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ORIGINAL ARTICLES
Women's awareness of obstetric danger symptoms: is there a need to promote a preconceptional educational program?
Ammal M Metwally, Dalia M Elmosalami, Lobna A El Etreby, Amira Mohsen, Rehan M Saleh, Samia AR Hemeda
January-June 2015, 10(1):9-17
DOI:10.4103/1687-4293.159369  
Background/aim Awareness towards the symptoms of obstetric complications will lead to timely access to appropriate emergency obstetric care. The aim of the study was to assess and compare the awareness towards obstetric danger symptoms among never-pregnant and ever-pregnant women and to identify predictors of their awareness as a measure for the need to promote a preconceptional educational program in Egypt. Participants and methods This study was conducted in selected villages of Alfayoum and Benisuef governorates as a comparative study between 173 newly married never-pregnant women and 827 ever-pregnant women who were randomly targeted by a structured interview during a period of 8 months. The questionnaire included personal data, social data, and data related to awareness of obstetric danger symptoms, complications, and action taken on having any of these symptoms. The scoring system was designed for women's awareness, with one degree allocated for a correct answer. Results The study revealed that the percent of women who gained a score of knowledge of at least 50% was higher among ever-pregnant women than among never-pregnant women (43.9 and 19.1%, respectively). Although bleeding is the highest reported cause for obstetric complications and is one of the reported causes of maternal deaths in the studied villages, only 26.6 and 20.2% of the never pregnant and 43.9 and 34.3% of the ever pregnant groups, respectively, knew that bleeding is a danger symptom during delivery and the postnatal period. Meanwhile, better awareness about obstetric danger symptoms and exposure to health educational messages was significantly higher among ever-pregnant women (OR = 3.08 and 2.28, respectively) (P < 0.001). Conclusion This study reflects the need for intensifying antenatal health educational messages given to pregnant women and the need for the implementation of preconceptional health education programs.
  2,105 288 -
Volatile compounds, antioxidants, and anticancer activities of Cape gooseberry fruit (Physalis peruviana L.): An in-vitro study
Manal M Ramadan, Ahmed H El-Ghorab, Kadry Z Ghanem
July-December 2015, 10(2):56-64
DOI:10.4103/1687-4293.175556  
Background/aim Cape gooseberry is golden-colored spherical fruit commercially produced in Egypt. It is primarily used in folk medicine for treating some diseases. To identify the aroma compounds in Cape gooseberry and to evaluate its antioxidant activities as well as its anticancer (for colon and breast cancers) effects in human cell lines. Materials and methods The volatile compounds were identified using gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS). Polyphenols (phenolics and flavonoids) were also determined. Antioxidant activity was determined by three different methods: 2,2΄-diphenyl-1-picrylhydrazyl (DPPH), 2,2-azinobis(3-ethyl-benzothiazoline-6-sulfonic acid) (ABTS), and ferric reducing antioxidant power (FRAP) assays. Anticancer (for colon or breast cancer) activity was determined in cancer cell lines using 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. Results A total of 34 components of the essential oil were identified by GC and GC-MS. The volatile compounds were grouped in classes of substances, including 11 terpene compounds (six monoterpenoids and five sesquiterpene), 11 esters, five alcohols, two phenolic compounds, two aldehydes, two ketones, and one lactone. Terpenes (monoterpenes and sesquiterpenes) were the most abundant volatile constituents, accounting for the largest portion of the total volatiles (36.09%). The next most abundant compounds were esters, comprising 17.17% of the total volatile components identified. Phenolic compounds were the next most abundant compounds, comprising 16.04% of the total volatiles. Alcohols and aldehydes represented 6.37 and 1.88% of the total volatile compounds, respectively. Ketones and lactones are less abundant in the profile of volatile compounds in Cape gooseberry. Ethanol extract had higher phenolic and flavonoid contents than did hexane extract. As ethanol extract of Cape gooseberry achieved higher antioxidant activity than did hexane extract, it tested as an anticancer (for colon or breast cancer) agent. Cape gooseberry extract was more potent in inhibiting colon cell lines (IC 50 : 142 μg/ml) compared with breast cell line (IC 50 : 371 μg/ml). Conclusion Egyptian Cape gooseberry fruits may be suggested as a potential source of natural antioxidants and anticancer agents.
  931 206 2
Assessment of compliance to standard precautions among surgeons in Zagazig University Hospitals, Egypt, using the Health Belief Model
Eman M Mortada, Marwa M Zalat
January-June 2014, 9(1):6-14
DOI:10.4103/1687-4293.137319  
Background/aim Although it is recommended that healthcare professionals should comply with the standard precautions to prevent acquiring blood-borne diseases (AIDS, hepatitis B and C), yet, they frequently do not comply with this recommendation. Understanding the reasons for compliance and noncompliance will help in designing educational programs for hospital staff and in determining a strategy for improving health behavior. The present study aimed to assess surgeons' compliance to standard precautions and determine surgeons' perceived beliefs affecting their compliance using the Health Belief Model. Participants and methods A cross-sectional study was carried out at surgical departments in Zagazig University Hospitals from December 2012 to May 2013. A questionnaire on various aspects of infection control and standard precautions practices was provided to 307 surgeons, with a response rate of 70%. Results Our findings indicated that 57.5% of the surgeons sampled in Zagazig University Hospitals were compliant with standard precautions. 59.8% of compliant surgeons had been exposed to at least one needle-stick injury in the previous 3 months, whereas slightly less than half of compliant surgeons (48.4%) had been exposed to splashes, with a highly significant difference compared with nonexposed surgeons. All Health Belief Model subscales were correlated directly with the surgeons' compliance, except perceived barriers. Conclusion There is adequate compliance with standard precautions among surgeons in Zagazig University Hospitals, especially female surgeons, with a high level of knowledge among compliant compared with noncompliant surgeons. All Health Belief Model subscales were correlated directly with the surgeons' compliance, except perceived barriers. Adequate training of surgeons, provision of infection prevention equipment, regular reporting, follow-up, and assessment of occupational exposures need to be introduced.
  885 152 2
REVIEW ARTICLE
Laboratory-acquired blood-borne parasites from accidental exposure
Elmeya H Safar
January-June 2017, 12(1):1-5
DOI:10.4103/jasmr.jasmr_19_16  
Background Infection caused by blood protozoa is becoming very common, especially in developed countries because of immunosuppressed persons and travelers. Therefore, this review aimed to illustrate the dangers of blood protozoa exposure among persons working in medical laboratories, especially when dealing with samples containing blood protozoa such as Babesia, Leishmania, Plasmodium, and Trypanosoma spp. Conclusion As protozoa multiply rapidly in humans even with a small inoculum, they can cause illness, in contrast to helminths. Diagnoses of infection can be confirmed through dermal scraping, examination of the stained slides by light microscopy, obtaining biopsy specimens for thin, stained smear, and needle aspiration for cultures of Leishmania spp. In addition, protocols should be provided for handling specimens that could carry viable organisms, using protective laboratory equipment.
  930 55 -
ORIGINAL ARTICLES
Lymphatic and testicular artery-sparing laparoscopic varicocelectomy in children and adolescents
Abdelaziz Yehya
January-June 2014, 9(1):1-5
DOI:10.4103/1687-4293.137318  
Background/aim The ideal operation for the treatment of adolescent varicocele has been debated for many years. The division of lymphatic vessels during varicocelectomy is complicated by hydrocele formation and decline in testicular function. The aim of this study is to report on our series of children who underwent lymphatic and testicular artery-sparing laparoscopic varicocelectomy (LTASLV). Patients and methods Thirty boys with primary left-sided varicocele were subjected to LTASLV. The indications for intervention were scrotal pain and discomfort in 18 cases (60%), hypotrophy in nine cases (30%), and family preference in three cases (10%). An intraparenchymal injection of 2 ml methylene blue was administered after induction of anesthesia. LTASLV was performed for all patients. The main outcome measurements included operative time, hospital stay, development of hydrocele, varicocele recurrence, and testicular atrophy. Results The study included 30 patients with primary left-sided varicocele. Their mean age was 12.25 ± 1.6 years (range 9-16 years). Grade 3 varicocele was present in 21 cases (70%) and grade 2 varicocele was present in nine cases (30%). Stained lymphatics could easily be observed alongside the testicular artery and veins in 28 cases, whereas in two cases, a second injection of methylene blue with lowering of CO 2 pressure was required for visualization. All procedures were completed laparoscopically without conversions or complications. The mean operative time was 40 ± 2.6 min (range 30-50 min). All patients achieved full recovery and were discharged within 24 h. The mean follow-up period was 18 ± 4.3 months (range 10-36 months). Residual varicocele was noted in one case (3.3%) with no hydrocele formation or testicular atrophy. Conclusion This study shows good results with respect to postoperative hydrocele rates. LTASLV resulted in 0% of hydrocele and decreased the risk of varicocele recurrence. However, larger series are necessary.
  918 50 -
Management of bile duct injuries: comparative study between Roux-en-Y hepaticojejunostomy and primary repair with stent placement
Adel M Khalaf
July-December 2013, 8(2):89-95
DOI:10.4103/1687-4293.123792  
Background Bile duct injury (BDI) is a major complication in biliary surgery such as laparoscopic cholecystectomy. The management of major BDI is a surgical challenge even for experienced hepatobiliary surgeons. The aim of this study was to introduce a new surgical technique for reconstruction of the biliary duct by primary repair after stent placement. Patients and methods The present study was carried out on a selected group of BDI patients (34 patients), who were referred for management of BDIs. Patients were divided into two equal groups: group A underwent primary repair of the bile duct by placement of a plastic stent (which is used in endoscopic retrograde cholangiopancreatography) and group B underwent Roux-en-Y hepaticojejunostomy. Results The study included 34 patients, 10 men (30.9%) and 24 women (69.1%) with a mean age of 40.84 years, whose main presentations were postoperative jaundice (82%) and bile leak (15%). All the patients underwent surgery successfully. There was no intraoperative mortality and bile leakage during the observation period, but primary repair of the bile duct with plastic stent placement was associated with better results as regards operation time, hospital stay, cost, safety, and postoperative complications. Conclusion Primary repair of the bile duct with stent placement showed good results, involved minimal morbidity, hospital stay, and cost; and helped avoid the drawbacks of Roux-Y hepaticojejunostomy. It also replaced exploration of the common bile duct with a T-tube, with advantages of function of the Oddis sphincter.
  848 76 -
Determinants of unintended pregnancy and its impact on the health of women in some governorates of Upper Egypt
Ammal M Metwally, Rehan M Saleh, Amira M Abdelhamed, Somia I Salama, Carine W Mores, Fatma A Shaaban, Osama M Azmy
January-June 2015, 10(1):1-8
DOI:10.4103/1687-4293.159368  
Background/aim Worldwide, more than half of all unintended pregnancies end in abortion, indicating the preference for increasingly smaller families. The present work aimed to assess the determinants of unintended pregnancy and its impact on women's health in El Fayoum and Benisuef governorates. Participants and methods A community-based cross-sectional household survey was conducted among 827 married women of reproductive age. The study was conducted in two governorates, El Fayoum and Benisuef, for a period of 6 months. Results The current study revealed that 15.9% of women who participated in the study had an unmet need for family planning, with subsequent unintended pregnancy. Higher age of women and her age at the time of marriage, illiteracy, short interpregnancy spacing, exceeding the desired number of children, negative attitude of husbands toward the use of family planning methods, and absence of discussion between partners on the use of means to postpone pregnancy increased the number of unintended pregnancies. Also, women with unintended pregnancy were at a higher risk of experiencing health problems during her pregnancy. Conclusion Despite the efforts taken by family planners, the problem of unintended pregnancy continues to increase in Egypt, with its adverse effect on pregnancy and maternal outcomes. Therefore, the strategy for maternal mortality reduction in Egypt should focus on addressing the unmet needs of high-parity, uneducated, nonworking women.
  767 136 1
Influence of sociodemographic factors and environmental conditions on husbands' behavior toward maternal healthcare
Ammal M Metwally, Ghada A Abdel-Latif, Lobna El Etreby, Amani Tawfik, Doaa Elsayed, Aida M Abdel Mohsen
January-June 2015, 10(1):18-26
DOI:10.4103/1687-4293.159370  
Background/aim Improving maternal health depends on husband's behavior which is affected by certain socio-demographic factors and environmental conditions. The study aimed to assess the husband's behavior toward maternal healthcare and emergency first aid measures for pregnancy and obstetric risks that might put life of women at risk of maternal death. The study also determined the socio-demographic factors and environmental conditions that influenced husband's behavior and attitude toward antenatal care providers and providers of assisted delivery. Methods One thousand husbands of women in childbearing period were randomly selected through a community-based study that was conducted in 23 rural villages of four chosen districts of Benisuef and Al Fayoum governorates of Egypt. The study is a cross-sectional investigation conducted over a period of 8 months starting from July 2010 until February 2011. Data were collected from interviews of husbands on their sociodemographic characteristics, environmental conditions, and their knowledge, attitudes, intention, and practices toward maternal healthcare and services provided as well as toward providers of maternal healthcare. Results The study revealed that husbands who were younger than 20 years at the time of marriage, had a lower middle environmental score, and an upper middle income were nearly two or more times as likely of being unaware of the risk symptoms during pregnancy [odds ratio (OR) = 2.73, 1.37, and 1.59, respectively], during delivery (OR = 1.93, 1.31, and 1.76, respectively), and during the postnatal period (OR = 2.42, 1.36, and 1.77, respectively) compared with those older than 20 at the time of marriage, who had an upper middle environmental score, and a lower middle income. Conclusion and recommendations It is recommended to target husbands as an influential factor among high-risk wives by educating them on maternal health risks and by increasing their accessibility to maternal and obstetric health services, with special emphasis on younger men and those living under poor environmental conditions irrespective of their economic status.
  740 137 -
In-vitro antibacterial and antioxidant properties of starch/chitosan edible composite film incorporated with thyme essential oil
Hamdy A Shaaban, Khaled F Mahmoud
July-December 2014, 9(2):54-61
DOI:10.4103/1687-4293.145627  
Background/aim Nowadays, packaging research is receiving considerable attention because of the development of ecofriendly materials made from natural polymers such as starch and chitosan. This study aimed to prepare composite films from starch-chitosan, incorporated with Thymus vulgaris essential oil (S-CH-Th), and to evaluate their antibacterial, antioxidant and optical properties. Materials and methods The molecular weight of chitosan was (~400 kDa, 75-85% deacetylated). 27% amylose corn starch, Tween 80, DPPH (2, 2-diphenyl-1-picrylhydrazyl) and Folin-Ciocalteu reagent were used to carry out research. Antibacterial activity testing was performed using the disk method. Antioxidant activity test was performed using a spectrophotometric method with DPPH as the radical source. Essential oil concentrations ranging from 0 to 2%, incorporated into a starch-chitosan composite (S-CH) film, were used. Results Antibacterial and antioxidant properties increased significantly with the incorporation of Essential oils (EO) (P < 0.05). On incorporating EO, there was an increase in the total colour differences (ΔE ), yellowness index and whiteness index, which were significantly higher than those of the control, and the transparency was reduced. Also, the results showed that chitosan edible films incorporated with T. vulgaris EO could be used as active films because of their excellent antibacterial and antioxidant activities. Conclusion S-CH edible films incorporated with thyme EO as a natural antibacterial and antioxidant agent may potentially be used as an active packaging to enhance the safety of foods and food products.
  685 123 -
Antidepressant-like effect of resveratrol in a subchronic model of depression
Rania F Ahmed, Rehab F Abdel-Rahman, Heba Abdallah, Dalia O Saleh, Omar A. H. A Farid, Alyaa F Hessin
July-December 2014, 9(2):48-53
DOI:10.4103/1687-4293.145619  
Background and aim Depression is one of the most serious and common mental diseases with major negative social consequences. Transresveratrol (trans-3,5,4΄-trihydroxystilbene) is a polyphenolic compound with a broad spectrum of pharmacological activities. It has been detected in some fruits and herbs, including the Asian plant Polygonum cuspidatum. The aim of this study was to assess the antidepressant-like effect of transresveratrol in a reserpine subchronic model of depression. Materials and methods Depression-like behaviours were induced in rats by reserpine injection (0.25 mg/kg, subcutaneously) every 48 h, for 20 days. Transresveratrol (60 and 120 mg/kg) and fluoxetine (10 mg/kg) were administered orally daily during the 20 days of the study. Behavioural tests, namely, open-field test and forced swimming test, as well as brain neurotransmitters levels and antioxidant contents and liver functions, were assessed. Results Data revealed that transresveratrol improved the rats' behaviour in both the open-field test and forced swimming test, and also elevated the brain's neurotransmitter content, normalized the liver enzymes level, and improved the antioxidant status of both the brain and liver, compared with those of fluoxetine. Conclusion The present study provided a clear evidence for the antidepressant-like of transresveratrol in the experimental model of depression. Further investigations are required to investigate the mechanism of action of transresveratrol as well as its applicability to be used as an antidepressant.
  644 86 -
Volatile compounds and antioxidant activity of the aromatic herb Anethum graveolens
Manal M Ramadan, Nadia N Abd-Algader, Hatil H El-kamali, Kadry Z Ghanem, Abdel Razik H Farrag
July-December 2013, 8(2):79-88
DOI:10.4103/1687-4293.123791  
Background/Aim Anethum graveolens L. (dill) (Apiaceae) is one of the most popular culinary herbs in the world. Dill has been cultivated since ancient times, and the use of this plant for medicinal and consumption purposes has been recorded dating back to the Greek and Egyptian civilizations. Dill is widely used to give flavor to food. The aim of this work was to assess the chemical composition of the volatile compounds in dill as well as their hepatoprotective and nephroprotective activity against free radicals generated by paracetamol. Materials and methods The chemical composition of the volatile compounds of dill was assessed by gas chromatography and gas chromatography-mass spectrometry. Four groups of rats were used (the normal control group, the A. graveolens-supplemented group, the paracetamol-intoxicated group, and the A. graveolens-protected group) for studying the effect of plant infusion on panadol (paracetamol)-induced free radicals and hepatotoxicity. Plasma total antioxidant capacity, plasma catalase, cellular glutathione peroxidase, plasma total protein, albumin, alanine amino transferase, aspartate amino transferase, alkaline phosphate, γ-glutamyl transferase, total bilirubin, and direct bilirubin levels were determined. In addition, kidney functions (plasma urea and creatinine) and histopathological and histochemical changes in the liver were investigated. Results The phytochemical results identified volatile components 7-α-hydroxy manool (24.43%), l-carvone (14.28%), limonene (13.9%), epi-α-bisabolol (6.81%), α-terpinene (5.44%), and α-phellandrene (4.63%) as the main constituents. p-Cymene (2.13%), sabinene (1.98), and α-pinene (1.43%) were determined as the minor constituents. The biochemical results showed that a mega dose of paracetamol induced the production of free radicals, which caused damage to hepatocytes and nephrocytes in rats. The aqueous extract of dill revealed high antioxidant properties and acted as an extracellular neutralizer of free radicals. Histopathological and histochemical observations showed severe damage in the liver. Supplementation with dill in paracetamol-intoxicated rats attenuated the damage to the liver. Conclusion The present study revealed that A. graveolens has antihepatotoxic properties that could minimize the deleterious effects generated by hepatotoxin paracetamol, and therefore it can be used as a potent antihepatotoxic agent.
  633 87 5
Impact of sperm cryopreservation on child sex after intracytoplasmic sperm injection
Ahmed M Omar, Mahmoud F Abdel Hamid, Amr H Abbassy
January-June 2015, 10(1):41-46
DOI:10.4103/1687-4293.159376  
Background/aim Sperm cryopreservation causes extensive damage to sperm membranes and its ultrastructural morphology, affecting the fertilization ability by decreasing the percentage of normal intact acrosomes and consequently the acrosine activity. This retrospective study aims at detecting the effect of sperm cryopreservation on the baby's sex after intracytoplasmic sperm injection (ICSI) in terms of the susceptibility of X versus Y chromosome baring spermatozoa to cryopreservation. Patients and methods This retrospective study included 87 ICSI cycles performed with post-thawed spermatozoa. The patients were classified into two groups (I and II) according to the total sperm count before freezing. Results This study included 87 ICSI cycles performed with post-thawed spermatozoa. Patients were classified into two groups (I and II) according to the total sperm count before freezing. Group I included 43 patients with a sperm count less than 0.1 × 10 6 /sample (countable samples). Group II included 44 patients with a sperm count more than 0.1 × 10 6 /sample (uncountable samples). The numbers of fertilized M II, good embryos, clinical pregnancy, and male babies were significantly higher in group I compared with group II. Conclusion ICSI using post-thawed spermatozoa of countable samples yielded a higher male sex ratio (80.8%) compared with uncountable samples (28.6%). Thus, spermatozoa that successfully survived the freeze-thaw procedure exhibited an improved chromatin structure and nuclear maturity. These data suggest that sperm cryopreservation may improve the fertilization rate, enhance early embryo development parameters, as well as pregnancy outcome after ICSI.
  619 75 -
Improving the production of unsaturated fatty acid esters and flavonoids from date palm pollen and their effects as anti-breast-cancer and antiviral agents: An in-vitro study
Kadry Z Ghanem, Manal M Ramadan, Hassan Z Ghanem, Mohamed Fadel
July-December 2015, 10(2):47-55
DOI:10.4103/1687-4293.175555  
Background/aim Pollens from different plants contain unsaturated fatty acid esters (USFAEs) and flavonoids that play a very important role as bioactive compounds. Therefore, the present study was designed to improve the production of volatile USFAEs and flavonoids from date palm pollen (DPP) in a culture of Trichoderma koningii and test its activities as an anti-breast-cancer and antiviral agent. Materials and methods The volatile esters of fermented and nonfermented date palm pollens (FDPPs) were identified using gas chromatographic-mass spectrometric (GC-MS) analysis. Antioxidant activities were determined using three different methods: the 2,2′-diphenyl-1-picrylhydrazyl (DPPH) assay, the ferric reducing antioxidant power assay, and the 2,2-azinobis(3-ethyl-benzothiazoline-6-sulfonic acid) (ABTS) assay. Polyphenols (phenolics and flavonoids) were also determined. Anti-breast-cancer and antiviral activities were determined using the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. Results GC-MS analysis showed an improvement in the level of USFAE in FDPP (47.99%) almost double that of the DPP results (24.11%) extract concentration. Flavonoids content of the FDPP extract (93.4 ± 6.3 mg/ml) was higher than that obtained by the DPP extract (45.4 ± 2.1 mg/ml), which was more than double the value. Antioxidant activity of the FDPP extract increased 3.16, 3.42, and 2.14 times that of the DPP extract as determined by the ABTS, ferric reducing antioxidant power (FRAP), and DPPH assays, respectively. The extract of FDPP showed strong anticancer activity against the MCF-7 cell line (IC 50 : 9.52 μg/ml) compared with the DPP extract (IC 50 : 96.22 μg/ml). Also, the FDPP extract had strong antiviral activity (CC 50 : 16.5 μg/ml) compared with DPP (CC 50 : 38.8 μg/ml). This is the first report in which the FDPP extract is used in biological studies as anti-breast-cancer and antiviral agents. Conclusion Fermentation of DPP by T. koningii improves many bioactive volatile USFAE and flavonoid contents; these have anti-breast-cancer and antiviral activity.
  565 121 -
Role of some phytoestrogens in recovering bone loss: histological results from experimental ovariectomized rat models
Hafiza A Sharaf, Nermeen M Shaffie, Fatma A Morsy, Manal A Badawi, Naglaa F Abbas
July-December 2015, 10(2):65-75
DOI:10.4103/1687-4293.175880  
Background/aim Osteoporosis is a disease characterized by a decrease in bone mass and is widely recognized as a major health problem. Ovarian hormone deficiency is a major risk factor for osteoporosis. A sharp decrease in ovarian estrogen production is the predominant cause of rapid bone loss and deterioration of bone architecture, resulting in increased bone fragility during the first decade after menopause. Materials and methods A total of 70 albino rats were used, divided into seven groups of 10 rats each. Group 1 was subjected to sham operation and used as a control group. In group 2, rats were ovariectomized (OVX) and used as a model of postmenopausal osteoporosis. Three months after the operation the OVX rats (group 2) were divided into six subgroups: one was considered the positive control group; another one was treated with synthetic estrogen compound; and the other four subgroups were fed a diet containing red clover, fennel, carob, and a combination of the three plants. At the end of the experiment (after 3 months' treatment) the animals were killed, and the femur shafts were extracted, decalcified, and processed into paraffin blocks. Sections were stained with hematoxylin and eosin for histopathological, image analysis, and morphometric studies. Other sections were stained with periodic acid Schiff for histochemical investigations. Results The histopathological results of this study revealed that ovariectomy caused a decrease in thickness of the cortical compact bone in the middle shaft of the femur and of the trabeculae in cancellous bone in the head of the femur bone. Histochemical results showed new bone formation in sections of rats treated with plants. The best results were detected in sections of rats treated with a combination of the three plants. Red clover, fennel, and carob individually or combined have a better ameliorating effect on ovariectomy-induced osteoporosis than does synthetic estrogen compound. Conclusion Treatment of OVX rats with phytoestrogens such as red clover, fennel, and carob might improve the histopathological and histochemical changes and morphometric parameters in bone with ovariectomy-induced osteoporosis.
  516 115 -
Evaluation of the phenolic content and antioxidant potential of Althaea rosea cultivated in Egypt
Nagwa M Ammar, El-Sayeda A El-Kashoury, Lamiaa T Abou El-Kassem, Rasha E Abd El-Hakeem
July-December 2013, 8(2):48-52
DOI:10.4103/1687-4293.123786  
Objective The aim of this study was to evaluate the total phenolic content (TPC) and antioxidant potential of Althaea rosea Cav., family Malvaceae, as well as to isolate and identify the flavonoid content of the methanolic extract of the aerial parts. In addition, a comparison between the TPC and antioxidant capacity of the methanolic extract of both aerial parts and flowers was carried out to discover new active constituents that can be utilized in drug industry. Materials and methods The extraction of the flavonoid compounds was carried out by percolation of the dried aerial parts of the plant under investigation with 70% methanol until exhaustion. The combined extract was then concentrated and defatted with petroleum ether (60-80°C). After separation of the lipoidal matter, the remaining extract was purified from mucilage and subjected to several column chromatographic techniques for isolation of the flavonoids. The identification of flavonoid compounds was carried out using physical, chemical, and spectral methods such as ultraviolet, 1 H NMR, and 13 C NMR. The antioxidant potential of the methanolic extracts of both aerial parts and flowers was determined using the s[table 2], 2-diphenyl-1-picrylhydrazyl free radical scavenging activity method. Furthermore, their TPC was also determined using the Folin-Ciocalteu method. Results Five flavonoid compounds were isolated from the aerial parts of A. rosea Cav., which were identified as quercetin 3-O-β-d-glucuronopyranoside-8-C-β-d-glucopyranoside, kaempherol-3-O-β-d-rutinoside, kaempherol-4΄-O-β-d-glucoside, kaempherol-3-O-β-d-glucoside, and kaempherol. The antioxidant activity was measured in terms of their IC 50 . The IC 50 values of the methanolic extracts of the aerial parts and flowers were 11 and 1 mg/ml, respectively, whereas the TPCs were 48 and 73 μg/ml, respectively. Conclusion The methanolic extracts of both aerial parts and flowers of A. rosea Cav. are rich in phenolic compounds and have a prominent antioxidant activity. The antioxidant activity of both extracts may be attributed to their phenolic content.
  528 84 1
The impact of neuromuscular electric stimulation versus aerobic exercise in rehabilitation of patients with chronic heart failure
Manal K Youssef
January-June 2014, 9(1):40-47
DOI:10.4103/1687-4293.137324  
Background/Aim Heart failure can be defined as an abnormality of cardiac structure or function leading to failure of the heart to deliver oxygen at a rate commensurate with the requirements of the metabolizing tissues, despite normal filling pressures. Cardiac rehabilitation programs have become an integral part of the standard of care in modern cardiology. The current study was carried out to determine the effect of neuromuscular electric stimulation (NMES) versus aerobic exercise in cases of chronic heart failure. Patients and methods Overall, 30 patients with chronic heart failure were included in this study from Cairo University Hospitals. Their ages ranged from 40 to 60 years and they were divided randomly into two groups (A and B). Group A received aerobic training. Group B received lower limb NMES for 2 months. All participants were evaluated before the first session of treatment and at the end of treatment by physical evaluation that included minute ventilation, maximum ventilation, heart rate, systolic blood pressure, diastolic blood pressure, and the 6-min walk test. Results Analysis of results showed a significant increase in minute ventilation and maximum voluntary ventilation in both groups (P ≤ 0.001) and no significant difference between both groups, 7.3 ± 0.6 and 7.4 ± 0.6. There was a significant decrease in heart rate, systolic blood pressure, and diastolic blood pressure in group A (P ≤ 0.001) and also a significant decrease in heart rate, systolic blood pressure, and diastolic blood pressure in group B (P ≤ 0.001). There was a significant difference between group A and group B in the decrease in heart rate, 131.1 ± 9.9 and 134.5 ± 9.6, respectively, systolic blood pressure, 121.3 ± 7.4 and 139.3 ± 24.9, respectively, diastolic blood pressure, 80.3 ± 3.5 and 84.7 ± 3.1, and 6 min walk, 33.9 ± 2.6 and 32.2 ± 8.1. Conclusion NMES can be used instead of aerobic exercise in cardiac rehabilitation, especially in critically ill patients. It exerts an effect similar to that of aerobic exercise without cardiac load, especially in the beginning of rehabilitation.
  493 57 -
Safety and feasibility of laparoscopic cholecystectomy during pregnancy
Mohammad Arafat, Ibrahim A Ghaffar, Ahmad F El-Hussainy, Mansour M Abd Alkhalik, Mahmoud S Ahmad, Taher Mostafa
January-June 2016, 11(1):9-13
DOI:10.4103/1687-4293.186779  
Background/aim Symptomatic biliary diseases in pregnant women remain a great challenge to surgeons. The present study aimed to evaluate the safety and feasibility of laparoscopic cholecystectomy (LC) during pregnancy. Patients and methods This prospective, observational study was conducted on 27 pregnant women with a mean age of 27.3 ± 4.1 (range 21–36) years who presented with symptomatic gallbladder diseases (stones or cholecystitis) and underwent LC. Gestational age, operative time, and maternal and fetal outcomes were noted. Results The mean operative time was 58.7 (range 32–78.5) min. Conversion to open cholecystectomy occurred only in one patient with acute cholecystitis due to the presence of severe adhesions (3.7%). No intraoperative or postoperative complications were observed, except for mild wound infection in only one patient (3.7%) and mild uterine contractions in two patients (7.4%). All patients went on to deliver at full term with no abortion or preterm labor. Conclusion Pregnant women with repeated attacks of biliary colic and/or cholecystitis after failure of conservative treatment can undergo LC easily and safely without hazardous effects on either mothers or fetuses, especially in the second trimester.
  457 90 -
Health related quality of life of children with epilepsy in Egypt
Zeinab M Monir, Inas R EL-Alameey, Eman Eltahlawy
July-December 2013, 8(2):53-66
DOI:10.4103/1687-4293.123787  
Background/aim Children with epilepsy are at an increased risk of poor health-related quality of life even in the absence of active seizures. The study was undertaken to assess the health-related quality of life and its predictors in children with epilepsy, comparing the relationship between different types of seizures and health-related quality of life in Egypt. Patients/methods This cross sectional case control study included 50 epileptic children aged 8-12 years, with a mean age of 9.35 ± 1.59 years and a male to female ratio of 1.8 : 1. They were divided into two subgroups according to the types of seizures: 26 patients with generalized seizures in subgroup I and 24 patients with partial seizures in subgroup II, and 50 apparently healthy children of matched age, sex, and social class were included as the control group. The Arabic version of the 23-item Pediatric quality of life Generic Core Scale (Parents' scale) was applied to evaluate the health-related quality of life of both patients and healthy controls. Results Diminished health-related quality of life is a common feature of epilepsy. Highly significant lower overall quality of life scores of all functioning domains of health-related quality of life were present between patients' subgroups (P < 0.001), and between total patients versus control groups (P < 0.001). Univariate analysis was performed to identify significant predictors of poorer quality of life in children with epilepsy. On analyzing the risk factors using odds ratio, epilepsy-related risk factors such as age at onset of seizures, types of seizures, duration of the illness, number and duration of antiepileptic drugs as well as children's clinical variables such as learning problems, developmental delay in milestones, limitation in child hobbies, urine incontinence, and prolonged sleep, and some family-related variables such as marital disharmony and parental anxiety were found to be significantly strong predictors of poorer health-related quality of life in children with epilepsy, with prediction of 95%. Conclusion Epileptic patients were found to be at a higher risk of developing impaired quality of life with lower mean scores of all domains of quality of life, especially patients with generalized, frequent fits, those on polytherapy, and patients with a younger age of seizure onset and a longer duration of illness. The scope of management of epilepsy should include optimal seizure control and improvement of the health-related quality of life of the affected children.
  459 80 -
Risk factors and outcome in ICU patients with end-stage liver disease
Hanan M Nafeh, Soha S Abdelmoneim, Sahar M Hassany, Youssef M Swifee
January-June 2014, 9(1):33-39
DOI:10.4103/1687-4293.137323  
Background/aim Acute or chronic liver failure is associated with numerous complications that may occur in combination, and patients may require ICU treatment. Therefore, it seems necessary to identify prognostic clinical parameters and risk factors at the time of ICU admission. The present study aims to estimate the frequency of mortality and evaluate morbidity from cirrhosis in patients with end-stage liver disease (ESLD) admitted to the ICU and evaluate the relationship between the demographic, clinical, and laboratory data (potential risk factors) of those patients and mortality. Patients and methods A total of 120 patients with ESLD were enrolled [102 (85%) male and 18 (15%) female patients]. History taking, clinical examination, and other laboratory investigations were carried out, and patients were classified according to the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD) scores. Results Regarding the clinical presentation, hepatic encephalopathy (HE) was found in 87.5% of patients, jaundice in 60%, hematemesis in 41.7%, hepatorenal syndrome (HRS) in 35.8%, and spontaneous bacterial peritonitis in 20.8% of patients. The mortality rate was 57.5%; the main causes of death were HRS (40.8%), HE (21.7%), aspiration pneumonia (10%), septic shock (2.5%), and irreversible shock (1.7%). There was a significant relationship between mortality and old age, CTP and MELD scores, and a longer stay at the ICU. Increased white blood cell count, increased hemoglobin and decreased prothrombin concentration, and elevated creatinine were independent risk factors of mortality in ESLD patients in the ICU. Mortality rates were higher in patients with 5-6 risk factors (86.2%) than in those with 1-2 risk factors (21.7%). Conclusion Mortality rate in ESLD patients admitted to the ICU was 57.5% and the most common cause of death was HRS. CTP, MELD score, HE, HRS, and jaundice were significant predictors of mortality in ESLD patients. Mortality increased with increased number of risk factors. Creatinine level, white blood cell count, hemoglobin, and prothrombin concentration were independent risk factors of mortality in ESLD patients.
  453 57 1
Protective effect of fish liver oil and propolis on anticonvulsant drugs-induced osteoporosis
Fatma A Morsy, Amina A Gamal El Din, Abdel Razik H Farrag, Nermeen M Shaffie, Manal A Badawi, Walid M Sharaf
July-December 2014, 9(2):81-89
DOI:10.4103/1687-4293.145644  
Background/aim Osteoporosis is a major health problem and its prevalence increases the risk of bone fracture. It is classified into primary (postmenopausal or age related) and secondary (related to chronic diseases, drug therapy, or life style). There is accumulating evidence that patients on antiepileptic drugs (AEDs) are at an increasing risk of developing osteoporosis. The present study aimed at investigating the protective effect of dietary natural products, fish liver oil, and propolis on osteoporosis caused by anticonvulsant drugs. Materials and methods A total of 105 albino rats were used, divided into seven groups of 15 rats each. Group 1 was used as a control group. In group 2, rats were injected intraperitoneally with pilocarpine (300 mg/kg body weight). The pilocarpine-induced epileptic rats in the other five groups were orally treated with valproate (400 mg/kg body weight), a combination of valproate and fish liver oil (0.4 ml/kg body weight/day), a combination of valproate and propolis (50 mg/kg body weight/day), fish liver oil, and propolis, respectively. At the end of the experiment (6 months treatment), animals were sacrificed, femur shafts were extracted, decalcified, and processed into paraffin blocks for histopathological and image analysis and morphometric studies. Results Rats treated with the antiepileptic valproate alone showed a decrease in the thickness of shaft cortical bone, with a marked decrease in the number of osteocytes, increase in Haversian canals, and decrease in bone trabeculae, disruption of normal architecture, and widening of bone marrow spaces compared with the control group. Conclusion Treatment with the dietary natural products, fish liver oil, and propolis along with the AED valproate might improve histopathological changes and morphometric parameters in bone associated with AED-induced osteoporosis.
  436 58 -
Serum levels of monocyte chemoattractant protein-1, interlukin-6, and paraoxonase-1 in childhood obesity
Enas R Abd El Hamid, Azza A Abdel-Shaheed, Rania N Sabry, Eman R Youness, Mones M Abu Shady, Amr Said Megawer, Nadia A Mohamed
January-June 2015, 10(1):27-31
DOI:10.4103/1687-4293.159371  
Background/aim Obesity is becoming an epidemic health problem. Elevated cytokines and chemokines are prominent features in obesity, which play a main role in the development of other chronic diseases. The aim of this study was to determine the serum levels of monocyte chemoattractant protein-1 (MCP-1), interlukin-6 (IL-6), and serum paraoxonase-1 (PON1) in childhood obesity. Materials and methods The present study included 40 obese school-aged children (5-15 years) and 40 healthy children as controls. The patients were presented to the outpatient clinic in National Institute of Nutrition. MCP-1, IL-6, PON1, total cholesterol, and triglycerides were measured in all participants. Results The mean serum levels of MCP-1, IL-6, and total cholesterol were significantly higher in obese participants than in controls (P < 0.0001), whereas the PON1 was significantly lower in obese participants than in controls (P < 0.0001). MCP-1, IL-6, and serum cholesterol levels showed significant positive correlation with BMI (P < 0.05), whereas PON1 showed a significant negative correlation with BMI (P < 0.05). Multiple regression analysis showed a strong association between PON1 activity and BMI (P < 0.0001). Conclusion Childhood obesity is associated with increased serum MCP-1 and IL-6 and decreased PON1 and hypercholesterolemia suggesting an increase in adulthood disease risk. Measuring serum MCP-1, IL-6, PON1 activity in obese children may be a good predictor for future chronic disease development and complications.
  417 66 -
Effect of Escherichia coli, Salmonella spp., and Staphylococcus aureus isolated from polluted drainage water on rats
Gamal A Osman, Medhat M Menshawy, Abdel Razik H Farrag
January-June 2016, 11(1):1-8
DOI:10.4103/1687-4293.186778  
Background/aim Water pollution not only damages the environment but also kills wildlife. The present study aimed to investigate the effect of Escherichia coli, Salmonella typhi, and Staphylococcus aureus, which were isolated from drainage water at El-Rahawey area, Giza, Egypt, on experimental rats. Materials and methods Water samples were collected from the subsurface layer for bacteriological examination, stored in an ice box, and delivered to the laboratory and analyzed to count the total viable bacterial counts/ml using the most probable number technique. The isolated bacteria were given to rats for 21 days at a dose equal to 103/ml and the liver and kidney were dissected for histopathological and histochcemical studies. Results Results showed that the average counts at 22 and 37°C were 105 and 106 CFU/ml, respectively, whereas the average counts by using the most probable number technique/100 ml were 105, 104, 103, 103, and 102 for total coliforms, fecal coliforms, E. coli, Salmonellae group, and total staphylococci, respectively. Isolation of pathogens from water sources were identified by using membrane filter technique on specific media. The histopathological examination of the liver of treated rats with E. coli, S. typhi, and S. aureus revealed swollen hepatocytes with decreased sinusoidal spaces and widely distributed necrotic foci. In the kidney, renal tubules showed extensive epithelial swelling with decreased lumen space and generalized necrotic changes with interstitial hemorrhage in renal cortex. The histochemical study indicated the depletion of staining of protein and polysaccharides. Conclusion E. coli, S. typhi, and S. aureus that are isolated from polluted drainage water cause histological and histochemical changes in the liver and kidney of rats.
  353 99 1
The relevance of Ki-67 and COX-2 immunoexpression in right-sided versus left-sided sporadic cancer colon in Egyptian patients
Walid M Sharaf, Reham S.E Esmail, Abdel Razik H Farrag, Enayat A Omara, Noha A Helmy, Nermeen M Shaffie
July-December 2014, 9(2):75-80
DOI:10.4103/1687-4293.145643  
Background and aim Cancer colon is one of the most common malignancies in Egypt. There are growing amount of data suggesting that carcinomas of the right and left colon should be considered as different tumor entities. Difference in tumor proliferation rates has been used as a prognostic tool. Ki-67 is a proliferation-associated nuclear and nucleolar protein antigen, which is expressed in all cycling cells, and it is an important marker to determine the degree of tumor malignance and invasion ability. Cyclooxygenase-2 (COX-2) is an important key enzyme required for the synthesis of prostaglandins, with high level seen in many cancers including colon cancer. Patients and methods A total of 167 colectomy specimens were reviewed during the period of 1 year. Fifty cases from the originally viewed 167 cases were chosen; 25 cases from the right-side colon and 25 from the left-side colon of comparable stages and grades. Each case was stained immunohistochemically for Ki-67 and COX-2 antibodies. Results The results of Ki-67 immunostaining showed that the difference between the right and left cases was significant (P < 0.05) in addition to the results of COX-2 immunostaining. We suggest that right and left cancer colon may be two different entities with possible different risk factors and different pathogenesis, and hence each may require different treatment polices as well. Conclusion COX-2 expression in right-side tumors more than in left-side tumors may provide a chance for right-side cancers to benefit from COX-2 inhibitor therapy.
  394 53 -
Assessment of the osteogenic potential of alendronate on isolated adipose-derived stem cells: An ex-vivo and in-vivo study
Mohamed S Ayoub, Effat A Abbas, Mohamed A Abd El Hamid, Houry M Baghdadi, Dina S Abd El Fattah, Marwa M Ellithy
January-June 2015, 10(1):32-40
DOI:10.4103/1687-4293.159374  
Background/aim Tissue engineering relies on the principle that mesenchymal stem cells are capable of differentiating to optimize almost all craniofacial structures. Temporary biomimetic scaffolds are necessary for accommodating cell growth and tissue genesis. The aim of this study was to evaluate the effect of alendronate on adipose-derived stem cells (ADSCs) from dogs and to compare bone regeneration in critical-sized calvarial bone defect in dogs using ADSCs in the presence and the absence of locally delivered alendronate. Materials and methods Seven dogs were used for the study. After isolating the adipose tissue from the inguinal pad of fat, stem cells were harvested and expanded in culture. The effect of alendronate 1 mg/ml on stem cells' osteogenic differentiation was tested for 7 days. Three critical-sized calvarial defects were created in each dog. One defect was filled with stem cells seeded on a chitosan scaffold and soaked in an osteogenic media, the second was filled with stem cells seeded on a chitosan scaffold and soaked with osteogenic medium, and the third one was filled with stem cells seeded on a chitosan scaffold. Bone formation was tested histologically after 8 weeks in each defect. Results Alendronate is capable of inducing osteogenic differentiation of ADSCs after 7 days of in-vitro culture. Bones such as trabeculae were deposited in alendronate and osteogenic medium defects, whereas the control group showed only fibrous tissue formation. There was no statistically significant difference in the surface area of the deposited bone trabeculae between the alendronate group and the osteogenic medium group. The surface area of individual bone trabeculae in this group was 147.99 ± 14.803 compared with the osteogenic group. Conclusion Alendronate may be used locally at a concentration of 10 mg/ml to induce osteogenic differentiation of ADSCs both in vitro and in vivo. The combination of a local, short-term alendronate treatment with ADSCs and biodegradable chitosan scaffold enhances the bone repair of a critical-sized calvarial defect in vivo.
  395 51 -
Biochemical evaluation of renal osteodystrophy in uraemic patients
Maha H Mohamed, Magda S Mahmoud, Mohamed D.E. Abd El-Maksoud, Tamer E Mosa, Adel A Ali
January-June 2014, 9(1):15-22
DOI:10.4103/1687-4293.137320  
Background/aim Renal osteodystrophy is a multifactorial disorder of bone remodelling that develops in patients with chronic renal failure (CRF). Biochemical markers of bone turnover have been proposed for the noninvasive diagnosis of renal osteodystrophy. The purpose of this study was to evaluate intact parathyroid hormone (iPTH) and some markers of bone disease in predialysis (preD) and haemodialysis (HD) CRF patients and correlate them with bone mineral density (BMD). Patients and methods Several biochemical markers were measured in the serum of 74 CRF patients (38 preD patients and 36 patients on regular HD). In addition, 30 healthy volunteers were included as controls. BMD of all patients was measured by means of calcaneal ultrasonography. Results BMD was measured by means of ultrasound. BMD was significantly decreased in both patient groups when compared with controls. Also, it was significantly lower in patients with osteoporosis than in those with osteopenia. iPTH, total alkaline phosphatase (ALP) and osteocalcin (OC) levels were significantly elevated in both patient groups when compared with controls. Ionized calcium (Ca 2+ ), free carnitine and insulin-like growth factor-1 (IGF-1) levels were significantly decreased in patients compared with controls. There was a significant inverse correlation of BMD with iPTH, ALP and OC and a significant positive correlation with Ca 2+ and IGF-1 in HD patients. PreD patients showed significant inverse correlation of BMD with iPTH and ALP and significant positive correlation with Ca 2+ . Conclusion The results of the present study suggested that ultrasound is a useful method for evaluating BMD and provides information about diverse regional skeletal changes in CRF patients. iPTH, ALP, OC and Ca 2+ can predict renal osteodystrophy in preD and HD CRF patients. PreD and HD CRF patients often have low serum concentrations of free carnitine and IGF-1.
  403 39 -
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