Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Role of Ligamentum Flavectomy in Lumbar Spinal Canal Stenosis
357
366
EN
Kamal
Abd El-Rahman Abd El-Hafez
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
Mohamad
Mohamad Fathy Fahmy El-Halawany
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
Mostafa
Abd Allah Kamal Mostafa
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
drghost1989@gmail.com
10.21608/amj.2020.67784
<strong>Background:</strong> Lumbar spinal canal stenosis (LSCS) is a degenerative condition in which changes in the discs, ligamentum flavum, and facet joints with aging cause narrowing of the spaces around the neurovascular structures of the spine. These changes lead to pain in the legs and back, as well as impaired ambulation and other disabilities.<br /> <strong>Objective:</strong> To provide an update review for determining the role of ligamentum flavectomy in lumbar spinal canal stenosis.<br /> <strong>Patients and methods:</strong> This study was carried out as an interventional prospective study on 23 patients with lumbar spinal canal stenosis from August 2018 till August 2019. Study was conducted in Orthopedic Surgery Departments, EL-Sayed Galal and EL-Haram specialized Hospitals and aimed at assessment of the role of ligamentum flavectomy in lumbar spinal canal stenosis.<br /> <strong>Results:</strong> The mean age was 50.5 ± 5.7 years ranging from 41 to 59 years. According to gender distribution, they were 13(56.5 %) males, and 10 (43.5%) females. The preoperative VAS ranged between 5-9 with mean 6.8 ±1.4. Six weeks after operation its range became 1-5 with mean 2.8 ±0.98. Twelve weeks later, the range was 1-3 with mean 1.7 ±0.7. The preoperative ODI ranged between 3-46 with mean 19.56 ±19.65. Six weeks later, the range between 1-18 with mean 7.3 ±7.26. At twelve weeks, the range was between 1-15 with mean 4.2 ± 8.86. At level L4/L5, ten patients (43.48%) have lumbar stenosis. At L3/L4 and L4/L5 levels seven patients (30.42%), and at L2/L3, L3/L4, L4/L5 levels six patients (26.1%) have stenosis.<br /> <strong>Conclusion:</strong> Ligamentum flavum hypertrophy is one of main causes of spinal canal stenosis so ligamentum flavectomy is an essential step in all surgical management of lumbar spinal canal stenosis for decompression of spinal canal.
Ligamentum Flavectomy,Lumbar Spinal Canal Stenosis
https://amj.journals.ekb.eg/article_67784.html
https://amj.journals.ekb.eg/article_67784_46c346c8c2cb87dec70b6addcb717f39.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
The Role of Central Neck Dissection in Differentiated Thyroid Cancer
367
378
EN
Mohamed
I. El-Anany
Department of General Surgery, Faculty of Medicine, Al-Azhar University (Cairo)
Mohamed
M. Ahmed
Department of surgical oncology, Faculty of Medicine, Al-Azhar University (Cairo)
Ahmed
A. Abdel Rahim
Department of General Surgery, Faculty of Medicine, Al-Azhar University (Cairo)
ahmedfouda86@gmail.com
10.21608/amj.2020.67785
<strong>Background:</strong> Thyroid cancer is the most common endocrine malignancy and differentiated thyroid cancer has a 10-year survival rate of 90%. Cervical lymph node metastases are a common feature of papillary thyroid cancer while follicular thyroid cancer often spreads hematogenously.<br /> <strong>Objective:</strong> To evaluate the role of central neck dissection in the management of differentiated thyroid cancer as regard its impact on both morbidity and overall outcome.<br /> <strong>Patients and Methods:</strong> This was a prospective cross sectional study conducted on 30 patients diagnosed as differentiated thyroid cancer (DTC) and admitted at the Surgical Oncology Department of Al-Azhar University Hospitals and Damanhour Oncology Centre. All patients of the study subjected to clinical assessment by complete history taking, complete laboratory investigations, imaging studies and tissue diagnosis by fine needle aspiration cytology.<br /> <strong>Results:</strong> the relation between positive LNs and tumor of 2-4 cm size which was central group which commonly diagnosed clinically and the absence commonly diagnosed radio logically and also associated with capsular invasion of thyroid. The most common type of the tumor was papillary type with a little percentage of follicular type and I131 was used as appellatives therapy for some of these cases.<br /> <strong>Conclusion:</strong> central neck dissection is still beneficial especially in high risk group of cases where there was capsular invasion.
central neck dissection,Differentiated thyroid cancer
https://amj.journals.ekb.eg/article_67785.html
https://amj.journals.ekb.eg/article_67785_bb8dc7fe7ed017db56ab205a52d606e5.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Comparative study between patching and conservative treatment of traumatic tympanic membrane perforation
379
386
EN
Mohamed
Abd El-Azez El-Daba
Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University
Ahmed
Mohamed Abd El-Fatah
Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University
Ahmed
Mostafa Ahmed Abo Mansora
Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University
ahmedmostafaabomansora@gmail.com
10.21608/amj.2020.67797
<strong>Background:</strong> Trauma remains a regular occurrence relating to activities and lifestyle of humans and it can affect any part of the body. The ear is located within the cranio-facial skeleton which is exposed to environmental trauma that can occur as blunt injuries like contusion, concussion, decompression, and penetrating injuries as fractures.
<strong>Objective:</strong> The aim of the present work was to investigate the effect of patching of traumatic TMP either with gel foam or steri-strips, and to compare it with conservative treatment depending on closure rate, closure time, hearing gain, and rate of otorrhoea.
<strong>Patients and Methods:</strong> This prospective study was carried out on sixty patients who attended to outpatient clinic of Al-Hussien and SayedGalalHospitals, Al-AzharUniversity from February 2019 to December 2019. All patients who came with traumatic tympanic membrane perforation were screened. They were divided randomly into three equal groups; group A was treated conservatively, group B was treated by steri-strip patch, and group C was treated by gel foam patch.
<strong>Results: </strong>The closure rates of the perforations in conservative group, Steri-Strips patching and gel foam patching groups were 80%, 95%, and 100%, respectively. There was no statistically significant difference in tympanic membrane closure rate between the 3 groups. Steri-Strip and gel foam patching groups showed shorter healing times compared with the conservative group. However, there was an increased rate of otorrhea in the Steri-Strip group and conservative group compared with gel foam patching group.
<strong>Conclusion:</strong> Steri-strip and gel foam patching accelerated the closure of small, moderate and large traumatic tympanic membrane perforations, closure rates and closure times did not differ significantly among the steri-strip and gel foam groups. The closure time increased in steri-strip and gel foam groups in comparison to conservative group and this difference is highly significant.
Conservative,patching,Traumatic tympanic membrane perforation
https://amj.journals.ekb.eg/article_67797.html
https://amj.journals.ekb.eg/article_67797_ba914fc9bed7f3d3dfa9bf2caece8b6c.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Risk Factors Associated with Peripheral Neuropathy in Type II Diabetic Patients
387
398
EN
Kamel
Mahmoud Hewedi
Departments of Neurology , Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ahmad
Farag El-Adawy
Departments of Neurology , Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Amr
Ahmed Rezk
Departments of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ahmed
Gamal Ahmed Yassen
Departments of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
ahmed.gamal312000@gmail.com
10.21608/amj.2020.67803
<strong>Background:</strong> Diabetic peripheral neuropathy (DPN) is a progressive distal-to-proximal degeneration of the peripheral nerves which leads to a variety of neuropathic manifestations. The estimated prevalence of DPN is approximately 50% among type 2 diabetic patients. It accounts for hospitalization more frequently than other complications of diabetes, and also is the most frequent cause of non-traumatic amputation.<br /> <strong>Objectives:</strong> The current study was performed to assess risk factors of peripheral neuropathy among a sample of Egyptian diabetics.<br /> <strong>Patients and Methods:</strong> One hundreds type II diabetic patients, diagnosed according to the American Association of Diabetes criteria, were included in the current study. Patients were furtherly categorized based on the presence of DPN into DPN and non-DPN groups.<br /> <strong>Results:</strong> Patients who fulfilled the eligibility criteria were enrolled in the current study. Of them 46(46%) patients had manifestations of DPN, whereby 54(54%) patients did not have DPN. The mean age of the included patients was 55.74±7.48 and 45.96±7.26 years among patients with DPN and those without DPN, respectively. Patients aged more than 60 years, illiterate people and patients who did not complete secondary school patients with family history of diabetes, patients with longer duration of disease (>10years), hypertensive patients, patients with high levels of triglycerides, and patients with uncontrolled glycaemic status were more susceptible to develop DPN.<br /> <strong>Conclusion:</strong> The prevalence of DPN is relatively high among Egyptian patients with T2DM. Appropriate screening programs along with adequate treatment should be given for high risk patients in order to improve the quality of life and to reduce the tumbledown complications of DPN.
peripheral neuropathy,diabetes,risk factors
https://amj.journals.ekb.eg/article_67803.html
https://amj.journals.ekb.eg/article_67803_32eacdcf1c1299368ed539e611a0663c.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Effect of Repetitive Transcranial Magnetic Stimulation with High Frequency Versus low frequency on Motor Symptoms of Parkinson's Disease
399
410
EN
Kamel
Mahmoud Hewedi
Department of Neurology, AL-Azhar Faculty of Medicine, Cairo, Egypt
Ahmed
Essmat Ali
Department of Neurology, AL-Azhar Faculty of Medicine, Cairo, Egypt
Ahmed
Abdelbaset Ahmed
Department of Neurology, AL-Azhar Faculty of Medicine, Cairo, Egypt
a7medhamour@outlook.com
10.21608/amj.2020.67801
<strong>Background:</strong> There is evidence that both high and low frequency repetitive transcranial magnetic stimulation (rTMS) may have therapeutic effects on motor performance of Parkinson’s disease (PD).
<strong>Objective:</strong> The aim of the study was to conduct direct comparison of the two approaches.
Patients and Methods: Sixty PD patients who attended The Neurology Clinic of Kobri El-Koba Military Hospital, Maadi Military Hospital and Al-Hussien University Hospital, Egypt from December 2018 to October 2019. They were randomly classified into three groups. Group I (sham group) received inactive stimulation, Group II received 5 Hz and group III received 1 Hz rTMS with a total of 2000 pulses over primary motor cortex (M1) of each hemisphere for ten days. Effects were assessed with the Unified Parkinson’s Disease Rating Scale part III (UPDRS) the day before stimulation, one week after the last session, and one month later.
<strong>Results:</strong> There was a significant improvement in all parts of UPDRS part III after 5 Hz rTMS (group II), and the effect persisted for one month after stimulation. As regard the Stage of disease, according to modified Hoehn and Yahr staging, there was an improvement in group II staging as nine patients improved to stage 2 where balance was regained and three patients in stage 5, as the severest stage, where patients were chair bound or bedridden improved partially to stage 4 and became able to walk unassisted with difficulty.
<strong>Conclusion:</strong> 5 Hz rTMS over M1 is superior to 1 Hz rTMS for motor symptoms of PD, particularly in advanced stages showing motor complication.
Repetitive transcranial magnetic stimulation,Parkinson's disease
https://amj.journals.ekb.eg/article_67801.html
https://amj.journals.ekb.eg/article_67801_bfef91eccd3f6aac7fe67e221d104670.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
BENEFIT OF ADDING SOFOSBUVIR TO INTERFERON AND RIBAVIRIN IN RETREATING CHRONIC HEPATITIS C PATIENTS NOT RESPONDING TO INTERFERON AND RIBAVIRIN
411
422
EN
Mohamed
Badry Bastawy
Department of Hepatogastroentrology and Infectious Diseases, Faculty of Medicine- Al-Azhar University
Medhat
Hassan El-Sahhar
Department of Hepatology and Gastroenterology, Police Hospitals
Sayed
Farouk Mohamed Ahmed
Department of Biochemistry, Faculty of Medicine- Al-Azhar University
Ahmed
Hanafy Ahmed Soliman Khattab
Department of Hepatology and Gastroenterology, Police Hospitals
ahmedkhattab78@yahoo.com
10.21608/amj.2020.68530
<strong>Background:</strong> Worldwide, more than one million people die each year from hepatitis C virus (HCV) related diseases, and over 300 million people are chronically infected with hepatitis B or C.<br /> <strong>Objective:</strong> Studying the benefit of adding sofosbuvir to pegylated interferon and ribavirin in chronic hepatitis C patients not responding to interferon and ribavirin as regards virological response and liver fibrosis regression.<br /> <strong>Patients and methods:</strong> A prospective study was conducted in cooperation with AL-AgouzaPoliceHospital. The enrolled patients were classified into two groups: Group (A): one hundred and fifty naïve patients with chronic HCV infection, and group (B): one hundred and fifty patients with chronic HCV infection who were non responders to prior treatment with pegylated interferon and ribavirin after at least 6 months of this treatment.<br /> Enrolled patients were treated using interferon (IFN) based regemin that included Pegylated INF alpha + ribavirin (weight based; 1200 mg if ≥ 75 Kg or 1000 if < 75 Kg of body weight) + sofosbuvir (400 mg/day for 12 weeks) according to National Committee for Control of Viral Hepatitis (NCCVH) hepatitis C treatment protocol update, May 2015.<br /> PCR was done 4 weeks after starting treatment (RVR), at the end of treatment (ETR), 12, 24, 48 weeks after the end of treatment to assess virological response in both groups.<br /> Fibroscan was done before treatment and 12-24 weeks after the end of treatment to assess liver fibrosis.<br /> <strong>Results:</strong> Of the 300 patients included, SVR12 was achieved in 275 patients (92%), SVR24 and SVR48 in 267 patients (89%). There was a statistically significant difference between both studied groups as regards SVR12, SVR24 and SVR48 where group (A) showed better virological response than group (B).<br /> Regression of fibrosis was achieved in both groups, and there was a statistically significant difference as regards pre-treatment and post-treatment fibroscan score in both groups.<br /> <strong>Conclusion:</strong> Adding Sofosbuvir to Interferon and Ribavirin in retreating chronic hepatitis C patients not responding to Interferon and Ribavirin improved the response of treatment and caused regression of liver fibrosis.
Sofosbuvir,Chronic hepatitis C,SVR12,regression of liver fibrosis
https://amj.journals.ekb.eg/article_68530.html
https://amj.journals.ekb.eg/article_68530_fee00b473b26f900ba7df48fe6af740c.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
ANTI-MICROBIAL ACTIVITY OF SILVER NANO PARTICLES (AG-NPS) ON BACTERIA ISOLATED FROM DIABETIC FEET
423
436
EN
Safia
Ahmed Amin
Botany and Microbiology Department, Faculty of Science, Cairo University
Mohamed
E. A. Dawood
Botany and Microbiology Department, Faculty of Science, Cairo University
mohamedeisa89@yahoo.com
Mohamed
Mahmoud
Biophysics Department, Faculty of Science, Cairo University
Doaa
Gheeth
Clinical Pathology Department, Faculty of Medicine, Cairo University
10.21608/amj.2020.68546
<strong>Background:</strong> Silver nanoparticles (Ag NPS) have long been known to have powerful antimicrobial activities.<br /> <strong>The aim of this study</strong>: to synthesize of silver nanoparticles (Ag NPS) in chitosan composite for possible use in biological application.<br /> <strong>Objective:</strong> Chitosan – silver nanoparticles composite materials was synthesized by adding AgNo3 0.5 gm and NaOH solution to chitosan solution at 120 c. Different concentrations of chitosan 0.05 % - 0.125 % - 0.25 % - 0.5 % were used for synthesis. Chitosan – silver nanoparticle composite materials were characterized by Ultraviolet visible spectroscopy (UV), particles size and zeta potential (NCS) and transmission electron microscopy (TEM). Bacteria isolated from diabetic feet were used to test the bactericidal efficiency of synthesized chitosan – silver nanoparticles composite materials. Results: The bacteriological tests showed either bacterial growth inhibition or cell death occurred depending on the concentration of chitosan used. Antibacterial effect of chitosan – silver nanoparticles composite materials increased by increasing chitosan concentration.<br /> <strong>Conclusion:</strong> The presence of Ag- nanoparticles in different concentrations of chitosan composite was enough to significantly enhance antibacterial activity.
silver nanoparticles (Ag NPS),Characterization,Diabetic feet,antimicrobial activity
https://amj.journals.ekb.eg/article_68546.html
https://amj.journals.ekb.eg/article_68546_d81cc8120d6c8ba28c5ca7df7745c754.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Serum Amyloid A as a novel marker to morbidly adherent placenta
437
446
EN
Khaled
Zakaria El-Sheikha
Department of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University
Abd El-Monsef
Abd El-Hamed Sedek
Department of Obstetrics & Gynecology,
Faculty of Medicine, Al-Azhar University
Ahmed
Abdul-Hameid Abo Zeid
Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University
Amr
Hassan Mohamed El-Shayeb
Department of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University
dramrelshayeb@gmail.com
10.21608/amj.2020.68555
<strong>Background:</strong> Placenta accreta is a placenta where the placental villi adhere directly to the myometrium, placenta increta is a placenta where placental villi invade into the myometrium, and a placenta percreta is a placenta where the placental villi invade through the myometrium and into the serosa. About 75% of morbidly adherent placentas are placenta accretas, 18% are placenta incretas, and 7% are placenta percretas.<br /> <strong>Objective:</strong> To detect the changes of serum amyloid A in women with morbidly adherent placenta, to assess the changes of serum amyloid A in women with morbidly adherent placenta and to assess use serum amyloid A as biological marker beside ultrasound & doppler findings for prenatal detection of morbidly adherent placenta.<br /> <strong>Patients and Methods:</strong> This study was conducted on women attending Al Azhar University Maternity Hospital, Obstetric clinic or emergency room and admitted to antepartum inpatient high-risk service. The current study had been conducted on 60 pregnant women who were divided into three equal groups as follows: Group I: placenta previa. Group II: placenta accreta or increta and Group III (control group): included normal pregnant women.<br /> <strong>Results:</strong> Regarding sensitivity and specificity of serum amyloid-A, maternal serum amyloid-A level ≥15.3 (μg/mL) had high specificity& PPV, and moderate sensitivity& NPV in differentiating previa group. Also, level ≥15.3 (μg/mL) had high specificity& PPV and low sensitivity& NPV in differentiating accreta group from control group. In addition to that maternal serum amyloid-A level ≥15.3 (μg/mL) had high specificity& PPV and low sensitivity& NPV in differentiating previa/accreta groups.<br /> <strong>Conclusion:</strong> Morbidly adherent placenta (MAP) was characterized by failure of the placenta to separate at delivery, with potential for significant perinatal and maternal morbidity and mortality. Detection of level of maternal SAA can be used as an additional tool to detect MAP.
Serum Amyloid A,placenta
https://amj.journals.ekb.eg/article_68555.html
https://amj.journals.ekb.eg/article_68555_c183058c7034ea4128a8b1539fd15d1b.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Assessment of the Endovascular Management of Flush Superficial Femoral Artery (SFA) Total Occlusion
447
456
EN
Mohamed
Abd El-Hamied Abd El-Rhman
Vascular Surgery Department, Al -Azhar University, Cairo, Egypt
Mohamed
Yahia Zakaria
Vascular Surgery Department, Al -Azhar University, Cairo, Egypt
Karim
Mohamady Eid Mohamady
Vascular Surgery Department, Al -Azhar University, Cairo, Egypt
karimalmohamady@gmail.com
10.21608/amj.2020.69751
<strong>Background:</strong> Involvement of the superficial femoral artery (SFA) in occlusive peripheral arterial disease (PAD) is extremely common representing 80% of the symptomatic patients undergoing angiography.<br /> <strong>Objectives:</strong> This study aimed to assess the endovascular management of flush SFA total occlusion in patients with PAD and with critical chronic lower limb ischemia due to flush occlusion of the SFA in the Vascular Surgery Department in Al-Azhar University Hospitals.<br /> <strong>Patients and Methods:</strong> Patients with chronic PAD and aged 40–65 years, with SFA flush total occlusion including heavily calcified, long, and fibrotic lesions, and the occlusions up to 15 cm long in the SFA were included in the current study. Patients were subjected either to contralateral approach, ipsilateral antegrade approach, ipsilateral horizontal puncture, or retrograde access to the SFA via popliteal or dorsalis pedis.<br /> <strong>Results:</strong> An overall 20 patients were enrolled in the current study with a mean age of 59.5± 6.77 years. There were 55% females and 45% males. The risk factors distribution among the studied group were diabetes mellitus (100%), hypertension (65%), smoking (65%), chronic hepatic disease (65%), dyslipidemia (55%), and only 5% had chronic vascular disease. Patients were clinically presented by toe gangrene (35%), followed by foot gangrene (25%), as the main presentation.<br /> <strong>Conclusion:</strong> Endovascular management strategies of flush SFA total occlusion in patients with PAD due to SFA total occlusion can be safely used with acceptable technical success, short term patency rates, and limb salvage.
Angioplasty-Stents,endovascular
https://amj.journals.ekb.eg/article_69751.html
https://amj.journals.ekb.eg/article_69751_724d9c55f0568af945deab5a15b5f1ed.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Comparative study between spontaneous fungal peritonitis (SFP) and spontaneous bacterial peritonitis (SBP) in patients with end stage liver disease (ESLD)
457
468
EN
Mohamed
El-Nadry
Hepato-Gastroenterology, Departments, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Abdallah
H. El-Shahat
Hepato-Gastroenterology, Departments, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mohamed
Abo-Ghabsha
Clinical-Pathology Departments, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Amr
G. Basiouny
Hepato-Gastroenterology, Departments, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
miroman1a@hotmail.com
10.21608/amj.2020.68846
<strong>Background:</strong> Bacterial infections in end stage liver disease are common and associated with increased mortality. Although extensive research has elucidated the impact of bacterial infections as the major precipitating event leads to increased frequency of liver-related complications and mortality in these patients.
<strong>Objective: </strong>Evaluating the clinical and laboratory characters, risk factors, and outcome of fungal and bacterial peritonitis in cirrhotic patients with end stage liver disease (ESLD).
<strong>Patients and Methods:</strong> This cross sctional study enrolled 60 patients with liver cirrhosis and ascites. Fifty patients were culture-positive spontaneous peritonitis, including 12 with spontaneous fungal peritonitis (SFP), and 38 culture-positive spontaneous bacterial peritonitis (SBP), and 10 patients without clinical or laboratory evidence of peritonitis as a control group, during the study period, between 1st February 2018 and 30th May 2019. We compared the clinical, laboratory findings, Child–Pugh scores, model for end stage liver disease (MELD) score, risk factors, and mortality rates between patients with spontaneous peritonitis associated with fungal culture-positive ascites, and those with spontaneous peritonitis associated with bacterial culture-positive ascites.
<strong>Results:</strong> Patients of the current study were critically ill. The mean duration of ESLD in the studied patients was 4.75 ± 1.8 year, 57 patients (95.0%) were Child score C, and 3 patients (5%) were Child score B. The mean MELD score was 23.32 ± 5.49. All patients with evidence of peritonitis were Child C, and mean MELD scores were 22.6 ±5.7 and 26.1±4.5 in SBP and SFP groups respectively. Jaundice, GI bleeding and hepatic encephalopathy were significantly for clinical presentation and predictors of mortality in SFP group compared to SBP and control group. Lower levels of hemoglobin (Hb), S. albumin and platelets count and increased level of total leukocytic count (TLC), international normalized ratio (INR), and bilirubin were significantly higher in SFP group compared to SBP and control group.
Duration of ESLD and hospital admission was significant in SFP compared to SBP and control group. HCC was evident in SFP group (66.7%) that was highly significant in comparison to SBP (28.9%), and control group (20%). Overall mortality rate among the studied groups was 45%, the mortality rate was significantly increased in SFP group (75%) compared to SBP (42.1%), and control group (20%).The mean MELD score significantly increased in non-survival group compared to survival group . The duration of ESLD significantly increased in non-survival group compared to survival group.
<strong>Conclusion:</strong> Prolonged and severe underlying liver disease with a high Child- Pugh or MELD score, renal impairment, HCC, and onset of severe sepsis have been reported as risk factors in increased mortality in patients with SFP than in SBP. In SFP, mortality was associated not only with the severity of the underlying liver disease, but also with delay in diagnosis and initiation of antifungal therapy.
Fungal infection,Liver cirrhosis,spontaneous fungal peritonitis
https://amj.journals.ekb.eg/article_68846.html
https://amj.journals.ekb.eg/article_68846_95586b6641eef341f1757c6bcd118354.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
CORRELATION BETWEEN PLASMA LEAD AND SERUM ANTI MULLERIAN HORMONE LEVELS IN WOMEN WITH PREMATURE OVARIAN FAILURE
469
480
EN
Yehia
Abd El-Salam Wafa
Departement of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
EL-Sayed
Mohammad Taha
Departement of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
Abd El-Raouf
Abd El-Raouf Abo Nar
Departement of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
Ateia
Ahmad Ateia
Departement of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
drateia4886@yahoo.com
10.21608/amj.2020.82566
<strong>Background:</strong> Lead is a highly toxic metal to humans, with the injurious effects on the hemopoietic, nervous and reproductive system. Lead crosses the placenta during pregnancy and has been associated with intrauterine death, prematurity and low birth weight.
<strong>Objective:</strong> To collate between plasma lead and serum antimullerian hormone levels in women with premature ovarian failure, by estimation of level of Anti Mullerian Hormone (AMH), Follicular Stimulating Hormone (FSH), Estradiol (E2) and plasma Lead level.
<strong>Subjects and Method:</strong> This study was conducted in Al Azhar University Hospital outpatient clinics after approval of the research and ethical committee during the period from December 2015 to December 2018. Study groups were: Group 1 included 50 normal candidate women under 40 years old has regular menstrual cycles (21-35 days), fertile (at least one natural pregnancy carried to term), and serum FSH was less than 10 mlU/ml, Group 2 included 50 patients with premature ovarian failure who aged under 40 years with absence of spontaneous menstrual bleeding for more than 12 months, serum estradiol level was less than 25pg/ml, serum FSH level more than 40 mlU/ml. AMH, plasma lead level in patients with premature ovarian failure diagnosed and correlated with level of serum FSH with the normal control group.
<strong>Results:</strong> There was a statistically significant positive correlation between plasma lead levels with FSH among the study group. On the other hand, there was no statistically significant correlation between plasma lead level and AMH level.
<strong>Conclusion:</strong> The anti mullerian hormone showed a significant difference between the cases of premature ovarian insufficiency and the control group. Moreover, AMH was a good marker for ovarian reserve and ovarian response for gonadotropins simulation. Chronic exposures to heavy metals, especially lead, affected the ovarian function and impairment in folliculogenesis which increased the incidence of Premature Ovarian Failure (POF) especially in rural area due to the low socioeconomic status.
Plasma Lead,Anti mullerian Hormone and Premature Ovarian Failure
https://amj.journals.ekb.eg/article_82566.html
https://amj.journals.ekb.eg/article_82566_1abc5087feb3b2434ee7b64d6f4b629b.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Comparative Study between incidence of Helicobacter Pylori Infection in Women with Hyperemesis Gravidarum and Normal Pregnancy
481
490
EN
Fahd
Abd El-Aal Al-Omda
Departments of Obstetrics & Gynecology, Faculty of Medicine, Al- Azhar University
Ashraf
Hamdy Mohamed
Departments of Obstetrics & Gynecology, Faculty of Medicine, Al- Azhar University
Mahmoud
Abd El-Latif Hashish
Clinical Pathology, Faculty of Medicine, Al- Azhar University
Mohamed
Abd Allah Bedier Abd Allah
Departments of Obstetrics & Gynecology, Faculty of Medicine, Al- Azhar University
abdallahmohmed892@gmail.com
10.21608/amj.2020.68899
<strong>Background:</strong> Nausea and vomiting in early pregnancy is so common that it can be considered a normal part of pregnancy. It is referred to as "morning sickness" although this is a misnomer because symptoms will often persist throught the day. Nausea and vomiting occurs significantly more often in primigravidas and women who were less educated younger-nonsmokers, obese or those with a history of nausea and vomiting in previous pregnancy.
<strong>Objective:</strong> This work aimed at assessing the possible relation between H. Pylori infection and hyperemesis gravidarum (HG).
<strong>Patient and Methods:</strong> Study setting: Al Azhar University Hospitals (Al_ Hussein and Sayed Galal), <strong>Duration of study:</strong> November 2018 to May 2019. The Study included two groups Group (A): (Thirty) pregnant women with hyperemesis gravidarum in the first trimester attending at antenatal clinics and admitted in the ward in addition to Group (B): (Thirty) normal pregnant women with antenatal care. The pregnant women with hyperemesis gravidarum, aged 18-40 years old and less than 16 weeks gestation.
<strong>Results:</strong> The current study found significant difference between two groups regarding positivity of HPSA. Positive stool antigen were found in 26 out of 30 of hyperemesis gravidarum (86.7%) compared with 11 out of 30 controls (36.7%) and highly statistical significant difference between studied groups as regard H pylori antibodies.
<strong>Conclusion:</strong> There was a significant association between Helicobacter Pylori infection and pathogenesis of hyperemesis gravidarum.
Hyperemesis gravidarum
https://amj.journals.ekb.eg/article_68899.html
https://amj.journals.ekb.eg/article_68899_9ccfa4c293f98fe6fca631f0c6d5b706.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
ASSOCIATION BETWEEN NEUTROPHIL TO LYMPHOCYTE RATIO AND INFLAMMATORY MARKERS IN HEMODIALYSIS PATIENTS
491
502
EN
Hafez
Ahmed Abd El-Hafeez
Departments of Internal Medicine,Faculty of Medicine, Al-Azhar University-Cairo, Egypt
Ahmed
Mohammed Al-Ashkar
Departments of Internal Medicine,Faculty of Medicine, Al-Azhar University-Cairo, Egypt
Nagah
Mohamed Abo Mohamed
Departments of Clinical Pathology, Faculty of Medicine, Al-Azhar University-Cairo, Egypt
Mohammed
Ibrahim Khalil
Departments of Internal Medicine, Faculty of Medicine, Al-Azhar University-Cairo, Egypt
dr_zohair@yahoo.com
10.21608/amj.2020.82567
<strong>Back ground:</strong> Hemodialysis patients have an inflammatory state which is attributed to their morbidity and mortality compared to the general population.
<strong>Objective:</strong> To study the association between neutrophil to lymphocyte ratio and other inflammatory markers: (Interleukin-6 (IL-6), high sensitive C reactive protein (hs-CRP), and other inflammatory markers) in hemodialysis patients.
<strong>Patients and methods:</strong> Forty two hemodialysis patients. Participated in this study. They divided into two groups. Group I: Patients whose hs-CRP > 10 mg. Group II: Patients whose hs-CRP < 10 mg. The association between neutrophil to lymphocyte ration and the other inflammatory markers war studied.
<strong>Results:</strong> 69% of the patients (29 patient) whose hs-CRP were more than 10 mg and 31% of the patients (13 patients) whose hs-CRP were less than 10 mg. Additionally, there has been a positive correlation between neutrophil to lymphocyte ratio and interleukin-6 along with platelet to lymphocyte ratio. Moreover, interleukin 6 that indicated inflammation in hemodialysis, was more than 30 ng. Further, the value of neutrophil to lymphocyte ratio which represented the inflammation in hemodialysis patients, was equal or more than 1.6.
<strong>Conclusion:</strong> Cardiovascular condition of hemodialysis patients affects their morbidity and mortality. Consequently, it could be assessed by neutrophil to lymphocyte ratio which has high specificity and sensitivity.
CRP,WBCs,ESR,ulcerative colitis
https://amj.journals.ekb.eg/article_82567.html
https://amj.journals.ekb.eg/article_82567_4073c7dd1059c52c021e76795ca93aa6.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
DEXMEDETOMIDINE AS AN ADJUVANT FOR INTRAVENOUS REGIONAL ANESTHESIA IN UPPER LIMB SURGERIES
503
512
EN
Mostafa
A. Abo El-Enin
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
Ahmed
M. El-Garhy
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
Ahmed
M. Abd El-Geleal
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
Hamza
M. Elewa
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
wezza.elzamalkawy@gmail.com
10.21608/amj.2020.82568
<strong>Background:</strong> Intravenous regional anesthesia (IVRA) is an anesthetic technique for surgical procedures on the body's extremities where a local anesthetic is injected intravenously.
<strong>Objective:</strong> To compare between the intravenous regional anesthesias using lidocaine only and lidocaine plus dexmedetomidine as regards onset of sensory and motor block, intraoperative hemodynamic effects, onset of tourniquet pain and postoperative pain assessment.
<strong>Patients and Methods:</strong> This study included 60 patients of both sex admitted for forearm surgeries carried out at Al-Azhar University Hospitals (El-Hussein and Bab El-Sha'arya). They were randomly allocated into two equal groups. <strong>Group I:</strong> lidocaine group received only lidocaine. <strong>Group II:</strong> received lidocaine plus dexmedetomidine. The following parameters were assessed between the two groups: onset of sensory and motor block, hemodynamics (MAP, HR and SpO2), onset of tourniquet pain and postoperative pain scoring.
<strong>Results:</strong> There is a statistically significant increase of the mean of Group II compared to Group I according to onset of sensory block (min). Also, there was a statistically significant increase mean of Group II compared to Group I according to onset of motor block (min).
<strong>Conclusion:</strong> Dexmedetomidine as adjuvant to lidocaine in intravenous regional anesthesia produces early onset of sensory and motor block, delayed onset of tourniquet pain, lower postoperative visual analogue score, longer duration of postoperative analgesia.
Dexmedetomidine,Intravenous regional anesthesia,upper limb,Surgery
https://amj.journals.ekb.eg/article_82568.html
https://amj.journals.ekb.eg/article_82568_6dccd31c1ec55ec19a536fe3003a9b2f.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
LATERAL DIVERGENT PINNING VERSUS LATERAL PARALLEL PINNING IN MANAGEMENT OF SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN
513
524
EN
Ahmed
Abd El-Hamid Shamma
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Egypt
Mohamed
Moawad Abd El-Motalb
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Egypt
Eslam
Mohammed El-Saied Abd El-Hamed Tash
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Egypt
dr.eslam.tash@gmail.com
10.21608/amj.2020.82569
<strong>Background:</strong> Supracondylar humerus fracture in children is a very common elbow injury. The commonly accepted treatment of type II and III supracondylar fractures of humerus in children is closed reduction with percutaneous pinning. Lateral pinning has an advantage of avoiding the possibility of iatrogenic ulnar nerve injury.
<strong>Objective: </strong>This study was conducted to compare the stability of lateral divergent pinning and lateral parallel pinning in treatment of type II and type III supracondylar humerus.
<strong>Patients and Methods:</strong> A prospective, randomized, single Centre, study was conducted at the Emergency Department of Al-Azhar university hospitals from March 2019 to November 2019. Thirty children with supracondylar humerus fracture Gartland type IIB and type III were treated with two techniques: lateral divergent (15 patients), and lateral parallel (15 patients). All of them were included for the study and analysis of results regarding functional outcome and graded according to Flynn`s criteria and Baumann’s angle.
<strong>Results:</strong> Thirty children were treated for displaced supracondylar fracture of humerus during the study period, 9 females and 21 males, and mean age was 5.1 years. The mean duration from admission to surgery was 17.3 hours; the mean follow-up duration was 3 months. In lateral divergent pinning group, 14 patients with excellent result and one good. In lateral parallel pinning technique 13 patients with excellent and 2 good.
<strong>Conclusion:</strong> There was no statistically significant difference with regard to functional outcome between the two groups. Both methods produced satisfactory results in all cases.
Supracondylar fracture humerus,divergent,Parallel,Lateral,Kirschner wires
https://amj.journals.ekb.eg/article_82569.html
https://amj.journals.ekb.eg/article_82569_c3f9f6974f742187be47c3f0b56c4050.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
PREVALENCE OF KERATOCONUS IN PATIENT COMING FOR LASIK FOR CORRECTION OF MYOPIA OR MYOPIC ASTIGMATISM
525
532
EN
Mahmoud
Mohamed Ismail
Departments of Ophthalmology, Faculty of Medicine, Al-Azhar University
Abd Al-Ghany
Ibrahim Abd Al-Ghany
Departments of Ophthalmology, Faculty of Medicine, Al-Azhar University
Mohamed
Sabry Mohamed
Departments of Ophthalmology, Faculty of Medicine, Al-Azhar University
drmsm788@gmail.com
10.21608/amj.2020.82570
<strong>Background:</strong> Keratoconus (KC) is a corneal collagen disorder in which the central portion of the cornea becomes thinner and bulges forward in a cone-shaped fashion resulting in myopia, irregular astigmatism, and eventually visual impairment.
<strong>Objective: </strong>Use of Pentacam topography to detect the prevalence of keratoconus and keratoconus suspect in patients coming for LASIK for correction of myopia and myopic astigmatism.
<strong>Patients and methods:</strong> A retrospective non-randomized clinical study included 1000 eyes of 500 patients coming for LASIK for correction of myopia and myopic astigmatism. All patients had undergone full ophthalmic history, history of ocular surgeries, complete ophthalmic examination (visual acuity, uncorrected visual acuity (UCVA) & best corrected visual acuity (BCVA), anterior segment examination using Slit-lamp biomicroscopy, intraocular pressure (IOP) measurement by applanation tonometry and fundus examination. In this retrospective clinical study, data from Pentacam (Allegro Oculyzer) such as K readings, corneal thickness, thinnest location and cylinder was retrieved from patient’s records coming for LASIK in the period from August 2018 to July 2019 to detect keratoconus and keratoconus suspect.
<strong>Results:</strong> In our study, there was high prevalence of keratoconus. It was 6.6 %, which was more than the commonly cited figures of (0.05–0.23%) for western countries. Conclusion: This study showed that the prevalence of keratoconus in patients seeking refractive surgery was 6, 6 % and the incidence of keratoconus suspect was 2, 6 %, this high incidence of keratoconus in these sample groups reflects the high incidence of keratoconus in the general population of Middle East countries compared with the western countries.
Keratoconus,deep anterior lamellar keratoplasty,laser in situ keratomileusis,Penetrating keratoplasty
https://amj.journals.ekb.eg/article_82570.html
https://amj.journals.ekb.eg/article_82570_1f2e95e89ba2cc558ab68ec78089ca4d.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
COMPARATIVE STUDY BETWEEN INFERIOR OBLIQUE RECESSION AND INFERIOR OBLIQUE RETRO-EQUATORIAL SCLERAL FIXATION (MYOPEXY) IN MANAGEMENT OF PRIMARY INFERIOR OBLIQUE OVER ACTION
533
540
EN
Mahmoud
Mohamed Ismail
Department of Ophthalmology, Al-Azhar Faculty of Medicine,Cairo, Egypt
Mohamed
Mahmoud Whdan
Department of Ophthalmology, Al-Azhar Faculty of Medicine,Cairo, Egypt
Heba
Metwally Ali
Department of Ophthalmology, Al-Azhar Faculty of Medicine,Cairo, Egypt
Ahmed
Samir Abbas
ahmed.samir.elfikky@gmail.com
10.21608/amj.2020.82571
<strong>Background:</strong> Weakening procedures on the inferior oblique muscle are numerous and include myectomy, graded recession- anteriorization, anterior transposition, anterior and nasal transposition, myotomy, marginal myotomy, nasal myotomy, disinsertion, and denervation and extirpation. Recently, New surgical Intervention for weakening of the inferior oblique muscle is inferior oblique retro-equatorial scleral fixation ( Myopexy).<br /> <strong>Objective:</strong> The aim of the study was to compare between recession of inferior oblique muscle(IO) and retroequatorial scleral fixation (myopexy) of inferior oblique muscle in management of primary inferior oblique over action.(IOOA)<br /> <strong>Patients and Methods:</strong> Thirty patients (60 eyes) presented by horizontal strabismus and primary inferior oblique over action, met the inclusion criteria, and were divided into two equal groups: Group A treated by recession of the inferior oblique muscle. And Group B treated by retro-equatorial scleral fixation (myopexy) of the inferior oblique muscle.<br /> <strong>Results:</strong> Both IO graded recession and IO myopexy were equally effective in correcting the degree of IOOA (elevation in adduction) , correcting associated pattern,with no statistical significant difference and both were equally effective in correcting the degree of objective fundus extorsion with no statistical significant difference.<br /> <strong>Conclusion:</strong> Our findings suggested that both surgical groups had positive outcomes, with good response and effect which was stable all over follow up visits uptill 6 months.
Inferior Oblique Muscle,Graded Recession,Myopexy,V pattern,torsion
https://amj.journals.ekb.eg/article_82571.html
https://amj.journals.ekb.eg/article_82571_4942fcbfaa04dde9fd8820ed525f327a.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
HYSTEROSALPINOGRAPHY VERSUS DIAGNOSTIC LAPAROSCOPY IN ASSESSMENT OF TUBAL PATENCY
541
550
EN
Mostafa
H. Hegab
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
Ahmed
S. Mohammed
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
Ahmed
M. Khalil
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
alwforever@gmail.com
10.21608/amj.2020.82572
<strong>Background:</strong> Investigations of tubal factor of infertility include hystero-salpingography, saline infusion sonohysterography as well as diagnostic laparoscopy with chromotubation. Hysterosalpingography (HSG) is a contrast study of the uterine cavity and fallopian tubes.<br /> <strong>Objective:</strong> To compare the role of laparoscopy and hysterosalpingograpy in the assessment of tubal factor of infertility.<br /> <strong>Patients and Method:</strong> This study was carried out on eighty patients attending the gynecology outpatient clinic of Al-HusseinHospital, Al-AzharUniversity. It included forty patients with primary infertility and forty patients with secondary infertility, all with minimum duration of one year after taking a written consent. complete laboratory investigation was done including CBC, PT, PTT, INR, HBV, HCV, HIV, Cr, Urea, ALT, AST. This study started at Oct 2017 and finished at Aug 2019.<br /> <strong>Results: </strong>Results of comparison of tubal patency assessment during Laparoscopy and its compatibility with previous hysterosalpingography results in case of female infertility were: In 55 cases that were diagnosed as free from tubal block by diagnostic laparoscopy {DL}, only 40 cases were confirmed by HSG (73.2%), while the other 11 cases were diagnosed as (2 cases bilateral block (4.9%), 4 cases Lt. block (9.8%), 3 cases minimal spill (7.3%) and 2 cases as Rt. Block (4.9%). In the 9 cases that were diagnosed as bilateral tubal block by DL, only 4 were confirmed by HSG (42.9%), while the other 5 cases were diagnosed free by HSG (57.1%). Twelve cases were diagnosed as unilateral tubal block by DL, 3 cases were confirmed by HSG, while 7 cases were diagnosed as free and one case was diagnosed as bilateral block by HSG. Peritubal adhesions were seen in 18.3% in all cases, of which 18.8% had Rt block, 27.3% had Lt block, and 54.5% had bilateral tubal patency. In 11 cases diagnosed as unilateral peritubal adhesion by DL, only 2 cases (Rt & Lt) were confirmed by HSG (39.3%). Fifty three cases were diagnosed as the Rt tube was free of adhesion by DL, 4 cases HSG were diagnosed as Rt peritubal adhesion (7.5%), while 56 cases were diagnosed as Lt tube free of adhesion by DL and 5 cases HSG were diagnosed as Lt peritubal adhesion (8.9%).<br /> <strong>Conclusion:</strong> Diagnostic laparoscopy has more accuracy in assessment of tubal patency in infertile patients more than hysterosalpingogram.
Hysterosalpinography diagnostic laparoscopy,tubal patency
https://amj.journals.ekb.eg/article_82572.html
https://amj.journals.ekb.eg/article_82572_bfd226b19085512315c7002bbeceee71.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Steroidal versus non-steroidal eye drops in prevention of cystoid macular edema after cataract extraction in diabetic patients
551
562
EN
Abdullah
E. Abd El-Gawad
Department of Ophthalmology, Faculty of Medicine, Al Azhar University
Mohamed
Mohamed-Aly Ibrahim
Department of Ophthalmology, Faculty of Medicine, Al Azhar University
Amr
Ahmed A. El-Ganainy
Department of Ophthalmology, Faculty of Medicine, Al Azhar University
amrganainy7@gmail.com
10.21608/amj.2020.68918
<strong>Background:</strong> Cystoid macular edema (CME) is addressed as one of the most important complication responsible for suboptimal visual acuity outcome after cataract surgery.
<strong>Objective:</strong> Comparison between topical steroids versus NSAIDs regarding ability to reduce CME after uneventful cataract surgery of foldable intraocular lens (IOL) implantation in diabetic patients.
<strong>Patients and methods:</strong> In this study, 30 patients underwent phacoemulsification surgery with posterior chamber foldable intraocular lens implantation in Ophthalmology Department, Al-AzharUniversityHospital between December 2017 and November 2018. Patients were randomly categorized into 2 groups. Group 1: Nepafenac eye drops (0.1%) 3 times daily for one month, Group 2: Prednisolone eye drops (1%) 5 times daily for one month.
<strong>Results:</strong> At the end of the follow up, foveal thickness changes in optical coherence tomography (OCT) were found to be slightly less in the no steroidal anti-inflammatory eye drops (NSAIDs) group than in the steroidal group with no significant change in the final visual outcome between the two groups.
<strong>Conclusion:</strong> There was no significant statistical difference between NSAIDs drops and steroids drops in prevention of development of pseudophakic macular edema post cataract surgery.
CME,NSAIDs,IOL,OCT
https://amj.journals.ekb.eg/article_68918.html
https://amj.journals.ekb.eg/article_68918_0a7dca590d28e041c20184346127161c.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Comparative study between Traditional and Stapled Gastrointestinal Anastomosis
563
572
EN
Ahmed
Abd El-Aziz Abd El-Ghaffar
Department of General Surgery, Faculty of Medicine, Al-Azhar University
Waleed
Ra´fat Abd El-Aaty
Department of General Surgery, Faculty of Medicine, Al-Azhar University
Hossam
Mohamed Badry Bastawi
Department of General Surgery, Faculty of Medicine, Al-Azhar University
hossam.bastawi@hotmail.com
10.21608/amj.2020.68819
<strong>Background:</strong> Intestinal anastomosis is a surgical procedure performed to establish communication between two formerly distant portions of the intestine. This procedure restores intestinal continuity after removal of a pathologic condition affecting the bowel. Intestinal anastomosis is one of the most commonly performed surgical procedures, especially in the emergency setting, and is also commonly performed in the elective setting when resections are carried out for benign or malignant lesions of the gastrointestinal (GI) tract.
<strong>Objective:</strong> The aim of this work was to compare single layer, double layers and stapler intestinal anastomosis (Stomach, Stomach to small, small to small, small to large, large to large) in abdominal procedures and to evaluate the effectiveness of these procedures as regards to its integrity and complications including leakage.
<strong>Patients and Methods:</strong> Prospective study on 50 patients presented with symptoms and signs suggestive for gastric operations, intestinal surgeries, resection and anastomosis according to inclusion and exclusion criteria. Cases were selected from Al-AzharUniversityHospitals and PublicHealthHospitals from March 2018 till June 2019.
<strong>Results:</strong> There were high statistically significance between two groups in intra-operative bleeding, time and cost of operation as 23 patients of stapled group suffered minimal to mild bleeding, high operation cost and less time of procedure while 27 patients suffered minimal to moderate intra-operative bleeding, lower operation cost and longer procedure time. The analysis showed high significance between two groups in post-operative oral nutrition and discharge from hospital as patients underwent stapled anastomosis were allowed for oral nutrition 8 to 24 hours postoperatively and were discharged after 1 to 3 days, while patients underwent traditional anastomosis were allowed for nutrition after 5 to 7 days postoperatively and were discharged after 5 to 10 days.
<strong>Conclusion:</strong> Stapled gastrointestinal anastomosis consumes lesser time at operation room, less intraoperative bleeding, early recovery and oral nutrition of patients, but has higher cost. Traditional gastrointestinal anastomosis consumes longer time at operation room, relatively more intraoperative bleeding, late recovery and oral nutrition of patients, but has lower cost. Both types of gastrointestinal anastomosis has the same postoperative co-morbidities.
Gastrointestinal anastomosis,hand-sewn,Stapled
https://amj.journals.ekb.eg/article_68819.html
https://amj.journals.ekb.eg/article_68819_56162c2f6666b025ba1093b8b8f50029.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
COMPARATIVE STUDY BETWEEN NASAL PACKING WITH CARBOXY METHYL CELLULOSE AND LATEX GLOVED MEROCEL IN THE SAME PATIENT AFTER FUNCTIONAL ENDOSCOPIC SINONASAL SURGERY
573
584
EN
Mohammed
Abd Al-Fattah Al-Tawy
Otorhinolaryngology, Faculty of Medicine, Al-Azhar Universtiy
Ayman
Abd Al-Aziz Al-Shahally
Otorhinolaryngology, Faculty of Medicine, Al-Azhar Universtiy
Ahmed
Mohammed Al-Didamouny
Otorhinolaryngology, Faculty of Medicine, Al-Azhar Universtiy
doctooooor15@gmail.com
10.21608/amj.2020.82574
<strong>Background:</strong> Nasal packing after functional endoscopic sinus surgery (FESS) is used as a standard procedure to control the postoperative bleeding, promote the mucosal healing and to prevent synechiae formation, but traditional non-resorbable packs have several disadvantages. The optimum solution to minimize these disadvantages may be accomplished using the new biodegradable packs.
<strong>Objectives:</strong> This study was done to compare between the effect of carboxy methyl cellulose (CMC) foam nasal pack and latex gloved merocel (LGM) nasal pack in the same patient after FESS regarding the prevention of postoperative bleeding, pain and synechiae formation.
<strong>Patients and Methods:</strong> A prospective, randomized, single-blinded controlled study was performed in 35 patients with bilateral chronic rhinosinusitis who were collected from ENT outpatient clinic of Al-HusseinUniversityHospital from Feb. 2019 to Nov. 2019. All patients underwent bilateral FESS by a single surgeon. At the end of the operation, each patient was packed with dissolvable CMC foam nasal pack in one nasal cavity and latex gloved merocel nasal pack in the other side. The hemostatic effect of the CMC foam and latex gloved merocel was assessed during the recovery period. Pain levels were recorded by the patients on a visual analogue scale 2, 6, 12 and 24 hours after surgery and at the time of packing removal. The effectiveness of prevention of synechiae formation was assessed endoscopically 4 and 8 weeks after surgery.
<strong>Results:</strong> There was no statistically significant difference between CMC group and LGM group as regard their effect on control the postoperative bleeding. Only five (14.3%) of the CMC group had primary postoperative bleeding, and it occurred in three (8.6 %) of gloved merocel group. The mean level of patient pain was 0.98 (Range: 0-2) in CMC group, but was 1.65 (Range: 1-3) in latex gloved merocel group which is statistically significant. As regarding synechiae formation, the difference between both groups was statistically insignificant at the 4 weeks period] Two (5.7%) of CMC group and five (14.3 %) of LGM group developed a synechiae [and statistically significant at the 8 weeks period] three (8.6%) of CMC group and nine (25.7 %) of gloved merocel group developed synechiae].
<strong>Conclusion:</strong> Dissolvable CMC foam nasal pack was associated with very low levels of localized pain, and with low levels of postoperative bleeding and synechia formation.
Endoscopic sinus surgery,Carboxymethyl Cellulose,Merocel,Resorbable,Nasal synechia,Nasal packing,Nasal complications
https://amj.journals.ekb.eg/article_82574.html
https://amj.journals.ekb.eg/article_82574_a2dfcbc4854890be9445ced9c28ac6d3.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
GRAPE SEED EXTRACT VERSUS CAPTOPRIL IN AMELIORATING 5-FLUOROURACIL-INDUCED NEPHROTOXICITY IN ADULT MALE ALBINO RATS: BIOCHEMICAL, HISTOLOGICAL AND IMMUNOHISTOCHEMICAL STUDY
585
610
EN
Wesam
Abd El-Salam Abd El-Wahab
Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
w_abdalwahab@azhar.edu.eg
Amal
Abd El-Majid Ahmed
Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
amalabdelmeged.medg@azhar.edu.eg
Mona
Mohamed Abd El-Galil
0000-0002-8837-5717
Histology Department, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
medicalmona2009@yahoo.com
10.21608/amj.2020.82575
<strong>Background:</strong> 5-Fluorouracil (5-FU) is one of the extensively used chemotherapeutic agents for different human malignancies. It has severe side effects and is considered a nephrotoxic agent. Captopril is one of the angiotensin-converting enzyme inhibitors (ACEI) used in treatment of hypertension and congestive heart failure. It is also an effective radical scavenger and antioxidant due to its free thiol group. Grape seeds extract is one of the effective radical scavengers with antioxidant, anti-proliferative and anti-inflammatory properties.
<strong>Objective:</strong> The present study was designed to assess the probable protective role of captopril and grape seeds extract against 5-FU-induced nephrotoxicity in adult male albino rats.
<strong>Materials and Methods:</strong> Forty eight adult male albino rats were divided into 8 equal groups;
Group I kept as the control group, Group II (grape seeds consumed group), received aqueous grape seeds extract (500 mg/kg/day) orally by gastric tube. Group III (captopril group), injected intraperitoneally by captopril solution (60 mg/kg) once daily. Group IV (grape seeds & captopril), Group V (5-Fluorouracil group), injected intraperitoneally by 5-FU solution (20 mg/kg) once daily. Group VI (grape seeds/5-FU), Group VII (captopril/5-FU) and Group VIII (grape seeds & captopril/5-FU). Treatment was continued at the same time daily for 4 weeks. At the end of the experiment, final body weight, blood urea nitrogen (BUN), creatinine (Cr) and uric acid levels were measured. Also, specimens of right kidneys were taken for histological and immunohistochemical studies with anti-inducible nitric oxide synthase (iNOS).
<strong>Results:</strong> 5-FU resulted in a significant reduction in final body weight and a significant elevation of (BUN), (Cr) and uric acid levels. Moreover, glomerular and tubular distortion, vacuolated epithelial lining, intraluminal acidophilic hyaline casts, congested peritubular capillaries, interstitial inflammatory infiltration, and increased fibrosis within the renal interstitium. The immunohistochemical expression of iNOS supported kidney impairment in the 5-FU group. Treatment with either grape seeds or captopril revealed some improvement in the final body weight, biochemical markers and histological changes. The best effect was encountered when grape seeds and captopril were combined.
<strong>Conclusion: </strong>and Recommendation: Grape seeds and captopril succeeded in ameliorating 5-FU induced nephrotoxicity with a better effect by their combination. So, it is recommended to use grape seeds extract and captopril during chemotherapy with 5 fluorouracil to reduce its renal toxicity.
Chemotherapy,5-Fluorouracil,grape seeds,captopril,Nephrotoxicity
https://amj.journals.ekb.eg/article_82575.html
https://amj.journals.ekb.eg/article_82575_7e02b740030f089fac60c6e5d28182d1.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
NANO FAT COMBINED WITH PLATELET RICH PLASMA INJECTION VERSUS NANO FAT INJECTION ALONE IN THE TREATMENT OF ATROPHIC SCAR
611
620
EN
Mamoun
El-Sayed Shalaby
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University
Shady
Mahmoud Attia Ibrahim
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University
Mohammed
Nasser Abdulhay Hassanin
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University
mohdnasser1990@gmail.com
10.21608/amj.2020.69752
<strong>Background:</strong> An atrophic scar is an indented scar that heals below the normal layer of skin tissue. Atrophic scars form when the skin is unable to regenerate tissue. As a result, it leaves behind imbalanced scarring.
<strong>Objective:</strong> To evaluate the efficacy and safety of the autologous emulsified fat transfer with or without platelet rich plasma in the treatment of atrophic scar.
<strong>Patients and methods:</strong> This study was carried out at Dermatology Department, Al-HusseinUniversityHospital, Faculty of Medicine, Al-AzharUniversity. This study included 60 patients with atrophic scar divided into 2 equal groups: group (A) treated with nanofat and platelet rich plasma, and group (B) treated with nanofat only. Scar in both groups caused by different etiological factors, their ages ranged from 19 to 59 years with 40 males and 20 females on a period from March 2019 to December 2019.
<strong>Results:</strong> No significant differences between group A and group B after treatment, revealing that the corner stone of significance created by nanofat injection including adipose derived stem cells and growth factors without obvious clinical and statistical significance of additional platelet rich plasma.
<strong>Conclusion:</strong> Nanofat injection has been shown to have beneficial effects in the treatment of atrophic scar, wrinkles, and skin discolorations, being highly effective in improving the height and pliability of all scars with mild improvement in pigmentation and vascularities, addition of platelet rich plasma to nanofat showed the same result which treated.
Nano fat,platelet rich plasma,Atrophic scar
https://amj.journals.ekb.eg/article_69752.html
https://amj.journals.ekb.eg/article_69752_5f6d770240b4e3c4f6b86a5bc0084c77.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Ambulatory blood pressure measurement and assessment of arterial stiffness in individuals with diabetes mellitus
521
628
EN
Mohammed
A. El-Alfy
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
alnoaman6@gmail.com
Ahmed
A. El-Mahdy
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Abd El-Mohsen
M. Abdu
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
10.21608/amj.2020.69761
<strong>Background: </strong>Ambulatory BP monitoring (ABPM) might be more accurate than clinical BP measurement. It allows detection of nocturnal BP and dipping patterns, and can reduce false-positive results by detecting white-coat hypertension and false-negative results by detecting masked hypertension.<br /> <strong>Objective:</strong> Assessing the use of ambulatory BP monitoring (ABPM) in individuals with diabetes mellitus to identify the presence of hypertension and its association with arterial stiffness.<br /> <strong>Patients and Methods:</strong> The study included 100 diabetic patients in addition to 20 apparently healthy individuals.<br /> <strong>Results:</strong> In comparison with healthy subjects, patients with diabetes were found to have hypertension using ABPM. ABPM appeared to be useful in the detection of hypertension in patients with diabetes. Comparison between patients and control showed statistically significant difference according to average day, average night and allover average readings. Arterial stiffness also found to be increased in patients with hypertension with statistically significant difference between studied groups according to stiffness index.<br /> <strong>Conclusion:</strong> ABPM analysis revealed that about one-third of the participants with diabetes had masked hypertension. Those individuals cannot be detected by office BP alone. Moreover, arterial stiffness increased in individuals with masked hypertension. These findings supported the use of ABPM to identify individuals at risk of cardiovascular disease.
ambulatory blood pressure,Arterial stiffness,Blood pressure patterns,cardiovascular risk,masked hypertension,Nocturnal hypertension,White coat hypertension
https://amj.journals.ekb.eg/article_69761.html
https://amj.journals.ekb.eg/article_69761_f2da76dfd04ba83726a8c456a815fadd.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Predictors of a difficult thyroidectomy
629
638
EN
Tarek
El-Sayed Mohamed Mohamed Radwan
General Surgery Department, Faculty of Medicine, Al-Azhar University
etarek355@gmail.com
Abd El-Fattah
Morsi Saied Mohammed
General Surgery Department, Faculty of Medicine, Al-Azhar University
Ashraf
Abd El-Hameid Abd El-Moneim
General Surgery Department, Faculty of Medicine, Al-Azhar University
10.21608/amj.2020.69766
<strong>Background:</strong> Thyroid surgery is one of the most common interventions in endocrine surgery. Thyroidectomy Difficulty Scale (TDS) was developed to identify more difficult operations, which correlate with long operative times, intraoperative problems and high complication rates.
<strong>Objective:</strong> To identify clinical, biochemical and pathological parameters this can predict difficult thyroidectomy preoperatively.
<strong>Patients and methods:</strong> This prospective study was randomized, non-interventional uncontrolled cross-sectional one. It was conducted on sixty patients. Those patients were already diagnosed to have thyroid disease needing thyroidectomy. Four items were used to score the difficulty of thyroid operations. Patient and disease factors were recorded for each patient. Difficult group and non-difficult groups were compared.
<strong>Results:</strong> A total of 60 patients were scored using that scale. Of them, 46 suffered from hyperthyroidism, 13 from Hashimotos, and 11 from thyroid cancer. Patients were with hyperthyroidism, level of antithyroglobulin antibodies for them was>4 IU/ml, and high thyroglobulin (>150 ng/mL) may associated with difficult thyroidectomy.
<strong>Conclusion:</strong> According to thyroidectomy difficulty scale, patients diagnosed as hyperthyroidism, increase of serum thyroglobulin, and antithyroglobulin antibodies preoperatively were associated with difficult thyroidectomy. This scale could assist surgeons in prediction of difficult operations and prepare for them.
Thyroidectomy Difficulty Scale,Thyroidectomy,Anti-thyroglobulin antibody,Hyperthyroidism,Hashimoto’s Thyroiditis
https://amj.journals.ekb.eg/article_69766.html
https://amj.journals.ekb.eg/article_69766_cff224edf95750470fe6b615e01c35f3.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Methylene Blue Photodynamic Therapy Versus Tuberculin Purified Protein Derivative (PPD) Immunotherapy in Plane Warts in Children
639
650
EN
Azmy
Ahmed Abdul Latif
Department of Dermatolgy, Venereology, and Andrology, Faculty of Medicine, Al-Azhar University
Ibrahim
Mohammad Abd El-Kareem
Department of Dermatolgy, Venereology, and Andrology, Faculty of Medicine, Al-Azhar University
Ayman
Abd El maksoud hasan
Dermatology and Venereology Department of Faculty of Medicine Al-Azhar University cairo Egypt
ayman444486@gmail.com
10.21608/amj.2020.69979
<strong>Background:</strong> Plane warts are caused by human papilloma virus (HPV) (most often HPV‐2, HPV‐3 or HPV‐10) and generally multiple, slightly elevated, smooth papules occurring most often on the face, hands, neck, and legs of children and young adults.
<strong>Objective:</strong> To compare the efficacy and safety daylight photodynamic therapy using methylene blue versus tuberculin purified protein derivative (PPD) immunotherapy intradermal injection in plane warts in children.
Patients and methods: Forty patients (Children) complaining of plane warts were enrolled in this study. They were randomly selected from the attendants of out-patient clinic Dermatology and Venereology Department, Al Hussein University Hospital, Faculty of Medicine, Al-AzharUniversity from April 2019 to November 2019. Patients were divided randomly into two groups, to undergo either methylene blue day light photodynamic therapy (MB-DL PDT) or tuberculin PPD intradermally.
<strong>Results:</strong> Tuberculin PPD-treated group showed significantly higher rates of complete response compared with MB- DL- PDT-treated group, complete response (60% versus 30% respectively); partial response (10% versus 30%), and no response (30% versus 40%).
<strong>Conclusion:</strong> PPD intradermally and MB-DL PDT has significant advantages over other treatments. Most treatment modalities were painful, needing multiple visits (time and money consuming), and were directed to each individual wart. This study confirmed that immunotherapy tuberculin PPD and MB-DL-PDT can be used to treat cutaneous Plane warts in children.
Plane warts,HPV,MB-DL PDT,PPD
https://amj.journals.ekb.eg/article_69979.html
https://amj.journals.ekb.eg/article_69979_bae5752cc7d506a30941c64210bfbd93.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
EFFECT OF HIGH FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION OF THE CONTRALESIONAL MOTOR CORTEX ON RECOVERY FROM POST-STROKE SEVERE MOTOR IMPAIRMENT
651
666
EN
Esam
Mahdy Ibrahim
Departments of Neurology, Faculty of Medicine, Al-Azhar University, Damietta
Mohamed
Ahmed Zaki
Departments of Neurology, Faculty of Medicine, Al-Azhar University, Cairo
Mohamed
Gaber Mahmoud Gabr
Departments of Neurology, Faculty of Medicine, Al-Azhar University, Damietta
gaber.neurology@gmail.com
10.21608/amj.2020.70959
<strong>Background:</strong> The traditional inhibition of contralesional primary motor area (cM1) with low frequency repetitive transcranial magnetic stimulation (rTMS) fails to improve post-stroke severe motor impairment. The role of contralesional motor areas in post-stroke motor recovery is still questionable. While the previous data suggested that cM1 exerts transcallosal inhibitory effect on ipsilesional M1 (iM1) following stroke, there isan evidence that contralesional motor areas, particularly the contralesional dorsal premotor area (cPMd), have compensatory roles in severely impaired patients who have extensive ipsilesional damage.
<strong>Objectives:</strong> To study whether facilitating cPMd with high frequency rTMS as a novel approach, instead of conventionally suppressing cM1, has beneficial effect on motor recovery of post-stroke severely impaired upper extremity (UE) or not.
<strong>Patients and Methods:</strong> Forty right handed, first ever stroke patients (3 months post event) with severe stroke symptoms, severe motor deficit, and radio logically evident massive right cerebral infarctions at baseline were randomly assigned to two equal groups, to receive, as adjunct to ordinary rehabilitation techniques, ten consecutive sessions of either: (1) High frequency rTMS at 5 Hz on cPMd; or (2) Sham rTMS. The Medical Research Council (MRC) for muscle strength and UE- Fugl Meyer Assessment (UE-FMA) were assessed before and after the intervention.
<strong>Results:</strong> By using the one way analysis of covariance (ANCOVA), we found significant improvements in grand means of MRC in the active rTMS group in relation to the sham group. The improvements included in particular the mean proximal MRC, whereas no significant improvement in the mean distal MRC. Similarly, we found that the UE-FMA totals were markedly improved in the active group in relation to the sham group, mainly in the proximal UE-FMA. Stepwise regression showed that lower baseline MRC of the affected UE muscles is an independent predictor of better response to the novel rTMS approach.
<strong>Conclusion:</strong> Applying high frequency rTMS to cPMd can improve motor functions of the disabled UE, mainly proximal functions, in more severely impaired stroke patients.
Contralesional,High Frequency,Repetitive transcranial magnetic stimulation,stroke,Severe Motor Impairment
https://amj.journals.ekb.eg/article_70959.html
https://amj.journals.ekb.eg/article_70959_b2bb1748550a31922b188f92cb655ff4.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
The Effect of Maternal Obesity on Sonographic Fetal Weight Estimation
667
676
EN
Yahea
A. Wafa
Department of Obstetrics and Gynaecology, Faculty of Medicine, Al Azhar University
Mohamed
El Mohandes
Department of Obstetrician and Gynecologist, El Galaa Maternity Teaching Hospital
Hamada
A. Sayed
Department of Obstetrics and Gynaecology, Faculty of Medicine, Al Azhar University
hamadaadly89@gmail.com
10.21608/amj.2020.69992
<strong>ABSTRACT</strong><br /> <strong>Background:</strong> Obesity is one of the most serious public health challenges of the 21st century. Obesity has reached epidemic proportions worldwide.<br /> <strong>Objective:</strong> To detect the possible effect of maternal obesity on the accuracy of sonographically estimated fetal weight (EFW) in the third-trimester shortly before labor and to compare the accuracy of the estimation between normal weight, overweight, and class I, class II and class III obese groups.<br /> <strong>Subjects and Methods:</strong> This was a prospective study of singleton pregnancies with sonographic fetal weight estimation prior to scheduled delivery. Women were classified according to current body mass index (BMI) into five categories: normal (BMI 18.5–24.9 kg/m2, n = 30), overweight (BMI 25.0–29.9 kg/m2, n = 30), obese class I (BMI 30.0–34.9kg/m2, n = 30), obese class II (BMI, 35.0–39.9 kg/m2, n = 30) and obese class III (BMI ≥ 40.0 kg/m2, n = 30).The EFW was compared with the actual birth weight(ABW), and the difference between them was recorded.<br /> <strong>Results:</strong> There was a statistically significant difference between US EFW by (g) and birth weight by (g) versus body mass index in obesity class II and III.<br /> <strong>Conclusion:</strong> Maternal obesity decreased the accuracy of sonographic fetal weight estimation. Clinicians should be aware of the limitations of sonographic fetal weight estimation, especially in obese patients.
Body Mass Index,Fetal Weight,Obesity,Ultrasonography
https://amj.journals.ekb.eg/article_69992.html
https://amj.journals.ekb.eg/article_69992_ba944eb16a09c9d51bf77819c745824a.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Aromatase Inhibitor Versus Clomiphene Citrate for Induction of Ovulation in Unexplained Infertility
677
686
EN
Ebtesam
M.A. Saeed
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Egypt
Fahd
A. El-Omda
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Egypt
Mahmoud
M.H. El-Tohamy
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Egypt
drmahmoudhelmy79@gmail.com
10.21608/amj.2020.70012
<strong>Background:</strong> Infertility is the inability of a sexually active couple with no contraception to achieve natural pregnancy within one year. Unexplained female infertility should be a term used when the female reproductive system has been evaluated according to current agreed standards, and no abnormalities are detected. Clomiphene citrate (CC) has been used as a first-line ovulation induction agent. Aromatase inhibitors are new groups of drugs for fertility treatment. Letrozole is an orally-active aromatase inhibitor, with good potential for ovulation induction.
<strong>Objective:</strong> This study compared the effect of clomiphene citrate and letrozole in induction of ovulation in the treatment of infertility.
<strong>Patients and methods:</strong> This prospective randomized controlled study was conducted at Obstetrics and Gynecology Department, Al-AzharUniversityHospitals and Al-AhrarHospital (ministry of health) on 100 women between 20 - 35 years old having unexplained infertility. Patients were divided into two equal groups: Letrozole group received 5 mg of letrozole orally daily from day 3 to day 7 of menses, and CC group, women received 100 mg of clomiphene citrate orally once daily from day 3 to day 7 of the menses and for up to three menstrual cycles.
<strong>Results:</strong> There was a significant increase of positive pregnancy test in letrozole group compared to clomiphene group.There was a significant difference in multiple pregnancy rate and high significant differences in Doppler flow indices between letrozole group and clomiphene group. Conclusion:Letrozole has a better ovulation rate with better follicular development and higher pregnancy rate, CC group has less effect on the endometrial thickness and side effects.
Unexplained infertility,induction of ovulation,Clomiphene citrate,letrozole (aromatase inhibitor)
https://amj.journals.ekb.eg/article_70012.html
https://amj.journals.ekb.eg/article_70012_bbbfa9241da09f654a3f997de36e19e4.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
EVALUATION OF PLASMA LEVEL OF HOMOCYSTEINE IN THE PERIPHERAL AND PENILE BLOOD BEFORE AND AFTER FOLIC ACID SUPPLENTATION IN VASCULOGENIC ERECTILE DYSFUNCTION PATIENTS
687
694
EN
Ibraheim
Mohammed Shahein
Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University,
Yaser
Fathy Mohammed
Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University,
Ahmed
Rashaad Mohammed
Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University,
Wafik
Ibrahim Ali
Clinical Radiology, Faculty of Medicine, Al-Azhar University,
Nabil
Fathy Ismail
Clinical Pathology, Faculty of Medicine, Al-Azhar University,
Hazem
Basuony ElـRazek
Dermatology, Venereology and Andrology at Etay Elbaroud Hospita, Elbehira, Egypt
hazem.bassiony.1988@gmail.com
10.21608/amj.2020.82578
<strong>Background:</strong> Erectile function may be secondary to much systemic illness, both physical and psychological, and is a well-documented side effect of prostatic cancer treatment.
<strong>Objective:</strong> To asses effect of folic acid supplementation on homocysteine plasma level in either peripheral and penile blood before among vasculogenic erectile dysfunction patients.
<strong>Patients and methods:</strong> This study included 22 Egyptian patients ranged from 30-60 years old with vasculogenic ED proved by penile duplex ultrasound. All patients subjected to penile Duplex ultrasound, peripheral and penile blood samples were for plasma homocysteine concentration evaluation before and after oral folic acid 500 mcg per day for 3 months.
<strong>Results:</strong> There was statistically significant difference between either peripheral or penile homocystiene before and after. There was a significant increase in peak systolic value (PSV) after the treatment than its value before the treatment. Also, the end-diastolic velocity (EDV) before therapy was significantly higher than its value after therapy. There was a significant increase in international index of erectile Function-5 questionnaire after the treatment (15.5±3.3) than its value before the treatment.
<strong>Conclusion:</strong> There was a significant relation between Hcys and either ED or penile arterial flow. From these results, Elevated plasma Hcys level was considered as independent risk factor for ED.
Erectile dysfunction,Folic acid,Homocysteine,penile,plasma,Vasculogenic
https://amj.journals.ekb.eg/article_82578.html
https://amj.journals.ekb.eg/article_82578_31ff563a2abb66dbe8e8472fcd3e37a2.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
THE PREVALENCE OF PERIPHERAL NEUROPATHY IN HEMODIALYSIS PATIENTS AT AL-AZHAR UNIVERSITY HOSPITAL IN NEW DAMIETTA CITY
695
704
EN
Sherief
M. Al-Shazly
Neurology Department, Faculty of Medicine, Al-Azhar University Damiatta , Eygpt
Mohammad
Ali Saeed Hassan
Neurology Department, Faculty of Medicine, Al-Azhar University Cairo, Eygpt
El-Sayed
Fathi Ali Hamed
Neurology Department, Faculty of Medicine, Al-Azhar University Damiatta , Eygpt
Mohammad
Mahmoud Abd El-Aziz Mohammad
Neurology Department, Faculty of Medicine, Al-Azhar University Damiatta , Eygpt
drzezo531@gmail.com
10.21608/amj.2020.82580
<strong>Background: </strong>Chronic kidney disease (CKD) is a worldwide public health problem. There are several etiologies for CKD. It can occur due to either primary kidney disease or as a complication of a multi-systemic disorder. Much emphasis has been placed on the increased cardiovascular risk and electrolyte abnormalities that accompany chronic kidney disease. The dreaded neurological complications are usually the uremic encephalopathy or a vascular event that accompanies hypertension.
<strong>Objectives:</strong> To study the prevalence of peripheral neuropathy in uremic patients on hemodialysis and its clinical and neurophysiological characters at Al-Azhar University Hospital in New Damietta.
<strong>Patients and Methods:</strong> This study was a cross-sectional study. This study was carried out at HemodialysisCenteratAl-AzharUniversityHospital in New Damietta.
Fifty hemodialysis patients were investigated in the HemodialysisCenteratAl-AzharUniversityHospital in New Damietta. All patients were submitted to clinical evaluation by the Michigan Neuropathy Screening Instrument (MNSI), and Electroneuromyography (ENMG), and laboratory investigations.
<strong>Results:</strong> The results of the study revealed that there was no significant relation between dialysis mode and severity of neuropathy, and there was significant relation between duration of dialysis and neuropathy of the studied cases.
<strong>Conclusion:</strong> The present study emphasized the high prevalence of peripheral neuropathy in a group of patients with end-stage kidney disease under hemodialysis maintenance treatment. The gold standard exam for diagnosis confirmation was nerve conduction studies. Thus, before undergoing dialysis, it would be recommended to submit all patients with CKD to nerve conduction studies.
dialysis,Neuropathy,severity,CKD,case-control,motor,sensory
https://amj.journals.ekb.eg/article_82580.html
https://amj.journals.ekb.eg/article_82580_bfadd69d259fdacbce19c66ffe1afc50.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
THE ROLE OF ULTRASOUND AND COLOR DOPPLER IN PREDICTION OF PLACENTAL MYOMETRIAL INVASION IN WOMEN WITH PLACENTA PREVIA AND A PRIOR CESAREAN DELIVERY
705
714
EN
Sayed
Muhammad Kamel
Obstetrics & Gynecology Department, El-Galaa Teaching Maternity Hospital, Egypt
sayedkamel986@gmail.com
Yehia
Abd El-Salam Wafaa
Obstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar University, Egypt
Hosam
El-Din Fahem Abd El-Raheem
Obstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar University, Egypt
10.21608/amj.2020.82581
<strong>Background:</strong> Placenta accreta is considered a life-threatening condition and the main cause of maternal mortality, postpartum hysterectomy, admission to ICU, and an inadvertent laceration to intestine or bladder during cesarean section.
<strong>Objectives:</strong> To evaluate the efficacy of transabdominal ultrasonography and color Doppler in prediction of placental myometrial invasion in patients with prior cesarean delivery.
<strong>Patients and methods:</strong> This prospective study was conducted at El-Galaa teaching maternity hospital in ultrasound unit, emergency department, and operation theatre where 100 pregnant women with gestational age of 30 weeks or more whose placentae were anterior and previa with previous cesarean deliveries by Trans abdominal real-time imaging
<strong>Results:</strong> Sensitivity, specificity, PPV, NPV, and accuracy of ultrasound in diagnosis of PA were 92.5%, 90.0%, 86.0%, 94.7%, and 91.0%, respectively. The detection of intraplacental lacunae has the highest positive predictive value (95.5%).with high sensitivity (92%).
<strong>Conclusion:</strong> The presence of intraplacental lacunae had the highest sensitivity for detection of PA and the use of a two‐criteria system allowed a good compromise between sensitivity and specificity, with high PPV and NPV.
Placenta Previa,placental myometrial invasion,cesrarean section
https://amj.journals.ekb.eg/article_82581.html
https://amj.journals.ekb.eg/article_82581_d9c5d32c1a2e6827e965408ff2a307bb.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
ROLE OF ULTRASOUND IN PREDICTION OF PREGNANCY OUT COME IN THREATENED ABORTION
715
722
EN
Yousry
Omar Salim Al-Maraghy
Department of Obstetrics and Gynecology, Faculty of Medicine - Al-Azhar University, (Assiut), Egypt
Abd El-Halim
Mohammed
Department of Obstetrics and Gynecology, Faculty of Medicine - Al-Azhar University, (Assiut), Egypt
Hanem
Ibrahim Ibrahim Khodira
Department of Obstetrics and Gynecology, Faculty of Medicine - Al-Azhar University, (Assiut), Egypt
hazmalmqdm2@gmail.com
10.21608/amj.2020.82583
<strong>Background:</strong> Threatened miscarriage constitutes 15–20% of pregnancies and is one of the commonest gynecological emergencies. Previously, the volume of an intrauterine hematoma (IUH) or on the presence of vaginal bleeding was considered but not the location of the hemorrhage.<br /> <strong>Objective: </strong>To predicted pregnancy outcome through sonographic finding in women presenting with symptoms of threatened abortion.<br /> <strong>Subjects and methods:</strong> This was a prospective study held on 300 patients who attended the out-patient clinic or the causality department of Obstetrics &Gynecology, in Tahta general hospital. Patients were with clinical diagnosis of threatened abortion in their 1st trimester of pregnancy, attended to outpatient clinic or causality department, giving a history of bloody vaginal discharge or vaginal bleeding.<br /> <strong>Results:</strong> there were statistically significant difference of mean values of sub trophoblastic arteries RI for the continued group and aborted group in all gestational age. There were statistically significant difference of mean values of sub trophoblastic arteries PI for the continued group and aborted group in all gestational age.<br /> <strong>Conclusion:</strong> CRL and FHR are good sonographic indicators for the prediction of outcome in women with threatened miscarriage. Color Doppler of subtrophoblastic arteries is useful in prediction of pregnancy outcome in threatened abortion .The incidence of maternal and fetal complications increased in cases with threatened miscarriage that completed the pregnancy.
Threatened,Miscarriage,Sonographic,Pregnancy
https://amj.journals.ekb.eg/article_82583.html
https://amj.journals.ekb.eg/article_82583_884bba3aae1ccd0195eab25d025f7dd9.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
SURGICAL OUTCOME OF PERCUTANEOUS ENDOSCOPIC INTERLAMINAR LUMBAR DISCECTOMY TECHNIQUE
723
734
EN
Osama
El-Ghannam
Departments of Neurosurgery, Al-Azhar Faculty of Medicine
Mamoon
Abo-Shosha
Departments of Neurosurgery, Al-Azhar Faculty of Medicine
Hatem
Saad Al-Kholy
Departments of Neurosurgery, Al-Azhar Faculty of Medicine
Hussein
Montaser
Departments of Radiology, Al-Azhar Faculty of Medicine
Ahmed
Fathi El-Sayed
Departments of Neurosurgery, Al-Azhar Faculty of Medicine
afathyneuro@gmail.com
10.21608/amj.2020.82585
<strong>Background:</strong> Minimally invasive lumbar surgeries are becoming more popular and a routine around the world. Although good surgical outcomes have been reported for the endoscopic approach to treat lumbar disc herniation (LDH), the procedure still appears to be relatively difficult so operative failures and complications may be occurred.
<strong>Objective:</strong> To assess the outcome of lumbar spinal endoscopic discectomy by Destandaeu technique as minimally invasive approach in Al Azhar experience.
<strong>Patients and Method:</strong> Thirty five consecutive patients proved to have lumber disc prolapse, were treated with percutaneous endoscopic lumbar discectomy through interlaminar approach discectomy by Destandau's technique using Endospine Karl Storz system between September 2017 and October 2019 at the Neurosurgery Department, Al-Azhar University Hospitals. All patients included in this study have lumbar disc prolapse fulfilled the following criteria: Unilateral Radicular pain correlated with MRI finding, failure of conservative measures for at least 6 weeks, single level disc prolapse, and disc prolapse was central or paracentral. Follow up for 6 months postoperative and Clinical outcomes were assessed by using Visual Analogue Scale (VAS) score (for Mean pre- and postoperative pain score measurement) and Oswestry Disability Index (ODI), Patients Satisfaction measured by Modified Macnab Criteria at 6 months postoperative, Time of return to work, Recurrence or persistence of symptoms which need revision open surgery.
<strong>Results:</strong> The mean age was 37.5 years, the mean operative time was 90 minutes, and the mean length of follow-up was 5 months. The mean hospital stay for endoscopic discectomy was 36 hours. There was a significant reduction in the severity of back pain and lower limb symptoms measured by (VAS) (ODI) in 87% (30 patients) at 6 months. The recurrence rate was 8.5% (3 patients) and persistent symptoms without improvement occurred in 5.7 % (2 patients) who subsequently underwent revision surgery. Most Patients returned to their previous occupation after surgery at a mean time of 35 days.
<strong>Conclusion:</strong> Endoscopic discectomy by Destandau's technique for lumbar disc prolapse in properly selected patients was safe and minimally invasive technique.
Endoscopic spine,endoscopic technique,interlaminar approach,Lumbar discectomy,Minimally invasive
https://amj.journals.ekb.eg/article_82585.html
https://amj.journals.ekb.eg/article_82585_92700cd76a2fe3d57dbd0c35556c39b2.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
EFFECT OF SPEXIN TREATMENT ON CARDIOMETABOLIC CHANGES IN OBESE TYPE 2 DIABETIC RATS
735
758
EN
Khaled
Abd El-Fattah Abul-Fadle
Department of Physiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
khafadle@gmail.com
Nour
El-Huda A. Mohammed
Department of Physiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Radwa
M. Al-Sayed
Department of Physiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Maha
M. Abdul-Rahman
Department of Human Anatomy and Embryology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Azza
Ismael Farag
Department of Human Anatomy and Embryology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
10.21608/amj.2020.82588
<strong>Background:</strong> Spexin is a peptide hormone that was expressed in brain regions and peripheral tissues of many species including human and rat. Several studies investigated its blood level changes with obesity and type 2 diabetes, but few studies assessed its effect on cardiometabolic, histological and morphometric changes in diabetes with some controversies in their results.
<strong>Objective:</strong> To explore the effect of spexin treatment on cardiometabolic, histological and morphometric changes of pancreas and heart tissue in obese type 2 diabetic rats, and the possible mechanisms involved.
<strong>Materials and Methods:</strong> Thirty adult male albino rats were divided randomly into 5 equal groups; control (fed ordinary laboratory chow along this 8 weeks’ study), diabetic [fed high fat diet along this 8 weeks’ study, but at the start of the 4th week, overnight fasted rats were injected with a single streptozotocin injection intraperitoneally (40 mg/kg body weight, dissolved in 0.01M citrate buffer, pH 4.5) to induce diabetes], diabetic metformin-treated [rats were managed as in diabetic group and in addition to that, metformin was given orally (300 mg/kg/day) by oral gavage to rats for 4 weeks from the start of 5th week to the end of 8th week], diabetic vildagliptin treated [rats were manipulated as in diabetic group and in addition to that, vildagliptin was given orally (10 mg/kg/day) using oral gavage to rats for 4 weeks from the start of 5th week to the end of 8th week], and diabetic spexin treated [rats were managed as in diabetic group and in addition to that, spexin dissolved in normal saline was injected intraperitoneally (35 μg/kg/day) for 4 weeks from the start of 5th week to the end of 8th week] groups. For histological, immunohistochemical and morphometric examinations, fresh heart and pancreatic specimens were collected from rats that were sacrificed.
<strong>Results:</strong> In diabetic group, a significant increase was detected in final body mass index, serum glucose, serum insulin, homeostasis model assessment-insulin resistance, serum total cholesterol, serum triglycerides, serum low density lipoprotein, atherogenic index, serum dipeptidyl peptidase-IV, serum tumor necrosis factor alpha serum interleukin-1 beta, serum malondialdehyde, serum lactate dehydrogenase, serum creatine kinase-myoglobin binding and mean arterial blood pressure, with a significant decrease in homeostasis model assessment-beta cell functionserum high density lipoprotein, serum superoxide dismutase and serum spexin in comparison to that in the control group. With spexin treatment (as well as with the administration of standard drugs metformin and vildagliptin), all these changes were reversed significantly in comparison with those in the diabetic group. Diabetes induced histopathological changes in cardiac muscle and pancreatic structure which were ameliorated by treatment with spexin as well as with the standard anti-diabetic drugs (metformin and vildagliptin). The morphometric analysis confirmed the histopathological results, as a statistically significant difference was detected in area percent of collagen deposition, area percent of insulin immune-reaction in pancreas and cardiac muscle Bax expression between both diabetic group and all other groups, with no statistically significant difference between diabetic metformin treated, diabetic vildagliptin treated and diabetic spexin treated groups.
<strong>Conclusion:</strong> Spexin ameliorated diabetes induced deleterious cardiometabolic, histopathological and morphometric disturbances. The anti-obesity, dipeptidyl peptidase-IV inhibitory, hypoglycemic, hypolipidemic, antioxidant, anti-inflammatory and cardio-protective properties of spexin may contribute to its useful effects.
Spexin,Cardiometabolic changes,Obese type 2 diabetic rats,Metformin,Vildagliptin
https://amj.journals.ekb.eg/article_82588.html
https://amj.journals.ekb.eg/article_82588_ca0be75699db8c7ac24ed448504f335b.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Anterior Lamellar Recession for Treatment of Cicatricial Entropion with or Without Blepharoplasty
759
766
EN
Abubakr
Mohammad Farid Abulnaga
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Ahmed
Sobhy
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Mohammed
Eid Abd El-Salam
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
mohammed
abdulmunsif
mousay
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
okaly1989@gmail.com
10.21608/amj.2020.70076
<strong>Background:</strong> Entropion is an inward rotation of the eyelid margin. It is one of the most common lid malposition encountered in clinical practice. There are four types of entropion: congenital, cicatricial, involutional and acute spastic. The pathophysiology of each of these types is different, and so is the treatment.
<strong>Objectives:</strong> To compare between anterior lamellar recession with blepharoplasty and without blepharoplasty.
<strong>Patients and Methods:</strong> Twenty cases of cicatricial entropion by anterior lamellar recession with age range age from 35-75 years were included in this study which was performed at Al-Azhar University Hospitals divided into two equal groups: Group (A): with upper eyelid cicatricial entropion had an anterior lamellar recession by gray line split technique and Group (B) with upper eyelid cicatricial entropion had an anterior lamellar recession by gray line split technique and blepharoplasty.
<strong>Result:</strong> In Group A, we had one case of recurrence observed after 3 months (10%) while in group B no cases of recurrence observed after 3 months (0%), In group A, success rate was 90%, and final aesthetic outcome was 30%, while in Group B success rate was 100%, and final aesthetic outcome was 80%, group B showed less post-operative complication than group A.
<strong>Conclusions:</strong> Combining the procedure of anterior lamellar recession with grey line split technique with blepharoplasty in surgical correction of upper eye lid cicatricial entropion has excellent both functional and aesthetic outcome, and a higher success rate with minimal complication than anterior lamellar reposition only, as simultaneous correction of associated lid laxity and dermatochalisis maximize the efficacy of ALR and enhance the postoperative cosmesis.
https://amj.journals.ekb.eg/article_70076.html
https://amj.journals.ekb.eg/article_70076_45e477b147db4226bba9900b4fdafb14.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Treatment of Acute Ankle Syndesmotic Injury by Syndesmotics Screw Fixation
767
774
EN
Ismail
Hammoudah
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
Faisal
Hasan Zayed
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
Mohamed
Abd El-Naser Haggag
dr.mido136@gmail.com
10.21608/amj.2020.70121
<strong>Background: </strong>The distal tibiofibular syndesmosis is a connection between tibia and fibula that consists of the anterior tibiofibular ligament, the posterior tibiofibular ligament, the transverse ligament and the interosseous ligament. Syndesmotic ligament injuries are most often seen in combination with ankle fractures, but can occur in isolation as well. The term ‘isolated syndesmotic injury’ is used for the syndesmotic rupture without ankle fracture, although concomitant other injuries may be present. These isolated injuries, which are often accompanied by deltoid ligament injuries.
<strong>Objective:</strong> To evaluate the efficiency of use of syndesmotic screw fixation in treatment of acute ankle syndesmotic injury.
<strong>Patients and Methods:</strong> This Prospective study included twenty adult patients with recent ankle syndesmotic injury who were treated by syndesmotic screw at Al-Azhar university hospital and mansheyat El-bakry hospital, Cairo, Egypt. Those twenty patients prospectively followed up for 12 months with average of 9 months. The clinical outcomes were calculated according AOFAS score.
<strong>Results:</strong> Those 20 patients prospectively followed up for an average of 9 months. Preoperative mean value for medial clear space (MCS) was 11.8±3.9 mm, tibiofibular clear space (TFCS) was 9.2±1.6 mm and tibiofibular overlap (TFO) was 2.2±4.7 mm. while the follow up mean MCS was 3.3±0.4 mm, TFCS was 3.2±0.4 mm and TFO was measured as 11.9±1.2 mm The mean AOFAS score was 97.0±3.8 (range 90–100).
<strong>Conclusion:</strong> Reduction of the syndesmosis is essential for improving functional outcomes and avoiding posttraumatic osteoarthritis. It is important to intraoperatively stress all surgically treated ankle fractures to evaluate latent syndesmotic injury.
Distal tibio-fibular syndesmosis,Anterior inferior tibiofibular ligament,range of motion
https://amj.journals.ekb.eg/article_70121.html
https://amj.journals.ekb.eg/article_70121_f61da6a6e2a65826aa3132295c94a4e6.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
ROLE OF HYSTEROSCOPIC GUIDED ENDOMETRIAL BIOPSY IN DIAGNOSIS OF ENDOMETRIAL PATHOLOGY IN PATIENTS WITH UNEXPLAINED RECURRENT IMPLANTATION FAILURE
775
784
EN
Ahmed
El-Sheikh
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
Hesham
Abou Senna
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
Mohamed
Hussein
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
dr_hasona@icloud.com
10.21608/amj.2020.82591
<strong>Background: </strong>Hysteroscopy is one of the most important investigations in women with recurrent implantation failure (RIF). It allows reliable visual assessment of the cervical canal and uterine cavity and it is considered to be the gold standard to diagnose intrauterine pathology and has minimal intra-operative and post-operative morbidity.
<strong>Objective:</strong> To evaluate the role of hysteroscopic guided endometrial biopsy in diagnosis of endometrial pathology in patients with unexplained recurrent implantation failure.
<strong>Patients and methods:</strong> This prospective study was done on 100 patients attended SayedGalalHospital from March 2018 to September 2019, with history of recurrent implantation failure.
All patients were evaluated by full history taking include (Personal, Menstrual, Obstetric, Past), Full clinical examination (General, Abdominal, Local), transvaginal ultrasound, hysteroscopy and biopsy. Samples were collected to be examined for histopathology to detect any disease and to be tabulated for computerized analysis.
<strong>Results:</strong> Of the 100 patients of infertility with a history of recurrent implantation failure undergoing endometrial biopsy guided by hysteroscopy, 48 (48%) showed normal findings and 52 (52%) showed abnormal findings: 28 were with normal hysteroscope but endometrial biopsy showed signs of chronic endometritis (28%),12 showed both abnormal hysteroscope and positive signs of chronic endometritis (12%), 7 showed endometrial polyp (7%) ,4 showed fine intrauterine adhesions (4%), and 1 showed cervical stenosis (1%).
<strong>Conclusion:</strong> Hysteroscopy is of a great value in the evaluation and diagnosis of the endometrial pathology in patients with unexplained recurrent implantation failure.
IVF,Infertility,hysteroscope,Biopsy,recurrent implantation failure,chronic endometritis
https://amj.journals.ekb.eg/article_82591.html
https://amj.journals.ekb.eg/article_82591_111122f572df88994bfa3b6e9518b686.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
FETUIN A AS AN EARLY MARKER OF DIABETIC NEPHROPATHY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
785
796
EN
Noura
A. Mitkees
Departments of Internal Medicine, Al-Azhar Faculty of medicine
nouramitkees@yahoo.com
Hoda
M. El-Sayed
Departments of Internal Medicine, Al-Azhar Faculty of medicine
Adela
M. Gad
Departments of Internal Medicine, Al-Azhar Faculty of medicine
Hayam
H. Mansour
Departments of Internal Medicine, Al-Azhar Faculty of medicine
Nagwa
A. Mohamed
Departments of clinical pathology, National Research Center
10.21608/amj.2020.82592
<strong>Background:</strong> Fetuin-A is a liver-derived plasma protein, mediates the formation and stabilization of calciprotein particles formation, ensures mineral solubilization, thus preventing pathological calcification, also it promotes insulin resistance.
<strong>Objective:</strong> To study the role of fetuin A as a marker for early diabetic nephropathy in type 2 diabetes mellitus.
<strong>Subjects and Methods:</strong> Cross sectional study including 30 diabetic patients without microalbuminuria (group I), 30 diabetic patients with microalbuminuria (Group II) and age and sex matched 30 healthy subjects served as a control group. All patients and control subjects were thoroughly examined clinically. Fasting and post prandial blood sugar, HbA1c, renal function tests, lipid profile, creatinine clearance, albumin/creatinine ratio and serum fetuin A by ELISA were investigated.
<strong>Results:</strong> Serum Fetuin A increased in diabetic nephropathy patients without microabuminuria compared to those with microabuminuria. Significant negative correlation was found between serum Fetuin A and albumin/creatinine ratio in diabetic patients with and without microalbuminuria. Cut off value of serum fetuin A was >294.2 ug/dl with sensitivity of 93.3% ,specificity 93% , positive predictive value 92.7%, negative predictive value 93.8% and diagnostic accuracy 91.6%.
<strong>Conclusion:</strong> Serum fetuin A can be used as an early marker for diabetic nephropathy before development of microalbuminuria in patients with type 2 diabetes mellitus.
Diabetes mellitus,Microalbuminuria,Serum Fetuin A,diabetic nephropathy
https://amj.journals.ekb.eg/article_82592.html
https://amj.journals.ekb.eg/article_82592_f99e4d1d47f8e0ab1e542275c25a5220.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Effect of Oxytocin Infusion on Reducing Blood Loss during Abdominal Myomectomy
797
806
EN
Abd El-Azeem
Mohamed Ahmed
Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University
Ahmed
Osama Abd El-Motaal
Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University
Osama
Mahmoud Abd El-Rhim
Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University
osama_mahmoud4@hotmail.com
10.21608/amj.2020.68847
<strong>Background:</strong> Open myomectomy remains the main option has been shown to have satisfactory results as regard fertility preservation and symptom resolution, especially when the number and size of leiomyomas do not permit any other routes of intervention. Hemorrhage remains the most important concern with open myomectomy. Blood loss during surgery mainly depends on the number, size of the removed fibroids and the technique adopted during myomectomy.<br /> <strong>Objective:</strong> Evaluation of the effect of intra-operative oxytocin infusion in decreasing blood loss during abdominal myomectomy.<br /> <strong>Patients and Methods:</strong> This controlled clinical trial was on 134 women: 67 interventional group and 67 control group who were candidates for elective abdominal myomectomy at Al-HusseinUniversityHospital. After induction of general anesthesia and immediately prior to the operation, an infusion of 30 IU oxytocin in 500 ml normal saline at a rate of 120 ml/h was started in the study group patients during myomectomy. In placebo group patients, a pure normal saline infusion was used at the same volume and rate.<br /> <strong>Results:</strong> There was no significant difference between the studied groups regarding preoperative hemoglobin. Postoperative hemoglobin was significantly higher among oxytocin group. Hemoglobin reduction was significantly lower among oxytocin group.<br /> <strong>Conclusion:</strong> The infusion of oxytocin intra-operatively (immediately after induction of general anesthesia) may be a safe and reliable method to help decrease blood loss during abdominal myomectomy.
oxytocin,Abdominal myomectomy
https://amj.journals.ekb.eg/article_68847.html
https://amj.journals.ekb.eg/article_68847_5606a849d9657adce5c1d8968269822d.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
TRANSNASAL ENDOSCOPIC PRELACRIMAL RECESS APPROACH IN A SURGICAL TREATMENT OF ANTROCHOANAL POLYP
807
814
EN
Ahmed
M. Khalefa
Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo
Ahmed
S. Gad
Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo
Abdelrahman
Sheta
Abdelrahman
Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo
boody_sheta2015@yahoo.com
10.21608/amj.2020.82594
maxillary sinus, through the maxillary sinus ostium with extension into the choana. They represent approximately 4–6% of all nasal polyps in the general population. Antrochoanal polyps are almost always unilateral, although there are few cases of bilateral ACPs in the literature.
<strong>Objective:</strong> To assess the effectiveness of endoscopic transnasal prelacrimal recess approach (ETPRA) in preventing the recurrence of antrochoanal polyps and evaluate the outcomes and possible complications of prelacrimal recess approach for treatment of antrochoanal polyps.
<strong>Patient and Methods:</strong> forty patients with antrochoanal polyp underwent surgery with a transnasal endoscopic prelacrimal recess approach. The approach was evaluated for the ability to visualise the origin of the polyp in the maxillary cavity, complications and recurrence of the polyp.
<strong>Results:</strong> Transnasal prelacrimal recess approach was successful in 80% of the patients (32/40), 80% of patients (32/40) did not encounter epiphora postoperatively, 85% of them (34/40) had no epistaxis, 90% of them (36/40) had no cheek edema. None of them had nasal obstruction, nasal stenosis or adhesions, All of them had the flap healed, and all of them had the inferior turbinate preserved. During the follow-up period (1 year) no recurrence had developed.
<strong>Conclusion:</strong> Prelacrimal recess approach is a safe procedure which allows for complete removal of the antral part of the antrochoanal polyps to prevent recurrence without major complications.
Prelacrimal recess approach,antrochoanal polyp
https://amj.journals.ekb.eg/article_82594.html
https://amj.journals.ekb.eg/article_82594_6e70cd398400faae8299403258407bdd.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
EVALUATION OF OCULAR RESPONSE ANALYZER IN ASSESSMENT OF CORNEAL BIOMECHANICS AND OCULAR PRESSURE IN GLAUCOMA SUSPECT INDIVIDUALS
815
824
EN
Mohammed
Salah El-Deen Mohammed
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
the_vagus22@yahoo.com
Hisham
Fawzy Khalleil
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
Hossam
El-Din -Abd El-Moneam Ziada
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
10.21608/amj.2020.82596
<strong>Background: </strong>The cornea exhibits viscoelastic properties, which give it the quality of hysteresis. Corneal hysteresis (CH) is an important indicator of the biomechanical properties of the cornea.
<strong>Objective: </strong>To evaluate the effect of ocular response Analyzer in assessment of corneal biomechanics and intraocular pressure in glaucoma suspect individuals.
<strong>Individuals and Methods: </strong>We conducted our study on 60 eyes which was divided into 30 eyes of normal populations and 30 eyes of glaucoma suspect patients.
<strong>Results: </strong>Elevation of intraocular pressure (IOP) led to decrease in corneal biomechanics as corneal hysteresis (CH) and corneal resistance factor (CRF).
<strong>Conclusion: </strong>Increase of IOP led to decrease in corneal biomechanics as CH and CRF.
Goldmann applanation tonometry,laser peripheral iridotomy,Corneal Hysteresis
https://amj.journals.ekb.eg/article_82596.html
https://amj.journals.ekb.eg/article_82596_9915daa91428a9144a15135aa323649b.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Augmented Anastomotic Urethroplasty for Long Segment Bulbous Urethral Strictures
825
838
EN
Mohamed
Ibrahim
Al-Gammal
Department of Urology, Al-Azhar Faculty of Medicine, Cairo, Egypt
gemykarter2020@gmail.com
Abdullah
Mohamed
Abdullah
Department of Urology, Al-Azhar Faculty of Medicine, Cairo, Egypt
Abul-Fotouh
Abd El-Maguid
Abul-Fotouh
Department of Urology, Al-Azhar Faculty of Medicine, Cairo, Egypt
Gamal
Ibrahim
Selmy
Department of Urology, Al-Azhar Faculty of Medicine, Cairo, Egypt
10.21608/amj.2020.82597
<strong>Background:</strong> During urethroplasty, if the stricture contains a 2 to 4 cm region that is particularly narrow and/or fibrotic, anastomotic repair is not ideal, so that portion may be excised with subsequent anastomosis of the ventral aspect of the urethra to shorten, widen and optimize the urethral wall onto which an onlay graft is to be placed. This procedure is termed augmented anastomotic urethroplasty
<strong>Objectives:</strong> Evaluation of the outcome of augmented anastomotic urethroplasty with dorsal onlay for long segment bulbar urethral stricture.
<strong>Patients and Methods: </strong>A prospective clinical trial was carried out during the period from March 2017 to September 2019 of 55 patients underwent dorsal onlay augmented anastomosis using buccal mucosa graft for long segment bulbar urethral strictures. All patients underwent pre-operative medical history taking and physical examination, sono-urethrography and voiding cystourethrogram. Patients were followed-up and re-assessed at 3 and 6 months post-operatively. Follow-up urethrography was performed at 6 months. The primary outcome was the procedure success rate defined by the successful voiding function. Stricture recurrence was defined the presence of intractable voiding symptoms or the need for any urethral interventions. The data were analyzed using the appropriate statistical tests.
<strong>Results:</strong> During the study period, 55 patients completed the follow-up protocol and included in the study. The mean age was 41.93±10.70 years. The mean intra-operative stricture length was 3.39±0.59 cm. Buccal mucosal graft was used in all cases. Mean graft length was 4.15±0.62 cm. At 6 months follow up, 51 patients had no evidence of stricture recurrence and required no further intervention with an overall success rate of 92.7%. Stricture recurrence occurred in 4 patients (7.3%). No donor site major complications were detected. The urethroplasty complication rate was 20.0%, and all were minor. No effect of urethroplasty on erectile function in adult sexually active patients. No penile shortening or chordee.
<strong>Conclusions:</strong> Dorsal onlay augmented anastomosis was a useful technique for long bulbar strictures. High stricture-free rates and complications are few and minor. Although longer follow up was needed.
Reconstructive surgery,stricture,Urethral reconstruction,bulbar
https://amj.journals.ekb.eg/article_82597.html
https://amj.journals.ekb.eg/article_82597_d365fadf5940696ca26aaa0e71c03775.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Zinc replacement in hepatic encephalopathy among the Egyptian patients
839
848
EN
Mohamed
Noshy
Al-Alfy
Departments of Internal Medicine and Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Amin
Mahmoud
Amin Hegazy
Departments of Internal Medicine , Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Kamel
Soliman Hammad
Departments of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Ahmed
Farouq
El-Sayed Shehata
Departments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
ahmedfsayed73@gmail.com
10.21608/amj.2020.85892
<strong>Background:</strong> Nutritional supplementation may affect the outcomes of liver cirrhosis. Zinc deficiency is common among patients with liver cirrhosis.
<strong>Objectives:</strong> To reveal the impact of zinc replacement therapy in the severity, frequency, and outcomes of hepatic encephalopathy (HE) among a sample of Egyptian patients.
<strong>Patients and Methods:</strong> Patients aged more than 18 years and had decompensated liver disease and developed HE regardless of its grade were included in the current study. Patients were categorized into three groups based on the serum level of zinc and whether patients received zinc replacement therapy or not.
<strong>Results:</strong> An overall 90 patients with decompensated liver disease as a sequel of HCV were enrolled in the present investigation. Patients were furtherly assorted based on the presence of zinc deficiency and replacement therapy into three groups. The mean ages of the included patients were 52.3±4.7, 47.23±4.7, and 41.35±4.28 among groups 1, 2, and 3, respectively. Patients with zinc deficiency and received zinc replacement therapy experienced better outcomes in the terms of short ICU stay and total hospital stays, in contrast to patients within groups 2 and 3 .There was a statistically significant negative correlation between the levels of Zinc and the frequency of HE.
<strong>Conclusion:</strong> Patients developed HE should receive a comprehensive treatment protocol including zinc replacement therapy even if they have normal zinc levels in order to ameliorate the catastrophic sequels of HE.
hepatic encephalopathy,zinc,replacement
https://amj.journals.ekb.eg/article_85892.html
https://amj.journals.ekb.eg/article_85892_ae45866486a0aee7134e545109146d5e.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
Comparative study between Surgical and Endovascular Management of Chronic Iliofemoral Venous Obstruction
849
860
EN
Abd Elfattah
Ali Ismail Ali
Department of Vascular Surgery, Faculty of Medicine – Al-Azhar University (cairo)
Mohamed
yahia zakaria
Department of Vascular Surgery, Faculty of Medicine – Al-Azhar University (cairo)
Mohamed
Abd Elhamed khedr
Department of Clinical Pathology, Faculty of Medicine – Al-Azhar University (cairo)
Salem
Rabae Desoukey Shahen
Department of Vascular Surgery, Faculty of Medicine – Al-Azhar University (cairo)
salemshahen01000@yahoo.com
10.21608/amj.2020.94553
<strong>Background</strong><strong>: </strong>Most of the chronic iliofemoral venous obstructions were managed with low morbidity and no mortality through endovascular intervention which was appropriate for patients with chronic venous obstruction. Endovascular treatment for iliofemoral venous obstruction had progressed rapidly,venous stenting was the primary choice as the stent placement was safe, effective and minimally invasive. However, surgical treatment remains an excellent option in cases in which endovascular techniques had failed or weren’t possible.<br /> <strong>Objective:</strong> The purpose of this study was to review and discuss comparative study between surgical and endovascular procedures in the management of chronic iliofemoral venous obstruction.<br /> <strong>Patients and Methods:</strong> This study included 30 patients (18 females and 12 males) with a ratio of 1.5:1 suffering from chronic ilio-femoral venous obstruction, randomly divided into two equal groups: group (1) for surgical treatment,group (2) for endovascular treatment. Their mean age was 40 years “ranging from 19-83 years” . All patients were belonging to CEAP classifications, C(clinical), E(etiological), A(anatomical) and P(pathological) which included C3 to C6 = clinically state of venous disease in which there was edema up to active venous ulcer.<br /> <strong>Results:</strong> There was no difference between the groups regarding the length of follow up. Iliofemoral venous stenting was safe and effective procedure which could be performed with low morbidity, no mortality, and long-term high patency rate patients for open venous surgery had complication with low patency rate.<br /> <strong>Conclusion</strong><strong>:</strong> Endovascular treatmentis the primary treatment for patients with chronic iliofemoral venous obstruction, open surgical treatment should be considered only in cases of unsuccessful or failed endovenous treatment.
Iliofemoral venous obstruction,surgical,endovascular
https://amj.journals.ekb.eg/article_94553.html
https://amj.journals.ekb.eg/article_94553_d41d8cd98f00b204e9800998ecf8427e.pdf
Al-Azhar Scientific Medical Society
Al-Azhar Medical Journal
1110-0400
49
2
2020
04
01
DIFFERENT REGIMENS OF MAGNESIUM SULFATE FOR MANAGEMENT OF WOMEN WITH SEVERE PREECLAMPSIA
861
871
EN
Mostafa
A. Hekal
Department of Obstetrician and Gynecologist, Faculty of Medicine, Al-Azhar University,
doctorhekal@gmail.com
Yehia
A. Wafa
Department of Obstetrician and Gynecologist, Faculty of Medicine, Al-Azhar University,
Mohammed
I. El-Mohandes
Department of Obstetrician and Gynecologist, Faculty of Medicine, Al-Azhar University,
10.21608/amj.2020.91612
<strong>Background:</strong> Preeclampsia is serious syndrome that can affect human pregnancy causing serious complications. Preeclampsia is pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation.<br /> <strong>Objective:</strong> To assess the comparative effects of three regimens for the administration of the magnesium sulfate when used for the care of women with severe preeclampsia to determine the minimal effective dose of magnesium sulfate in controlling cases with severe preeclampsia and prevention of eclampsia and to determine whether only loading dose of magnesium sulfate is effective in prevention of eclampsia or not.<br /> <strong>Patients and Methods:</strong> 240 patients were recruited and divided into three groups. Each group contains 80 patients, the first group received only the loading dose of MgSO4 and the second group received loading dose plus 12 hours maintenance dose while the last group received the loading dose and the full maintenance dose of MgSo4 for 24 hours.<br /> <strong>Results:</strong> Although strong evidence supports the use of magnesium sulfate for prevention and treatment of eclampsia, there was no significant difference between occurrence of eclampsia in the three groups after either administration of loading dose of MgSO4 only or administration of loading dose with maintenance dose for 12 hours or maintenance dose for 24 hours in the studied patients.<br /> <strong>Conclusion:</strong> Magnesium sulfate proved to cause many hemodynamic changes as it has vasodilator effect on maternal and fetal blood vessels; however, magnesium sulfate should be given to all patients with severe preeclampsia.
magnesium sulfate,Management,severe preeclampsia
https://amj.journals.ekb.eg/article_91612.html
https://amj.journals.ekb.eg/article_91612_20fe02d8fe3387102c5ba6de13ea2f4d.pdf