Evaluation of the Role of Apoptosis in Vitiligo: Immunohistochemical Expression of P53, Bcl-2 and MART-1 Antigens The Egyptian Journal of Hospital Medicine Vol., 8 : 1 11 September 2002
I.S.S.N:
12084
1687-2002
Evaluation of the Role of Apoptosis in Vitiligo: Immunohistochemical Expression of P53, Bcl-2 and MART-1 Antigens
Ahmed M. Abdel-Aal*; Mohammad A. Kasem**and Ahmed H. Abdel-Rahman*** From the Department of Dermatology, Venereology & Andrology,Al-AzharUniversity in Cairo*; Departments of Histology *
* and Pathology***, Al-AzharUniversity, Assuit
Abstract It is clear that melanocytes are absent from the vitiliginous skin. However, the mechanism of melanocyte disappearance has never been clearly understood. It is not clear whether melanocyte loss in vitiligo results from apoptosis or other causes of cell death. A very few data were published about the role of apoptosis in vitiligo. To investigate the role of apoptosis in vitiligo, ten biopsies from patients and ten normal control biopsies were taken from the skin of the thigh by the scalped biopsy technique. Each biopsy included adjacent areas of the lesional, peri-lesional and non-lesional skin. All subjects were males selected at Al-Housein University Hospital and ranged between 25 to 43 years in age. The expression of MART-1 protein as a melanocyte marker, Bcl-2 as an antiapoptotic molecule and P53 as a proapoptotic molecule were evaluated by the immunoperoxidase technique and computerized image analysis. The study revealed complete absence of MART-1 positive melanocytes in the lesional skin, gradual appearance in the peri-lesional areas and showed no significant difference between the non-lesional areas and the normal skin (P=0.43). The melanocytic Bcl-2 expression was higher in normal skin than the non-lesional area, lower in the peri-lesional areas and lowest in the lesional areas (p<0.05). Conversely, more expression of melanocytic P53 was seen in the lesional than the peri-lesional areas, lower in the non- lesional skin and lowest in the normal skin (p<0.05). Accordingly, the study revealed more susceptibility to apoptosis in the vitiliginous skin than in normal skin. We hope that these data can help in understanding the pathogenesis and the progression of this disease as well as providing better lines of its treatment.
Introduction: Vitiligo is an acquired progressive
morphology, representing 10-15% of the
skin disorder characterized by depigmen-
total cell population; these include
tation caused by selective destruction of
Langerhans cells, melanocytes and Merkel
melanocytes which are highly specialized
cells. Melanocytes are cells with a dendritic
cells responsible for skin pigmentation (Le
morphology, of neural crest origin located Poole et al., 1993). Clinically, vitiligo is
within the basal cell layer. The ratio of
manifested as white macuoles on the skin
melanocytes to basal keratinocytes along
that can be localized or generalized. The
the dermoepidermal junction is site depen-
course of the disease is unpredictable but is
dent and ranges from approximately 1:4 in
often progressive with phases of stabilized
the cheek to 1:11 in the thigh ( Breathnach,
depigmentation (Castanet and Ortonne, 1971). They label on routinely-processed 1997).
tissue sections with antibodies to MART-1
Normally, the epidermis has a strati-
protein (Kanitakis, 1998, Palermo et al,
fied, keratinizing epithelium consisting of 2001 and Carlson et al., 2002).
keratinocytes
(85-90%)
and
non-
Melanocytes also constitutively express
keratinocyte cells usually with a dendritic
bcl-2 oncoprotein; a 25 kDa cytoplasmic
1
Conventional TENS Efficacy on Autonomic Function and MCV of the Neuropathic The Egyptian Journal of Hospital Medicine Vol., 8 : 12 17 September 2002
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Conventional TENS Efficacy on Autonomic Function and MCV of the Neuropathic Tibial Nerve. Z. Mowafy Emam Mowafy*, Wafaa H. Borhan * and Akef A. Khowailed**
* Physical Therapy Department for Surgery , Faculty of Physical Therapy, Cairo
University. Egypt.
** Physiology Department Faculty of Medicine , Cairo University, Egypt.
Abstract
This study has been conducted to determine efficacy of conventional TENS on the autonomic function by assessing the big toe skin temperature (TST) and the motor conduction velocity (MCV) of the neuropathic tibial nerve. Thirty neuropathic patients (20 males, and 10 females) ranging in age from 30 to 50 years (X= 45.41±1.16) who were divided into 3 groups of equal number (two study and one control) and consented to receive 40 Hz and 80 Hz conventional TENS along the tibial nerve course for the first and second study groups respectively, while the third (control group) received placebo TENS. Both TST and MCV were recorded before and immediately after treatment (one session for 25 minutes). Treatment and data collection procedures were done in air conditioned room with the ambient room temperature was adjusted within the comfortable zone between 24ºC to 28ºC. Data collected showed a significant differences in both TST and MCV in meter/ second, in the first study group (P<0.05) and in the second study group (p<0.001). While there was no significant differences in the control group (p>0.05). There was a correlation between the TST and MCV in both study and control groups. The 80 Hz conventional TENS was more fruitful in enhancing the autonomic and electrophysiological functions of the neuropathic tibial nerve as manifested by the increased TST and MCV than 40Hz conventional TENS.
Introduction:-
Clinical
electrophysiology
began
tone in many neurological disturbances as
toward the end of the eighteenth century
polyneuropathy lead to increased systemic
with Galvani's discovery of animal
vascular resistance, decreased cutaneous,
electricity,5.8.12.
muscular, and endoneurial blood flow
Electrophysiological assessments of
resulting
in
nerve
function
muscle and nerve are now considered
alterations,18.20.27.
indispensable in the practice of neurology,
Certain patients are more susceptible
physical therapy, and other related clinical
to a peripheral neuropathies as alcoholics,
disciplines,3.9.11.14.25.
diabetics and others, as well as the old aged
The clinical measurement of nerve
because they are less mobile, and their
conduction
velocities
has
become
nerves do not tolerate pressure well, 2.6.28.30.
increasingly popular since the late articles
Transcutaneous
electrical
nerve
by Hodes et al. (1940 and 1948), which
stimulation is an effective, noninvasive, non
contained the first clinically relevant
-aversive , non-addictive method of
discussion of conduction velocity testing
managing pain, muscle guarding and
and created great interest in the subject of
dysfunction of the pain cycle as well as the
electrophysiological testing,1.7.11.15.21.
internal changes that accompanied the pain
Skin temperature assessment is one of
cycle can be managed or at least reduced by
the most important autonomic nerve
TENS application. As pain produces a state
functions as dominance of the sympathetic
of muscle tension that results in a
12
On The Interaction between Induced Diabetes Mellitus and Schistosomiasis: Mechanism and Protection The Egyptian Journal of Hospital Medicine Vol., 8 :18 31 September 2002
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1687-2002
On The Interaction between Induced Diabetes Mellitus and Schistosomiasis: Mechanism and Protection
Nahla S. El-Shenawy and Maha F. M. Soliman
Zoology Department, Faculty of Science, Suez Canal University, Ismailia, Egypt.
Abstract In this study mice were percutaneously exposed to 50 S. mansoni cercariae. Seven weeks post infection (pi), infected mice were either injected i.p. a single dose of alloxan (200 mg kg-1) or treated with a single dose of alloxan followed, three days later, with daily i.p. treatment of ethanolic extract of Cleome droserifolia (0.31 g kg-1) for 18 days. Diabetes mellitus (DM) affected characteristics of Schistosoma infection as shown in alteration of oogram pattern, impairing of egg maturation and lowering of faecal egg output. However, extract treatment (EXT) affected the previously mentioned aspects in addition to its remarkable effect on worm load, diminishing of hepatic granulomas and suppressing the formation of involutional granulomas. Results indicated that DM increased the complications of schistosomiasis that was manifested by the augmented increase of serum glucose level, the severe decrease of serum thyroid hormones (tri-iodothyronine; T3 and tetra-iodo-thyronin; T4), insulin levels, liver
glycogen content and hepatic DNA. In addition, a decrease in hepatic GSH that was accompanied by an increase in serum uric acid were observed in infected-DM mice. Serum total proteins concentrations were obviously decreased and some of protein fractions were also decreased or absent in both infected and infected-DM mice except for gamma globulin that was increased in both groups. EXT succeeded efficiently to alleviate these alterations in infected- diabetic mice, to various extents. The beneficial effects of EXT on thyroid and pancreatic hormones status seem to be contradictory to its beneficial anti-schistosomiasis effects. This contradiction may suggest that EXT exerts its beneficial effects through its direct effects on the parasite, not secondary to its effect on the host. The current results showing differential effects of both diabetes and extract on schistosomiasis, though both are beneficial, serve to corroborate this hypothesis.
Introduction The physiological relationship betw-
metabolic pathways of mammalian hosts
een S. mansoni and its host is complex
should affect schistosomiasis, as metabolic
moreover, the details of several bioche-
changes
accompanying
malnutrition
micalprocesses affecting this relationship
(Rocha,
1982),
vitamin
deficiency
are still to be determined (Neves et al.,
(Turchetti-Maia et al., 1983), administrat-
2002). Host provides a nutrient-rich enviro-
ion of enzyme inhibitor or hormonal
nment from which the parasite benefits by
therapy (Chen et al., 1991) and insulin-
taking up copious amounts of glucose and
dependent diabetes mellitus (Hulstijn et al.,
other metabolites needed for its develo-
2001 & 2002).
pment and reproduction. Since the host
The importance of several hormones
environment is crucial for the biology of the
(insulin, steroids and thyroid hormone) on
parasite, therefore, changes in the host
worm development, egg production and the
metabolism due to other illnesses, or
way schistosomes might exploit host
physiological complications could alter the
signaling molecules to evade the hosts'
normal course of schistosomiasis (Hulstijn
immune
system
was
emphasized et al., 2002). Doubtless, changes in the
(Mendonca et al., 2000 and Salzet et al.,
18
Effect of Ankle Joint Inversion Trauma on Common Peroneal Nerve MCV The Egyptian Journal of Hospital Medicine Vol., 8 :32 36 September 2002
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Effect of Ankle Joint Inversion Trauma on Common Peroneal Nerve MCV.
Z. Mowafy Emam Mowafy* , Wafaa H. Borhan* And Akef A Khowailed** * Physical Therapy department for surgery, Faculty of Physical Therapy, Cairo University, Egypt. ** Physiology department, Faculty of Medicine, Cairo University, Egypt.
Abstract
This study has been conducted to determine effect of ankle joint inversion trauma on
common peroneal nerve motor conduction velocity (MCV). Twenty patients (8 males and 12 females) who were 30 to 45 years of age (X=33.75+1.15) participated in this study. They received the same medical care and manual tests for the inversion trauma. The involved lower limbs were considered the experimental group, while the normal contralateral lower limbs were considered the control group for all the twenty patients. Measurements of the MCV were carried out 10 days post trauma as a first record and one month post trauma as a second record for the both groups. Data collected for the first record showed that averages of MCV (m/sec), were 29.50+2.14 and 42.45+3.08 for the experimental and control groups respectively. While data collected for the second record showed that averages of MCV (m/sec), were 31.02+2.25 and 42.80+3.11 for the experimental and control groups respectively. Results showed a highly significant reduction in MCV for the first record in the experimental group, and in the second record for the experimental group, MCV was still significantly reduced. Results of this study support the hypothesis that inversion ankle trauma is frequently accompanied by peroneal nerve lesions. Also suggest that MCV measurements can be a valuable tool in evaluating more objectively the functional instability of the ankle joint.
Introduction
The most common painful injury to
exceed a critical level, lateral capsular and
the ankle joint is sprain, this injury may
ligamentous structures are injured,1.3.7.13.
vary from a simple strain in which the
Various degrees of sprain-may occur,
ligaments are merely elongated with
the ligament may be over-stretched
Minimal microtrauma to serious
(strained) without disruption of the integrity
tearing of the ligamentous fibres with or
of the fibres, usually this is minor and
without avulsion of the bones to which they
recovery is rapid and complete. Fibres may
attach,5.8.11.15.
be torn constituting a sprain, which is more
The severity of a sprain is so
severe and requires a longer healing period,
frequently unrecognized that the statement
fiber tearing may be partial or complete
of Watson Jones must be heeded "It is
tear, the simple strain does not impair joint
worse to sprain an ankle than to break it."
stability, all difficult sprains must be
This implies that fracture receives adequate
considered to have ligamentous damage
treatment and sprain is neglected or receive
impairing joint stability and thus must be
inappropriate care,2.4.10.14.
probably treated,6.21.22..
The most common ligamentous injury
With the steady improvement of
occurs to the ankle lateral ligaments from
recording apparatus, nerve conduction
inversion stress, most epidemiological
studies have become a simple and reliable
studies report that approximately 95% of all
test of peripheral nerve function, the
ankle sprains are lateral and occur when
method
has
now
been
adequately
foot is a plantar flexed and inverted position
standardized and widely used as a means of
at the time of injury, when forces applied
not only objectifying the lesion but also
INTERLEUKINS & FETAL FIBRONECTIN LEVELS IN PRETERM DELIVERY The Egyptian Journal of Hospital Medicine Vol., 8 : 37 49 September 2002
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1687-2002 Interleukins & Fetal Fibronectin Levels In Preterm Delivery Ragab H. EL-Yamani* and Maha G. Soliman**
* Obstetric and Gynecology Dept. Faculty of Medicine, Al-Margab University, Great Socialist
People's Libyan Jamahiriya and ** Pharmacology Dept (Medical microbiology and
immunology unit) Notional Organization for Drug Control and Research
Abstract Although the prevention of preterm birth remains the most important challenge in obstetrics, the mechanism for the onset of preterm labor has not been fully explained. The purpose of the present study is to investigate the usefulness of cervicovaginal fetal fibronectin and certain cytokines (interleukin-1B and interleukin-8) levels during pregnancy as markers of preterm and term delivery. This study was performed on 130 pregnant women at 24 to 29 years old age. The women were classified into group I (women not in labor, n=65) and group II (women with spontaneous labor, n=65).Each group was classified into two subgroups [preterm delivery (<37 weeks gestation, n=40) and full term delivery (>37 weeks gestation, n=25)].We obtained cervicovaginal swabs for fetal fibronectin and cervicovaginal fluids for cytokines determination. The present study revealed that fetal fibronectin, IL- lB and IL-8 levels were significantly higher in patients in preterm labor than in patients at preterm not in labor. They were significantly higher in women at full term in labor than in women at full term not in labor. Interleukin- lB and IL-8 obtained from women not in labor increased exponentially as gestational age increased, and the cytokines levels were significantly correlated. This study revealed that cervicovaginal measurement of fetal fibronectin, IL-lB and IL-8 in combination with clinical findings may be useful for the evaluation of patients with threatened premature delivery. Introduction Preterm birth is probably the most
hazardous treatment for thousands of
challenge problem in modern medicine
women annually (Gibbs et al., 1992 and (Malak et al., 1996). Although preterm Iams et al., 1995). Part of the clinical
delivery (prior to 37 completed weeks of
problem arises from the absence of
gestation) occurs only in 7% to 11% of
objective criteria for the prediction or early
births, they account for about 85% of
diagnosis
of
preterm
delivery.
neonatal deaths of normally formed infants
Unfortunately, the initial promise shown by (Creasy, 1993; Copper et al., 1993). In
risk scoring systems including a history of
addition to the increased risk of neonatal
previous preterm delivery or abortion,
morbidity, many of survivors will be per-
uterine anomalies, heavy work, low socio-
manently handicapped or disabled (Taylor,
economic status and cervical incompetence 1984). Despite significant advances in
has been limited by its poor predictive
prenatal medicine, the incidence of preterm
value and its populations specific analysis
delivery has remained unchanged and stills
and predicts at best 50% of preterm
a serious obstetric problem (Chien et al.,
deliveries (Creasy and Merkatz 1990; 1997). Keirse, 1995). Cervical examination,
The diagnosis of early preterm labor
screening for reduced breathing movements
is difficult and is accompanied by a high
on ultrasound scanning or screening for
false positive rate. These false diagnosis
recurrent uterine contractions provides little
result in unnecessary and potentially
additional predictive power (Lockwood,
37
Response of Intestinal Mucosa to Trichinosis in immunized and non-immunized Albino Rat The Egyptian Journal of Hospital Medicine Vol., 8 : 50 61 September 2002
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Response of Intestinal Mucosa to Trichinosis in immunized and non- immunized Albino Rat
Azza A. Elnokaly and Abdel-Mawgoud A. Ismaeil Departments of Parasitology and Histology, Boys and Girls Faculties of Medicine, AlAzhar University
Abstract The intestinal mucosa is reported to be greatly affected by infestation by Trichinella spiralis. The infestation by the worm is also controlled by intestinal tissue factors including cytokines and immune response. Vaccination with larval muscle antigen was reported to be of limited effect. However, vaccination with adult worm crude antigen may infer better protection. The aim of this work is to relate the histological, morphometric and immunological response of the intestinal mucosa of T.spiralis infested rat to worm burden, female fecundity and worm expulsion before and after immunization with crude antigen of the adult worm. This relationship is expected to give better evaluation of immunization by this antigen. 45 adult albino rats were allotted among three equal groups: control, T.spiralis infested and immunized infested group. Infection was done by 300 freshly isolated infective T.spiralis larvae. Five rats from each group were sacrificed at the end of the first, second and third week of infestation. The efficacy of immunization was assessed weekly by measuring adult worm burden and female fecundity, in relation to changes in the histological appearance, relative villus length, number of goblet, and mast cells and the amount of histamine in the intestine. The results indicated that the worm burden was at its peak by the end of the first week after infestation. The mean protection value due to immunization in this parameter was 67%. Immunization resulted in a protection value relative to larval emergence of 38%. Maximum changes in the host tissue parameters were detected a week after that of worm burden. Measurement of the host intestinal response represented 78% change in villus/crypt ratio, 13.3% in number of goblet cells in the villus and 16.22 in the crypts, 22.5% in mast cell number and 16.8% in histamine content. The results indicate that immunization by crude antigen of the adult T.spiralis has a protective effect of the intestinal mucosa of the host due to inhibition of worm vitality and larval emergence. Mast cell production of histamine and goblet cell secretion of mucins could also play a role in protection.
Introduction Trichinosis remains an important
presence of Trichinella in these animals
zoonotic food-born parasitic disease of
followed the use of proteins of animal
world wide distribution (Murrell, 2001).
origin in breeding herbivorous animals, Trichinella spiralis parasitizes many mam-
which is now a common practice in many
mals including man. The pig is considered
countries(Pozio et al., 2001) including
the main component of the epidemo-
Egypt.
epizootologic chain (Leiby et al., 1990).
The relationship between parasites
Although in Egypt pork meat is not a
and hosts can be considered according to
common dish due to religious instructions,
the concept that the host is an environment
yet the risk of infection is still there, since
providing microhabitats for parasites to
sheep proved to be a source for human
exploit (Rollinson and Anderson, 1985).
trichinosis (Rosa et al., 1992; Kim, 1993;
Parasites divert resources from the host to
and Theodoropoulos et al., 2000). Recently,
their own use. So, the host is under strong Trichonella larvae have been also detected
selection pressure to stop, or at least, reduce
in ostriches (Piergilli-Foretti et al., 2001)
this drain of his resources. One result of
and horses (Viveros et al., 2001). The
these pressures has been the evolution of
50
Protective effect of deoxynucleotide triphosphates on DNA damage in different mammalian cells exposed to g-radiationThe Egyptian Journal of Hospital Medicine Vol., 8 : 62 69 September 2002
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Protective effect of deoxynucleotide triphosphates on DNA damage in different mammalian cells exposed to -radiation
Elmaghraby, T National Center for Radiation Research and Technology,Egypt.
Abstract
DNA is generally considered to be the most critical cellular target when considering the
lethal, carcinogenic and mutagenic effects of drugs, radiation and environmental chemicals. So the study aim to the determination the damaging effect of -radiation on DNA and the protective effect of deoxynucleotide triphosphates (dNTPs). The study includes three cell types, lymphocytes, kidney cells of African gree monkey (Vero) and hepatocellular carcinoma of human (HePG2) exposed to 1-5 Gy of -radiation and by using fluorometric analysis of DNA unwinding (FADU) method, DNA damage was measured after radiation. The cells were divided into two groups: The first received 5x10-5 dNTPs from 0-30 minutes after radiation, while the second group was not supplemented with deoxynucleotides. Clonogenic survival for vero and HePG2 cell lines was measured. The results revealed that the increase of irradiation dose precipitates an increase of DNA strand breaks. The slope curve of initial DNA damage and mean inactivation dose (D ) differ between vero and HepG2 cell line by a factor of up 3.5 and 2, respectively. dNTPs have clear ameliorating effect on DNA damage. FADU method can play an important role in the choice of a suitable treatment (radiation or drugs) and its dosage according to measurement of DNA damages in selective malignant tissues. Moreover, using dNTPs mixture can reduce the side effect of these treatment especially after experimentally on live mammals (mice) . Introduction:
DNA is generally considered to be the
Although base damage may have
most
critical
cellular
target
when
serious consequence for a cell, low levels of
considering the lethal, carcinogenic and
base damage are difficult to measure by
mutagenic efects of drugs radiation and
physical or chemical means (Paterson,
environmental chemicals. These agents may
1978), by contrast, DNA strand breaks can
damage DNA by altering bases or
be detected with great sensitivity by many
disrupting the sugar-phosphate backbone. It
methods. Pulsed field gel electrophoresis
is generally accepted that cell death induced
(PFGE) Whitaker, et al., (1995), constant
by ionizing irradiation is due to DNA
field gel electrophoresis. (CFGE) Dikomey
double strand breaks (Steel et al., 1989). et al., 1997) and neutral filter elution
The molecular mechanisms that control
(Zaffaroni et al., 1994) have shown a
variations in radiation induced DNA
correlation between radiosensitivity and
damage between cell types are not
residual unrepaired DNA double-strand
understood. Both the initial DNA damage
breaks.
and the residual unrepaired DNA damage
A common thing in these methods is
may be critical determinants in the
that they measure DNA double strand
processes leading to cell death.
breaks and hence are sensitive for
62
Physiological Changes Induced by Long Term Administration of Saccharin Compared With Aspartame to Male Albino Rats The Egyptian Journal of Hospital Medicine Vol., 8: 70-81 September 2002
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Physiological Changes Induced by Long Term Administration of Saccharin Compared with Aspartame to Male Albino Rats
Inas Z.A. Abdallah
Nutrition and Food Science Dept., Faculty of Home Economics
Helwan University Abstract:
Artificial sweeteners have been in use by food industries for a long time. Safety concerns raised
about artificial sweeteners since they are widely used nowadays. The present work aims to study the possible changes in body weight, blood picture, liver functions, blood glucose and liver glycogen content as wel as histopathological changes induced in liver and urinary bladder of male albino rats after administration of two artificial sweeteners (saccharin or aspartame). Male rats were administered saccharin (50 mg/kg b.w.) or aspartame (100 mg/kg b.w.) daily by intragastric gavage for 14 weeks. The results revealed that both saccharin and aspartame provoked highly significant reduction in body weight gain %. Saccharin exerted highly significant reduction in haemoglobin (Hb) level, haematocrit (Hct%) and red blood cel s (RBCs) count, while aspartame induced insignificant changes in al haematological parameters. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity levels were significantly increased with saccharin and aspartame. Alkaline phosphatase (ALP) levels in serum showed slightly insignificant increase by saccharim administration, while aspartame caused a significant rise in ALP. Blood glucose level of rats given saccharin significantly dropped, while aspartame caused a significant elevation in blood glucose level. Liver glycogen content of rats given saccharin significantly increased, while aspartame caused a significant reduction in liver glycogen content. Microscopic examination of liver sections showed lymphocytic and macrophages infiltration of the portal traid in rats administered saccharin, while aspartame group showed no histopathological changes except slight hydropic degeneration of hepatocytes. Urinary bladder sections of rats administered saccharin revealed proliferation of the mucosal epithelial cel s into papil ary invaginated projections with highly vascularized connective tissue core and mononuclear inflammatory cel s infiltration, while aspartame group showed no histopahtological alterations. It could be recommended that the use of saccharin as an artificial sweetener should be restricted, while aspartame should not be administered to diabetic. When it is necessary to use artificial sweeteners, fresh fruits and vegetables should be ingested as they act as scavengers for the liberated free radicals and help to delay the postprandial rise in blood glucose level.
Introduction:
Food additives are substances not
and xylitol are just some of the many nutritive
normally found in foods which are added to
sweeteners used in foods (Wardlaw, 2000).
extend shelf life, and improve flavour, colour
Non-nutritive sweeteners are also referred to
and texture or stweeten food. Most highly
as intense sweeteners, very low caloric or
processed foods cannot be made without
alternative sweeteners. These were discovered
them. Additives include antioxidants, prese-
in the last century, beginning with saccharin
rvatives, sweeteners, colourants, flavors,
which was discovered in 1879, later, this was
emulsifiers and stabilizers (Duyff, 2002).
followed by many other artificial sweeteners
Sweeteners could be classified as natural
including, sucralase, alitame, cyclamate,
nutritive and artificial non-nutritive sweeten-
acesulfame-k and aspartame (Marion and
ers. Nutritive sweeteners include monosac-
Franz, 1993).
charides, disaccharides and sugar alcohols
There are various reasons why
from either natural or refined sources. White
sweeteners are used. In previous times, there
sugar, brown sugar, honey, corn syrup,
was a medical need and purpose for
glucose, fructose, lactose, maltose, sorbitol
developing artificial sweeteners, but today
70
þÿ The Egyptian Journal of Hospital Medicine Vol., 8 : 82 87 September 2002
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Study of Interleukin-1ß in Essential Hypertension Hoda A. Hassan ,Amal Ahmed Mokhar,Adila M.Gad, Amal Abdel Aleem*
Department of General Medicine & Clinical Pathology*
Al Azhar University (Girls) Abstract The observation of increased blood interleukin 1ß levels in subjects with hypertension is a finding that raises the hypothesis that the immune mechanisms may be involved in the atherogenic cascade . Our aim in this study was to investigate the possible interrelations between blood pressure, lipid profile and IL-1ß to clarify the possible participation of this cytokine in the cascade phenomena presented during the process of essential hypertension (EH) such as atherogenesis. 28 hypertensive patients and 10 healthy volunteers served as control matched for age and sex were included. IL-1ß (enzyme immunoassay), total cholesterol , triglycerides, high and low density lipoprotein cholesterol were estimated. Significant elevation of IL- 1ß in hypertensive patients in comparison to the control was found with positive correlation between IL- 1ß and diastolic. Systolic and the mean Blood pressure r=0.16, 0.046 and 0.28 respectively . Also the study showed positive correlation between IL-1ß and body mass index (r=0.42), serum cholesterol and LDL cholesterol and negative one with TG while no correlation was found with HDL cholesterol TG. Elevated IL-1ß levels in subjects with EH may be related causally to the role of immunologic mechanisms in the development of EH and even to the atherogenic cascade.Thus we can suggest that the presence of high levels of IL-1ß may be an additional risk factor for atherogenesis in patients with EH Introduction
The dysfunction of the immune
cellular matrix proteins by endothelium
system has been implicated recently in the Montensano et al ., (1984) and promotion
pathogenesis of essential hypertension (EH)
of vascular permeability Martin et (Dalekas et al.,1997) ,On the other hand al.,(1989). In 2002 Vito et al observed that
alteration in renal handling of salt and
nitric oxide and IL-1ß exert a tonic inhib-
water, the rennin angiotensin system, the
itory action on central sympathetic nervous
vascular structure , systemic haemody-
system activity. IL-1ß also suppresses
namics, the sympathetic activity, environ-
vascular contractility and has procoagulant
mental or genetic factor, the hyperins-
activity Bevilacqua et al., (1986). In 1989
ulinaemia and the tissue resistance to Wang et al detected increased levels of IL-
insulin have been involved to varying
1 and IL- IB m RNAs in human atherosc-
degree in the pathog-enesis of essential
lerotic plaque, however, increasing evide-
hypertension. IL-I forms part of a complete
nce has accumulated in the last years
integrated group of cytokines that has been
supporting the speculation that alterations
shown to mediate the inflammatory host
in the function of the immune system could
response to infection Dinarello,1998 , it has
significantly contribute to the cause of
also been implicated in the pathophysiology
many forms of experimental and human
of endotoxin and immune mediated shock.
essential hypertension. Alteration in both
In vitro evidence suggests that this cytokine
humoral and cellular immunity (khraibi,
may act as a regulatory protein in the ather- 1991), inherited abnormalities of the compl-
osclerotic process. Several mechanisms
ement system and immunogenetic correl-
have been suggested including stimulation
ations between histocompatibility antigens
of leukocyte adherence to the endothelium,
with either borderline hypertension have
modulation of LDL metabolism Rasmuss
been found (Titkov, et al .,1993). It has en &Seljehid ,( 1989) , induction of extra
recently been shown that antihypertensive
82
Comparative study of Ropivacaine versus Bupivacaine for pediatric caudal block The Egyptian Journal of Hospital Medicine Vol., 8: 88 93 September 2002
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Comparative study of Ropivacaine versus Bupivacaine for pediatric caudal block
Omar Elsafty MD, Ahmed M.S. Hamed MD, Sherif Wadie MD &Maged M.Kamel
Departement of anesthesia Ain shams university Abstract:
Ropivacaine is a long acting amino-amide local anesthetic, it is less cardiotoxic and less likely to cause motor blockade than bupivacaine. In our study we compared the effectiveness, degree of motor block produced by either ropivacaine or bupivacaine as well as the onset and duration of both drugs. Fourty children ASA I scheduled for elective minor lower abdominal surgery were randomly allocated to receive a single caudal extradural injection of 1ml/ kg of either ropivacaine 0.375% r group (n=20) or bupivacaine 0.375 % b group (n=20) after induction of general anesthesia. Heart rate and arterial blood pressure were measured every 5 minutes from the beginning of G. A. until the child is transferred to the ward. The extent of motor block in the recovery room was scored according to modified Bromage scale , time to first analgesic requirement were recorded. Both groups were similar in age, weight, and there were no difference in heart rate or arterial blood pressure. Yet the degree of motor block was significantly different between the two groups. Ropivacaine group showed a shorter duration of motor block than bupivacaine group, postoperative analgesia was required at almost equal time in both groups. These findings suggest that there is no great difference between ropivacaine compared with bupivacaine as regard the hemodynamics or sensory block, yet ropivacaine is superior for it s safety and less motor block.
Introduction:
Ropivacaine is the s-enantiomer of
Caudal analgesia is a relatively simple
amide local anesthetic, which has been
technique with a predictable level of
extensively evaluated in adults and older
blockade, provides excellent postoperative
children. Recently it has been used in
analgesia. It is the most popular regional
younger children and several studies have
anesthetic used in pediatric surgery for
reported its clinical efficacy and safety
various surgical procedures, such as lower
when administered for caudal epidural
abdominal, urologic and lower limb
analgesia, for lumber epidural, for
operations. This long-acting regional
peripheral nerve block and as a continuous
technique provide analgesia beyond the
epidural infusion (1).
duration of surgery, with a smooth recovery
Ropivacaine has several properties
period and good postoperative pain control,
which may be useful in pediatric practice,
and therefore reduces analgesic requirement
namely the potential to produce differential
and facilitates early discharge.
neural blockade with less motor block and
Long acting anesthetics, such as
reduced cardiovascular and neurological
bupivacaine, have had a well-defined role
toxicity. (2) These features are particularly
in regional anesthesia and analgesia for
attractive for day case surgery in children,
many years. Since the report of several
which is increasing in frequency.
cases of systemic toxic reactions after
88
Clinical importance of P53 and P21 determination as a biomarkers in bladder cancer and bilharzial patients The Egyptian Journal of Hospital Medicine Vol., 8: 94 103 September 2002
I.S.S.N:
12084
1687-2002
Clinical importance of P53 and P21 determination as a biomarkers in bladder cancer and bilharzial patients Wafaa Abd-Allah* Sohair A Hassan**, Faten E Hafez and*** Hafez Faruk*.
* Cancer Biology Department, National Cancer Institute, Cairo, Egypt.
** Medicinal Chemistry Department, National Research Center , Cairo, Egypt.
***Clinical Pathology Department, National Cancer Institute, Cairo, Egypt.
Abstract The present study was made to shed more light on the clinical importance of early detection of bladder cancer using p53 and p21 mutant proteins as a biomarkers using simple, applicable ELISA techniques. Serum samples were collected from 70 patients , the first group included 50 bladder cancer patients, the second included 20 bilharzial patients ,while the third group consisted of 20 healthy individuals used as control. P53 wild and mutant types showed significant changes (p<0.02 and <0.007,respectively ) in bilharzial patients. Also they showed significant changes in bladder cancer patients with (+ve) lymph node (p<0.02 and p<0.01, respectively) when compared to control as well as it showed great differences between low and high grade ( p< 0.01 and p<0.001) for wild and mutant type. Moreover p53 showed higher sensitivity levels for mutant and wild type in both bilharzial 19.5, 31.2 compared to 23.9 and 35.9%, respectively in bladder cancer one . P21 mutated amino acids were proved to be of significant values in bladder cancer group (p<0.001) compared to bilharzial group. The p21 mutated amino acids showed a correlation with different histological grades for bladder patients, while ARG12 and ASP13 were highly related to bladder cancer with bilharzial history with the notion that ASP13 achieved high sensitivity level to bladder cancer group 91% and 83% for those of bladder cancer with bilharzial history .In conclusion the results of the present study revealed that determination of both p53 and p21 are of great value in the early detection and follow up of bladder cancer patients and screening for risky bilharzial ones .
Introduction
Bladder cancer represents a main
is not entirely explained by differences in
health problem in Egypt . Its a major
cigarette smoking or occupatio-nal exposure
urological disease and accounted for 30.3 %
( Hartge et al., 1990).
of total malignancies according to the
In Egypt, the male incidence of bladder
registry of National Cancer Institute ( NCI )
cancer is higher (Mokhtar, 1991) due to
Cairo University in 1990 (Mokhtar, 1991).
frequent field exposure and bilharzial
In fact bladder cancer is uncommon below
infestation among men. Considerable evide-
the age of 40 years ( Samuel and Sonny,
nce suggests that schistosomiasis plays an
1992). In younger ages as they exposed to
important role in the development of
bilhazial infection the incidence of
bladder cancer in Egypt and other countries
bilharzial bladder cancer is remarkably
where infection with the parasite is
higher when compared to non-bilharzial
epidemic (El-Bolkainy, 1998). Several
series (Payne, 1959). The incidence of
hypothesis have been proposed to explain
bladder cancer increases with age reaching a
the etiological roles of schistosomal
peak between 50 to 60 years old ( El-Bolkainy
infection in the development of bladder et al., 1972, Fitzpatrick and Reda, 1986).
cancer. Among these roles only two are
Bladder cancer is five times more frequent in
strongly contributing in the development of
men than in women, a different causes that
the tumor. The first one is increasement of
94
The minimum effective intravenous dose of ondansetron for prevention of postoperative nausea and vomiting after adenotonsillec The Egyptian Journal of Hospital Medicine Vol., 8: 104 115 September 2002
I.S.S.N:
12084
1687-2002
The minimum effective intravenous dose of ondansetron for prevention of postoperative nausea and vomiting after adenotonsillectomy in dexamethasone pretreated children Asharf Mahmood A. Swellam and Tarek Ali Helal*
Assistant Professor - Anesthesia Department, Ain-Shams University, Cairo, Egypt
* Assistant Professor - E.N.T Department, Cairo University, Egypt
Abstract Postoperative nausea and vomiting (PONV) remains a distressing and common problem after tonsillectomy with an incidence ranging from 40-73% in those who did not receive prophylactic antiemetic. This study was done to identify the minimum effective IV dose of ondansetron to decrease the incidence and severity of PONV in the dexamethasone (150ug/kg) pretreated children undergoing adenotonsillectomy. In this prospective, randomized, double- blinded, placebo-controlled study, 150 children (3-12 years old) received dexamethasone 150g/kg IV (maximum 8mg) premedication were randomly assigned to receive either placebo (saline) or ondansetron in a dose of 25, 50, 75 or 150g/kg IV immediately after induction of anesthesia. All children received standardized perioperative care, including surgical and anesthetic techniques, IV fluid, postoperative analgesic and rescue antiemetic (RAE). The incidence and severity of PONV were recorded in a standardized fashion at the intervals 0-2, 2- 12 and 12-24h postoperatively. The time to first postoperative analgesic, total analgesic consumptions, the need for rescue antiemetic (RAE), the fast tracking time (FTT), the time to first oral intake and parent's satisfaction score were recorded as clinically true outcome measures. The five treatment groups were similar with respect to patients's characteristics and operative data. There was no significant difference with respect to the incidence (P>0.05) or severity (P>0.05) of PONV between the placebo and 25g/kg ondansetron group during the study period (0-24h). The incidence of early (0-2h), delayed (2-12h), and late (12-24) PONV were significantly less in the 50 (P<0.05), 75 (P<0.05) and 150 (P<0.05) g/kg ondansetron groups compared with placebo. The incidence of 24h PONV was 43, 37, 13, 10 and 7% in placebo, 25, 50, 75 and 150g/kg ondansetron groups, respectively. The PONV severity scores (0-3) were significantly less (p<0.05) in children who received ondansetron in a dose of 50g/kg or more compared with the placebo. There was no statistically significant difference with respect to the incidence (P>0.05) or the severity (P>0.05) of PONV between the 50, 75 and 150g/kg ondansetron groups. The time to first postoperative analgesic, the total postoperative analgesic consumptions, the need for RAE, the time to first oral intake and the fast tracking time (FTT) were significantly less (P<0.05) in children who received 50, 75 and 150 g/kg ondansetron in comparison with placebo. The parent's satisfaction scores were significantly high (P<0.05) for those children who received ondansetron in a doses of 50g/kg or more compared with placebo. There was no significant difference with respect to the clinically true outcome measures in children who received ondansetron in dose of 50g/kg or more.In conclusion, ondansetron 50g/kg IV was the minimum effective IV dose to decrease the incidence and severity of PONV in dexamethasone (150g/kg IV) pretreated children undergoing adenotonsillectomy. This dose was associated with a significant reduction in the time to first postoperative analgesic, total analgesic consumptions, the need for rescue antiemetic (RAE), the time to first oral intake, the fast tracking time (FTT) and a high parent's satisfaction scores. Increasing the dose of ondansetron to 150g/kg provided no significant benefits in reducing the incidence or severity of PONV in dexamethasone (150g/kg IV) pretreated children undergoing adenotonsillectomy.
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