d:\skydrive\Jor\vol51_1The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51 , Page 179 189 Evaluation of the Biological Effects of Radiations on Pulmonary functions of NMA Employees in the Black Sand Project at Rashid and Abou-Khashaba Sites Year 2012 Nesriene Mohamad El Margoushy
Medical and Radiation Research Department, Nuclear Materials Authority Abstract: Background: Almost all workers in the Black Sand Project at Rashid and Abou-Khashaba sites of NMA (Nuclear Materials Authority) are obligatorily exposed to ionizing radiations during their routine work. The most apparent harmful effects in Rasheed employees were reflected easily on pulmonary function tests which may occur due to increase registered dust radio activities than the accepted level for air concentration. Objectives: This study was done mainly to evaluate the biological effects of ionizing radiations on lung and pulmonary functions of workers in the Black Sand Project at Rashid and Abou- Khashaba sites of NMA in the year 2012 and to start follow up of these workers Measurements: This research was done on 30 male workers aging 25 - 56 years to measure pulmonary function tests. Certain radiological measurements were also performed to assess the levels of exposure to radiations Results: Out of the 30 members; regarding the radiological measurements all levels measured were within the reference range accepted internationally, except radioactive dust levels were elevated mildly above the reference range accepted internationally this results in deterioration of pulmonary function of some workers. Conclusions: Generally, workers of the Black Sand Project at Rashid and Abou-Khashaba sites were receiving a good radiological protection protocol. Radioactive dust levels were elevated mildly above the reference range accepted internationally this result in pulmonary function disorders in some workers.
Introduction:
The nuclear fuel cycle does not give rise to
exceeding 10 Gy was inevitably fatal; however,
significant radiation exposure for members of the
experience with nuclear accident victims suggests
public. Radiation protection standards assume that
that when patients survive gastrointestinal and
any dose of radiation, no matter how small,
bone marrow syndromes, respiratory failure
involves a possible risk to human health.
become the major cause of death. This effect is
Nuclear radiation arises from hundreds of different
known as a delayed effect of acute radiation
kinds of unstable atoms. While many exist in
exposure (4).
nature, the majority are created in nuclear
Pulmonary Function Testing (PFT) has been a
reactions. Ionizing radiation which can damage
major step forward in assessing the functional
living tissue is emitted as the unstable atoms
status of the lungs as it relates to how much air
(radionuclide) change (decay) spontaneously to
volume can be moved in and out of the lungs and
become different kinds of atoms (1).
how fast it moves, how stiff are the lungs and chest
Radiation to almost any organ can produce both
wall, the diffusion characteristics of the membrane
acute and chronic adverse effects. Sources of
through which the gas moves and how the lungs
exposure include industrial or medical radiation
respond to chest physical therapy procedures.
sources capable of producing high dose rates.
Pulmonary Function tests are used for different
Detrimental effects can occur due to radiation
reasons as: screening for the presence of
exposure, however they are dose dependent (2).
obstructive and restrictive diseases, evaluating the
On the lung, clinical and experimental data are
patient prior to surgery especially in old obese
used to describe the acute and late reactions of the
smoker patients with previous history of
lung to both external and internal radiation
pulmonary disease as vital capacity is an important
including pneumonitis, fibrosis and carcinogenesis
preoperative assessment tool. PFT is important (3). In situations of accidental exposure, it was
also in evaluating the patient's condition for
initially assumed that a whole-body dose
weaning from a ventilator, documenting the
179
d:\skydrive\Jor\vol51_2The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51 , Page 190 199 Improving Health status of bronchial asthma patients in Nuclear Materials Authority Nesriene Mohamad El Margoushy
Medical and Radiation Research Department, Nuclear Materials Authority
Abstract: Background: Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness and shortness of breath. Asthma can result in variable restriction in the physical, emotional, and social aspects of the patient's life. Setting: out patient clinic in Nuclear materials Authority Objectives: This study was done mainly to Improve health status including symptoms and quality of life in bronchial asthma patients in Nuclear Materials Authority Method: The study was carried out on 51 subjects, they were chosen from those attendants of the out patients clinic in Nuclear Materials Authority in el Katamya in the period from January to May 2012, by measurement of lung function and bronchial hyperresponsiveness as supplemental tools in evaluating the efficacy of treatment with inhaled corticosteroids (ICS) and other controller medications in asthmatic employees. Results: the asthmatic patients were 51 patients (36 males and 15 females), their ages ranged from 27- 59 (46.2±7.3) years, they weredetected from those attendants of the out patient clinic in Nuclear Materials Authority in El Katamya representing (2.1% ) of workers. 15 (29.4%) patients were smoker, and 36 (70.6%) patients never smoked, 21 patients (41.2%) were exposed to radioactive materials in their labs in the form of radioactive substances and30 patients (58.8%)patients were not exposed.19 (37.3%) patients had intermittent asthma, 11 (21.6%) patients had mild persistent asthma 9 (17.6%) patients had moderate persistent asthma and 12(23.5%) patients had sever persistent asthma. 11(21.6%) patient used long acting anti-inflammatory medications, 23 (45.1%) patients received other controller medication in the form of short acting steroids as Clenil inhaler and ketotifen as zaditen while the majority of patients received rescue medication 34(66.7%) in the form of short acting bronchodilators and oral steroids. Conclusion: Patient education, measurement of lung function and review of the treatment plan as supplemental tools in evaluating the efficacy of treatment with inhaled corticosteroids and other controller medications in asthmatic employees improve health status including symptoms and quality of life in bronchial asthma patients in Nuclear Materials Authority. Introduction: Asthma is a common chronic inflammatory
investigation and doing pulmonary function to
disease of the airways characterized by variable
classify the degree of the disease whether mild,
and recurring symptoms, reversible airflow
moderate or sever and educating the patients
obstruction, and bronchospasm. Symptoms
about the triggering factors, type of treatment,
include wheezing, coughing, chest tightness
proper use of medication as regard timing, how
and shortness of breath. Asthma is clinically
to use and correcting misconceptions (3).
classified according to the frequency of
The severity of asthma is classified as
symptoms, forced expiratory volume in 1
intermittent,
mild
persistent,
moderate
second (FEV1), and peak expiratory flow rate
persistent or severe persistent (1) and (4). (1), the disease is characterized by a variable
The most effective treatment for asthma is
degree of bronchial hyper responsiveness and
identifying triggers, such as cigarette smoke,
airway remodeling. Recent evidence indicates
pets, or aspirin, and eliminating exposure to
an important role of inflammation pathways,
them. If trigger avoidance is insufficient,
airways remodeling and epithelium activation
medical treatment is recommended. Treatment
in asthma genetics (2).
pl
a
n i
s s
c
he
dul e
d a c
c
o r
di
ng t
o t
he type and
Improving health status of these patients
degree of asthma. Clinical classification of
require close monitoring and follow up by
severity of asthma is done according to
proper history taking, physical examination,
symptom frequency, night time symptoms,
190
d:\skydrive\Jor\vol51_3The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51 , Page 200 215
A Comparative Study Between Whole Body Magnetic Resonance Imaging and Bone Scintgraphy In Detection of Bone Metastases In Patients With Known Breast or Lung Cancer Wafaa Raafat Ali Abdel Hamid; Department of Radiodiagnosis, Ain Shams University
ABSTRACT Purpose: The aim of this work is to compare the ability of whole body MRI including diffusion study with that of 99m Tc-Methylene Diphosphonate Scintigraphy to detected skeletal metastases in patients with breast and lung cancer. Patients and methods: 60 patients comprising 38 females and 22 males ranging in age from 30 to 60 years with a mean age of 48.1 years (mean age 47.3 years for females and 49 years for males) were enrolled in the study. 29 females are histopathologically proven cases of breast malignancy, 9 females and the 22 males are histopathologically proven cases of lung cancer. The patients were referred from Oncological departments to perform the whole body MR study and bone scan at Ain Shams University hospitals MRI units and a private center during the time interval from December 2008 till December 2012. All patients were subjected to both whole body MRI and bone scintigraphy. The whole body MRI was mainly obtained using 4 contiguous coronal stations for body coverage using the body coil and 2 contiguous sagittal stations for the spine using T1W FSE and STIR sequences. 48 out of 60 patients toke IV contrast and post contrast T1W imagaes with fat suppression were taken. The MRI examinations were performed using a superconducting 1.5 Tesla magnet (Achieva: Philips Medical Systems).
Standard skeletal Scintigraphy was performed using a planar one phase technique (delayed phase). The examination was done 2-3 hours after IV injection of technicium 99m labeled Methylene Diphosphonate with a maximum dose of 20 mCi.
Results: 42 patients out of 60 were positive for metastases based on histopathological verification or follow up. On MRI, 39 patients had metastases, 3 were false negative, 12 were true negative and 6 were false positive. On bone scan, 35 were true positive, 7 were false negative, 4 were false positive and 14 were true negative. Based on lesion detection, on comparing bone scan to WB-MRI with and without diffusion, bone scan had an overall sensitivity of 85.6%, specificity 67.5 %, PPV 61.7% and NPV 66.3%, while WB-MRI had statistical values of 73.4%, 68.8%, 78.1% and 62.6% respectively. On adding DWI, values raised to 88.9%, 82.9%, 93% and 69% respectively. Quantitative analysis of DWI was also included in this study revealing an overlap between the Low ADC values of red marrow and metastasis at the range of 0.61 to 0.69 x10-3 mm2/sec and then between metastasis and other benign pathological marrow entities at the range of 0.9 to 1.03 x 10-3 mm2/sec. WB-MRI also detected 64 soft tissue metastatic lesions which became 71 lesions on adding DWI with a distribution of hepatic, pulmonary, brain, adrenal, lymph nodes, pleural, leptomeningeal and renal lesions.
Conclusion: we don't think that WB-MRI should replace bone scan in the quest for skeletal metastases. However, we believe that WB-MRI should be the modality of choice when both skeletal and soft tissue metastases are suspected and in the follow up of a known metastatic patients for adequate coverage of both skeletal and soft tissue structures combined with qualitative and quantitative features of DWI helping assess tumors at cellular levels even prior to gross morphological changes verifying response to therapy as early as possible sparing patients precious time from drifting with delayed decision making.
Introduction:The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51 , Page 216 225
Role of Dynamic Magnetic Resonance Imaging in Assessment of Female Pelvic Floor Dysfunction Aliaa S Sheha, MSc*, Ola M Nouh, MD*, Inas M Azab, MD*, Mohamed A Nassef*, MD*, Ahmed M Ibrahim, MD**.
* Departments of Radiodiagnosis and ** Obstetrics and Gynecology, Faculty of Medicine,
Ain Shams University. Abstract
Introduction: Pelvic floor weakening is a major health problem in older women, with an 11.1% lifetime risk of women over 50 years old to undergo surgery for pelvic organ prolapse and urinary incontinence. Clinical examination is the main method of diagnosis, yet imaging is essential especially in patients with multicompartment defects. Pelvic Magnetic Resonance (MR) Imaging is expected to play a role in the preoperative planning for complex cases due to its high soft tissue resolution, which will help perform site-specific repair and so avoid recurrence.
Aim of the work: The aim of this work is to evaluate the role of Magnetic Resonance Imaging as a non invasive method in the assessment of female pelvic floor dysfunction.
Methods: The studied group included 40 female patients complaining of pelvic organ prolapse and / or stress urinary incontinence or fecal incontinence. All patients were subjected to full history taking, clinical examination and Dynamic Magnetic resonance Imaging using 1.5 Tesla Philips MR Scanner.
Results: Good concordance was found between Dynamic MRI and clinical examination in all three compartments. The concordance was 82.5% in the anterior compartment, 80% in the posterior compartment, 85% in enteroceles and 65.0% in the middle compartment.
Conclusion: Dynamic MRI is a promising method that can be used as an imaging tool in the preoperative planning of pelvic organ prolapse.
INTRODUCTION
Weakening of the female pelvic floor is
the clinical and intraoperative findings related
a prevalent and debilitating disorder. It results
to pelvic floor prolapse.Pelvic MR imaging
in abnormal descent of the urinary bladder, the
should also help to document and advance
uterovaginal vault, and the rectum, resulting in
knowledge of surgical repair methodology (4).
urinary incontinence, fecal incontinence, and
THE AIM OF THE WORK
pelvic organ prolapse (1). Eleven percent of
The aim of the work is to highlight the
women undergo surgery for pelvic organ
role of MRI as a non invasive method in the
prolapse and/or urinary incontinence during
assessment of pelvic floor dysfunction in
life time, and 30% of them undergo repeat
females.
surgery (2).
METHODS
Given the paucity of understanding of
This study was conducted over a period
pelvic floor dysfunction pathophysiology and
of 2 years and included 40 female patients,
the high rate of recurrence and repeat surgery,
complaining of stress urinary incontinence,
imaging, like dynamic magnetic resonance
fecal incontinence or pelvic organ prolapse.
(MR) plays a major role in its clinical
Patients of interest were recruited from the
management, especially for the preoperative
obstetrics and gynecology department in Ain
assessment of patients with multi-compartment
Shams University Maternity Hospital. We
defects and failed surgical repairs(3).
excluded patients with bad general condition,
Pelvic
MR
imaging
using
the
those who had a contraindication for MRI, and
combination
of
motion-insensitive
T2-
patients with detrusor instability.
weighted single-shot fast spin echo and high
After taking oral consent from all
soft tissue resolution standard T2-weighted fast
patients to undergo dynamic MRI of the pelvic
spin echo techniques has helped to identify soft
floor, these patients were subjected to full
tissue abnormalities that directly correlate with
clinical history, physical examination with
216
d:\skydrive\Jor\vol51_5The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51 , Page 226 239
Role Of CT Virtual Colonoscopy In Diagnosis Of Colo-Rectal Neoplasms Eman AF Darwish , Mohammed Abu-el Huda Darwish, Hisham H Wagdy, Sahar M Al Gaafary
Radiodiagnosis department, Faculty of Medicine, Ain Shams University
Abstract Purpose: to assess the role of CT colonography (virtual colonoscopy) as a non-invasive imaging technique in detection and diagnosis of colorectal neoplasia using conventional colonoscopy and/or operative findings as a reference standard, as well as highlighting its advantages and possible pitfalls.
Methods: sixty patients were examined by CT after standard bowel preparation, rectal insufflation and IV contrast injection. Imaging was performed in both supine and prone positions. Evaluation consisted of review of the transverse CT images, sagittal and coronal reformations and 3D endoluminal lmages. CT colonographic findings were correlated with standard conventional colonoscopic and/or operative findings.
Results: Virtual colonoscopy correctly identified all 6 carcinomas (100%), 12 out of the 13 polyps that measured 10mm or more (92.3%), 19 of the 23 polyps that measured 6 - 9 mm (82.6%) and 28 out of 48 polyps that measured 5mm or less (58.3%). There were 11 false positive findings of polyps by virtual colonoscopy and no false positive findings of cancer. Virtual colonoscopy also detected 35 incidental extracolonic findings in 25 patients while non were detected by conventional colonoscopy. 17 of the 24 patients who had no lesions during conventional colonoscopy were considered free of lesions by CT colonography yielding a per-patient specificity of 70.8%
Conclusion: CT colonography has high sensitivity for the detection of clinically important polyps and cancer as well as multiple advantages over conventional colonoscopy in imaging of colorectal neoplasms.
Introduction and aim of work Colorectal carcinoma is among the leading
causes of malignancy related deaths in the
Though colonoscopy is currently considered the
world. Because of the natural history of the
reference standard for the detection of colorectal
progression from colorectal polyp to carcinoma,
neoplasia it has various potential limitations.
with most frank colo-rectal cancers arising from
First, up to 10% of colonoscopic examinations
pre-existing polyps, early and prompt diagnosis
are technically difficult even for experienced
can have a significant effect on patient mortality
colonoscopists. In addition to poor bowel (1). Not only will detection and removal of
preparation, an experienced colonoscopist may
precursor adenomas result in a decrease in the
be unable to complete the colonoscopy and
incidence of colorectal cancer, frank colo-rectal
intubate the cecal pole for a variety of reasons
neoplasia has a great potential for cure when
(redundant colon; colonic spasm; marked
detected at an early stage.
diverticulosis; obstructing masses or strictures;
and angulation or fixation of colonic loops, most
There is a continued search for method of early
commonly due to previous pelvic surgery).
detection of colorectal neoplasms that is cost-
Second, it does not allow evaluation of the liver
effective, safe, and acceptable to patients.
and other organs outside the colon. Third, it has
Current methods used to detect colorectal polyps
a blind area, as a colonoscope passes in only one
and colonic cancer include sigmoidoscopy,
direction. For example, the opposite side of a
colonoscopy, and double-contrast barium enema
colonic fold cannot be evaluated exactly.
examination. The effectiveness of each modality
Finally, it is invasive and uncomfortable (3).
remains controversial, and each method has
Therefore, in search for a rapid, less invasive,
inherent limitations (2).
accurate, and well-tolerated technique which can
226
d:\skydrive\Jor\vol51_6The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51 , Page 240 252 Epi- On versus Epi- Off Techniques of Corneal Collagen Cross Linking for Treatment of Keratoconus Mona El Sayed Ali Hassan
Al Azhar University, Faculty of Medicine for Girls
Abstract
Aim of the Work: The aim of this study is to evaluate and compare the epi-on versus the epi-off techniques of corneal collagen cross linking as regards their safety and efficacy for treatment of mild to moderate degree keratoconus.
Design: Prospective, non randomized study.
Patients and Methods: Thirty eyes in 15 patients (9 males and 6 females) with bilateral mild to moderate degree keratoconus were included in this study. Their mean age ± SD was 26.2 ± 3.9 years. Diagnosis of keratoconus was based on clinical evaluation as well as pentacam examination. All patients were subjected to corneal collagen cross linking. According to the technique used, eyes were classified into 2 groups:
Group I: Included 15 eyes in 15 patients, where cross linking was performed after removal of the corneal epithelium (Epi-off). Group II: included the other 15 eyes of the same patients, where cross linking was performed with intact epithelium (Epi-on). Comparison between the two groups as regards visual outcome, keratometric readings, least corneal thickness, refraction outcome and corneal haze was done.
Results: No intra operative complications were reported in our study. Re-epithelialization in eyes of group I was reported within a week except three eyes were re- epithelialization was reported after 10,14and 21 days. There was a statistically significance improvement in best corrected visual acuity in both groups (0.36 before versus 0.60 six months after surgery) but the difference between both groups was not significant. As regards refraction, there was reduction in spherical error 6 months after surgery in both groups (-6.14D before,-5.22D 6 months after surgery) as well as cylindrical error (4.87D before 3.79 D 6 month after surgery). Differences between both groups were statistically not significant. There was increase in the least corneal thickness after surgery (448.6 microns before surgery versus 451.9 microns 6 months after surgery) but statistically the difference was not significant (P=0.75) and the difference between both groups was also not significant. Changes in keratometric readings were statistically not significant, and the difference between both groups was also not significant. Corneal haze was observed one month post operatively in four eyes in group one versus 3 eyes in group II. Persistent haze at the end of follow up was reported in three eyes in group I versus two eyes in group II. The incidence of haze as well as its density was higher in group I than group II with statistical significant difference.
Conclusion: Both epi-on and epi-off techniques of corneal collagen cross linking are safe and effective in stabilization or even improvement of mild to moderate degree keratoconus as regards best corrected visual acuity, refraction, keratometric readings, and least corneal thickness. The epi-on technique is easier and more tolerable by the patient with less postoperative corneal haze. Key words: Keratoconus- collagen cross linking- Epi-on, Epi-off - corneal haze.
240
d:\skydrive\Jor\vol51_7The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 253 263
Immunomodulatory Changes Induced By High Doses Of Dextromethorphan In Male Rats Hanan Mostafa Rabei
Narcotic Department, the National Centre for Social and Criminological Research, Cairo-Egypt
ABSTRACT Background:
Dextromethorphan (DXM) is a synthetic opioid analogue, similar to codeine that has antitussive
effect but no opiate-like analgesic activity. It is widely used as an over-the-counter cough suppressant available in various cough and cold preparations; it is one of the often overlooked types of substance abuse by adolescents and young adults in the United States and around the world. So, the present study aims to investigate the side effects of the DXM abuse (sub-chronic and lethal doses) on the immune functions in rats. Material and Methods:
The rats were divided into three equal groups, the first one served as control, and the second and
third were treated. Treated groups received oral doses of DXM which increasing per 10 days (double dose) for a month. Results
We examined the sub-chronic and lethal effects of DXM administration on the cellular immune
responses in rats. T cell stimulator, Phytohemagglutinin showed a significant suppress on lymphocytes of peripheral blood proliferation and a highly significant decrease on phagocytic and killing of S. aureusby PMN and macrophage cells. Moreover, it induced a significant decrease in serum IL-6, andIFN- levels, but, it exhibited a highly significant increase in serum IL-10 level throughout the period of experiment. In addition, it induced also a significant decrease in the production of cortisol during the experimental time except the last period of treatment in the 3rd group, where, serum cortisol level gradually return to normal level. Conclusion:
These results suggest that sub-chronic and lethal doses of DXM administration in rats disturbed
cellular immune responses, exhibited potent anti-inflammatory actions, suppressed of leukocytes dependent production of cytokines such as IL-6 and IFN-. Moreover, it has some effects on serum cortisol concentration presumably via blockade of NMDA receptors. Key words: Dextromethorphan, IFN-, IL-10, IL-6, Phagocytosis, Lymphocytes transformation,
Cortisol, Albino rat.
Introduction
Dextromethorphan (DXM) is an over-the-
However, it interacts at non-opioid sites
counter (OTC) cough suppressant commonly
and possesses other pharmacological activity.
found in cold medications (1). DXM is often
For example, DXM is both a substrate and an
abused in high doses by adolescents to generate
inhibitor of CYP450 2D6 (6). It is metabolized to
euphoria and visual and auditory hallucinations
an active metabolite dextrorphan, which, along
(1,2). DXM is an antitussive that has been
with DXM, antagonizes the N-methyl-D-
proposed to have potential utility in the
aspartate
receptors
(NMDA),
producing
treatment of various neurological disorders (3).
phencyclidine (PCP) - like effects, inhibiting
Moreover, it has been suggested to be useful in
serotonin reuptake, competing for serotonergic
attenuating tolerance to opioids, reducing opioid
receptors, and eliciting adrenergic effects by
withdrawal and inhibiting the reinforcing
inhibiting peripheral and central catecholamine
properties of a variety of abused drugs (4). Aside
uptake (7). It is well known that the central
from its effects, DXM is essentially devoid of
nervous system and behavior can influence
other opioid-type effects (5).
immune function (8).
253
Ashraf MThe Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 264 274
CARDIOMETABOLIC PROTECTIVE EFFECTS OF SOME MEDICINAL PLANTS IN DIABETIC ALBINO RATS Waleed S. Mohamed, 1 Ashraf M. Mostafa, 2 Abdel Hamid A. Serwah, 3 And Khaled M. Mohamed 4
Internal Medicine Department1, 3, Anatomy and Histology Department 2, College of Medicine, Taif
University, KSA; Pharmacognosy Department 4, College of Pharmacy, Taif University, KSA. Author of Correspondence: Waleed S. Mohamed, Internal Medicine Department, College of Medicine, Taif University.E-mail: [email protected]Mobile: 00966/553420886 Abstract Background and aim of the study: DM represents an important independent risk factor for the development of and mortality from coronary heart disease (CHD), increasing the risk by 2 to 4 times. According to WHO data, more than 75% of patients with DM die due to vascular accidents. This study investigated the effects of some plants used in Saudi Arabia and some other Arab countries as antidiabetic agents and explores its metabolic effects. Material and Methods: One hundred fifty adult male Albino Rats were divided into six experimental groups each consist of twenty five rats. The first group was considered as a control group. The rest of groups were affected by induction of experimental diabetes by subcutaneous injection of Alloxan. The second group consisted of diabetic rats without any treatment. The third group was treated by the aqueous extract of mixture contains Foenugreek, Nigella sativa and Termis seeds. The fourth group was treated with the aqueous extract of Nigella sativa seeds (100 mg / kg of body weight), while the fifth group was treated with the aqueous extract of Foenugreek seeds (100 mg / kg of body weight). The sixth one was treated with the aqueous extract of Termis seeds (100 mg/kg body weight). After four weeks of treatment, different biochemical parameters were performed including estimation of blood sugar level and serum insulin level. Pancreatic and liver samples were obtained and processed for microscopic and quantitative evaluation after staining the prepared sections with both Heamatoxylin and Eosin as well as special stain for demonstration of the different pancreatic cells in the Islet of the Langerhans. Results: The usage of the mixture or each plant alone corrected the glucose level and insulin level. Microscopically there was definite decrease in the number and diameter of beta pancreatic cells in the diabetic group while the other pancreatic cells were not affected (alpha and delta cells). The use of medicinal plants in the different groups of this study greatly improved such cellular changes and the level of blood sugar level was corrected. Also, improve dyslipidemia present in diabetic rats. The results showed that the activity of the mixture was better when compared with Nigella, Foenugreek or Termis seeds alone. Conclusions: The water extract of the mixture is the most powerful in amelioration hyperglycemia and most of all damage effects of Alloxan on hematological parameters and lipid profile. Also, it can control most of the metabolic risk factors of CAD in diabetic rats. So it is advised to use the plant mixture as an antidiabetic agent rather than the use of each plant separately. Repeating such study with the use of variable doses may be helpful in better evaluation for the required dose. Key words: Alloxan - Diabetes - Antidiabetic plants Pancreas coronary artery disease
Introduction Coronary heart disease (CHD) has been a global
from heart disease and stroke. Adults with
problem since long. It prevails in high class
diabetes are two to four times more likely to have
society to low class society and affects all ages
heart disease or suffer a stroke than people
specially the middle age group. It is the cause of
without diabetes. High blood glucose in adults
25-30 percent of deaths in most industrialized
with diabetes increases the risk for heart attack,
countries. (1)
stroke, angina, and coronary artery disease. (3)
Diabetes mellitus (DM) is possibly the world's
People with type 2 diabetes also have high
fastest growing metabolic disease. (2) CHD is a
rates of high blood pressure, lipid problems, and
major complication of diabetes and the leading
obesity, which contribute to their high rates of
cause of early death among people with diabetes.
CVD. Smoking doubles the risk of CVD in
About 65 percent of people with diabetes die
people with diabetes. (4)
264
CHAPTER IIThe Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 275 284
Purification of The Antitumor Active Metabolite from Streptomyces xylophagus Ha.Ph-7 Crude Extract Isolated from Hamam Pharaoh Hot Spring Saad AM Moghannem1*, Kouka SE Abd-elwahab2, Hussein H Elsheikh3
1,3
Botany and Microbiology Department, Faculty of Science, Al_Azhar University,Cairo, Egypt.
2Virology Laboratory, Microbiology Department, Faculty of Medicine for Girls(FMG), Al_Azhar
University, Cairo, Egypt. ABSTRACT: Aim: This study aimed at production, extraction, purification and characterization of active antitumor compound from marine actinomycete secondary metabolites crude extract that was selected as most potent crude secondary metabolites from the preliminary screening of total fifty one extract. Material and methods: These tumor cell lines were breast cancer (MCF-7) (ATCC HTB-22) and Hepato-cellular carcinoma (HepG2) (ATCC 77400), colon cancer (Caco) (ATCC HTB-37) and cervix carcinoma(HeLa) (ATCC CRL-13011) cells. Purification process was done using silica gel column chromatography while purity was detected using thin layer chromatography (TLC). The active fraction was detected using morphological changes (cytotoxicity) by microscopic examination and anti-proliferative activity using MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay. Result: The result indicated that there is only one fraction responsible for antitumor activity. This active fraction has cytotoxic and anti-proliferative activity against HepG2, MCF7, Caco and HELA cells with IC50=24.5, 20.1, 27.6 and 17.7µg/ml respectively. The analysis of physico-chemical, elemental and spectroscopic analysis (UV, IR, H.NMR, Mass spectroscopy) indicated that; the active compound has the nature of anthracycline compound. Conclusion: This purified compound has promising broad spectrum cytotoxicity and anti- proliferative activity in an in vitro system. The next research step shall include different optimization parameter that maximize productivity with long-term goal; discovery of an antitumor drug from actinomycetes native to Egyptian hot springshabitat. Key words: Actinomycete extracts, antitumor, Cytotoxicity, Anti-infectivity, HepG2, Caco, MCF7, HELA. Email:[email protected]
INTRODUCTION: Actinobateria represents one of the largest
microorganisms [16-20], perhaps because of
taxonomic units among the 18 major lineages
their
close
relationships
with
marine
currently recognized within the domain
eukaryotic
organisms
including
Bacteria [1]. In addition, the isolation of
mammals[2,9]. Polyketides are a large family
marine actinomycetes has been a great source
of natural products produced by step-wise
of new compounds and their isolation all
decarboxylative Claisen type condensation of
around the globe, from shallow costal
acyl-CoA precursors, reactions catalyzed by
sediments to the deepest sediments from the
polyketide synthases (PKSs). Three types of
Mariana
Trench,
demonstrates
that
PKSs are known to date: type I PKSs are
actinomycetes are ubiquitous in marine
multifunctional enzymes organized into
sediments, but at lower numbers than in soil
modules, type II PKSs are multienzyme
[2-14]. Progress has been made recently on
complexes carrying out a single set of
drug discovery from actinomycetes by using
activities and type III PKSs, also known as
high-throughput screening and fermentation,
chalcone synthase-like PKSs, are iteratively
mining genomes for cryptic pathways, and
acting condensing enzymes [21]. In addition
combinatorial biosynthesis to generate new
anthracyclines represent a wide family of
secondary metabolites related to existing
compounds with indicator-like properties, red
pharmacophores [15]. Marine actinomycetes
in acid and blue-violet in alkaline solution,
have attracted great attention since they have
that are produced by cultivation of
developed unique metabolic and physiological
microorganisms belonging to the genus
capabilities that not only ensure survival in Streptomyces [22] Anthracyclines are among
extreme habitats, but also offer the potential to
the most effective and widely prescribed
produce compounds with antitumor and other
anticancer agents [23]. Anthracycline has
interesting pharmacological activities that
three mechanisms of action: 1- Inhibits DNA
would not be observed in terrestrial
and RNA synthesis by intercalating between
275
d:\skydrive\Jor\vol51_10The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 285 288
Relationship between Peripheral Artery Disease and Cardiac Function in Elderly Patients with Ischemic Heart Disease Moatasem S Amer*, Heba M Tawfik*, Manar MA Maamoun*, Ayman M Abd Elmoteleb #
*Geriatrics and Gerontology department, # Cardiovascular department; Faculty of Medicine,
Ain shams university, Cairo, Egypt Abstract
Background: There is high prevalence of combined peripheral and coronary artery disease (CAD) related to atherosclerosis with associated increase in morbidity and mortality . Objectives:The aim of our study was to find an association between ankle brachial index (ABI) and cardiac function in elderly patients with CAD using ejection fraction (EF). Method: A Case control study. The case group included 100 elderly patients who had peripheral artery disease ( PAD) divided into 2 groups according to age ( 60- 70 and > 70 years). The control group included 100 elderly subjects who didn't have PAD which were divided also into 2 groups according to age . Both groups have CAD and underwent coronary angiography (CA) showing significant CAD lesions. Echocardiography were done to all patients showing cardiac function. Results: EF was lowest in cases > 70 years (46.84 ± 9.82) and was highest in controls > 70 years (53.02 ± 5.53) which is statistically significant (P- Value 0.009). Also EF is correlated with ABI. Conclusion: There is a significant positive relationship between ABI and EF.
Keywords: Coronary artery disease Peripheral artery disease Ankle brachial index Ejection Fraction Elderly Introduction
Atherosclerosis is a disorder that
Patients with lower extremity PAD
comprises the development of focal
undergoing PCI for CAD have lower
atheromas, within the intima and inner
procedural success rates, higher in-
portion of the media. As the disorder
hospital cardiovascular complication
advances, the atheromas undergo a
rates, and higher longterm rates of MI,
variety of complications as calcification,
target vessel revascularization, and
internal hemorrhages, ulceration, and
mortality [4].
sometimes superimposed thrombosis
Studies have consistently shown that patients
[1].
with PAD have more severe CAD, often with
Studies found that in patients with
severe and multivessel involvement, than
PAD, the prevalence of CAD ranges
CAD patients without PAD [5].
from 20% to 60% when based on
medical history, physical examination, Methodology:
and electocardiography (ECG) and up to Study design:
90% in patients who have undergone CA
The study is a case control study
[2].
conducted to assess the relationship between
In about 99 % of cases, CAD is due
PAD using ABI and EF in elderly patients
to
atherosclerotic
changes.
with CAD
Atherosclerosis begins as early as the Selection of Subjects
first or second decade of life and is a Sample size:
progressive
disease
over
time.
200 male and female elderly patients
Manifestations of CAD are seen as early
60 years known to have ischemic heart
as the second or third decade of life, but
disease are divided into two groups:
as patients age, the severity of the Case group:
disease increases [3].
100 cases with ABI < 0.9 further subdivided according to age into:
285
The Egyptian Journal of Hospital Medicine (April 2013) Vol The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 289 299 Expression of Matrix Metalloproteinase 1(MMP1) in HepatoCellular Carcinoma (HCC): Immunohistochemical and Biochemical Studies Mohy Eldin abdel Fattah abdel Atty Yassen*, Olfat Ali Ibrahim Hammam** and Hazem Kamel Abdel-Aziz Mohamed Sarhan***.
Chemistry Dept., Faculty of Science, Suez Canal University, Pathology Dept Theodor Bilharz Institute,
Academy of Scientific Research. Medical and Radiation Research Dept., Nuclear Material Authority.
Abstract Background: The present study aimed to evaluate the expression of Matrix Metalloproteinase-1 (MMP1) in HepatoCellular Carcinoma (HCC) by using the Immunohistochemical technique, which allows us to integrate the biological aspects of this enzymatic expression in the morphological context of HCCs. Material and Methods: The study was performed on 70 subjects from out and in patients of Tropical medicine Department, Thiodor Billhars Institute during the period from January 2011 until June 2012. The present study included 60 patients with chronic hepatitis C who had undergone liver biopsy. They consisted of 42 men and 28 women with ages ranging from 36 to 66 years. The diagnosis of chronic hepatitis C was made on the basis of positivity for anti-HCV (by the second generation ELISA), and confirmed by HCV- RNA reverse transcription polymerase chain reaction (RT-PCR). Patients were divided into four groups: Group I: included 10 normal persons with no history of liver disease with normal liver enzymes and free ultrasonographic finding as normal control. It included 6 males, 4 females, with ages ranging from 34 to 48 years. Group II: included 20 HCV infected patients without cirrhotic changes. It included 11 males, 9 females, with ages ranging from 39 to 53 years. Group III: included 20 HCV infected patients with liver cirrhosis, 12 males, 8 females, with ages ranging from 48-63 years. Group IV: included 20 HCV infected patients with HCC, 16 males, 4 females, with ages ranging from 53-64 years. Results: Blood Picture, (Hb, WBCs, RBCs, Plts, PC and ESR). Liver Function Test (ALT, AST, ALB, GGT, ALP, T. BIL and D. BIL). Matrix Metalloprotenase 1(MMP1) Measurements: Serum MMP1. Histopathological investigation Including histopathological changes in the liver tissue. Conclusion: our results suggest that MMP-1 is overexpressed in a large proportion of patients with HCC and the high expression level of protein correlated with the disease progression and poor clinical outcome in HCC. Furthermore, MMP-1 high expression proved to be a risk factor for tumor recurrence and independent molecular marker of prognosis in HCC and may become a novel target in the strategies for the prediction of tumor progression and prognosis of this disease. Key words: Patients, HCV, Cirrhosis, HCC, and MMP-1
Introduction: Tommaso, (4),
reported
that,
Hepatocellular carcinoma (HCC) is the fifth most
Hepatocellular carcinoma (HCC) is a common
common cancer and sixth leading cause of death
form of cancer that arises from hepatocytes and
among cancers worldwide (1), and HCC is a
whose risk may be affected by several known
heterogeneous group in terms of biological
environmental factors, including hepatitis viruses,
behavior and molecular profiles (2). Recent
alcohol, cigarette smoking, and others. Rare
studies support that tumors may be initiated and
monogenic syndromes, such as alpha1-antitrypsin
maintained by a small population of cells that
deficiency, glycogen storage disease type I,
have stem-like features, and this highly
hemochromatosis, acute intermittent and cutanea
tumorigenic cell subset within the tumor bulk has
tarda porphyria, as well as hereditary tyrosinemia
been considered as cancer stem cell (3). Invasion
type I are associated with a high risk of HCC.
is a characteristic feature of HCC, it frequently
Several common conditions or diseases inherited
shows early invasion into blood vessels as well as
as polygenic traits e.g. autoimmune hepatitis,
intrahepatic
metastasis
and
later
shows
type 2 diabetes, a family history of HCC,
extrahepatic metastasis.
hypothyroidism, and non-alcoholic steatohepatitis
also show an increased risk of HCC compared to the general population. Hepatitis C infection
289
d:\skydrive\Jor\vol51_12The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 300 305
Role of 3-D Conventional Angiography In Evaluation of Intra Carnial Aneurysms Ahmed M Bassiouny*, Maher M Arafa*, Sameh M Abdelwahab*, Motaaz M Albeblawy *, Amr M Abdelsamad*.
*Department of Radio-diagnosis, Faculty of Medicine, Ain shams University
Abstract Introduction: intracranial aneurysms are pathological enlargement of the brain arteries that are most commonly located in the circle of Willis. Intracranial aneurysms are relatively common with a prevalence of approximately 4%. The real danger of aneurysms is subarachnoid hemorrhage. 3D digital subtraction angiography has become a critical imaging tool in neuroradiology allowing for the visualization of detailed cerebral vasculature prior to any intervention. Aim of the work: The aim of this work is to evaluate the diagnostic performance of 3D conventional angiography in the evaluation of intracranial aneurysms compared with the conventional cerebral angiography. Methods: The studied group included 20 patients (5 men and 15 women) with subarachnoid hemorrhage or known to have cerebral aneurysms. All patients were subjected to conventional cerebral angiography and 3D cerebral angiography, using C-arm (Toshiba) rotational technique. Results: 3D digital subtraction angiography is superior to conventional digital subtraction angiography in 100% of the cases 3D imaging revealed the proper aneurysmal shape, size, precise assessment of its neck and relation to the surrounding vessels. Conclusion: Three-dimensional DSA improves the detection and delineation of intracranial aneurysms KEY WORDS: 3-D Conventional Angiography , Intra Carnial Aneurysms.
INTRODUCTION Intracranial aneurysms are pathological
patients with subarachnoid hemorrhage or
enlargement of brain arteries that are most
known to have cerebral aneurysms 5men, 15
commonly located in the circle of Willis (1).
women; age range 3070years with cerebral
The incidence of subarachnoid hemorrhage
aneurysms
and
variable
clinical
(SAH) due to rupture aneurysm is 10-
presentations, the most common one was
25:100,000 and is a devastating event
headache (18 cases) 15 after subarachnoid
associated with high morbidity and mortality
hemorrhage. Other complains include eye
from rebleeding and vasospasm (2).
pain and visual deficits (2 cases).Some of
3D digital subtraction angiography (3D DSA)
our
Patients
had
pre-procedural
has demonstrated its clinical efficacy in
investigations including PT, PTT, INR and
precise depiction of the aneurysmal neck and
renal function tests.
its relationship to adjacent vessels. Moreover,
After taking consents from all patients or
it has been shown that 3D DSA reveals
their first degree relatives in unconscious
aneurysms not seen with conventional digital
and emergency cases, patients usually fast 4-
subtraction angiography (DSA) (3). These
8 hours before the procedure but are
features are important to consider when one
permitted to take any regular medications
decides surgical or endovascular treatment(4).
(particularly antihypertensive & antiplatelet THE AIM OF THE WORK
medications) orally with a little water.
Is to assess the diagnostic performance of 3D
Patients receiving long term anticoagulation
conventional angiography in the evaluation
should discontinue warfarin 6 hours prior to
of intracranial aneurysms compared with the
the procedure to decrease the risk of
conventional cerebral angiography
punctural hematoma. Similarly, patients with METHODS
preexistent renal disease are admitted on the
3D conventional cerebral angiography was
prior day for intravenous hydration.
performed over a period of 2 years on 20
300
d:\skydrive\Jor\vol51_13 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 306 316 Diagnostic Validity of Serum and Peritoneal TNF-alpha, high sensitivity CRP and Plasma Cell-Free Nuclear DNA (ccf nDNA) as Biomarkers of Pelvic Endometriosis- A Case Control Study Ahmed F Koura, MSc*, Mohamed A Yehia, Waleed H ElTantawy, Adel S Salah El Din, Dina El-Sayed ElShennawy
* Departments of Obstetrics & Gynecology and** Clinical Pathology, Faculty of Medicine, Ain
Shams University. Abstract Introduction: Endometriosis is a disease defined by the presence of endometrial glands and stroma located outside the uterine cavity. These ectopic implants can be found throughout the pelvis, on and within the ovaries, abutting the uterine ligaments, occupying the rectovaginal septum, invading the intestinal serosa, and along the parietal peritoneum. Endometrial implantation at distant sites such as the pleura, lung, within surgical scars, and along the diaphragm also has been reported. (1). It results often in subfertility and pain, occurs mainly in women of reproductive age (1650 years) and has a progressive character in at least 50%, but the rate and risk factors for progression are unknown. Endometriosis can be classified into four stages: minimal, mild, moderate and severe. The gold standard for the diagnosis of endometriosis is laparoscopic inspection, ideally with histological confirmation. (2), however, is an invasive technique and should be performed only after imaging techniques prove insufficient for confident diagnosis. (3) Lack of a non-invasive diagnostic test contributes to the long delay between onset of symptoms and diagnosis of endometriosis. (2) Additional tools are needed for non-invasive classifications in order to reduce the number of unnecessary laparoscopies without adversely affecting outcomes. Finding specific and more sensitive biomarkers in endometriosis is critical, because endometriosis is usually diagnosed only in advanced stages, and there is a high rate of morbidity for this disease. (4) Aim of the work: The aim of the current study is to assess the validity of serum and peritoneal high sensitivity CRP and TNF-alpha and plasma cell-free nuclear DNA (ccf nDNA) as biomarkers in early diagnosis of pelvic endometriosis. Methods: This study was conducted at the Obstetrics & Gynecology department, Maternity Hospital, Ain Shams University. This is a case control study of 120 women scheduled for diagnostic laparoscopy. Laparoscopy was indicated in these women whether for various causes of subfertility or for chronic pelvic pain between January 2011 and January 2012. The patients were divided into the following groups: Group I (endometriosis group/ study group) consisted of 80 patients diagnosed to have endometriosis during laparoscopy. Group I cases were subdivided into two subgroups, Group IA: consisted of 34 cases with stage 1or minimal endometriosis and Group IB: consisted of 46 cases with stage 2 or mild endometriosis. Group II (non-endometriosis group/Control group): consisted of 40 cases with no detected pelvic pathology. During the laparoscopy procedure, both peripheral venous blood and peritoneal samples were withdrawn. Serum and peritoneal levels of high sensitivity CRP and TNF-alpha as well as plasma levels of ccf nDNA were compared in both groups and in early stages (minimal and mild) of endometriosis within the study group. Results: Serum TNF-a, serum hs-CRP and plasma ccf DNA were significantly elevated in cases compared with the control group. They were also elevated in patients with group IA and group IB as compared to control group. However, there was no statistically significant difference between cases and control group as regards peritoneal TNF-a and peritoneal hs-CRP. There was no significant difference between the group IA and group IB as regards all biomarkers. Conclusion: Our results showed that serum TNF-alpha , serum hs-CRP and plasma ccf DNA are highly reliable biomarkers for screening and early diagnosis of endometriosis, but they can not be used to discriminate between stage I and stage II. On the other hand, peritoneal TNF-a and peritoneal hs-CRP are non reliable for early diagnosis of endometriosis and can not be used to discriminate between stage I and stage II of endometriosis.
INTRODUCTION
Endometriosis is a disease defined by
uterine ligaments, occupying the rectovaginal
the presence of endometrial glands and stroma
septum, invading the intestinal serosa, and
located outside the uterine cavity. These
along the parietal peritoneum. Endometrial
ectopic implants can be found throughout the
implantation at distant sites such as the pleura,
pelvis, on and within the ovaries, abutting the
d:\skydrive\Jor\vol51_14The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 317 325 STUDY OF SOME FACTORS ASSOCIATED WITH HIGH-RISK ASTHMA IN CHILDREN Inass M. Taha *, Sahar M. Ali **, Ahmad Abdelsadek Mohammad ***, and Nany M.S. Nawar ****
*Internal Medicine Department, Faculty of Medicine, Taibah University, Saudi Arabia. **Microbiology and
Immunology Department, Faculty of Medicine, Menufiya University, Egypt. ***Chest Department, Faculty of
Medicine, Benha University, Egypt. ****Immunology Department, King Fahad Hospital (MSC biochemistery),
Saudi Arabia. Abstract
Background: Bronchial asthma is characterized by lower respiratory tract inflammation associated with bronchial hyper responsiveness with variable and reversible airflow obstruction. The majority of asthmatics are sensitized to at least one common allergen. Aim of the study: The aim of this study is to determine the association of high-risk asthma with allergy-related parameters (total serum IgE levels, serum levels of allergen- specific IgE, eosinophil count, eosinophil percentage ) and pulmonary functions in children. Subjects and methods: 50 Children aged 8-15 years diagnosed with atopic asthma were enrolled in the study. Pulmonary function tests, total leukocyte count (TLC), eosinophil count, and eosinophil percentage were estimated. Total serum immunoglobulin E (IgE) levels and serum IgE levels specific to antigens from 1 to 9 allergens with class 1 or higher, namely, Dermatophagoides pteronyssinus (D. pteronyssinus) , Dermatophagoides farina (D. farina ), cat dander , dog dander, cockroach, egg white, milk, Aspergillus fumigatus, and fish, were measured using UniCAP fluoroenzyme immunoassay (FEIA).
Results: This study includes 50 participants, 20 (40%) belonged to the high-risk and 30 (60%) to the low-risk groups. This study revealed no significant association in peak expiratory flow rate (PEFR, ) values between high-risk and low-risk asthma groups (p 0.05). There was no significant association in forced expiratory volume in first second [ FEV1 (L)] values between high-risk and low-risk asthma groups ( p 0.05), whereas there was significant association in FEF 25-75% (forced expiratory flow 25-75%) values between high-risk and low-risk asthma groups ( p 0.05). There was a significant association between total serum IgE level and high-risk asthma, but TLC, eosinophil count, and eosinophil percentage showed non significant association with high-risk asthma. Serum levels of IgE specific to D. pteronyssinus, D. farina, cat dander, and dog dander were significantly associated with high-risk asthma. The high-risk group had higher serum levels of IgE specific to D. pteronyssinus ( p < 0.0001), D. farina ( p < 0.0001), cat dander ( p < 0.0001), and dog dander antigens ( p < 0.0001) compared with those in the low-risk group. There was no significant association between high-risk asthma and the serum levels of IgE specific to antigens from other allergens (including cockroach, egg white, and milk). Serum levels of IgE specific to Aspergillus fumigatus and fish were both negative (class level < 1) in both the high-risk group and the low-risk group.
Conclusion Children with higher serum levels of IgE specific to D.pteronyssinus, D. farina, cat dander and dog dander antigens, and total serum IgE levels, and lower FEF25-75% values belong to the high-risk asthma group. The characterization of risk factors has enabled us to identify high-risk asthma in children , leading to better treatment options. Key words: HIGH-RISK ASTHMA,CHILDREN.
317
d:\skydrive\Jor\vol51_15 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 326 331
Association of A Novel Adipokine With Insulin Resistance And Disease Severity in HCV Infected Patients Wafaa Gh. Shousha 1,*, OM Kolsoum El-Haddad2, Ashraf A. Basuni3, Hatem A. El- Mezayen1, Amany A. Abdalla1
1Chemistry Department, Helwan University, Egypt
2Clinical Hepatology Department, Menofiya University, Egypt
3Clinical Biochemistry Deparment, Menofiya University, Egypt
Corresponding author: Wafaa Gh. Shousha; Chemistry Deparment, Helwan University, Egypt
Email: [email protected] . Mobile: 002 01227112178
Abstract: Retinol-binding protein 4 (RBP4) has been identified as a protein contributing to insulin resistance (IR). As insulin resistance is present in nearly all patients with liver cirrhosis, we evaluated RBP4 in patients with chronic hepatitis C virus infected patients (CHC). This study aimed to evaluate the role of serum retinol binding protein 4 (RBP-4) as a predictor for early detection of insulin resistance (IR) in patients with CHC infection. Research Design and Methods: Serum RBP4 was measured in 60 non diabetic CHC Patients classified according to Child- Pugh classification (Child A, Child B, Child C), 20 diabetic CHC patients and 20 age- and sex-matched healthy blood donors served as control subjects. RBP-4 correlation with the homeostasis model assessment of insulin resistance index (HOMA-IR) and metabolic factors was investigated. Results: Serum RBP-4 levels were significantly lower in HCV infected patients and HCV diabetic patients compared with controls (HCV 16545.17± 10633.16, Diabetic HCV 10310 ± 4371.31, Control 27820.0 ± 9316.46, P< 0.001). In addition, serum levels of RBP-4 significantly decreased between all stages of cirrhosis, with the lowest level in Child C. HOMA-IR not significantly higher in HCV infected patients compared to control (HCV 5.54 ± 3.67, and Control 4.11 ± 2.42). RBP-4 levels correlate positively with GGT (P<0.01), CHOL (P<0.05) and TG (P<0.05) in HCV Child C, additionally, it shows significant positive correlation with TG (P< 0.05) in HCV Child B. Conclusions: Disease severity may limit the role of RBP4 as a predictor of IR in CHC. These data demonstrate that RBP4 in CHC patients decreased due to reduced hepatic production, and it is not associated with insulin resistance. Keywords: HCV, RBP4, Insulin Resistance Abbreviations: RBP4: Retinol-binding protein 4, IR: insulin resistance, HOMA-IR: homeostasis model assessment of insulin resistance index, CHC: Chronic Hepatitis C Virus. Introduction Chronic Hepatitis C Virus (HCV)
of HCV RNA in pancreatic cells which
infection is associated with a wide
has a direct cytopathic effect at the islet-
spectrum of liver histological lesions,
cell level, accompanied by morphological
ranging from mild chronic hepatitis to
changes and functional defects in insulin
cirrhosis and hepatocellular carcinoma.
secretion(12). Therefore, HCV infection is
The highest HCV prevalence in the world
able to trigger autoimmune mechanism(s)
occurs in Egypt at an estimated 12%
against the insulin producing pancreatic
among the general population (13). HCV
beta cells leading to diabetes (10).
infection is recognized as a systemic
Retinol-binding
protein
4
disease involving oxidative stress, insulin
(RBP4) has been identified as a novel
resistance, steatosis, fibrosis, apoptosis,
adipokine that mainly secreted by
altered gene expression and hepatocellular
hepatocytes (80%), but also by adipose
carcinoma(3).
Patients
with
chronic
tissue (20%). Several mechanisms link
hepatitis
have
impaired
glucose
RBP4 to insulin resistance and type 2
metabolism with hyperinsulinemia and
diabetes. It was reported that serum RBP4
insulin resistance. One explanation to the
correlated positively with the presence of
higher prevalence of DM is the presence
insulin resistance in individuals with
326
d:\skydrive\Jor\vol51_16 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 332 345
Structural Adaptations Associated with Osmotic Stress of The Salt Gland in Birds Zeinab M. El- Gohary, Fawkeia I. El-Sayad, Hanaa A. Hassan and Aya M. Hamoda
Zoology Dept., Faculty of Science, Mansoura University, Egypt
Abstract: Introduction:When the drinking water of many species of ducks is changed from freshwater to saline, their salt glands hypertrophy and the principal cells showed numerous lateral cell evaginations and abundant mitochondria, enhancing their capacity to excrete salt. Aim of the work:The purpose of this investigation was to demonstrate and evaluate the anatomical, histological, and ultrastructural adaptations of the salt gland of the domestic female ducks associated with high salt osmotic stress. Material and methods: The present study was carried out on two groups of female domestic ducks and one group of wild ducks. Where as one group of domestic ducks was exposed to osmotic stress; imposed by replacing drinking tap water with 1% sodium chloride solution for two consecutive weeks. Morphometric measurements as well as histological and ultrastructural aspects of the salt glands were considered. Results: The investigation revealed that the weight and size of the salt glands of the salt- stressed ducks were markedly heavier and larger in comparison to those of the control and wild ducks. The number and the diameter of secretory lobules as well as the length of secretory tubules of the salt-stressed group were greater compared to the control ones.The degree of the proliferation and differentiation of the peripheral cells was distinctly greater for the salt-stressed than the control and wild ducks. The basal and lateral surfaces of the fully specialized secretory cell type in the salt-stressed and wild birds were obviously amplified and in many cases the folds of adjacent cells meshed with one another forming an elaborate complex of extracellular spaces and intracellular compartments. The cytoplasm of the fully specialized principal cells displayed abundant endoplasmic reticulum, numerous well developed mitochondria and deeply well developed basal foldings which increase the absorptive surface. Conclusion: The recorded peculiar features of the salt glands of the salt-stressed birds may be presented as an adaptive features to satisfy its special demands to eliminate the remarkable increased levels of sodium chloride load effectively. Key words: Histology, Supraorbital salt gland, Adaptations, Osmotic stress, Ultrastructure
Introduction: Active nasal salt glands have been
longitudinal
lobules
composed
of
reported
in
several
avian
orders
secretory tubules radiating from central
(Spheniciformes,
Precelariformes,
canals. These, in turn, form secondary and
Charadriformes,
Pelecaniformes,
primary ducts running toward the nasal
Anseriformes, Phoenicopteriformes), in
cavity and discharging the hypertonic fluid
which post-renal transport mechanisms are
through the nares (6). There are no evident
used to conserve urinary water and to
differences in tubule length or in types and
recycle excess NaCl to the nasal salt
distribution of secretory cells within the
glands (1,2). The salt glands are not
medial and lateral segments even though
restricted to birds that live in saline or
they have different embryonic origins (7).
maritime habitats, but are also present in
Since the avian salt gland provides an
some terrestrial avian species (3,4).
extra-renal pathway for the maintaince of
A typical salt gland is a bilateral paired
homeostasis because bird kidneys are
crescent-shaped organ, composed of
generally incapable of excreting all
separate medial and lateral segments (5).
electrolytes (8), many species of ducks be
Each segment consists of several
able to switch seasonally between
332
d:\skydrive\Jor\vol51_17 The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 346 360
The Functional Alterations of The Avian Salt Gland Subsequent to Osmotic Stress Zeinab M. ElGohary, Fawkeia I. El-Sayad, Hanaa Ali Hassan and Aya Mohammed Magdy Hamoda
Zoology Dept., Faculty of Science, Mansoura University, Egypt
Abstract: Background: Many terrestrial non-marine birds have functional salt glands. Their salt glands are usually quiescent. However, such glands show remarkable levels of phenotypic plasticity both morphological and physiological as a consequence of drinking saline water. Objective: The current investigation was conducted to reveal in more detail the different functional alterations of the duck`s salt glands subsequent to high salt osmotic stress. Material and methods: The selected avian species were the domestic female (Anas platyrhyncha)and the wild migratory (Anas clypeata ) ducks. Two groups of domestic and one group of wild ducks were considered in the present study , each of which included nine adult ducks. The high salt osmotic stress was induced by replacing drinking tap water of the domestic ducks with 1% sodium chloride solution for two consecutive weeks. The measured parameters were included some electrolytes in both serum and glandular tissue. Also, Na-K- ATPase activity and aldosterone concentrations were considered. Results: The present study elucidated that serum sodium, potassium, chloride and uric acid of the wild migratory ducks were markedly higher than those of both salt-stressed and control ducks. In addition, serum aldosterone concentration of the wild migratory ducks was distinctly higher in comparison with those of the control and the salt-stressed ones. Moreover, salt gland tissue homogenate electrolyte contents followed the same pattern as those of serum electrolyte concentrations. In contrast, the activity of Na-K-ATPase of the salt gland homogenates was higher in the salt-stressed ducks in comparison to both wild migratory and control groups. Conclusion: From the above mentioned results, it was concluded that the peculiar functional status of the salt gland of the experimentally salt-stressed ducks comparing to the control may be presented as an adaptive features to satisfy its special demands to eliminate the remarkable increased levels of sodium chloride load effectively. Key words: Ducks, Salt gland, Osmotic stress, Electrolytes, Na-K-ATPase
Introduction: The osmotic regulation in vertebrates is
Because salt gland provides an elegant
largely the result of controlled movements
model of the mechanisms involved in
of water and solutes across epithelial
active transport of sodium and chloride,
membranes. In mammals, the kidneys play
the physiological efficiency of the gland
the critical role in this process. On the
has been exclusively investigated ( 4,5,6).
other hand, in birds the kidneys, intestine,
The salt gland removes sodium chloride
and in some species, the supraorbital salt
from the blood far more efficiently than
glands all play important roles in
does the avian kidney and excretes it as
osmoregulation. Although the presence of
brine through a duct into the nasal cavity
the supraorbital salt gland in marine birds
and is eliminated in liquid form through
has long been known to ornithologists,
the nostrils, often accompanied by
however, its excretory function was not
vigorous shaking of the bird's head or
discovered until 1957-1958 when Knut
forced "sneezing"(7). The concentration of
Schmidt-Nielsen and co-workers found
the secreted fluid is always high, several
that these glands in the herring gulls
times as high as the maximum urine
(Larus argentatus) excreted sodium
concentration in birds (8).
chloride (NaCl) in concentrated solution
All marine birds have salt glands that,
(1). Such glands enable marine birds to
together with the kidneys, maintain body
drink brackish or full seawater, secrete salt
fluid homeostasis, despite the excess
and conserve osmotically free water (2,3).
sodium chloride (NaCl) they ingest. They
346
d:\skydrive\Jor\vol51_18The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 361 366
Pulmonary Functions After Injection Sclerotherapy Of Esophageal Varices & After Band Ligation Mohamed A. Metwally*, Ahmad Abdelsadek Mohammad,**Galal A. Moawad,*.
Hepatology, Gastroenterologytious Diseases Department -Benha University (*), Chest
Department -Benha University (** )
Abstract Aim of the study: To study changes in pulmonary function tests after esophageal variceal injection sclerotherapy in comparison to changes after esophageal variceal band ligation. Patients & methods: This study was designed as non randomized controlled study. Thirty patients with hepatic cirrhosis & portal hypertension who were admitted to Hepatology, Gastroenterology and Infectious Diseases department , Benha university hospital for elective esophageal variceal therapy (secondary prophylaxis) were classified into group I:15 patients treated with sclerotherapy by using 5-15 ml ethanolamine oleate and group II:15 patients treated with band ligation. Patients were subjected for full clinical evaluation including history, general, chest, and abdominal examination. Laboratory and radiological investigation including complete blood count, liver function tests, kidney function tests and blood sugar and plain chest x-ray (P.A. and lateral views) were done. Pulmonary function tests and arterial blood gasses were done before, one day after and one week after the procedure. Results: The results revealed , significant decrease in vital capacity in group I one day after injection ( p 0.05),but no significant decrease in vital capacity in group II. There was a significant decrease in PaO2 in group I one day after injection sclerotherapy ( p 0.05) but no significant changes in group II and no significant changes in PaCO2 in both groups one day after the procedures. The study has also revealed no significant changes in FVC,FEV1/FVC and PaCO2 in group I and group II after procedures. The study revealed significant linear correlation between the decreases in PaO2 and the percentage decrease in vital capacity( p 0.05). One week after procedure, pulmonary functions that has been affected in group I returned back to baseline values. Conclusions: esophageal injection sclerotherapy produces restrictive defect (decrease in PaO2 and vital capacity) in pulmonary functions one day after injection and improved within one week, while there was no effect for band ligation on pulmonary functions tests. Key words: esophageal varices, sclerotherapy, band ligation, pulmonary functions test. Introduction
Esophageal
varices
are
Endoscopic therapies for varices
extremely dilated sub-mucosal veins in the
aim to reduce variceal wall tension by
lower third of the esophagus[1]. They are
obliteration of the varix. The two principal
most often a consequence of portal
methods available for esophageal varices
hypertension, commonly due to cirrhosis
endoscopic
therapy
are
endoscopic
and one of the common causes of upper
sclerotherapy (EST) and endoscopic band
gastrointestinal bleeding. Diagnosis of
ligation (EBL). Endoscopic therapy is a
variceal bleeding or risk of bleeding is done
local treatment that has no effect on the
by upper gastrointestinal endoscopy [2].
pathophysiological mechanisms that lead to
Variceal bleeding is a major complication of
portal hypertension and variceal rupture.
portal hypertension and represents a leading
However, a spontaneous decrease in hepatic
cause of death in patients with cirrhosis.
venous pressure gradient occurs in around
Diagnostic and therapeutic developments
30% of patients treated with either EST or
have led to a significant improvement in the
EBL to prevent variceal rebleeding [4].
prognosis of variceal bleeding [3].
The complications of injection
sclerotherapy
have
been
extensively
reviewed [5].They can be divided broadly
361
ASSESSMENT OF GROWTH AND OXIDIZED HIGH-DENSITY LIPOPROTEIN LEVEL IN CHILDREN ONThe Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 367 375
Assessment of Growth and Oxidized High-Density Lipoprotien Level in Children on Regular Hemodialysis Soheir Bahgat Fayed*, Manal Abd EL-Salam*, Iman Mouhamed El-Bagoury**, Rabab Moussa*
Pediatric department*, Clinical Pathology Department**, Faculty of Medicine (for girls)
Al-Azhar University, Cairo, Egypt
Background: The cause of growth failure in chronic kidney disease (CKD) is multi-factorial with linear impairment being a final common pathway of various factors including malnutrition, increased catabolism, loss of nutrients and antioxidants, and aggressive dietary restrictions during dialysis .Anemia, metabolic acidosis and persistent micro inflammations are also causative factors. Objectives: To assess growth in children with CKD on regular hemodialysis and measure oxidized high density lipoprotein (OX-HDL), highly sensitive C-reactive protein (hsCRP) and to discuss their roles as a risk factors of malnutrition among studied cases. Patients and Methods: The study included 25 children with end stage renal disease (ESRD) on regular hemodialysis more than 6 months. Their ages ranged from 5-15 years with a mean of 10.76 years, also 25 of apparently healthy, age and sex matched were included. The study sample was selected from pediatric dialysis unit and outpatients clinic, of AL-Zahraa University hospital .Anthropometric measurements were assessed with determination of OX- HDL and hsCRP serum levels in both cases and the controls. Results: Anthropometry showed significant decrease in weight, height, body mass index, mid arm circumference and triceps skin fold thickness in patients when compared to the controls. 100% of patients had high level of OX-HDL and hsCRP, and positive correlation between OX-HDL and Z-score for Wt and Ht were detected. Conclusion: Malnutrition, and growth delay are common in children with chronic kidney disease on regular hemodialysis. High rate of inflammation in dialysis children as there were high level of hsCRP and OX-HDL. HDL, in regular hemodialysis children loses its protective function as an anti-oxidant, anti-inflammatory and becomes pro-inflammatory factor. Key words: CKD, dialysis, OX-HDL, malnutrition Corresponding author: Manal Abd El-Salam e-mail: [email protected] INTRODUCTION
The growth failure in CKD
High-density lipoprotein ( HDL) is
children is multi-factorial, the age at onset
known as a "good" lipoprotein, because high
of the disease, primary renal disease,
levels seem to protect against advancing
severity of CKD, hormonal resistance,
atherosclerosis by carrying cholesterol away
chronic anemia, metabolic acidosis,
from the arteries and back to the liver. HDL
malnutrition,
renal
osteodystrophy,
possesses antioxidant and anti-inflammatory
persistent micro-inflammation, recurrent
activities in interactions with circulating
infection,
cardiac
dysfunction
and
cells, inhibiting leukocyte and platelet
inadequate dialysis are all implicated ¹.
activation and thus exerting further systemic
Despite good progress with regard to
anti-inflammatory actions .
both conservative treatment and renal
In the presence of systemic
replacement therapy (RRT), 30% to 60%
inflammation and oxidative stress, these
of children with end stage renal disease
antioxidant enzymes can be inactivated
(ESRD) still grow up to become stunted
and HDL can accumulate oxidized lipids
adults²,
psychosocial
problems
in
and proteins that result in a pro-
children with CKD, the age at onset of
inflammatory
nature.
Under
these
ESRD, the duration of chronic renal
conditions, the main protein of HDL, apo-
failure, gender and primary disease were
lipoprotein (apo) A1, can be modified by
related to final height³.
reactive oxygen species. Alterations of
367
Introduction:The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 376 384 Value of Multidetector Computed Tomography in Evaluation of Thoracic Venous Abnormalities among Pediatrics with Congenital Heart Disease Dalia F Elbeih*, Mervat M El-Gohary *, Naglaa H Shebrya*,Mohammed A Saleh **
* Departments of Radiodiagnosis and** Cardiology, Faculty of Medicine, Ain Shams University. Abstract Introduction: Venous anomalies of the thorax can involve systemic or pulmonary veins and range from isolated incidental findings to components of more complex anomalies, most often congenital heart disease (CHD). Although echocardiography and catheter directed cardiac angiography are generally accepted as the primary imaging techniques for evaluation of CHD, CT and MRI are important complementary diagnostic tools. Multi-detector computed tomography (MDCT) with its increasing availability and utility is now becoming a further method of imaging CHD. In light of its widespread availability, MDCT and 3D imaging are increasingly considered as a viable "one-stop shop" for preoperative imaging evaluation of cardiovascular structures in selected pediatric patients. Aim of the work: The aim of this work is to evaluate the role of MDCT in visualization of the thoracic venous system in pediatrics with congenital heart disease, show prevalence and types of venous anomalies and to compare this data with echocardiographic findings. Methods: The studied group included 30 cases referred to us by pediatric cardiologists to be examined by MSCT angiography of the heart and thoracic vessels. All the patients were known cases of congenital heart disease and underwent echocardiography. They were referred to answer specific anatomic question raised by inconclusive echocardiography, to assess suspected systemic and suspected pulmonary venous anomalies. All patients were subjected to full history taking, clinical examination and MDCT examination with CT lightspeed VCT XT 64-detectors row scanner (General Electric, Medical Systems, Milwaukee, Wisconsin, USA). Results: CTA findings had 77.8 % concordance with echocardiographic findings regarding SVC anomalies, 66.7 % concordance with echocardiography regarding IVC anomalies and 90 % concordance regarding pulmonary venous anomalies. Conclusion: Low dose protocol CTA is a promising method that complementary to Echocardioraphy for imaging of extracardiac vascular structures in pediatrics with congenital heart diseases. Key words: Congenital heart disease. Computed Tomography Angiography. Systemic venous anomalies. Pulmonary venous anomalies.
INTRODUCTION
Anomalies of the heart and the great
functional assessment of patients with CHD.
vessels are mostly present from birth. The
However, the clinical decision to precede with
majority of such disorders arise from faulty
such an investigation needs to be balanced
embryogenesis during gestational weeks 38,
with the risks associated with an invasive
when major cardiovascular structures develop
procedure, which also involves exposure to (1). Venous anomalies of the thorax can involve
ionizing radiation (4). Despite the great
systemic or pulmonary veins and range from
capabilities of MR imaging for anatomic and
isolated incidental findings to components of
functional assessment of the heart, an
more complex anomalies, most often
examination with this modality is time-
congenital heart disease (2).
consuming and may require a lengthy period of
Echocardiography, which can provide
patient sedation(5).
both anatomical and functional information, is
Multi-detector computed tomography
the mainstay of imaging for evaluating
(MDCT) with its increasing availability and
intracardiac lesions in infants and children (3).
utility is now becoming a further method of
.In addition to being highly operator
imaging CHD (6).
dependent, echocardiography may not be
sufficient
for
evaluating
extracardiac THE AIM OF THE WORK
structures, such as the pulmonary arteries,
The aim of the work is to evaluate the role of
pulmonary veins, and the aortic arch and great
MDCT in visualization of the thoracic venous
vessels due to acoustic window limitations(4).
system in pediatrics with congenital heart
Cardiac catheterization remains an
disease, show prevalence and types of venous
important component of both anatomical and
376
Abstract:The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 385 394 Role of Multidetector CT in Evaluation of Acute Chest Pain: Non- Cardiac Vascular and Pulmonary Causes Rania S Sayed *, Hisham M Mansour **, Mohammad H Khaleel ***, Sherif H Abo Gamra ** and Merhan A Nasr **
Radiodiagnosis Dept., Nasr City Health Insurance Hospital, Ministry of Health*,
Radiodiagnosis Dept., Ain Shams University** and Cardiology Dept., Nasr City Health
Insurance Hospital, Ministry of Health***
Abstract: Background: Triage of patients with acute chest pain is one of the most important issues currently facing physicians in the emergency department. Acute chest pain may be a symptom of a number of serious conditions and is generally considered a medical emergency. The causes of acute chest pain range from non-serious to life threatening. A rapid, accurate and cost- effective approach for the evaluation of emergency department patients with chest pain is needed. Aim of the work: This work aims to emphasize the role of multidetector CT in assessment of non-cardiac vascular and pulmonary causes of acute chest pain. Method: The studied group included 89 patients (59 men and 30 women) presented by acute chest pain. All patients were subjected to MDCT and/or MDCT angiography using a Toshiba 64 detectors CT scanner. Results: The high spatial resolution and relatively non-invasive nature make MSCT angiography a strong and serious competitor to established vascular imaging techniques. Having the additional ability to simultaneously acquire information on other organs, which enables the early diagnosis of complications. Conclusion: Continued technical improvements in acquisition speed and spatial resolution of computed tomography images, and development of more efficient image reconstruction algorithms which reduce patient exposure to radiation and contrast result in increased popularity of MDCT. Keywords: Acute chest pain, Aortic dissection, Pulmonary embolism, Pneumothorax, Computed tomography angiography.
Introduction
Chest pain is one of the most
potentially life saving treatment that is
common presenting symptoms for patients
markedly different than treatment for
coming to the emergency department
ACS(3).
(ED)(1).
The consequences of diagnostic
As the spectrum of acute chest pain
failure are extremely serious and have
causes is broad and not all life threatening
resulted in expensive, time consuming
causes are of cardiac origin. Our study
strategies to categorize patients presenting
concerned with non-cardiac vascular and
to the ED with acute chest pain. There is a
pulmonary causes. Pulmonary causes of
clear need for an accurate, rapid and
chest pain include: pulmonary embolism,
economical way to reduce unnecessary
pneumonia,
pneumothorax,
tension
admissions without compromising the care
pneumothorax and pleurisy while vascular
of patients in need(4,5).
causes include acute aortic syndrome(2).
The proper diagnosis of the cause Patients & Methods
of chest pain in ED patient is further
The studies were performed with
complicated by the often difficult challenge
64 slice, multidetector CT scanner
of recognizing patients who have an acute
(Toshiba, Aquilion) over a period of two
aortic syndrome (AAS), or pulmonary
years on 89 patients with acute chest pain,
embolus (PE), which, while less frequent
59 men and 30 women. The mean age of
than acute coronary syndrome (ACS),
patients was 47 years, with a maximum of
necessitate rapid diagnosis for institution of
77 years and minimum of 13 years.
385
TNF-@ Gene Expression in Chronic Hepatitis C virus infectionThe Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 395 404
Tumour Necrosis Factor-Alpha Gene Expression in Chronic Hepatitis C Virus Infection. Saadia Farid, Laila Rashid, Samya Swelam.
Department Of Medicine, Biochemistery. National Hepatology and Tropical Medicine Research
Institute and Faculty of Medicine Cairo University.
Abstract Objective: Tumour necrosis factor (TNF)-alpha, a prototype proinflammatory cytokine, has been implicated as an important pathogenic mediator in a variety of liver conditions. Some genetic polymorphisms in the human TNF-alpha promoter region, such as the G-A transitions -308 and 238, have been shown to influence TNF-alpha expression in chronic hepatitis C virus infection. Aim of the work: The present study was to investigate the influence that the 308and 238 TNF- alpha promoter polymorphisms have on the response to interferon and ribavirin therapy in chronic hepatitis C virus infection. Patients and methods: One hundred forty patients with chronic hepatitis C virus infection, their age ranges between (20-56) years, selected from the National Hepatology and Tropical Medicine Research Institute were included in this study, during interferon and ribavirin therapy and thirty five healthy individuals were included to serve as controls, the patients and controls were divided into two groups the first group forty patients and fifteen controls for the detection of TNF-alpha - 308, -238 genotypes polymorphisms, the second group were one hundred patients and twenty healthy controls for the detection of serum levels of TNF-. All the patients and controls were subjected to the following history, clinical examination, abdominal ultrasonography and collection of blood samples for routine laboratory investigation, CBCs and serological assay, genotyping of 308, 238 TNF-alpha promoter polymorphism and serum levels of TNF-. Results: There was no statistically significant difference between chronic HCV patients and healthy controls as regarding TNF-alpha -238 different alleles. The frequencies of TNF-alpha gene polymorphism with A/G and G/G mutation at 308 were significantly higher in chronic HCV patients than those in the controls. The serum level of TNF-alpha was markedly higher in the chronic HCV patients than in the healthy controls. There were significant association between TNF- alpha gene polymorphism in the 308 A/G, G/G alleles and increased serum TNF- alpha in CHCV infection. Conclusion: The results indicate that the TNF-alpha gene polymorphism at position -308 is associated with susceptibility of chronic HCV infection. Recommendations: Our major concern was to improve the response to treatment in patients with chronic HCV infection, whether the disadvantage of having the TNF-alpha -308 allele became more apparent after interferon and ribavirin therapy is unclear and needs further study that detecting the polymorphism of the -308 TNF-alpha allele before administering interferon therapy may be valuable for predicting the treatment response, especially in difficult- to treat patients. Key Words: TNF-alpha, apromoter polymorphism at position 238, 308, chronichepatitisC virus infection therapy.
Introduction The hepatitis C virus (HCV) is a major
ribavirin are unable to clear virus from the
public health problem and a leading cause of
serum (3,4). When host genetic factors are
chronic liver disease (1). An estimated 180
considered in disease and treatment
million people are infected worldwide (2).
response, the role of single-nucleotide
Approximately thirty percent of patients
polymorphisms
(SNPs)
becomes
treated with pegylated interferon and
increasingly important (5). Proinflammatory
395
þÿ/H1The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 405 421
The Role of Bee Venom in Controlling Albino Rats Fetal Morphometric and Morphological Changes by Carbimazole Induced Hypothyroidism Abu Gabal H*, Moamena M** and Al Moalla H**
* College of Science and Humanity Studies, Salman Bin Abdul Aziz University.
**College of Science, Princess Nora Bent Abdul Rahman University. Aim of the work. The present study was planned to investigate the role played by Bee venom in improving the morphometric and morphological changes induced by carbimazole in pregnant albino rats and their embryos. Materials and method .A total number of 60 mature virgin female and 30 male Wistar wistar albino rats (for fertilization) were used in this study.Pregnancy was ascertained by vaginal smears.The experimental animals were divided into the following groups: - (Normal group): in this group the pregnant rats were injected intraperitonealy by distilled water (The solvent of both carbimazole and bee venom) by dose 1ml/200g.body weight, from day 1 to day 18 of gestation. II-The group of treated animals: this group was divided into 3 subgroups: 1-The carbimazole group: this group was divided into2 subgroups, the pregnant rats were orally injected at a dose 2 and 3mg /200g.body weight, daily from day 1 to day 18 of gestation. 2-The Bee venom group: the pregnant rats were intraperitonealy injected with a dose 0.6 mg/200g. body weight on days 2,3,4,7,8,9,10,11,12,15 and 16 of gestation.
3-The treatment group: the pregnant rats were intraperitonealy injected with Bee venom at a dose 0.6 mg/200g. body weight 1 hour after the intraperitonealy injection by the 2 doses of carbimazole (2 and 3mg /200g. body weight).The days of injection for both treatments (Bee venom and carbimazole) were as mentioned before. Results. The results of the present study showed thatcarbimazole treatment with its 2 doses induced highly significant increase in the body weights of pregnant rats, highly significant reduction of the uterus weight with shortness of the horns as well as unequal distribution of the embryos between them, increased number of the resorbed fetuses when comparing with the control group, Bee venom injection revealed improvement of these changes .The orally injection of the 2 doses of carbimazole resulted in very highly decrease in fetuses body weights and lengths; however Bee venom induced obvious improvement as compared with the carbimazole effects. Orally injection of carbimazole at the dose 3mg /200g body weight showed increased fetal mortality rate as compared with the control group; however, intraperitonealy injection of Bee venom resulted in improvement in the rate of live fetuses and never of dead ones was observed after Bee venom treatment. The 2 doses of carbimazole induced lots of malformations of embryos such as variations in the size of embryos of the same mother, the embryos exhibited fragile skin, sub dermal blood coagulation beside edema in different regions of the fetal body ,as well as malformations of the regions of the eye resembled in exophthalmos and rostrum region such as cleft lips, beside clubbed fore and hind limbs , kyphosis of the body of the embryos, exencephaly.Bee venom treatment resulted in control of the changes induced by carbimazole injection. The fetuses were resembled to those of the control group. Conclusion: It is clear that bee venom plays an important role in controlling the morphometric and morphological changesin fetuses of albino rats suffering from hypothyroidism induced by carbimazole Key words: Carbimazole, Thyroid gland, Bee venom. Pregnant Rats, fetuses.
405
d:\skydrive\Jor\vol51_24The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 422 433
Chronic exposure to MDMA (ecstasy)induces DNA damage, impairs functional antioxidant cellular defenses, enhances the lipid peroxidation process and alters testes histopathology in male rat. *Nadia Gamal Zaki, ** Laila Abdel Kawy
Narcotic Research Department, the National Center for Social and Criminological Research, Cairo, Egypt Abstract: Background : 3,4-Methylenedioxymethamphetamine (MDMA or "ecstasy") is consumed mainly by young population. For this reason, it is especially relevant to take into consideration the effects on the reproductive system. The influence of MDMA on the fertility and reproduction of the male rat was assessed in this study. Material and methods: MDMA was administered orally at 0 mg/kg (control), 10 and 30 mg/kg to male rats for 15,30,45 consecutive days followed by 15 days withdrawal. Hormonal, biochemical, histological and testicular were evaluated in the rats. The present study aimed to investigate if daily oral administration of ecstasy at low doses(10mg) for 45 days has any deleterious effects on reproductive functions of male rats. Animals were randomly divided into four groups of ten rats each, assigned as control rats, or(0mg ecstasy), rats treated with 10mg ecstasy for, (15,30,45) days, rats treated with 30mg/kg body weight ecstasy for(,15,30,45)days by oral gavage. The third group(45 days) was followed by 15 withdrawal period(W15). Results: The activities of superoxide dismutase, catalase, glutathione reductase and glutathione peroxidase in testicular homogenate were decreased while the levels of lipid peroxidation increased significantly in the treated rats as compared with the corresponding group of control animals. In group 30mg, only, arachidonic acid was significantly elevated in the testicular homogenate while linoleic acid was decresed when compared to control. Testis DNA fragmentation was observed in 30mg group, but not 10.mg. It is concluded that low doses of ecstasy exposure(10 mg/Kg) had moderate detrimental effects on reproductive organ system and more severe effects are likely to be observed at higher dose levels. These results indicate that ecstasy is directly toxic to primary Leydig cells, and that the decreased percentage of normal cells and the increased level of DNA damage in ecstasy -exposed Leydig cells may be responsible for decreased testosterone secretion. The results suggested that graded doses of ecstasy elicit depletion of antioxidant defence system and induce oxidative stress in testis of rats. In conclusion: the adverse effect of ecstasy on male reproduction may be due to induction of oxidative stress. Key words:MDMA(ecstasy),testes,free fatty acids,oxidant/antioxidant status
Introduction:
3,4-ethylenedioxymethamphetamine
in it(3,4). MDMA is almost taken by
(MDMA, Ecstasy) is a psychoactive drug
mouth and is prepared as single-dose
with significant abuse liability and
tablets for this purpose, though the great
neurotoxic potential (1). A recent national
majority consist of a single active drug.
survey indicates that recreational MDMA
The typical dosage range of MDMA for
use may be once again on the rise (2).
recreational use varies from 50 mg to 150
Ecstasy" (MDMA) and related drugs are
mg, but the amount per tablet in different
amphetamine derivatives that also have
batches of tablets may vary 70-fold or
some of the pharmacological properties of
more, from almost zero to well over 100
mescaline. They have become popular with
mg ( 5,6,7). MDMA and the other ring-
participants in "raves," because they
substituted amphetamine derivatives act by
enhance energy, endurance, sociability and
increasing the net release of the
sexual arousal. This vogue among
monoamine neurotransmitters (serotonin,
teenagers and young adults, together with
noradrenaline and, to a smaller extent,
the widespread belief that "ecstasy" is a
dopamine) from their respective axon
safe drug, has led to a thriving illicit traffic
terminals. MDMA does not act by directly
422
EFFECT OF BOSWELLIA ON ALLOXAN-INDUCED DIBETES MELLETUS IN MALE ALBINO RATSThe Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 434 447
Comparison between the effect of ozone and vitamin C in treatment of diabetes mellitus Eman G. E. Helal*, Samia M. Abd-Elwahab **and Anwaar Alkamel Mohammad ***
Departments of Zoology Faculty of Science-Al-Azhar University (Physiology* & Histology **) and
Department of Medical Science- Faculty of dentistry Sinai University***
ABSTRACT: Objectives: There is strong evidence that diabetes results a state of oxidative stress and that reactive oxygen species contribute to the production of insulin resistance, -cell dysfunction and both the microvascular and macrovascular long-term complications of diabetes. Antioxidants are used as supportive therapy in the treatment of DM, so, we use ozone and vitamin C to study if they can regulate the oxidative complications of DM. Material and method: twenty male adult albino rats were divided into two groups; group 1: control group, group 2: alloxan induced diabetic rats which divided into three subgroups. subgroup1: diabetic untreated rats, subgroup2: diabetic treated with ozone and subgroup 3: diabetic rats treated with vitamin C. After thirty days of treatment the body weight gain was detected. Blood sample were collected to1- estimate biochemical parameters as: glucose, serum insulin, lipid and protein profiles and liver and kidney functions 2- estimate some hematological parameters. Also, liver samples collected to determine their glycogen content and pancreatic samples were obtained for microscopic and quantitative evaluation. Results: in diabetic untreated rats the results showed reduction of gained body weight, hyperglycemia, and hypoinsulinemia, significant increase in liver and kidney functions and change in lipid and protein profiles and decreased liver glycogen content. While, O3 and
vitamin C treated rats reported an amelioration of the most toxic effect of alloxan and returned most of these parameters nearly normal. Microscopically pancreatic beta cells showed definite vaculation, degeneration, karyolysis and pyknosis in the diabetic group while pancreatic alpha and delta cells were not affected. The use of O3 and vitamin C treatment in
this study showed significant improves of such cellular changes when compared to diabetic untreated rats but still abnormal when compared with normal rats. Conclusion: it was recommended that the use of the O3 or vitamin C as a supplementary agent to reduce
oxidative stress damage of hyperglycemia and recommended to use variable doses and different periods of treatment to evaluate the best dose and period. Key words: Alloxan; Hypoglycemia; Diabetic; antioxidant. Introduction:
WHO estimates that more than
peroxidation (LPO) [3], DNA damage [4],
180 million people worldwide have
and protein degradation [5]. Host survival
diabetes. This number is likely to more
depends upon the ability of cells and
than double by 2030 without urgent action.
tissues to adapt to or resist the stress and
In 2005, an estimated 1.1 million people
repair or remove damaged molecules and
died from diabetes, almost 80% of them
cells.
occur in low and middle-income countries,
Presently available oral hypoglycemic
and half of them in people under the age of
agents do not show marked improvement
70 years; 55% of diabetes deaths are in
in oxidative stress in diabetic patients [4].
women[1].
Ozone (O3) has been used as a therapeutic
In clinical and experimental research,
agent and beneficial effects have been
attention is paid to the role of antioxidant
observed. However, so far only a few
defense systems in the prevention of
biochemical
and
pharmacodynamic
human diseases such as cancer, diabetes
mechanisms have been elucidated. The
mellitus, and cardiovascular pathologies
possibility that ozone could induce a
[2]. During the progression of these
useful adaptation to chronic oxidative
diseases, oxidative stress events occur, and
stress was described in 1996 [6]. Other
free radicals and reactive oxygen species
studies [7-9] reported that controlled
(ROS) are generated. These free radicals
ozone administration may promote an
and ROS are thought to contribute to lipid
oxidative preconditioning or adaptation to
434
Materials and methodsThe Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 448 460
Antioxidant effect of Flaxseed against liver Cirrhosis induced in Thioacetamide intoxicated rats WafaaGh. Shousha1, Hatem A. El-mezayen1 , Shawkia S.Abdul-Halim2 ,Elham A. Mohmmed2
1Chemistry department, HelwanUniversity,Egypt.
2 Nutritional Biochemistry, National Nutrition Institute, Egypt. Corresponding author:Prof Dr/ WafaaGh. Shousha., Chemistry department, Helwan University, AinHelwan Egypt
Abstract:
Background/Aim:There has been a current upsurge in the medical implications of free radicals and related species during the past several decades. These chemical species are integral components produced during normal biochemical and physiological processes but leads to oxidative stress when produce in excess and causes potential damage to cells. A wide range of non-enzymatic and enzymatic antioxidant defenses exists to counteract the damaging effects of free radicals. There exist epidemiological evidences correlating higher intake of antioxidant rich foodstuffs with greater free radical neutralizing potential to lower incidence of several human morbidities or mortalities.
Material andMethods: liver cirrhosis model was induced by TAA,hepatobichemical and antioxidant parameters were assayed. Results: Flaxseed induced enhancement in liver function test, antioxidant status and lipid profile. Conclusion: Flaxseed can be used as hepatoprotective against liver cirrhosis induced with TAA as compared to reference drug Silymaringroup. Keyword: liver Cirrhosis, Thioacetamide , Flax seed , Silymarin, Antioxidant. Introduction The liver plays a crucial role in the
etiology and pathology comparable to the
metabolic elimination of most drugs and
one seen in humans [4].
other foreign compounds, thus making it
an
important
target
for
toxicity.
In recent years, flaxseed is gaining
Hepatotoxic agents can react with the
importance in diet supplements, as they
basic
cellular
components
and
possessnutraceutical properties. Flaxseed
consequently induce almost all types of
is one of the oldest domesticated crops and
liver lesions [1]. Toxins and drugs are
it is being increasingly used in the human
among the basic etiopathogenet- agents of
diet because of its potential health
acute liver failure in Western countries [2].
benefits, particularly for cardiovascular
protection [5].
Thioacetamide (TAA) was originally used
as a fungicide to preserve agricultural
Flaxseed is the richest natural source of
citrus products, but later it was determined
plant
lignans,
with
that it was a potent hepatotoxin and
secoisolariciresinoldiglucoside
(SDG)
carcinogen because its thono-sulfur-
being the principal lignan compound,
containing compound endowed with liver-
chemically 2, 3-bis [4- hydroxy-3-
damaging and carcinogenic activities [3].
methoxyphenyl)methyl]-1,
4-butane
On a prolonged exposure, TAA leads to
diglucoside. The concentrations of SDG in
the formation of hyperplastic nodules, cell
flaxseed vary with different cultivars. SDG
adenomas,
hepatocarcinomas,
concentrations in twenty-seven flaxseed
andcirrhosis. TAA-induced cirrhosis in
speciesranged from 1.19 to 2.59% for
rats has been shown to be a suitable
SDG and 0.22 to 0.5% (w/w) for its
experimental model of this disease with
diastereoisomer [6] . Flaxseed commonly contains 3445.6% total fat, and a-
448
d:\skydrive\Jor\vol51_27The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 461 472
Unmet Health Care Needs Among Clients from Outpatient Clinic of Ain Shams University Hospitals , Cairo, Egypt Ismail, N. A* Abdlrhman, S.I.**1, Abd El-Maksoud, M. M**2., Bakr, I.,* Dewedar,S.*
Department of community, environmental and occupational medicine, Faculty of Medicine, Ain Shams
University* Community Health Nursing, faculty of Nursing**, Zagazig University1, Helwan University2,
Cairo, Egypt
Abstract Background: The concept of unmet needs refers to the difference between health services necessary to treat a particular health problem and services actually received. Aim: This study examined the prevalence of self-reported unmet needs for health care and the extent to which they were attributable to perceived problems with service availability or accessibility or acceptability. Study design: descriptive analytical study. Sample: 1316 individuals Clients from some out patients, clinic of Ain Shams University hospitals. Setting: out patients, Clinic of Ain Shams University Hospitals, Cairo, Egypt. Subjects: patients randomly chosen from out patients, clinic of Ain Shams University hospitals. Tools of the study: A questionnaire tool developed to collect data about the prevalence of unmet needs for health care in the previous 6 months. Results: This study conducted on 1316 individuals where 580 (44.8%) reported unmet health care needs. As regard causes of unmet needs, 33.6% of unmet needs attributed to accessibility problems, while service availability problems accounted for 57.4% of the unmet needs. The largest group, accounting for 92.4% of unmet needs was acceptability problems. Conclusions: The causes of unmet needs attributed to accessibility and availability problems. The most common reported reason for an unmet health care need was that the too long waiting time, and the high cost of examination. Recommendations: Re-plan health care service to treat causes of unmet needs, which attributed to accessibility and availability problem.
Key words :Prevalence - Unmet health care needs- availability, accessibility, acceptability reasons
Introduction:
The concept of unmet needs refers to the
complications, a worse prognosis, and longer
difference between health services thought
hospital stays. (3, 4)
necessary to treat a particular health problem
The number of people reporting unmet needs has
and services actually received (1). A person who
increased over the last few years. According to
perceived the need to receive medical services Statistics Canada, reports of unmet needs have
but who has not obtained these services has
risen across the country from 4% in 1994-1995
unmet health care needs. Unmet health care may
to 6% in 1998-1999 and to 13% in 2000-2001 to
result from limited availability or unavailability
18% in 2004. (1)
of health care services, when or where they were
In United States, the prevalence of
required. Also it can be caused from individual
unmet varied from 25% in 1999 to 7% among
accessibility problem, such as cost or
insured population and 18 % among uninsured
transportation, or from acceptability problem,
population in 2001. (5) Therefore, to assess unmet
such as attitude toward and knowledge about
health care needs, it is important to understand
health care. (2)
the barriers associated with them based on
While a country's health policy aims to
existing literature. (3,4) These factors examined
provide health services to all who need them, an
in relation to the three types of unmet needs are:
appreciable proportion of sick people do not get
age, sex, marital status, household income,
the health services at the time of illness they
education, employment, urban/rural residence,
need in their viewpoints to restore health,
health status, chronic conditions, chronic pain,
particularly in developing countries. Delayed or
distress, physician consultations, and attitudes
non-receipt of medical care may result in more
towards physicians, authority and self-care.
serious illness for the patient, increased
Previous studies have found that the main cause
461
Anticarcinogenic Effects of Raphanus sativus on 1, 2 dimethylhydrazine (DMH) Induced Colon Cancer in White Rats The Egyptian Journal of Hospital Medicine (April 2013) Vol. 51, Page 473 486
Anticarcinogenic Effect of Raphanus sativus on 1, 2 Dimethylhydrazine (DMH) Induced Colon Cancer in Rats Mohamed A. Abd-Elmoneim*, Ashraf A. Bakar*, Isis M Awad***, Ehab M. Mohamed **, Sorial A. Moharib ***
Department of Supplementary Medical Science- Faculty of Dentistry Sinai University*,
Department of Biochemistry Faculty of Science-Tanta University** and Departments of
Biochemistry National Reasearch Center ***).
ABSTRACT Background: Colon cancer is a major health problem worldwide and rated among as one of the top frequent cancers and is a major cause of morbidity and mortality. Treatment outcome is still not satisfactory and other treatment options are strongly needed. Carbohydrate protein interactions play a major role in numerous biological processes including cancer. However, the seeds of Raphanus sativus have never been tested for its anticancer effects on colon cancer. Therefore, this study aimed at elucidating the anti-carcinogenic effect of Raphanus sativus in combating chemically (DMH) induced colon cancer. Materials and methods: polysaccharides extract of Raphanus sativus (RS) was tested for its ability to reverse the carcinogenic effects of 1, 2 dimethylhydrazine (DMH) which is used for chemical induction of colon cancer in animal models.Rats were injected with DMH and the effects of RS extract either concomitant with or after the administration of DMH were evaluated. . We measured the serum Carcinoembryonic antigen and Carbohydrate antigen as a tumor markers, Glutathione reducatse and Glutathione S transferase as markers of antioxidant activity and liver functions. Results: RS significantly reduced Serum CEA (P<0.01) and CA19-9 (P<0.01) as an evidence of its anticarcinogenic effect in colon cancer. Moreover, RS was able to significantly increase activity of Glutathione reductase (p<0.01) and Glutathione- S- transferase (p<0.01) as a measure of antioxidant compared with DMH untreated group.Also RS was able to significantly increase activities of ALAT, ASAT and ALP (p<0.01). Chemical analysis of RS done by NMR and paper chromatography revealed that the polysaccharide in RS was -galactan and the type of bond that exists between sugar residues is 1, 3 and 1, 6 glucosidic linkages. Conclusions:This study shows that -galactan of Raphanus sativus has pronounced cytotoxic effects on colon cancer cell line. Moreover, it reduces serum tumor markers and enhancing antioxidant activity in the DMH injected animals. This polysaccharide might be a suitable candidate as a chemopreventive and as an adjuvant therapy for colon cancer. Key words: Raphanus sativus , -galactan, DMH, colon cancer, tumor markers.
INTRODUCTION
Colorectal cancer (CRC) is the third
age 30-34 years. The results also shows
most common cancer in males and second
significantly lower incidence of colorectal
most common in females worldwide [1].
cancer in subjects over age 40 years
Colon cancer is the third most commonly
compared to the same age group in the
diagnosed cancer and the second leading
United States SEER [3].
cause of cancer death in men and women
Most colon cancers are sporadic
combined in the US. The American Cancer
with only a few types having a familial
Society estimates that 142,820 people will
basis, such as the familial adenomatous
be diagnosed in 2013 and that 50,830 will
polyposis (FAP) and hereditary non-
die from colon cancer in the United States
polyposis colorectal cancer (HNPCC) which [2]. Hospital-based studies in Egypt showed
accounts for about 5 % of all colorectal
low incidence of colorectal cancer and high
cancers, this multistep carcinogeneis
proportion of young-onset disease [3]. In
process starts with normal colonic cells
comparing rates of Egyptian colorectal
which acquire genetic alterations in
cancer to the Surveillance Epidemiology
important genes. The mutated cells can
and End Results Program (SEER) of the
grow stepwise and eventually to carcinomas
United States, Egypt had higher rates up to
and invade other tissues [4].
473