the introduction of the primary
Its small enough to allow for clear
health care concept, a variety of vertical
diagnosis of the problems and needs of its
22
Protective Effect Of Oral And Intranasal Bacterial Lysates In Mice The Egyptian Journal of Hospital Medicine Vol., 13 : 37 56 Dec 2003
I.S.S.N:
12084
1687-2002
Protective Effect Of Oral And Intranasal Bacterial Lysates In Mice
Hanaa, A. Mansour* and Maha G. Soliman**
*Pharmacology Department (Medical microbiology and immunology unit), National
Organization for Drug Control And Research (NODCAR).
**Zoology Department, Faculty of Science ( girls ) , Al Azhar University. Abstract
In this study albino mice were used to test the beneficial effect of bacterial lysates vaccination against lethal dose of Pseudomonas aeroginosa. Escherichia coli lysate, Pseudomonas aeroginosa lysate, Staphylococcus aureus lysate and mixed bacterial lysates were administered through the oral and the intranasal routes, both in the presence and absence of Freund's adjuvant versus a placebo. Pseudomonas aeroginosa fifty percent lethal dose (LD50 ) was injected intraperitonealy following intranasal and oral vaccination. The placebo and the four bacterial lysates were also used in association with Freund's adjuvant. The results of the LD50 in intranasal vaccinated groups were 50%, 37.5%, 100%, 0% and 12.5%, and those with Freund's adjuvant were 25%, 25% , 12.5%, 62.5%, 0% and 0% respectively. The results of LD50 in oral vaccination were 50%, 25%, 62.5% 0% and 37.5%, and those treated with Freund's adjuvants were 12.5%, 12.5 %, 12.5%, 37.5 %, 0% and 25% respectively. The bacterial lysates vaccinated groups were studied for the total body weight (T), liver (L), spleen (S), thymus (Th) weights and the L+S+Th/T ratio. Besides, the peripheral blood and the peritoneal fluid total and differential leucocytic counts were determined and the bone marrow lymphocyte percentage. The serum immunoglobulins G and M were assessed using the immundiffusion plates. Our conclusion is: Bacterial lysates can play an important role as immunomodulators when used by oral or intranasal routes.
Introduction
Few substances have a greater
and safe even in young or pregnant animals
positive impact upon health care mana-
,an example is Leptospira vaccines
gement than antibodies, vaccines and
(Kurstak, 1994).
adjuvants . For most of this century, these
Rutishauser et al. (1998) showed
immunological agents have enjoyed wides-
that the use of an oral bacterial lysate
pread medical applications, predominantly
was effective in patients with recurrent
for the treatment, prevention of infectious
respiratory tract bacterial infections. Their
diseases. Technologies are evolving that are
study demonstrated that the use of an oral
leading to safer, more effective and more
bacterial lysate consisting of the antigens of
cost- efficient vaccines. In Europe, a killed
seven bacteria commonly involved in
bacterial is referred to as a bacterial
respiratory tract infections has been
vaccine, while in the United States a killed
developed for the induction of specific and
bacterial product is referred to as a
non specific immune responses of the
bacterin and the term vaccine is reser-
mucosa associated lymphoid tissue. Tablet
ved for an immunizing agent that
formulation were taken once daily during
contains live inactivated microbial compo-
two periods of four weeks each. The
nents (Bey et al, 1997) . Inactivated
clinical severity score was significantly
whole bacterial cell suspensions are
lower in patients treated with bacterial
probably the most common type of
lysate compared to patients given placebo.
vaccine used in domestic animals. These
The infection rates revealed reduction of
vaccines proved to be extremely effective
39% in children and reduction of 44% in
33
ABSTRACT The Egyptian Journal of Hospital Medicine Vol., 13: 57- 65 Dec.2003 I.S.S.N: 12084 1687-2002 Evaluation Of The Potential Mutagenic Effects Of Ginseng On Maternally Treated Postimplanted Mouse Foetuses H.M. El Ashmaoui, S. M. Girgis and Abd El Raouf, A. Cell Biology Department, National Research Centre, 12622 Dokki, Cairo, Egypt
Abstract The aim of this study was to evaluate the potential mutagenic effects of ginseng (herbal medicine) on maternally treated postimplanted mouse foetuses. A total of 60 adult albino female mice were used and divided into 6 groups (10 females each). The first group (I) served as a control group and received oral doses of the vehicle (0.5 ml disteled water ) for 60 days before pregnancy to 13th day of pregnancy. The rest 5 groups received orally 4mg/kg.bw of ginseng for 7, 14, 30, 45 and 60 days before day 0 of gestation and extended to 13th day of pregnancy. Then 6 females of each group were sacrificed, feotuses sample from each female were taken and subjected to cytogenetic analysis. The rest females of each group (4 females) were continuously treated and sacrificed at day 17 of getation, foetuses were examined morphologically and for different features such as implanation sites, living feotuses, resorbed foetuses and foetus body weight. Chromosome analysis of the present study (Table 1) revealed that there were numerical aberrations (peridiploidy). There was a difference only between group II and III in respect to hypodiploid (2n-), meanwhile, hyperdiploid (2n+) were more frequent in group IV and VI than that in control group (group I). For the total numerical aberrations, there were significant differences between groups II, VI compared to the control group. All groups had little frequencies of structural aberrations especially for chromatid gaps, breaks and fragments. There were a significant differences between group IV and VI compared with the control group for the deletions. Chromosome breaks were more frequent in the groups III and IV compared to the control group, whereas groups V, VI had more frequencies of centromeric attenuations than the control group. There were no differences between control group and the rest of all groups investigated for implantation sites, living foetuses and resorbed foetuses (Table 2), whereas for gross malformation, 5.41 % of group VI where abnormal and the rest of all groups had no malformations. For the mean fetal body weight, there was a significant difference among the control group (I) and the groups number II, III and VI. We conclude that treatment with ginseng as a herbal medicine may cause fetal chromosomal aberrations as well as gross malformation especially when taken for a long time and extended during pregnancy. So, we recommend that the use of ginseng during first trimester of pregnancy should be with caution. Key words:Panax ginseng, mutagenicity, maternally treated, foetus, chromosomal aberration, mice.
Introduction
Ginseng (Panax ginseng) is a commonly
and Canada; and 3) P. notoginseng, grown
used herbal medicine world-wide (one
in southwest China. Siberian ginseng is not
meant to be taken regularly that has
ginseng at all, although it is in the same
cumulative strengthening effects). There are
family (Araliaceae) and is also used for its
several varieties of ginseng . The three
tonic effects. Panax species commonly used in herbal
Ginseng
contains
ginsenosides
medicine are: 1) P. ginseng, grown in
(triterpene
saponines);
polyacetylenes
northeastern
China
and
Korea;
2)
(ginsenoynes A-K) and sesquiterpenes. P.quinquefolius, grown in the United States
Ginsenosides are believed to be major
57
Immuno-histochemical study of the expression of Bcl2 in the skin of mice under the effect of exposure to ultra violet rays type-B, before and after local Rotinoic acidThe Egyptian Journal of Hospital Medicine Vol., 13 : 66 74 Dec 2003
I.S.S.N:
12084
1687-2002
Immuno-histochemical study of the expression of ICAM-1 in the skin of mice under the effect of exposure to ultra violet rays type-B, before and after topical Retinoic acid
Somaya H. Mohamed*, Fouad M. Badr*, Howayda Abed El-Aal,Rushdy W. Mohamed, and Bassem S. Ahmed
From Departments of Histology*, Pathology and Dermatology Suez Canal Faculty of
Medicine and Histology department Al-Azhar Faculty of Medicine - Assuit
Abstract The exposure to ultraviolet radiations (UVR) become a medical problem, not just cosmetics or aesthetic concern, but for their skin photoaging and photodamage. The naturally and synthetic derivatives of vitamin A (Retinoids) may have a role in treatment and prophylaxis against skin photodamage. The current work studied the effect of ultraviolet-B rays on the ICAM-1 expression of mice's skin, before and after topical retinoids acid. Thirty-six mice were subjected to ultraviolet-B rays in dose of 1.4J/cm2 for 15minutes every other day for 10weeks. The mice were subdivided into 3 equal groups; Radiated, Prophylactic, Treated, besides the non-exposed skin samples, which considered as control group. The prophylactic mice were subjected to topical Retinoic acid one day before UVR exposure, the mice of treated groups were subjected to topical Retinoic acid after the last UVR exposure 3times weekly for 10weeks. Paraffin sections slides were prepared and stained with Hematoxylin and eosin stains for study the morphology. The immuno-histochemical study for detection of ICAM-1 expression was performed using labeled streptavidin biotin technique (Dako) with the monoclonal antibody {ICAM-1 (G- 5)}. The ICAM-1 expression was evaluated as optical density, and the obtained data was statistically analyzed by using student's t-test. The study revealed a clinical signs of photodamaged skin only in radiated group mice. Histologically epidermal thickness associated with keratinocytic atypia, and necrotic cells were observed in radiated group mice. There was a statistically significant increase in the optical density of ICAM-1 expression in radiated and prophylactic groups mice (p<0.001 and p< 0.005 respectively).. The study concluded that retinoic acid given after UVB completely reversed the morphological, histological and ICAM-1 expression changes induced by UVB exposure and retinoic acid given before UVB prevented some of the morphological, histological and ICAM-1 expression changes induced by UVB exposure.
Introduction Repeated exposure to UVR leads to
beds have become a popular source of
chronic changes in the appearance and
artificial UVR (Fitzpatrick, 1997).
function of the skin described as
Photoaging and photodamage include;
Photoaging and photodamage (Kaminar,
wrinkles (fine and coarse), roughness, 1995). The most prevalent and well-known
laxity,
mottled
pigmentation,
actinic
source of UVR is the sun. Phototherapy is
(lentigines and keratosis), scaling, xerosis
an additional potential source and tanning
and telangiectasia (Leyden, 2001).
66
Quantitative microscopical and histochemical study of the skin of mice under the effect of exposure to ultra violet rays type-The Egyptian Journal of Hospital Medicine Vol., 13 : 75 89 Dec 2003
I.S.S.N:
12084
1687-2002
Quantitative microscopical and histochemical changes in the Liver and Testis of adult rabbit under the effect of oral intake of cotton seeds Gossypol
Hassan S. El-Dawi, Ahmed N. Al-Kasaby, Bassem S. Ahmed* and Amir M. Al-Nagar*
Histology Department, Faculty of Medicine Al-Azhar University Cairo and Assuit*
Abstract Gossypol is a natural yellowish phenolic compound (dimeric or bis-naphthalene) isolated from the seeds of cotton plants (Gossypium species). The aim of the present work was to study the possible microscopical and histochemical changes in the liver and testis of adult rabbit under the effect of oral intake of cotton seeds Gossypol. Eighteen 6month age adult male rabbits were subdivided into 3 equal groups (control, experimental and recovery). The experimental and recovery groups were subjected to 1.05mg/day Gossypol suspended in olive oil intubation for 9weeks and the recovery rabbits were left 9weeks after last dose. Liver and testis paraffin sections were processed and stained with Hematoxylin and eosin stain for morphological changes. Glycosaminoglycans in the seminiferous tubules were stained by PAS technique. Studying of the nucleic DNA in the spermatogenic cells was done by Feulgen technique. Quantitative study included seminiferous tubules thickness; spermatogonia and primary spermatocytes cell areas. Also the distribution of PAS positive materials analyzed as area percent and nucleic DNA as optical density. All analysis was done by the aid of image analysis System. The study showed that liver was affected by gossypol administration. The changes appeared as distinct pinpoint foci of coagulative necrosis, vacuolar degeneration of hepatocytes and dilation of the sinusoids with mild perivascular lymphoid aggregation. The testis showed distortion loss of spermatogenic cells, Sertoli and germ organization under the effect of gossypol. Sertoli cells showed an intracellular vacuolization. Also, there were luminal multinucleated giant cells as well as a prominent DNA fragmentation in the spermatogonia nuclei. The quantitative study showed statistically significant decrease in the mean thickness of seminiferous tubules , the mean area of spermatogonia, and primary spermatocyte , mean area percent of distribution of PAS positive materials of seminiferous tubules and a significant increase in the mean optical density of nucleic DNA of spermatogonia affinity to Feulgen stain in experimental group, (p<0.001). After 9weeks recovery periods most of the morphological and quantitative changes were still present. The study concluded that gossypol has a toxic effect on the liver and testis of rabbits and their toxicity may be more prominent in humans. The study recommend restriction of uses of cotton seed oil in human uses and further study on the possible risk of uses of cattle fed on cottonseed meals.
* Endocrinology and ** clinical pathology
Departments- Al- Azhar university (Girls)
Abstract Hirsutism is an androgen excess related disorder that commonly affects women causing a variety of negative metabolic disturbances. Early and accurate diagnoses of androgen over- production or hypersensitivity to normal circulating androgen have an important implication for treatment and follow up of patients. The aim of this work is to study the validity of hyperandrogonemic index (HAI) and index of free testosterone (IFT) in, diagnosis of hirsute Egyptian women, and its correlation to hair score as a clinical marker for hirsutism. Twenty-four hirsute women aged 19-32 y's, median (24.25 ± 4.3) were studied. Ten age matched nonhirsute females, were studied as controls. Patients and control were subjected to the following, full history and clinical examination. Biochemical and hormonal parameters were measured, fasting blood sugar (FBLS), 2 hours post prandial blood sugar (2h pp BL. S), serum total testosterone (TT), free testosterone (FT), dihydroepiandrosterone (DHEA), Dihydroepiandrosterone sulphate (DHEAS) androstenedion (ADION), prolactin (PL) and sex hormone binding globulin (SHBG). Index of free testosterone (IFT) and index of hyperandrogenemia (IHA) were calculated. Results showed significant higher BMI (P< 0.009), 2hrs PPBLS. (P< 0.001), TT (P< 0.005), FT (P< 0.000), SHBG (P< 0.02) and (ADION) (P< 0.000) in hirsute females compared to controls. Hair score was positively correlated with IFT only while it was not correlated with all of the measured hormones. FT was positively correlated with BMI (P< 0.004), FBLS (P< 0.001) and 2hrs PPBL.S (P< 0.000). While TT was positively correlated with BMI (P< 0.001). Androstenedion was positively correlated with systolic BL.P (P< 0.000), diastolic BL.P (P< 0.02), FBL.S (P< 0.001) and 2hrs PPBL.S (P< 0.000). IFT was positively correlated with hair score (P< 0.05), BMI (P< 0.01), systolic BL.P (P< 0.004), FBL.S (P< 0.001) and 2hrs PPBL.S (P< 0.01). SHBG was negatively correlated with systolic BL.P (P< 0.04), FBL.S (P< 0.05) and 2hrs PPBL.S (P< 0.03). Conclusion Hirsutism is a clinical symptom associated with hyperandrogenism. It must be diagnosed accurately, and as early as possible. The most accurate diagnostic measurement is IFT rather than IHA or other hormones individually. Hirsutism must be studied in depth not as a simple complaint, as it may be the entrance to the more complex metabolic syndrome. IFT is beneficial in diagnosis of borderline hirsute women.
Introduction
Hirsutism is one of the most common
more likely, a nonserious medical problem;
endocrine disorders in women of fertile age. (George et al 2003).
In these women, the hairiness implies the
Increased androgen production causes well-
presence of abnormal androgen level / or
documented negative metabolic changes,
action, which may represent a serious or, (Conway et al 1992). Those women are at
90
Influence of ionizing radiation on Cobra (Naja haje) and Cerastes cerastes venoms: Toxicological and immunological aspects The Egyptian Journal of Hospital Medicine Vol., 13 :99 111 Dec 2003
I.S.S.N:
12084
1687-2002
Influence of ionizing radiation on Cobra (Naja haje) and Cerastes cerastes venoms: Toxicological and immunological aspects.
Esmat A. Shaban
Assistant Professor, Drug Research Departement,
National Center for Radiation Research and Technology,
Atomic Energy Authority. Abstract The effect of gamma irradiation (15 KGy) on the Cobra Naja haje and Cerastes cerastes venoms toxicity and immunogenicity was evaluated. Irradiated venoms were at least 28.1% less toxic than non-irradiated venoms. However the antigenic response was not changed as judged by the capacity of irradiated venoms to react with polyvalent antivenom horse serum. The immunodiffusion method showed identity between irradiated and non-irradiated samples. The effect of gamma radiation on some venom enzymes and venoms profile was studied. Proteolytic, phospholipase A2 and hemorrhagic activities were inhibited by irradiation. Irradiation with gamma rays resulted in structural changes in the venoms as indicated by the changes in their molecular weights. The results indicated that irradiation of toxic protein -using suitable dose- can promote significant detoxification but still retaining many of the original antigenic and immuonological properties of native venom.
Introduction
Venoms in general are weakly
physicochemical changes that can alter their
immunogenic, yet fairly toxic (Magalhaes,
primary , secondary or tertiary structures,
1986). This causes problems because
while keeping many of their native
serotherapy is the treatment of choice in
immunological properties intact (Shalka
snake bite-accidents and horse antisera
and Antoni , 1970). Lauhatirananda et al.,
availability is dependent upon venom
(1970) observed that several functions of a
immunogenicity. To improve antisera
protein have different radio-sensitivity and
production and extend the useful life of
that its antigenic properties are the most
immunized horses much effort has been
radioresistant. Hati et al., 1990 showed that
devoted to decrease chronic venom toxicity.
Russell viper venom was detoxified by
Several techniques have been used to
gamma radiation (100 Krad or 200 Krad)
detoxify venoms such as mixing the venom
and used for active immunization of rabbits.
with carboxymethlycellulose (Moroz et
Shaban (1990) found that irradiation of
al.,1963), irradiation by gamma rays
Androctonus amorexia scorpion venom
(Baride et al ., 1980), adding formaldehyde,
with gamma rays in dry state (15 and 30
(Costa et al., 1985), controlled iodination
KGy) decreased its lethal and toxic activity
(Daniel et al., 1987) and encapsulation of
while retaining its antigenicity. Therefore,
purified toxins in liposomes (Freitas and
irradiation of toxic proteins can promote
Frezard, 1997).
si
g n i f i c
a
n t
d e t
o
xi f i
c
a t i
o
n,
but still retain
One method that has been shown to
many of the original antigenic and immuno-
be effective for attenuating venom toxicity
logical properties of native venom.
and maintaining immunogenicity is gamma
Snake venoms are complex mixtures
radiation (Baride et al., 1980; Hati et
which may show qualitative differences in al.,1990; Shaban, 1990; Mandal et al.,
their composition not only between species
1993, Nascimento et al., 1996).
but also from individual to another
Proteins irradiated either in the dry
(Tu,1977). Cerastes cerastes and Naja haje
state or in solution undergo chemical and
snakes one belong to family Viperidae and
99
Hormonal Profile And Histopathological Study On The Influence Of Silymarin On Both Female And The Egyptian Journal of Hospital Medicine Vol., 13 :112 122 Dec
2
200
I.S.S.N:
12084
1687-2002
Hormonal Profile And Histopathological Study On The Influence Of Silymarin On Both Female And Male Albino Rats
Enas A.M.Khalil
National Organization for Drug control and Research
Abstract
Silymarin is a mixture of flavonoids extracted from seeds of milk thistle (Silybum marianum [L] Gaertn ). Extracts of S. marianum have been used in the treatment of liver diseases for more than 2000 years. Flavonoids are a large group of polycyclic phenols of plant origin. Flavonoids displaying estrogenic effects (phytoestrogen). Phytoestrogens show an estrogenic activity owing to the structural similarity with the estrogen skeleton ,mimicking natural estrogens, it binds to estrogen receptor and modulates its activity . These effects cause complex changes inducing a shift in an overall hormonal balance of the individual. Long term intake of feeds with a higher content of phytoestrogens can induce transient or permanent infertility. Silybum marianum leaves have been traditionally used in Egypt for their antifertility effects .Also, the antifertility property of silybum marianum leaves was investigated in female albino rats. This property highlights the impotance to clarify the role of silymarin (420mg /day ) a human therapeutic dose on both female and male albino rats. Silymarin (151.2 mg/kg BW) prevented pregnancy in adult female albino rats on days 1-5 post coitum. In female rats the follicle stimulating hormone (FSH) displayed marked increase, while the luteinizing hormone (LH) and estradiol remained within normal levels. These results showed a distinct increase in number and size of ovarian growing follicles while the effect of silymarin on the uterine wall was in the form of hypertrophy of endometrial epithelium, also increase in the number of uterine glands. Ovaries taken from females treated with silymarin for one and two months contained a large number of growing follicles. In male rats treated with silymarin (151.2 mg/kg BW) for one month, testosterone and LH were increased significantly, meanwhile estradiol not changed. Testes of rats treated with silymarin for one month showed well developed spermatogenesis with lot of sperms. The epididymis of the same group contained a heavy number of sperms. While rats treated with silymarin for two months displayed significant decrease in serum testosterone levels, while LH and estradiol not changed. These rats displayed some tubules contained well developed spermatogenic layer and normal leyding cells, others appeared moderated by affected. The epididymis contained less number of sperms. These results indicated that silymarin (151.2mg /kgBW) a dose equivalent to human therapeutic dose (420mg/ day) prevented pregnancy in female rats and caused some histological changes in the ovary and uterus, while it has biological benefits for male rats during short treatment.
Introduction
Silymarin is a mixture of flavonoids
Bombardelli,1995). Silymarin is a hepatop-
extracted from seeds of milk thistle
rotective (Schriewer et al.,1975), cytopro-
(silybum marianum [ L.] Gaertn ) which
tective (Valenzuela et al. ,1985; Valenzuela
contains silybin, silydianin , and silychristin et al. ,1987; Muriel et al.,1992 ; Schonfeld
as the major constituents. (Morazzoni and et al. ,1997; Sonnenbichler et al. , 1999),
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A Six -Year Clinical, Microbiological and Radiological Study Outcome Following Treatment of Peri-implantitis The Egyptian Journal of Hospital Medicine Vol., 13 :123 134 Dec
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A Six -Year Clinical, Microbiological and Radiological Study Outcome Following Treatment of Peri-implantitis Abeer, S. Gawish* and Susan, A. Hassan**
Lecturer of Oral Medicine, Periodontology, Oral Diagnosis and Oral Radiology, **
Associate Professor of Oral Maxillofacial Surgery,
Faculty of Dentistry, for Girls, Al Azhar University Abstract
The present study evaluated the long-term outcome of a combined surgical and composite graft (bovine porous bone mineral BPBM and autogenous bone) in the treatment of peri-implantitis. Six individuals with titanium implants demonstrating a marginal bone loss. Baseline ,1 and 6 years measurements, including introral digital radiographs, gingival index (GI), probing depth(PD) and probing bone level (BL) were performed. In each implant subgingival bacterial samples were obtained and subjected to microbiological analysis by culture. Surgical exposure of the lesions and cleaning of the implants using hydrogen perioxide and2% aqueous solution of chlorohexidine gluconate were performed. The autogenous bone was harvested from the chin combined with BPBM and packed into the bony defects. The treatment was evaluated clinically, microbiologically and radiographically at 1 and 6 years. Results: revealed a significant reduction in plaque and gingival bleeding. The mean probing depth was 6.94+ 1.16 at the baseline and it was 1.91 + 1.21 at the end of the study period. All treated implants showed bonegain. The mean gain in bone level was 5.12 + 0.5 and radiological evaluation of bone density was measured at crest, mid-implant and lateral apical area of interest AOI 32.0 + 0.87, 72.91 +0.83, 63.0 + 0.94 at baseline and it reached 109.5 + 0.53, 141.63 + 1.19 and 144.0 + 0.47 respectively. The presence of putative periodontal pathogens significantly declined at the end of the study period. Conclusions: The results of the study suggest that the use of composite bone grafts as the treatment strategy for peri-implantitis lesions with maintenance of good oral hygiene appears to be an efficacious treatment approach for restoring hard tissue support of dental implants during the 6 year follow-up period.
Introduction
Implant dentistry is a relatively new
negative bacteria similar to periodontitis
and fast growing area of oral health services
(5). Peri-implantitis has been associated
(18). Successful treatment results and
with gram- negative bacteria similar to
patient satisfaction with dental implant
periodontitis (20). The goal of implant
treatment
modalities
must
include
dentistry today should be the control of
prevention and treatment of peri-implant
periodontal pathogens in the oral cavity.
infections
(25).
Peri-implantitis
and
Once a peri-implant inflammatory process
periodontitis are often described as
starts, implant sites get compromised by
inflammatory diseases with oral pathogens
severe loss of peri-implant supported bone.
emerging either at implants, within the
Meffert et al, (21) classified implants
intraimplant components or teeth. Peri-
with complication into three types: Ailing
implantitis has been associated with gram-
implant in which bone loss accompanies
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Ability of Gamma-Irradiated Polyvalent Antivenin to Neutralize the Toxicity of the Egyptian Cobra (Naja haje) Venom The Egyptian Journal of Hospital Medicine Vol., 13 :135 152 Dec
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Ability of Gamma-Irradiated Polyvalent Antivenin to Neutralize the Toxicity of the Egyptian Cobra (Naja haje) Venom
Esmat A. Shaban* and Manar N. Hafez**
*Drug Rad. Res. Dept. and **Rad. Biol. Res. Dept.
National Center for Radiation Research and Technology,
Atomic Energy Authority, Cairo. ABSTRACT
In this study, the lethality as well as the biochemical and histological effects of Cobra (Naja haje) envenomation at a sublethal dose has been investigated in mice and rats. The venom injected intraperitoneally in rats (0.2 mg/kg) produced marked increase in the activities of ALT, AST, ALP and LDH. Also, serum glucose, urea and creatinine levels were significantly elevated. These results are in accordance with the histological findings of the liver that showed vacuolated hepatocytes and scattered necrotic and haemorrhagic areas together with congestion and dilatation of blood vessels and sinusoids. The spleen also displayed small diffuse white pulps with ill-defined outlines and extravasation of blood that extended to infiltrate the widened sinusoids. The venom also produced severe degeneration of the cardiac muscle with loss of striations and extensive haemorrhage inbetween the myocardial bundles. These biochemical and histological envenomation disorders, were markedly and effectively neutralized by the polyantivenins (non-irradiated and gamma-irradiated in a sterilizing dose of 25 kGy). The neutralization ability of both antivenins was the same against a lethal dose of the venom (2.5 LD50). The minimal protective dose of the polyantivenins was
calculated to be 16000 µg/20 gm mouse. Rats injected with mixtures of venom and antivenins (non-irradiated and irradiated) showed a decrease in all elevated biochemical parameters investigated. The histological examination also showed less severe injuries in all organs examined (liver, spleen and heart) which appeared more or less normal with very few abnormalities remaining. Comparative study was also done on these antivenins using immunodiffusion technique which showed the same precipitin bands with the tested venom. Thus, it can be concluded that both antivenins (non irradiated and 25 KGy gamma-irradiated) have similar immunoglobulins and have no differences in their antilethal and enzymatic neutralizing ability as well as in ameliorating the degree of tissue damage induced by the venom.
INTRODUCTION
Poisoning by snake bite is a real clinical Cerastes cerastes, etc.... A polyvalent
problem, espesially in tropical areas, and
antivenin prepared against Naja haje,
efficacious treatment should, therefore, be Cerastes cerastes, Cerastes viper and Naje
available. Since the beginning of this nigrocolus is widely used in Egypt in the
century, antivenom serotherapy constitutes
treatment
of
envenomation.
Usually,
the major therapeutic approach (Chippaux,
vaccines and sera are prepared under
1991).
aseptic conditions and filtered through
In Egypt, there are many varieties of
bacterial filters. This procedure involves an
snakes, some of them cause severe damage
extensive and strict aseptic conditions
to snake bite victims like Egyptian Cobra,
which makes the product very expensive.
135
þÿ The Egyptian Journal of Hospital Medicine Vol., 13 :153 161 Dec 2003
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12084
1687-2002
Interleukin 18 and other inflammatory cytokines as independent predictors of diabetic nephropathy in patients with type 2 diabetes mellitus.
Sahar M.Shawky *; and Eman A. Ismail**
Internal Medicine* and Clinical Pathology ** Departments. Faculty of Medicine, Ain Shams University
Abstract
Diabetes Mellitus is a very common cause of glomerular disease in adults and is a very common cause of end stage renal failure. The pathogenesis of diabetic nephropathy is not completely understood dispite extensive investigations. Involvement of the kidneys in patients with diabetes mellitus includes not only hyperglycemia, advanced glycosylation products but also activation of proinflammatory cytokines. Data about the relationship of inflammation to nephropathy in type 2 diabetes mellitus are scarce. Our study was conducted to compare levels of interleukin - 18 ( IL- 18), tumor necrosis factor-alpha.( TNF- ) and interleukin- 6 (IL-6) in serum of diabetic patients with various degrees of nephropathy. The study included 50 patients and 35 normal control subjects presented at Ain Shams University Hospitals. The diabetic subjects were divided into 3groups according to urinary albumin excretion ( UAE):
o Group I : included 22 subjects with UAE < 30 g/mg creatinine i.e diabetic patients
with normoalbuminuria.
o Group II : included 20 subjects. with UAE 30 to 300 g/mg creatinine i.e. diabetic
patients with microalbuminuria .
o Group III : Included 8 subjects with UAE > 300 g/mg creatinine i.e. diabetic patients
with macroalbuminuria.
The serum levels of IL18, TNF- and IL-6 were measured for the control group to determine the normal values and for all diabetic subjects with various degrees of nephropathy . The results revealed highly significant statistical differences in serum levels of IL-18, TNF- and IL-6 between the patients and control subjects. In addition, IL-18 levels were increased in diabetic patients with proteinuria as compared with those without proteinuria. Also TNF- and IL-6 in diabetic patients with microalbuminuria and clinical albuminuria were significantly increased as compared with diabetic patients without albuminuria. These results suggest that serum levels of IL-18, TNF- and IL-6 may have etiopathogenic roles in diabetic nephropathy and are independent predictors of UAE in type 2 diabetes mellitus. So, in addition to metabolic and hemodynamic factors, it is possible to consider the participation of inflammation on the pathogenesis of diabetic nephropathy. Introduction
Nephropathy is a major contributor to
arterial blood pressure ( Timothy et al.,
overall morbidity and mortality in diabetic 2000 )
patients(Dipetrillo et al., 2003 ).
Diabetic nephropathy is one of the
Diabetic nephropathy is a clinical
leading causes of chronic renal failure.
syndrome characterized by persistent
Although both type I diabetes mellitus and
albuminuria > 300 mg/day, with a decline
type 2 diabetes mellitus lead to end stage
in glomerular filteration rate, and elevated
renal disease, the great majority of patients
153 Refree : Prof ; Dr. Badowi Labib. Refree : Prof ; Dr. Salwa Aboul-Hana.