Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301ROLE OF GENE POLYMORPHISM OF INTERLUKIN-1 AND ITS RECEPTOR ANTAGONIST IN CAROTID ATHEROSCLEROSIS OF RHEUMATOID ARTHRITIS PATIENTS113435510.21608/zumj.2014.4355ENAbd El SamadEl HewalaRheumatology and Rehabilitation Department, Faculty of medicine, Zagazig University, Zagazig, EgyptEmanEl-ShahawyRheumatology and Rehabilitation Department, Faculty of medicine, Zagazig University, Zagazig, EgyptRababZaghlolRheumatology and Rehabilitation Department, Faculty of medicine, Zagazig University, Zagazig, EgyptYousriHusseinBiochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, EgyRandaMohamedBiochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, EgyHossamAbdel RahmanRadiodiagnosis Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.Journal Article20171203Aim: To investigate the possible association between genes polymorphisms of the interlukin 1- β (IL-1 β) and IL-1 receptor antagonist (IL-1 ra) and susceptibility to carotid atherosclerosis in rheumatoid arthritis.<br />Subjects and methods: The study included two groups. Group I: 120 premenopausal female patients who fulfilled the American College of Rheumatology classification criteria for rheumatoid arthritis (RA) and Group II: 120 premenopausal female's apparently healthy subjects were selected as control group. Cases and controls symptomatic for atherosclerosis or having traditional risk factors for atherosclerosis were excluded. Blood was obtained for DNA determination of IL-1 β gene and IL-1 Ra gene polymorphisms from both cases and controls.They were subjected to carotid ultrasound examination to measure carotid inimal medial thickness (CIMT) in addition to detailed history and physical examination and<br />Results: It was found that RA patients who had the IL 1-β allele 1 showed an increased risk to develop atherosclerosis with CIMT ≥ 0.9mm (OR = 13.2, P = 0.000) compared with RA patients with IL 1-β allele 2 (OR = 11.3, P = 0.000). While in control there was no risk to develop atherosclerosis with IL1- β alleles. Also, It was found that RA patients who had the IL1-ra allele 1 showed an increased risk to develop atherosclerosis with CIMT ≥ 0.9mm (OR = 39, P = 0.000) compared with RA patients with other alleles of IL1-ra (OR = 14.3, P = 0.000) .While in control there were no risk to develop atherosclerosis with IL1-ra alleles.<br />Conclusion: These data suggest that allele 1 of the IL-1 β gene and allele 1 of the IL-1ra gene represent a susceptibility factor in the development of carotid atherosclerosis in RA patients.https://zumj.journals.ekb.eg/article_4355_956178f06bd7807e954b6b607fc7bc01.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301ROLE OF VOLUME(THREE DIMENSIONAL) ULTRASOUND IN ESTIMATION OF FETAL WEIGHT IN APPROPRIATE AND INAPPROPRIATE FETAL GROWTH18435610.21608/zumj.2014.4356ENAnwarIsmailDepartment of Obstetric and Gynecology, Zagazig UniversityMohammedAzzamDepartment of Obstetric and Gynecology, Zagazig UniversityGamalEl-SayedDepartment of Obstetric and Gynecology, Zagazig UniversityHossamAbd-elnabyDepartment of Obstetric and Gynecology, Zagazig UniversityJournal Article20171203This observational prospective study was approved by the council of the gynecology and obstetric department 2009 to evaluate the role of volume (3D) ultrasound as a new method for more accurate estimation of fetal weight than conventional 2D ultrasound.<br />Research methodology: One hundred and thirty-five women prospectively underwent two-dimensional and three-dimensional ultrasonography within 7 days of delivery. Birth weights (BWs) ranged from 1700 to 4550 g. Fetal measurements were extracted using volume datasets for biparietal diameter, abdominal circumference, femur diaphysis length, and fractional thigh volume. Fractional limb volumes were manually traced from a central portion of the femur diaphysis. Median percentage differences were calculated for EFW. The sensitivity of EFW within 10% of BW were calculated for the following formulas Hadlock (AC), Hadlock (BPD, AC, FDL), Tvol, Lee1and Lee 2.<br />Results: Ultrasound scans were performed between 30 and 41weeks’ menstrual age. Optimal model sensitivity (87.7%) resulted from using a combination of biparietal diameter, abdominal circumference and fractional thigh volume (Lee2). The precision of this model was superior to results obtained using a Hadlock model (83.1%), although accuracy of these predictions was slightly decreased by decreased aminiotic fluid index and placental anterior position. For all fetuses, the prediction model that incorporated fractional thigh volume except for model (Tvol) correctly classified a greater proportion of EFW within 10% of BW when compared with the Hadlock model.<br />Conclusion: Fractional thigh volume can be added to two-dimensional sonographic measurements of the head and trunk to improve the precision of fetal weight estimation. This approach permits the inclusion of soft tissue development as part of a weight estimation procedure.https://zumj.journals.ekb.eg/article_4356_1708c504b6f61cfa315f42ca30a32143.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301MRI AND HIGH RESOLUTION CT IN CONGENITAL HEARING LOSS114435710.21608/zumj.2014.4357ENAhmedAbd AllaDepartment of Radiology, Faculty of medicine, Zagazig UniversityIbrahimLebdaDepartment of Radiology, Faculty of medicine, Zagazig UniversitySoniaMohamedDepartment of Radiology, Faculty of medicine, Zagazig University.EzzatMerwadDepartment of Otolaryngology, head and neck surgery, Faculty of medicine, Zagazig UniversityJournal Article20171203Purpose: The aim of this study is to assess the role of Magnetic resonance imaging (MRI) and high resolution CT (HRCT) in patients with congenital hearing loss.<br />Patients and methods: Sixty patients who having congenital hearing loss (CHL) will be included in our study. Full history taking, clinical examination, Oto-laryngology examination and audiological evaluation tests, MRI and non-enhanced HRCT.<br />Results : The results of this study cannot be analysed from an epidemiological point of view due to the absence of a comprehensive repeated investigation, but they illustrate and clearly justify the need to perform a standardized aetiological work-up. HRCT was superior in detection of bony landmarks of the temporal bones. These findings were the shape and orientation of the petro-temporal bones, the patency of the external auditory canal (bony atresia), associated tympanic cavity and ossicular chain anomaly. MRI of the both temporal bones were accurate in detection of abnormalities in the membranous labyrinth and inner ear malformations. The use of balanced-Fast Field Echo (b-FFE) series on the internal auditory canals to evaluate the cochlear nerve. Our MRI studies were unable to evaluate the condition of the middle ear and mastoid cavity, which appears as intermediate and bright signals seen in both T1- and T2-weighted images. However, HRCT clearly shows the condition of the bone cavity and bone marrow of the tympanic cavity, and the pneumatization of the mastoid process if present.<br />Conclusion : Imaging plays an important role in diagnosis and work-up of patients with congenital hearing loss. There are a whole lot of etiologies, many of which have typical findings on HRCT and MRI, which help in differentiation of these causes and therefore guides the treating surgeon in further management. Both HRCT and MRI are complimentary to each other and should be judiciously used by the radiologist in diagnosing the various congenital malformations.https://zumj.journals.ekb.eg/article_4357_2a79c266cc391c50a93eab5772527b99.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301EFFECT OF GHRELIN ON TESTICULAR FUNCTIONS IN STREPTOZOTOCIN INDUCED TYPE 1 DIABETIC RATS115435810.21608/zumj.2014.4358ENMaherIbrahimPhysiology department-Faculty of medicine-Zagazig UniversityAliAsalahPhysiology department-Faculty of medicine-Zagazig UniversityDaliaAbd-AlaleemPhysiology department-Faculty of medicine-Zagazig UniversiSuzanMoursiPhysiology department-Faculty of medicine-Zagazig UniversiJournal Article20171203Background: Oxidative stress is increased in diabetes mellitus (DM). Ghrelin is a peptide hormone produced by different tissues and its circulating level is decreased in type 1 DM. Recently, it has been shown to have antioxidant properties. Objective: This study was designed to investigate the effects of diabetes mellitus on pituitary testicular functions and the role of ghrelin in the modulation of these effects in a rat model of type 1 diabetes mellitus induced by streptozotocin. Materials and methods: 32 healthy adult male albino rats of initial body weight 170-195 gm were included. Rats were randomly and equally divided into 4 groups, group (1a): Vehicle treated (control) group, group (1b): Ghrelin treated normal group, group (IIa): STZ-diabetic group and group (IIb): Ghrelin treated diabetic group. Rats were weighed and examined for the serum levels of glucose, insulin, FSH, LH& testosterone levels, epididymal sperm count and motility, testicular malondialdhyde (MDA) level and superoxide dismutase (SOD), catalase (CAT) & glutathione peroxidase (GPX) activities and testicular weight(wt) & histopathology. Results: STZ-induced diabetes significantly decreased the body wt, testes wt, serum insulin, FSH, LH & testosterone levels, epididymal sperm count & motility and testicular SOD, CAT & GPX activities but significantly increased serum glucose & testicular malondialdhyde levels together with deterioration of the testicular histoarchitecture. Moreover, it was found that exogenous administration of ghrelin resulted in a significant recovery of all the above mentioned parameters in the diabetic group, while in the normal group, it was only associated with potentiation of the testicular antioxidant system as well as a significant increase in both the body and testes weights. Conclusion: Ghrelin has a potential protective role against diabetes-induced pituitary testicular dysfunction which may be due to its antioxidant properties and maintenance of glucose & insulin homeostasis.https://zumj.journals.ekb.eg/article_4358_b23bfcc74be7bf6b9382fba74ee68f62.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301WILMS' TUMOR GENE 1 (WT1) EXPRESSION IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA15435910.21608/zumj.2014.4359ENMohamedBadrDepartement of pediatrics, Faculty of medicine ,Zagazig universityTamerHassanDepartement of pediatrics, Faculty of medicine ,Zagazig universityAsmaaEshDepartment of clinical pathology, Faculty of medicine ,Zagazig university.WesamMokhtarDepartement of pediatrics, Faculty of medicine ,Zagazig universityJournal Article20171203Aim &Objectives: Wilms ٰ ٰ tumor 1 (Wt1) gene is over expressed in majorty of acute leukemia.The aim of this study is to evaluate(WT1) gene expression in children with acute lymphoblastic leukemia and to find out the relationship between it and other morphological, immunophenotypic and prognostic factors.<br />Subjects &Methods:An case-control study was conducted in pediatric Hematology & oncology unit ,zagazig university children's hospital ,zagazig university during the period of January 2011 to June 2013.we examined the level expression of (WT1) gene in 44 newly diagnosed children with acute lymphoblastic leukemia and 20 controls patient with hematological problems other than hematological malignancies. A fresh peripheral blood samples were collected patients and controls and submitted to RNA extraction, reverse transcription of extracted RNA and real-time quantitive PCR.<br />Results:we detect a wide range of Wt1 gene expression level among 44 patients of acute lymphoblastic leukemia. Statistically, Wt1 gene expression level was significantly higher in T-cell acute lymphoblastic leukemia than in B-cell Precursor acute lymphoblastic leukemia(P<0.001) and also higher in those with expression of myeloid marker than those without expression of these markers. Analysis of relapsed cases (3/44) indicated that abnormally increase of wt1 gene expression level was associated with increased risk of relapse.<br />Conclusion: This study suggest that Wt1 expression in childhood acute lymphoblastic leukemia is very variable and much more expressed in t cell leukemia than BCP ALL and show higher levels in relapsed patients thus indicating a possible prognostic marker of childhood acute lymphoblastic leukemia.https://zumj.journals.ekb.eg/article_4359_7724dd8c3c868bf5fd2fc48721d95d45.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301ASSESSMENT OF PRIMARY IMMUNODEFICIENCY DISORDERS AMONG CHILDREN AT ZAGAZIG UNIVERSITY HOSPITAL111436010.21608/zumj.2014.4360ENSamehHussienPediatric Departments, Faculty of Medicine, Zagazig UniversityMohammadAbd El SalamPediatric Departments, Faculty of Medicine, Zagazig UniversityMervatZidanDepartments, Faculty of Medicine, Zagazig UniversityJournal Article20171203Aim of study: To identify and report various type of primary immunodeficiency disorders in children at Zagazig university hospitals, and their characteristic features, clinical manifestations and laboratory profiles.<br />Patients and methods; patients with history,clinical findings and laboratory findings matching with any of eight classes of primary immunodeficiency were included in this study, also we used ten warning signs,immunodediciency disease related score in evaluation of patients.<br />Results: Fifty patients were diagnosed with different primary immunodeficiency disorders in Pediatric department, Zagazig University Hospital during period from July 2011 to July 2013. The spectrum of PIDs in our center was as follow: predominantly antibody deficiency was the most common category (46%) followed by combined immunodeficiency (22%) then well defined syndromes (20%), auto inflammatory disorders (8%), complement disorders (4%). No cases were diagnosed in any category of phagocytic disorders, innate immunity or immune dysregulation. Selective IgA deficiency was the most frequent disease type. Median age of onset of symptoms was 7 months, the median age of diagnosis lag was 24 months.Pneumonia was the most common presentation. Consanguinity rate was 60%. Mortality rate was 20% mostly duo to bronchopneumonia.<br />Conclusion: primary immunodeficiency disorders are not rare in our center ,but under diagnosed.https://zumj.journals.ekb.eg/article_4360_f770659186e34a2e9932b683bfb86856.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301A COMPARATIVE STUDY OF TWO DIFFERENT TECHNIQUES OF BRACHIAL PLEXUS BLOCK IN CHILDREN, INFRACLAVICULAR VS AXILLARY BLOCK19436110.21608/zumj.2014.4361ENMohamedMoemenAnesthesia and Intensive Care, Faculty of Medicine, Zagazig University, EgyptZenabEl-HossaryAnesthesia and Intensive Care, Faculty of Medicine, Zagazig University, EgyptKameliaAbazaAnesthesia and Intensive Care, Faculty of Medicine, Zagazig University, EgyptHalaRashadAnesthesia and Intensive Care, Faculty of Medicine, Zagazig University, EgyptJournal Article20171203Background: The potential benefits of using ultrasound guidance for regional blocks include the visualization of the surrounding structures (pleura, axillary artery and vein) and the real-time control of the needle movement. Objectives: to assure the introduction of ultrasonography to improve the ability to perform these blocks with greater ease and precision. Patients and methods: Forty pediatric patients of both sexes (ASA physical status I or II )who were scheduled for upper limb surgery at or below elbow.The ages of the patients were ranging from 5 to 15 years and their body weights from 15 to 55 kg,they were randomly allocated into two equal groups (20 patients each) by sealed envelope. These groups were: Infraclavicular group ( groupI) and Axillary group (A) in which both blocks was performed using ultrasound technique. All patients received oral midazolam 0.25 : 0.33 mg/kg as apremedication. All blocks were performed by US-guidance with a Mindray Sonoline unit (DP1100 china), a 5–9 MHz 35 mm linear probe and a short-bevelled needle with extension tube (25–22 G/35–50 mm), All patients were received a sleeping dose of ketamine 1mg/kg with oxygen mask applied then the block was performed. Maintenance of anesthesia was carried out with Isoflurane 1MAC in 50% oxygen/air until the end of the surgery an increase in heart rate or blood pressure ≥10% or an increase in respiratory rate ≥20% and this was considered failed block. Postoperative analgesia was evaluated using modified objective pain score in children from 5 to 10 years old and a numeric pain scale in older children. The following parameters were detected and recorded in each group: Block performance time, The success rate, The duration of sensory and motor blockade, Post-operative analgesia and associated side effects, Results: There were no statistically significant results as regard to intra and post-operative analgesia, duration of sensory and motor blockade, however infraclavicular block was quicker to perform compared with the axillary block (7.7±2.3 vs 8.6±3.5) ,higher success rate although non-significant for infraclavicular block compared to axillary block 95.5 vs 90.9 . there was one case of vascular puncture in the infraclavicular group and no vascular puncture in the axillary group. Conclusion: Ultrasound-guided infraclavicular BPB can reduce the performance time compared to ultrasound-guided axillary block and there was no significant difference in the success rate, duration of sensory and motor blockade and complications for both blocks.https://zumj.journals.ekb.eg/article_4361_bdedd8810ed0042921654d5b16d65b1b.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301ASSESSMENT OF SOME APPROACHES FOR WEIGHT REDUCTION AMONG ADULT FEMALES;AN INTERVENTIONAL STUDY AT ZAGAZIG UNIVERSITY HOSPITAL110436210.21608/zumj.2014.4362ENNahedSherefDepartments of Public Health and Ansethiology ,Faculty of Medicine, Zagazig UniversityAhmedSalamaIntensive Care , Faculty of Medicine, Zagazig UniversityMonaAbo SreaaDepartments of Public Health and Ansethiology,Faculty of Medicine, Zagazig UniversitySamarAmerDepartments of Public Health and Ansethiology,Faculty of Medicine, Zagazig UniversityJournal Article20171203Background: Obesity and overweight are growing global epidemic,Resulting in significant morbidity and mortality and reduce quality of life Managing one’s weight is one factor in preventing chronic diseases Aim & Objectives: Assessment of some approaches for weight reduction to decrease the prevalence of obesity to avoid its inherent hazards ,through the following objectives1-To assess overweight and local obesity .2- To educate participants about healthy lifestyle(dietary habits).3-To apply diet restriction ,acupuncture and mesotherapy Courses . 4-to assess the effect of the previous approaches in preventing obesity. Subjects & Methods: An interventional study was conducted in obesity clinics at Zagazig University Hospital during the academic year between 2011 and 2012.This study designed to compare the weight reduction effects of 3 approaches (mesotherapy, acupuncture and diet restriction) versus control for 460 adult women with body mass index BMI <35, treated for 8 successive weeks and obesity indexes including body weight, BMI and waist/hip ratio(WHR) were evaluated. Versus baseline, The study was carried out through 3 phases Results:. the obesity indexes decreased at the end of each treatment course (diet and acupuncture)(p < 0.05), while no decrease at BMI at the end of the mesotherapy course(p>0.05) with significant reduction at WHR (p<0.01). Conclusion: This study revealed that, that acupuncture then dietary caloric restriction reduced body weight while mesotherapy are effective body contouring approacheshttps://zumj.journals.ekb.eg/article_4362_063cb9e4396228fef8b3c22e3bc897dc.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301INTERLEUKINE-33 AND SOLUBLE ST2 AND THEIR CORRELATION WITH ASTHMA SEVERITY AND AS FUTURE THERAPEUTIC TARGETS.18436310.21608/zumj.2014.4363ENEnsafAzaziMicrobiology and Immunology Department, Faculty of Medicine. Zagazig universityAshrafEl-shoraChest Department, Faculty of Medicine.Zagazig universityEnasTantawyMicrobiology and Immunology Department, Faculty of Medicine. Zagazig universityMarwaElsaydMicrobiology and Immunology Department, Faculty of Medicine. Zagazig universityJournal Article20171203Interleukin-33 is a member of IL-1 family of cytokines and binds to two receptors: ST2 (IL-1-R1) and IL-1 receptor accessory protein (IL-1RAP). There are Two isoforms of ST2 proteins: ST2L which is a transmembrane form and a soluble ST2 (sST2) which is a secreted form that can serve as a decoy receptor of IL-33. The IL-33/ST2 signaling pathway activates airway eosinophils that exacerbate airway inflammation.<br />The aim of this study was to analyze the serum levels of IL-33 and its receptor sST2 in patients with bronchial asthma to assess if the serum levels of IL-33 and/or sST2 may be markers of the disease severity and potential therapeutic targets.<br />Patients and methods: This study was carried out at Microbiology & Immunology and Chest Departments, Faculty of Medicine, Zagazig University Hospitals during the period from December 2012 to September 2013.The study included 30 patients diagnosed as bronchial asthma . Patients were classified to two groups: Group I: included 15 patients (8 males and 7 females) with a mean age of 36.2 15.8 during exacerbations of bronchial asthma. Group 2: include 15 patients (8 males and 7 females) with a mean age of 37.3 12.8. They were stable asthmatic patients. There were 30 normal healthy persons as a control group. All patients were subjected to, full medical history, general and local examinations, Plain chest X-ray PA and lateral views, pulmonary function tests, Liver and kidney functions tests, intradermal skin prick test, measurement of serum levels of IL-33 (WKEA MED), soluble ST2 (sST2) (OmniKine) and total IgE (IMMUNOSPEC) by enzyme linked immunosorbent technique using commercial kits.<br />Results: There was a high significant increase in the mean serum levels of IL-33 in both groups of patients (p < 0.001) with the highest mean serum level 960 ± 336 ng/L in group 1 followed by 732.2 ± 68.3 ng/L in group 2 while the normal control group mean serum level was 174 ± 41 ng/L. As regards serum levels of sST2, there was a high significant increase in its mean levels in both groups of patients (p < 0.001) with the highest mean serum level 96.8 ± 25 pg ∕ ml in group 1 followed by 83.3 ± 5.3 pg∕ml in group 2 while the normal control mean serum level was 33.9 ± 9.6 pg∕ml. In acute exacerbated patients there was significant – ve correlation between FEV1% and serum levels of IL-33 and in stable asthmatic patients there was significant + ve correlation between PEFR variability and serum levels of sST2.<br />Conclusion: The serum levels of IL-33 and its receptor sST2 were markedly elevated in patients with bronchial asthma and this supports the concept of sST2 and Interleukin-33 as therapeutic targets in bronchial asthma.https://zumj.journals.ekb.eg/article_4363_6090dd093c17aa204262928d0f3bc24a.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301CORRELATION BETWEEN PHENOTYPIC AND GENOTYPIC IDENTIFICATION OF TRICHOPHYTON VIOLACEUM19436410.21608/zumj.2014.4364ENAliSolimanDepartments of Dermatology and
Faculty of Medicine and Veterinary Medicine, Zagazig UniversitySamiaIbrahimDepartments of Dermatology and
Faculty of Medicine and Veterinary Medicine, Zagazig UniversityMohamedTahaDepartments of Microbiology Faculty of Medicine and Veterinary Medicine, Zagazig UniversityAymanFaroukDepartments of Dermatology
Faculty of Medicine and Veterinary Medicine, Zagazig UniversityJournal Article20171203Background: Trichophyton violaceum is an anthropophilic dermatophyte. It is the most common etiologic agent causing dermatophytosis especially tinea capitis in Egypt. As routine phenotypic identification of dermatophytes is either slow or lack specificity, improved identification methods are required. The application of PCR has made rapid and precise identification of T. violaceum possible.<br />Aim: This study was designed to correlate between phenotypic and genotypic identification of T. violaceum.<br />Subjects: Two hundred patients with tinea capitis (122 males and 78 females) with a mean age of 8.5±3.1 were the subjects of this study.<br />Methods: Phenotypic identification of T. violaceum determined by observation of its macroscopic and microscopic characteristics and culture on differential media was correlated with ITS-based PCR.<br />Results: Genotypic identification results of T. violaceum in comparison with phenotypic identification results were identical.<br />Conclusion: Although there is no difference between the results of phenotypic and genotypic identification methods of T. violaceum isolates, genotypic method is recommended as it is rapid and accurate.https://zumj.journals.ekb.eg/article_4364_43387750a0694a0d0ab03ffa912167cd.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301TRANSESOPHAGEAL ECHO STUDY IN PATIENTS WITH ACUTE ISCHEMIC STROKE115436510.21608/zumj.2014.4365ENKamalMansourCardiology Department, Faculty of Medicine, Zagazig University.ManarElzakiCardiology Department, Faculty of Medicine, Zagazig University.KhaledElsharkawyNeurology Department, Faculty of Medicine, Zagazig UniversityWaleedElawadyCardiology Department, Faculty of Medicine, Zagazig UniversityAl-ShaimaaAl-SadekCardiology Department, Faculty of Medicine, Zagazig UniversityJournal Article20171203Background: Stroke is one of the major causes of death and disability and due to the high mortality and morbidity rates associated with stroke ,it is becoming a major community health problem worldwide. It has been estimated that cardiogenic emboli are a source of transient ischemic attack (TIA) or stroke in 20% to 40% of all cases. Transesophageal echocardiography (TEE) has been proven superior to transthoracic echocardiography (TTE) for the detection of potential sources of cardiac embolism in patients with previous stroke. In particular, the additional value of TEE in the patients above 45 years of age, in whom TEE is still far from routine procedure, was evaluated. In addition, emphasis was placed on therapeutic consequences, ie, the indication for anticoagulation, based on the results of TEE.<br />Aim of the work : The aim of our study is to evaluate the role of TEE (transesophagealecho) to find indications of anticoagulation despite false absence of its benefit by clinical and transthoracicecho (TTE) examination.<br />Patient and methods: The study was conducted in Zagazig university hospitals and included 100 patients diagnosed with ischemic stroke The diagnosis of stroke was made based on clinical data and brain CT. A full TEE was done and the presence of the following potential sources of embolism was specifically examined (a)left atrial spontaneous echo contrast and thrombus , (b)Impaired Left atrial appendage velocity and the presence of LAA (Left atrial appendage )thrombi , (c)Atheroma in the thoracic aorta, (d)Patent foramen ovale and atrial septal aneurysm (e) others, including valvular vegetations and intracardiac masses .<br />Results:Among the different age groups studied , the prevalence of PFO and MVP (mitral valve prolapse) were highest in patients ˂ 45 years old while the prevalence of complex aortic atheroma was highest in patients ˃45 years old .Risk of stroke recurrence was highest in patients with complex aortic atheroma .Among patients with dyslipidemia,prevalance of ischemic stroke was highest in those older than 45 years old and was significantly higher in low HDL (high density lipoprotein ) (˂40 mg/dl ) and high cholesterol (˃200 mg/dl) group.Furthermore, the risk of stroke recurrence was significantly higher in patients with hypercholesterolemia.<br />Conclusion: TEE has proved to be a very useful tool in diagnosing causes of ischemic stroke .The benefit was not only seen in young age (˂45 years old), but also in those in older age groups .https://zumj.journals.ekb.eg/article_4365_0134596e3c8836583910ea26fa139cb1.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301IMPACT OF SUBPECTORAL IMPLANTATION OF THE IMPLANTABLE CARDIOVERTER DEFIBRILLATORS ON DEFIBRILLATION THRESHOLD17436610.21608/zumj.2014.4366ENHishamRoshdyCardiology department, Faculty of Medicine, Zagazig University, Zagazig, EgyptJournal Article20171203Aims: the aim of this study is to find out the effect of subpectoral implantation of unipolar active case Implantable Cardioverter Defibrillators (ICD), on defibrillation threshold (DFT), compared to the conventional subcutaneous approach.<br />Methods: unipolar, active case ICDs were implanted subcutaneously in 7 patients (group I), and subpectoraly in another 7 patients (group II); all patients were diagnosed with ischemic cardiomyopathy. DFT, shock lead impedance, R wave amplitude, slew rate, pacing lead threshold and pacing lead impedance were compared between the two groups.<br />Results: DFT was significantly lower in group II, 14.8±5.5 vs 7.29±5.1 J (P=0. 017) in groups I and II respectively. Other parameters were comparable in the two groups. One patient with high DFT on subcutaneous ICD implantation showed an acceptable reduction of DFT when the device was implanted subpectoraly.<br />Conclusion: reduction in DFT with subpectoral implantation of ICDs is among the benefits of this approach, which is an easy and workable approach to high DFT patients.https://zumj.journals.ekb.eg/article_4366_15e31dd49103bac3b00d17992734ed84.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301DIRECT HIS-BUNDLE PERMANENT PACING AS AN ALTERNATIVE TO CONVENTIONAL RIGHT VENTRICULAR APICAL PACING: A PILOT STUDY IN ZAGAZIG UNIVERSITY CARDIAC ELECTROPHYSIOLOGY LABORATORY17436710.21608/zumj.2014.4367ENHisham S RoshdyRoshdyCardiology department, Faculty of Medicine, Zagazig University, Zagazig, EgyptJournal Article20171203Aim: was to evaluate the feasibility of direct his bundle pacing (DHBP) as one of the physiological pacing approaches in our EP lab.<br />Methods: All suitable patients admitted for permanent pacemaker implantation, between January and June 2013, were given a trial for DHBP. Using his bundle (HB) recording through a quadripolar catheter as an electrical and radiological guidance, custom shape stylet was used to direct an active fixation lead to the target position; a pacing protocol was applied to insure pure HB capture. A matching group of patients with apical right ventricular pacing (ARVP) were used as control, to assess the feasibility of DHBP technique.<br />Results: Pure DHBP was successful in 12 out of 32 patients 38%.The DHBP procedure was costly when compared to ARVP in total procedure time (94.7±30.4 vs. 43.2±17.4 minutes), fluoroscopy time(35.2±10.9 vs.<br />10.1±3.6 minutes), patient x-ray exposure (34.1±7.8 vs. 11.9±4.9 Gy Cm2)and acute pacing threshold (2.1±0.6 vs.0.6±0.4 V). But in the other hand it was better in paced QRS width (76.8±14.8 vs. 193.9±35.8 ms.), patients’ exercise capacity as percentage of achieved METS from Max METS for age (75.5±8.7 vs.54.9±8.7%). the DHBP procedure time was progressively shorter indicating a steep learning curve.<br />Conclusion: Although DHBP has many technical difficulties, it can be achieved with a reasonable coast in our EP lab with a demonstrable benefit, and a steep learning curvehttps://zumj.journals.ekb.eg/article_4367_8b0fb7427a0fc23d493dd17096fd35df.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301THE EFFECTS OF VITAMIN D3 AND CALCIUM SUPPLEMENTATION ON FASTING PLASMA GLUCOSE, SERUM LIPIDS, RATE PRESSURE PRODUCT AND BODY MASS INDEX IN HEALTHY ADULTS19436810.21608/zumj.2014.4368ENAmlNadaDepartment of Internal Medicine, Unit of Endocrinology, Diabetes and Metabolism, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.Journal Article20171203Aim: to investigate the effect of vitamin D3 replacement on body mass index, blood pressure, pulse rate, fasting plasma glucose and serum lipids, in healthy vitamin D deficient adults.<br />Patients and methods: Twenty-five healthy adult participants (3 males and 22 females) with vitamin D3 deficiency were recruited from the endocrine clinic in a tertiary care hospital in Saudi Arabia. History was taken and clinical examination was done for all participants. Height, weight, sitting blood pressure, and pulse rate were measured. Laboratory investigations in the form of vitamin D3 level, fasting plasma glucose, and lipid profile were measured before the participants received any oral vitamin D3. The same anthropometric and biochemical parameters were measured 9 months after starting vitamin D3 supplementation in the form of oral cholecalciferol. Replacement was given as 4500 units of vitamin D3 drops daily for one month, then 3000 units daily for another month, then 2000 units daily for seven months. This was combined with oral calcium carbonate intake of 500 milligrams daily throughout the nine month study period.<br />Results: Pretreatment serum vitamin D3 level was 9.01±3.2 nanogram/milliliter. A vitamin D3 level of 35.4±6.84 nanogram/milliliter was achieved by the end of the study. A significant reduction in the pulse rate (p=0.000) and the systolic blood pressure was noticed (p=0.002). The diastolic blood pressure did not significantly change (p=0.148).The rate pressure product (RPP) was significantly reduced by the end of the study (p <0.001). The increase in vitamin D3 level was not associated with significant changes in fasting plasma glucose (p=0.184) or any of the measured components of the lipid profile. There was no significant effect on the body mass index (p=0.31).<br />Conclusion: Vitamin D3 replacement is associated with a significant reduction of the pulse rate, the systolic blood pressure and the rate pressure product. This indicates a reduction of the cardiac work which may partially explain the cardioprotective effect of vitamin D3. The body mass index does not significantly change with vitamin D replacement . No significant effect of vitamin D replacement on fasting plasma glucose in healthy adults, who are neither diabetic nor prediabetic. Also, no effect of vitamin D replacement on the lipid profile in the same group of healthy population.https://zumj.journals.ekb.eg/article_4368_872512fdaeb78be5f1981ae04e2c3972.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301URINARY SE-CADHERIN AND PLASMA CYSTATIN C AS NOVEL BIOMARKERS OF DIABETIC NEPHROPATHY116436910.21608/zumj.2014.4369ENMohammadAlyInternal Medicine Departments, Faculy of Medicine, Zagazig UniversityNeveenEl-AntounyInternal Medicine Departments, Faculy of Medicine, Zagazig UniversityGhadaAmrClinical Pathology Departments, Faculy of Medicine, Zagazig UniversityGeorgeShakerInternal Medicine Departments, Faculy of Medicine, Zagazig UniversityJournal Article20171203Background and aim : Diabetes is a major cause of chronic kidney disease (CKD). Urine albumin and estimated glomerular filtration rate (eGFR) are the two key markers for chronic kidney disease (CKD). The aim of our work was to explore the possibility of plasma cystatin C and urinary sE.cadherin as useful biomarkers for early detection of diabetic nephropathy (DN).<br />Methods: - A total number of 80 subjects were included and were classified into three main groups. Group I (20) normal subjects with no history of DM, hypertension or other diseases and with albumin / creatinine (Alb / Cr) ratio below 30 mg/ g. Group II (30) type 2 diabetic patients with Alb / Cr ratio below 30 mg/ g. Group III (30) type 2 diabetic patients with Alb / Cr ratio between 30 and 300 mg/ g. The latter two groups were divided in two sub groups A and B according to GFR by MDRD: normal (≥ 90 ml /min / 1.73 m2) and < 90 ml /min / 1.73 m2. All subjects underwent urine analysis, complete blood picture, liver function tests, kidney function tests, INR, fasting plasma glucose level, HbA1c, lipid profile, abumin/creatinine ratio, pelvi-abdominal ultrasound, plasma Cystatin C and urinary human sE-Cadherin.<br />Results: - Plasma cystatin C and urinary sE.cadherin/ cr levels were increased with micro-albuminuria. Also, plasma cystatin C and urinary sE.cadherin/ cr levels were significant between normoalbuminuric subjects with GFR ≥ 90 mL/min/1.73 m2 calculated by the MDRD equation and those below 90 mL/min/1.73 m2 being higher in the later. In multivariate logistic analysis, plasma cystatin C level was the only independent factor associated with eGFR < 90 mL/min/1.73m2 estimated by MDRD equation in patients with normoalbuminuria. There are high significant positive correlations of plasma cystatin C with age, total cholesterol unlike urinary sE.cadherin/ cr, but both had positive correlations with serum Cr, blood urea and Alb / Cr ratio and negative correlations with GFR.<br />Conclusion and Recommendations:- Plasma cystatin C and urinary sE.cadherin levels could be useful markers for detection of microalbuminuria and renal impairment in type 2 diabetic patients with normoalbuminuria.https://zumj.journals.ekb.eg/article_4369_4e334015558ce1eada8f9eb3fb5f60ea.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301EFFECT OF RAMADAN FASTING ON DIABETIC MICRO-VASCULAR COMPLICATION113437010.21608/zumj.2014.4370ENMohamedKamarDiabetes &endocrinology unit, internal medicine department, faculty of medicine, Zagazig University, EGYPTAbbasOrabiDiabetes &endocrinology unit, internal medicine department, faculty of medicine, Zagazig University, EGYPTIhabSalemDiabetes &endocrinology unit, internal medicine department, faculty of medicine, Zagazig University, EGYPTArafaEL- ShabrawyDiabetes &endocrinology unit, internal medicine department, faculty of medicine, Zagazig University, EGYPTJournal Article20171203Fasting during Ramadan, one of the five pillars of Islam is an obligatory duty for all healthy adult Muslims. During Ramadan, Muslims must abstain from eating, drinking, taking oral medications, and smoking from the exact time of dawn until time of sunset; there are no restrictions on food or fluid intake between sunset and dawn. Islamic rules allow patients who are diseased and fasting may be hard or harmful for them not to fast. This study aimed to study the relation between Ramadan fasting and course of micro vascular complication of DM, and to find advices for patient during fasting to help in regression of micro vascular complication of DM. We started the study on 74 diabetic patients but only 64 completed the clinical visits with us and the other 10 missed from the follow up visits. Before Ramadan and After Ramadan fasting all patients were subjected to:. Electroretinogram (ERG), Mean Conduction Velocity (MCV), and Urinary Albumin Creatinine Ratio (UACR) in addition to serum insulin, proinsulin. The results showed There was increase in the mean oscillatory potentials in the second (OS2 ) of both eyes from 8.96±3.96 to 9.49±4.77.and other changes in the ERG which indicate significant improvement of diabetic retinopathy after Ramadan fasting , MCV decreased from 43.92± 21.68 to 39.85±13.50 ms. and albumin creatinine ratio was increased from 98.41 ±160.49 to 141.49 ±228.62.<br />Conclusion: Fasting of the whole month of Ramadan has a beneficial effect on β cell function. The relation between Ramadan fasting and micro-vascular complications is variable, with some improvement of diabetic retinopathy. neuropathy show adverse effects. Ramadan fasting increase the albumin creatinine ratio but there is improvement among patients with microalbuminuria.https://zumj.journals.ekb.eg/article_4370_dab7c2ea94406b17bb5163bd8194802e.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301GENE POLYMORPHISM OF TRANSFORMING GROWTH FACTOR BETA-1 (TGF-Β1) AND ITS LEVEL IN RHEUMATOID ARTHRITIS PATIENTS ASSOCIATED WITH OSTEOPOROSIS DISEASE18437110.21608/zumj.2014.4371ENGinaSaidBiochemistry Department, Faculty of Pharmacy, Zagazig University, Egypt,
Biochemistry Department, Faculty of Pharmacy, MSA University, EgyptYoussriHusseinMedical Biochemistry Department, Faculty of Medicine, Zagazig University, EgyptHodaEl-SayedBiochemistry Department, Faculty of Pharmacy, Zagazig University, EgyptMervatAskarBiochemistry Department, Faculty of Pharmacy, Zagazig University, EgyptJournal Article20171203Objective: The imbalance between pro-inflammatory and anti-inflammatory cytokines is a feature of rheumatoid arthritis (RA). The role of transforming growth factor beta-1 (TGF- β1) and its receptor in the pathogenesis of RA is conflicting. We aim to investigate the role of polymorphisms in the gene in susceptibility and severity of RA and osteoporosis.<br />Methods: Eighty-six RA patients and eighty-four control were enrolled in the study.<br />Genotyping of TGF- β1 T/C869 and TGF- β1 G/A800 was determined by restriction fragment length polymorphism-polymerase chain reaction (PCR-RFLP).<br />Results: Subjects carrying T allele of TGF- β1 T/C869 genotype were significantly more likely to have osteoporosis than subjects carrying C allele (OR:6.95, 95% CI: 2.7-15.7, P: 0.001).Also, Subjects with A allele of TGF- β1 G/A800 genotype were significantly more likely to have osteoporosis (OR: 1.13, 95% CI: 1.05-1.2, P: 0.001).<br />Conclusion: T/C869 genotype and G/A800 genotype of TGF-β1 gene affecting on severity of RA and have the ability to develop the risk to osteoporosis in patients carrying T allele and A allele of T/C869 and G/A800 gene polymorphism respectivelyhttps://zumj.journals.ekb.eg/article_4371_6b9ddda7cebd10bea81a28a97fbb710c.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301SEX HORMONE BINDING GLOBULIN GENE POLYMORPHISM AND RISK OF TYPE2 DIABETES MELLITUS IN EGYPTIAN MEN17437210.21608/zumj.2014.4372ENShereenEl TarhounyMedical Biochemistry Department, FOM, Zagazig University, Egypt & Taibah University, KSASohaZakariaMedical Biochemistry Department, FOM, Tanta University, Egypt & Taibah University, KSKhaled DHadhoudInternal Medicine Department FOM, Zagazig University, EgyptManalHanafiCommunity Medicine Department FOM, Alexandria University, Egypt & Taibah University, KSAAzzaKamelMedical Biochemistry Department, FOM, Menofia University, Egypt & Taibah University, KSAOmarAl NozhaMedicine Department FOM, Taibah University, Al Madina, KSAJournal Article20171203Conditions of hypoandrogenism in men have been linked to insulin resistance, suggesting that alterations in normal sex steroid physiology could play a role in the pathogenesis of type 2 diabetes (T2DM). Sex hormone binding globulin gene polymorphisms may be the cause of sex steroid alteration The aim of this work to study effect of sex hormone binding globulin (SHBG) gene polymorphisms on type 2 diabetes mellitus risk through its impact on testosterone and estradiol level in Egyptian men. In 185 diabetic men and 120 matched healthy controls, two polymorphisms (rs6257 and rs6259) of the gene encoding sex hormone–binding globulin were genotyped and serum levels of sex hormone–binding globulin, testosterone and estradiol were measured by ELISA; Our results showed significant decrease in sex hormone binding globulins in type 2 diabetic patients compared with the control group. Carrier of variant allele of SHBG single nucleotide polymorphism (SNP) rs6259 had a higher level of SHBG in serum (p=0.000) While carrier of SHBG rs6257 SNP had a lower level of SHBG level in serum SHBG gene polymorphisms are associated with risk of type 2 diabetes in Egyptian men, through lowering circulating levels of sex hormone–binding globulin and consequently lowering testosterone and elevating estradiol level. SHBG rs6257 genotype may have a predictive value of developing type II diabetes mellitushttps://zumj.journals.ekb.eg/article_4372_c9ccfc64fd63ec9c1313cbf62e05bb08.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301STUDY OF ENDOGENOUS SEX HORMONES AND INFLAMMATION IN ELDERLY WOMEN WITH DIABETES MELLITUS114437310.21608/zumj.2014.4373ENJournal Article20171203Background .C-Reactive Protein (CRP), an acute phase reactant has long been considered as a classic marker of inflammation. Ageing is characterized by a chronic, low-grade inflammatory status, the so-called “inflame-ageing”. Diabetes is known to be also associated with low-grade inflammation .The normal process of reproductive ageing is characterized by marked hormonal changes, during menopause, estradiol (E2) level decreases dramatically, whereas testosterone level presents a small decline or remain unchanged. A large body of clinical data suggests the important roles of endogenous sex hormones in the pathogenesis of type 2 diabetes. In many studies in women, plasma estradiol and testosterone have been positively associated with glucose intolerance and insulin resistance, independently of adiposity. Objective .The aim of this study was to assess serum levels of endogenous sex hormones (estrogen and testosterone) as well as high sensitive C -Reactive protein ( hs-CRP) in elderly women with and without type 2 diabetes.<br />Research Design. This study was done in the period between august 2009 to august 2011, The study population included a total number of 60 post menopausal elderly females, 20 healthy non diabetic elderly females as control group and 40 diabetic females. The diabetic females were further divided into two groups according to presence or absence of complications cardiovascular diseaes complicated group and non complicated group. They were also divided into two groups according to glycosylated hemoglobin level (HbA1c) to controlled group and non controlled group.<br />Methods. Total testosterone, total estradiol, hs-CRP and HbA1c were measured in diabetic and non diabetic elderly women.<br />Results. As regard hs-CRP there was a high significant difference between patients(2,2±,56 mg/L) and control group(1.60 0.39 mg/L) and also there was a significant difference between complicated(2.160.51 mg/L) and non complicated group(2.080.76 mg/L) and no significant difference among diabetics whether controlled or non controlled . As regard the serum estradiol, there was a high significant difference between patients (22.513.9 pg/ml) and control group (12.92.71 pg/ml). While there was no significant difference as regard presence or absence of complication and diabetes control. As regard the serum testosterone, there was no significant difference between patients and control group, presence or absence of complication and control of diabetes.<br />Conclusion. In type 2 diabetic postmenopausal elderly women there was significant association between inflammation and serum estradiol while there was no association between inflammation and serum testosterone. As regarding presence or absence of cardiovascular complication and diabetes control neither of two hormones were associated with inflammation.https://zumj.journals.ekb.eg/article_4373_59239abe8b39b81eee6d95f06169927f.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301EARLY POSTOPERATIVE MEASUREMENT OF CALCIUM AND PARATHRMONE LEVELS AS PREDICTORS OF EARLY PARATHYROID INSUFFICIENCY AFTER TOTAL THYROIDECTOMY16437410.21608/zumj.2014.4374ENJournal Article20171203Background: Declines in serum calcium or intact parathyroid hormone (iPTH) levels after surgery have been suggested as being reliable predictors of postoperative hypocalcemia. Although measurements of serum calcium or iPTH allow the identification of patients who have no risk of hypocalcemia after total thyroidectomy, it is not always easy to predict which patients can be discharged early from the hospital or to identify those requiring close monitoring of serum calcium levels or those that should receive calcium and vitamin D supplements. Aim of the work To evaluate early postoperative parathyroid insufficiency following total thyroidectomy by estimating parathyroid hormone and calcium level in the early postoperative period, and whether we can rely on to start Ca supplement or not. Patients and methods: This study was done in General Surgery department, Zagazig University on 50 patients; 10 males (20%)) 40 females (80%) who underwent total thyroidectomy. Serum total Calcium and Parathormone levels were evaluated in all patients 6 h and 24 h in early postoperative period. Results: Our results showed highly significant VALUE OF relative decline of serum calcium and parathyroid hormone 6 h and 24 h after total thyroidectomy. The results showed also highly significant positive correlation between serum calcium and parathyroid hormone both preoperative and postoperative and highly significant positive correlation between relative decline in serum calcium and relative decline of serum parathyroid hormone at both 6h and 24 h after total thyroidectomy IN HYPO CALCEMIC PATIENTS. There was no significant relationship between hypocalcemia and any of demographic, clinical, ultrasonographic and pathological data. There is significant relationship between both relative decline of serum calcium and relative decline parathyroid hormone and postoperative hypocalcemia. Conclusion: Relative decline of parathyroid hormone 6 h and 24 h after total thyroidecomy is a good predictor of postoperative hypocalcemia and is reliable for allowing safety discharge of patients 24 h after total thyroidectomy.https://zumj.journals.ekb.eg/article_4374_acb905c6b5e214407dd4d9907dc698dc.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301APIGENIN RESTORES NORMAL VASCULAR REACTIVITY IN DIABETIC RATS VIA PROTEIN KINASE C INHIBITION15437510.21608/zumj.2014.4375ENNoraDesoky1Department of Pharmacology, Faculty of Pharmacy, Zagazig University, EgyptHanyEl-BassossyDepartment of Pharmacology, Faculty of Pharmacy, Zagazig University, Egypt
,Department of Pharmacology, Faculty of Pharmacy, King Abdulaziz University, kingdom of Saudi ArabiaAhmedFahmyDepartment of Pharmacology, Faculty of Pharmacy, Zagazig University, EgyptAhmadAzharDepartment of Pediatric Cardiology, Faculty of Medicine, King Abdulaziz University, kingdom of Saudi ArabiaJournal Article20171203Deterioration of vascular reactivity has pivotal role in diabetic vascular complications. Apigenin is a natural flavonoid with protein kinase C inhibiting activity and antioxidant effect.<br />Objective: In the present study, the effect of the flavonoid apigenin on diabetes-induced deteriorated vascular reactivity was investigated.<br />Materials and methods:Insulin deficiency was induced by streptozotocin while, insulin resistance (IR) by fructose. Rats were left tenor twelve weeks after STZ or fructose administration respectively, isolated thoracic aorta reactivity to phenylephrine (PE), KCl, acetylcholine (ACh) and sodium nitroprusside (SNP) was studied.<br />Results: Insulin deficiency increased responses to PE and KCl, decreased response to ACh but not affect response to SNP, while incubation with apigenin (7μM, 20min) normalized responses to PE, KCl andACh. In addition, insulin resistance (IR) increased responses to PE and KCl, decreased response to ACh but not affect the response to SNP, while in vitro incubation with apigenin normalized responses to PE, KCl and ACh. Furthermore, , protein kinase C stimulation by incubation with phorbol 12-myristate 13-acetate (PMA, 800nM, 1h) led to a similar impairment in isolated normal aorta to that seen in case of insulin deficiency and insulin resistance while co-incubation with apigenin restored normal vascular reactivity.<br />Discussion and conclusion: Apigenin, a natural protein kinase C inhibitor, restores normal vascular reactivity in diabetes via a mechanism involving PKC inhibition.https://zumj.journals.ekb.eg/article_4375_d3e39f63049c4d3ee72fd788fc38430b.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301EVALUATION OF MULTIMODAL THERAPY USING ENDOSCOPIC RESECTION WITH CONCURRENT GEMCITABINE AND RADIOTHERAPY IN THE TREATMENT OF MUSCLE-INVASIVE BLADDER CANCER112437610.21608/zumj.2014.4376ENAbd El RahmanEl FayoumiUrology department,Faculty of Medicine, Zagazig University.AshrafShahinUrology department, Faculty of Medicine, Zagazig University.TalaatEl MokademClinical oncology and Nuclear Medicine department, Faculty of Medicine, ZagazigAbd El MotalebMohammedClinical oncology and Nuclear Medicine department, Faculty of Medicine, ZagazigJournal Article20171203Background: Radical cystectomy is the preferred line of treatment for MIBC. Multimodal therapy including concomitant chemo-radiotherapy gives promising results comparable to cystectomy especially in those patients with solitary, low stage, small size tumors that are amenable to complete resection.<br />Aim of the work: to evaluate the role of bladder preservation protocol including concomitant chemo-radiotherapy in the treatment of muscle invasive bladder cancer as regard: local control, systemic control, and quality of life.<br />Materials and methods: Forty patients with primary (T2-4a, Nx, M0) TCC of the bladder with adequate performance status and eligible for cystectomy were enrolled over a period from March 2011 to July 2013. All patients are subjected to maximal TURBT, Intra-venous gemcitabine infusion (300 mg/m² body surface area weekly during radiotherapy), and 60 Gy /6 weeks using linear accelerator 4-6 mev. 1st phase:- total pelvic radiation of 40 Gy by dose of 20 fractions in 20 days. While 2nd phase:- localized pelvic field dose of 20 Gy by 10 fractions in 10 days. The endpoint of the study is either treatment failure or completion of the follow up period via cystoscopy every three months for 2 years, and upper tract surveillance was performed by ultrasonography every six months and CT yearly.<br />Results: After phase I; 22 (55%) patients had complete response (complete disappearance of all measurable lesions), 8 (20%) patients had partial response (more than 50% reduction of all measurable lesions or no increase in any lesion or no new lesions) and 10 (25%) patients had stable disease (less than 50% reduction of measurable lesions or < 25% increase of measurable lesions). Patients who had stable disease were subjected to salvage cystectomy. Patients who had CR and PR (totally 30 patients) started phase II. After phase II, only 3 patients underwent salvage chemotherapy and 27 patients had CR. At the end of treatment protocol, 27 (67.5%) patients had CR with bladder preservation while 13 (32.5%) patients were subjected to salvage cystectomy. Kaplan-Meier analysis of recurrence-free survival, overall survival of the patients was done.<br />Conclusion: Bladder preservation protocol including concomitant chemo-radiotherapy gives comparable results with cystectomy in local control of the disease and survival rates of the patients with better quality of life especially in those patients with solitary T2, high grade tumors that are less than 5 cm and are amenable to complete resection.https://zumj.journals.ekb.eg/article_4376_6508f262664be25d15f0640652d1bd7d.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301ESTROGEN AND VITAMIN D RECEPTORS GENES POLYMORPHISMS IN BREAST CANCER WOMEN19437710.21608/zumj.2014.4377ENMagdyIbrahimMedical Biochemistry Departments, Faculty of Medicine, Zagazig UniversityWaelElsawyClinical Oncology Departments, Faculty of Medicine, Zagazig UniversitySamyIbrahimMedical Biochemistry Departments, Faculty of Medicine, Zagazig UniversityMarwaHusseinMedical Biochemistry Departments, Faculty of Medicine, Zagazig UniversityJournal Article20171203Background: Estrogen receptor (ER) and vitamin D receptor (VDR) is a ligand-activated transcription factor that mediates estrogen and vitamin D actions in target tissues. Several common polymorphisms of the ER- αgene and VDR gene have been reported to be associated with alterations in receptor expression and function. Objective: We evaluated the hypothesis that genetic polymorphisms in the PvuII restriction site of ER- α gene and FokI restriction site of VDR may be associated with breast cancer risk in Egyptian. Methods: In this study the involvement of two RFLPs, one at the ER-α gene locus, denoted as PvuII and the other at the VDR gene denotes as FokI in breast cancer were examined in 50 breast cancer cases and50 age frequency-matched controls. A case-control comparison was performed and the genotype distributions examined according to different tumor and population parameters. Result(s): PvuII polymorphism was associated with an increased risk of breast cancer (OR = 1.9 (0.75 5.0), P=0.01), while there was no significant difference in genotype frequency of the FokI polymorphism between controls and cases . In addition, significant association was found in patients with LN metastasis carrying the ER –α PvuII polymorphism. Also this study showed non-significant but generally higher relative risk of breast cancer for the f allele carriers of FokI polymorphism of Vitamin D receptors gene with breast cancer risk (OR =2,65(1.5- 5.2) P=0.000). We did not find significant association between ERs gene PvuII res polymorphism and VDRs gene FokI polymorphism however there is significant association between the f allele and the p allele in cases (P=0.02). Conclusion(s): These results suggest that biomarkers for genetic polymorphisms could be used for the identification of breast cancer risk among Egyptian women.https://zumj.journals.ekb.eg/article_4377_ee0413502b7bf80c6e09c21cde06312d.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301DETECTION OF JAK-2 MUTATION BY PCR TECHNIQUE IN CHRONIC MYELOPROLIFERATIVE DISORDERS17437810.21608/zumj.2014.4378ENMervatAzabClinical pathology departments; Zagazig university hospitals, Egypt.NadiaAlbazClinical pathology departments; Zagazig university hospitals, Egypt.FoaadAbotalebMedical oncology departments; Zagazig university hospitals, EgyptAbdel-RahmanNaeemClinical pathology departments; Zagazig university hospitals, Egypt.Journal Article20171203At this study we aimed to detect the prevalence of JAK2 V617F mutation in various myeloproliferative neoplasms (MPNs) that represent a major advance in molecular understanding of CMPN disorders in order to identify its diagnostic value.<br />In this study we evaluated it's clinical and laboratory correlates in 40 patients with MPNs. The mutation was detected by allele-specific PCR.<br />The mutation was detected in 8 patients: 80% (8/10) of those with polycythemia vera, 63.6% (7/11) of those with essential thrombocythemia, 62.5% (5/8) of those with chronic idiopathic myelofibrosis and 0% (0/11) of those with chronic myeloid leukemia. The patients carrying the mutation were older (p = 0.003) and have splenomegaly in polycythemia vera group (p = 0.05) but no statistical difference was found between positive and negative JAK2 carriers as regarding HB, TLC ,PLTs count or gender type (P > 0.05).<br />This study implies that the JAK2–V617F mutation may be useful for the diagnosis, classification and the management of patients with MPDs.https://zumj.journals.ekb.eg/article_4378_8193e7227e331fa49a133f89b3908f82.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301ULTRASOUND GUIDED FOAM SCLEROTHERAPY FOR TREATMENT OF LONG SAPHENOUS VIEN REFLUX18437910.21608/zumj.2014.4379ENWaelElshimyVascular surgery Unit, Faculty of Medicine, Zagazig University.AhmadTawfikVascular surgery Unit, Faculty of Medicine, Zagazig University.WalidAbdalbadieVascular surgery Unit, Faculty of Medicine, Zagazig University.MedhatAllabodyVascular surgery Unit, Faculty of Medicine, Zagazig University.AymenSamirVascular surgery Unit, Faculty of Medicine, Zagazig University.AymenSalemVascular surgery Unit, Faculty of Medicine, Zagazig University.Journal Article20171203Objectives: To assess the efficacy and safety of ultrasound guided foam sclerotherapy (UGFS) with a long saphenous trunk reflux.<br />Methods: One hundred and seventy cases with primary long saphenous (LSV) trunk reflux underwent foam sclerotherapy. Patients were evaluated using Venous Clinical Severity Score (VCSS) and duplex ultrasound pre procedure, 2 weeks and 6 months following the procedure. Complications were detected and recorded 2 weeks and 6 months following the procedure.<br />Results: Between (September 2010 and December 2011). One hundred and seventy patients with (LSV) trunk reflux underwent foam sclerotherapy 102 females (60%), 68 males (40%). The mean age of patients was 38.8 years, SD (11.35). Two weeks after the first treatment session, the success rate was 93.5%. The failure rate was 6.5%. The complications detected in 23 cases 2 weeks after the first treatment session and included thrombophlebitis in 8 cases, DVT in 3 cases and pain in 12 cases. Six months after the first treatment session, the success rate was 88%. The failure rate was 12%. The complication detected 6 month after the first treatment session was skin staining in 19cases.<br />Conclusion: UGFS is a safe and effective method of treating long saphenous trunk reflux.https://zumj.journals.ekb.eg/article_4379_0b3629b6da0050c017c28c90d1b5b207.pdfZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143120220140301COMPARATIVE STUDY BETWEEN SUTURED INTESTINAL ANASTOMOSIS AND THAT REINFORCED WITH CYANOACRYLATE TISSUE ADHESIVE110438010.21608/zumj.2014.4380ENOsamaGharibDepartment of general surgery Zagazig UniversityAlaaKhalilDepartment of general surgery Zagazig UniversityWesamAmrDepartment of general surgery Zagazig UniversityAshrafGodaDepartment of general surgery Zagazig UniversityMoustfaMohamedDepartment of general surgery Zagazig UniversityJournal Article20171203Background: This experimental study evaluated the effectiveness and safety of using cyanoacrylate tissue adhesive for reinforcement of intestinal anastomosis and as a protective seal to prevent leakage.<br />Methods: Twenty healthy adult model rabbits weighting 2000 ± 100 gm were included in this study. They were divided into two groups. Group I ( experimental group ) underwent intestinal resection anastomosis with one interrupted vicryl layer sutures , and N- butyl -2- cyanoacrylate as a tissue adhesive for reinforcement of anastomosis, while in group II ( control group ) the anastomosis was performed with one interrupted vicryl layer without cyanoacrylate . After 15 days the ileum was gently removed and assessed for wound infection, anastomotic leakage, adhesions, and for anastomotic stricture. The assessment also included pathological evaluation for inflammatory cell infiltration and collagen deposition.<br />Results: There was no statistically significant difference in anastomotic leakage, adhesions and anastomotic stricture. There was significantly lower inflammatory reaction and collagen deposition in the experimental group (I) when compared with the control group (II).<br />Conclusion: In this study we confirmed the effectiveness of N – butyl -2- cyanoacrylate for reinforcement of intestinal anastomosis, as an immediate sealing of the tissues and as support to the physiological wound healing process.https://zumj.journals.ekb.eg/article_4380_8e5bb0c6220f2c893cf0592634bbd2cb.pdf