2024-03-28T11:15:45Z
https://amj.journals.ekb.eg/?_action=export&rf=summon&issue=18054
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
Learning and Assessment in COVID- ERA in Al-Azhar Faculty of Medicine
Moustafa
Abdelnasser Aly
2020
10
01
1
1
https://amj.journals.ekb.eg/article_120550_f69185f74a059e7b1380c38f7a6cadf5.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
EFFICACY OF NITROGLYCERINE INFUSION VERSUS SUBLINGUAL NIFEDIPINE IN SEVERE PRE-ECLAMPSIA
Emad
Lamloum Abd El-Hamid
Ismail
Abd El-Azim Mira
Hani
Maged Abd El-Aal
Farid
Ahmed Kassab
Background: Pre-eclampsia is a pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation. The incidence of preeclampsia is estimated to range between 2.5 and 5%. An accurate estimate, as well as its global burden, is difficult to obtain, due to lack of data from several countries and standardization of diagnostic criteria.
Objective: To compare between the uses of continuous i.v. administration of nitroglycerine versus sublingual nifedipine in the management of women with severe pre-eclampsia who were being managed with controlled plasma volume expansion and MgSO4 loading and maintenance doses.
Patients and Methods: Patients were taken from Sayed Galal Hospital. This study was carried out on 100 women with severe pre-eclampsia who were being managed with controlled plasma volume expansion and MgSO4 loading and maintenance doses. Those women were randomly assigned into two equal groups: Nitroglycerine or nifedipine. Both groups were compared as regard maternal adverse effects of vasodilator therapy, mean arterial pressure changes within one hour after vasodilator therapy, post therapy changes in fetal cardiotocography (CTG) and for feto-maternal complications including gestational age of termination of pregnancy, time of maternal intensive care unit (ICU) stay and the need of neonatal ICU.
Results: Statistical analysis of the magnitude and time course of maternal hypotensive responses after initiation of the vasodilator therapy showed that, in nitroglycerine group, a statistically significant decrease in both systolic blood pressure (SBP) and diastolic blood pressure (DBP) started just 5 min. after the initiation of nitroglycerine infusion, while in nifedipine group, the significant decrease in SBP and DBP started 15 min. after oral nifedipine. The SBP and DBP measurements in nitroglycerine group were significantly lower than those in nifedipine group. The feto-maternal safety margin observed was similar in the two study groups.
Conclusion: IV infusion of nitroglycerine was effective, safe and alternative therapy for severe pre-eclampsia.
Pre-eclampsia
nitroglycerine
Nifedipine
ICU
2020
10
01
1477
1486
https://amj.journals.ekb.eg/article_120551_8cd65d10ea20c733d82072619fbc26e2.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
ROLE OF LAPAROSCOPY IN DIAGNOSIS AND TREATMENT OF ACUTE ABDOMINAL PAIN
Abd Al-Rahman
Mohammed Ali
Mohammed
Fathi Sharaf
Eslam
Taha Ghalwash
Background: Abdominal pain is a common complaint in the surgical department. Emergency laparoscopy in patients with "acute abdomen" is a part of common surgical practice.
Objective: Evaluation of the role of laparoscopy in management of acute abdominal pain.
Patients and Methods: 100 patients with acute abdominal pain presented to the Department of Surgery, Al-Hussein and Al Minia Health Insurance Hospitals were included in the study during the period from April 2018 to April 2019. They were divided into two groups: known preoperative diagnosis (therapeutic n= 67 patients) and unknown (diagnostic and therapeutic n= 33 patients). Their ages ranged between 12 and 60 years old (35 patients were males and 65 patients were females). Laparoscopy was performed for all patients under general anesthesia.
Results: The definitive diagnosis was established in 99 % of cases. 64 % of those cases were managed successfully by use of laparoscopy and conversion rate was 33 %. Time required for each operation varied according to the procedure. Intraoperative morbidity was 7 %, post-operative complications were 11 % and the mortality of study was 1%.
Conclusion: Laparoscopic intervention for abdominal emergencies is safe, feasible and effective. It resulted in minor trauma, has a rapid postoperative recovery, and reduced morbidity. Laparoscopy can help to avoid unnecessary non- therapeutic laparotomies. It can also help to guide the operating surgeon for choosing the proper targeted incision.
Acute abdomen
Emergency
Laparoscopy
2020
10
01
1487
1496
https://amj.journals.ekb.eg/article_120552_870601c8c300ab1565d122a33acd897f.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
MANAGEMENT OF INTRAARTICULAR FRACTURE OF THE BASE OF THE FIRST METACARPAL BONE BY DYNAMIC EXTERNAL FIXATOR
Mohammed
A. M. Abdellah
Mohamed
A. Negm
Ahmed
Saied
Background: Fractures of the hand are common injuries and in particular, fractures involving the articular surfaces can present difficulties to the orthopedic surgeon in practice.
Objective: To assess how to surgically manage intra-articular fracture of the base of the first metacarpal bone by Dynamic K-wire External Fixator.
Subjects and methods: This was a non-randomized clinical trial carried out at Al-Azhar University Hospitals on 10 patients, during the period from March 2018 till May 2020.
Results: The mean time before operation was 9.5±5, Blunt trauma was most common type of trauma with a percent of 60%.The mean operative time (minutes) was 40.1 ±2 with range of (30-45) minutes and mean time for k wire removal was 28.1 ±5 with range of (15-41).There was significant improvement of Quick DASH functional scoring. There was high significant improvement of range of motion. There is significant difference between the normal and operated side as regard range of motion. Regarding complications, 10% of cases had post-operative pain which continued whole period of follow up, 0% had secondary arthrosis, 10% had superficial pin tract infection and 0% had valgus deformity.
Conclusion: Closed reduction and external fixation can be effective and safe treatments for unstable fractures at the base of the first metacarpal. Such external fixation structures were simple and versatile and able to simultaneously achieve effects such as meeting the retractor, adjusting the angulation, and shortening the displacement, especially for local wounds.
Rolando fracture
Thumb
Metacarpal
External fixator
2020
10
01
1497
1510
https://amj.journals.ekb.eg/article_120553_bb3ad3b3f071c28bebd8caf291487fe0.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
LIMBERG FLAP VERSUS EXCISION WITH PRIMARY CLOSURE IN PILONIDAL SINUS
Sawsan
Soliman Mohamed
Mohamed
O. Alfy
Background: Pilonidal sinus disease (PNS) is a potentially debilitating condition. It was first described by Anderson in 1847 and is often seen in the intergluteal region and can cause loss of work time. Several procedures have been advocated for treatment and the fact that no single procedure is superior in all respect.
Objective: This study aimed to compare the outcomes of excision and primary closure versus Limberg-flap (LF) techniques.
Patients and methods: This randomized, prospective observational study was carried out at the Department of surgery, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt over 2 years (January 2018 to January 2020) on 60 patients out of which 30 underwent rhomboid excision with Limberg flap reconstruction (group A) and 30 underwent excision with primary closure (group B). Post-operative follow up was done till 12 months and complications were recorded.
Results: There was no statistical difference between the two groups as regards demographic data, partial wound dehiscence, and time to complete healing. There was a statistically significant difference between the two groups as regards wound complications (3.3% in group A versus 20.0% in group B) and the recurrence rate (13.3% in group B versus 0% in group A).
Conclusions: Limberg flap method for the pilonidal sinus is a better choice than midline closure after elliptical excision in terms of postoperative wound complications and recurrence.
Pilonidal Sinus
Limberg flap
primary closure
2020
10
01
1511
1518
https://amj.journals.ekb.eg/article_120554_7ec1f6c551bb302fcbe671181fedfe04.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
ASSESSMENT OF SURGICAL MANAGEMENT OF FEMALE BREAST CANCER PATIENTS AFTER NEOADJUVANT SYSTEMIC THERAPY FOR INVASIVE DUCTAL VERSUS INVASIVE LOBULAR CARCINOMA (T3 STAGE)
El-Said
Ahmed Mahmoud Douma
Saied
Hosny Bendary
Ahmed
Yosry El-Agamawi
Amr
Mahmoud Zayed
Nader
Mohamed Abd El-Hamid
Background: In the treatment of locally advanced breast cancer, neoadjuvant chemotherapy approach has several objectives, including downsizing of irresectable tumor into operable disease. ILC is known to be less responsive to NAC. The reported proportions of ILC patients with a pathologic complete response (pCR) range from 1 to 3 % compared with 9 to 15 % for IDC patients Objectives: To assess surgical decision after using neoadjuvant systemic therapy for locally advanced breast cancer patients with invasive ductal carcinoma (IDC) versus whom with invasive lobular carcinoma (ILC). To determine the impact of neoadjuvant chemotherapy (NAC) on different pathological types of locally advanced breast cancer cases. Patients and Methods: This retrospective study included 50 patients in the period from Jun 2018 to Jun 2019 who were diagnosed as invasive ductal and invasive lobular Carcinoma classified into two equal groups. Each group had received neoadjuvant systemic therapy, at Department of Clinical Oncology and Nuclear Medicine, while surgical treatment, in form of modified radical mastectomy (MRM) or breast conserving surgery (BCS), was done between June 2019 and Mar 2020, at the Surgical Oncology Department in Al-Azhar university hospitals. Results: In our study, we observed a reduction in T stage after NAC in 6 cases (24%) of ILC patients compared to clinical down staging in 20 cases (80%) of IDC group. Conclusion: ILC patients were less responsive to neoadjuvant chemotherapy compared with IDC patients. BCS is less frequently achieved after NAC in patients with lobular histology compared with ductal histology.
Locally advanced breast cancer
Neoadjuvant chemotherapy
surgical management
invasive duct carcinoma
invasive lobular carcinoma
2020
10
01
1519
1527
https://amj.journals.ekb.eg/article_120555_79e65acff27afbc9472e6e5dfed74a2d.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
MANAGEMENT OF BLEEDING AFTER ENDOSCOPIC BILIARY SPHINCTEROTOMY IN PATIENTS WITH OR WITHOUT COAGULOPATHY DEFECTS
Hamdy
El-Badry Seddik
Mohamed
Mohamed Al-Kurdi
Sameh
Gabr Attia
Background: Post Endoscopic sphincterotomy (ES) bleeding is a common complication, and it can be challenging to manage post ES bleeding through a side-viewing endoscope.
Objective: To establish a well-accepted clinical strategy for management of bleeding after endoscopic biliary sphincterotomy in patients with or without coagulopathy defects.
Patients and Methods: This prospective interventional selective study was carried out on 100 consecutive patients with jaundice at General Surgery Department, Al- Azhar University Hospitals (Cairo) Egypt. All patients underwent ERCP during the period between January 2016 and August 2019. Patients were divided into 2 equal groups according to presence or absence of coagulopathy: Group A without coagulopathy defect, and group B with coagulopathy defect.
Results: Among 100 patients with endoscopic retrograde cholangiopancreatography (ERCP), post ES bleeding was recorded in 33 patients. Only 1 of 33 was among group A which represented 3% of bleeding cases, and 1% of the total. The cause was vigorous sphincterotomy. Of 33 patients, 32 were among group B, and represented 97% of bleeding cases, and 32% of total cases in our study. The arrangement of the use of different hemostatic measures in our study was based on accessibility of the facilities and also severity of bleeding. In mild cases, bleeding stopped simply with balloon tamponade. If not, adrenaline spray was used. Endoclip was used for difficult and recurrent cases. Delayed bleeding occurred (1±7 days -mean, 2.5 days) following the procedures. Among the 9 patients with delayed bleeding, 7 patients were managed by endoscopic intervention. The other 2 patients managed conservatively by drugs and intravenous fluids with. No patient required angiography or surgery for delayed bleeding.
Conclusion: Patients must be carefully assessed and prepared pre procedure. Centers must be equipped with all hemostatic measures and facilities. Endoscopists must be well trained and qualified. Bleeding was controlled in all patients easily without morality.
Sphincterotomy
Coagulopathy
Bleeding
ERCP
2020
10
01
1529
1540
https://amj.journals.ekb.eg/article_120556_0c092b04dd51e457a0f864fd6f99d527.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
ROLE OF ENDOVASCULAR INTERVENTION IN ILIAC ARTERY DISEASE TASC C AND D CLASSIFICATION
Tamer
El-Sayed Abo Gazia
Sameh
El-Sayed El-Imam
Bosat
Elwany Bosat
Yehia
Kamal Sadek
Background: For more than forty years, endarterectomy and bypass grafting have been the primary means of surgically revascularizing peripheral vessels threatened by atherosclerotic diseases. However, with today's endovascular technology, stenosis and occlusions in nearly every circulatory system can he approached intraluminally with balloon dilation and intravascular stents.
Objective: To evaluate the technical success rates, primary patency, limb salvage, patient survival and complications for TASC C, and D iliac lesions treated by endovascular procedure. Additionally, the influence of the access site and the clinical outcomes were analyzed.
Patients and Method: Between 2017 and 2019, data from 40 consecutive patients at Al-Zahra’a University Hospital and Damanhor Teaching Hospital with 47 chronic iliac artery stenosis, and/or occlusion who were treated with EVT were reviewed.
Results: The procedure time was longer for TASC D lesions than for TASC C lesions (180.43 ± 45.97 VS131.69 ± 37.49: p= 0.001). There were two postoperative deaths in the TASC D lesion group, with the cause being one myocardial infarction, and one postoperative hospital acquired pneumonia. The total perioperative complication occurred in the TASC D lesions was [four (10%) vs. zero; p = 0.011] TASC C lesions. Corresponding 2-year primary patency rates were 100% in TASC C lesions, 71.4% in TASC D lesions, and for all cases were 87.5%.
Conclusion: The outcomes of EVT for TASC C and D aorto-iliac lesions were acceptable, with better technical success in TASC C lesions than in TASC D lesions. The 2-year patency rate for both TASC C and TASC D lesions was acceptable, and brachial access was useful for complex anatomy.
Endovascular procedures
Iliac artery
Trans-Atlantic Inter- Society Consensus (TASC)
Patency
Peripheral artery disease
2020
10
01
1541
1550
https://amj.journals.ekb.eg/article_120557_d356b064b184aa78097fd75653ff40b5.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
EVALUATION OF LIGATION OF INTERSPHINCTERIC FISTULAS TRACT (LIFT) FOR THE TREATMENT OF TRANSSPHINCTERIC ANAL FISTULA
Abou Bakr
Abd El-Kader Ateya
Mahmoud
Mohamed Abu Al-Yazid
Nader
Mohamed Abd El-Hameid
Background: Fistula-in-ano consists of a primary track which passes from the internal opening in the anal canal to the external opening in the perineum. Most of the anal fistulas are originated from the infection of anal glands which are connected to the anal crypts (cryptoglandular origin). Age distribution is spread throughout adult life with maximal incidence between the third and fifth decades. Men are 2 to 5 times more likely to develop anal fistula than women.
Objective: The aim of this study was to evaluate the LIFT technique for the treatment of trans-sphincteric anal fistula.
Patients and Methods: This study included 20 patients with trans-sphincteric fistula from August 2018 till April 2020, while anal fistula due to specific disease and other types of law anal fistula have been excluded from the study. Regarding demographic data, 90% of the included patients were males and the mean age was 38 years. The median duration of symptoms was 8 months, and the median length of the fistula tracts was 7cm. The mean BMI of patients was 38, seven patients (35%) were diabetic. All patients were investigated with pre-operative MRI and 3D CT fistulography.
Results: The main finding of this study was overall healing of 80% of patients, with a 6 months follow-up. There were 1 failure, and 3 recurrences between 3 and 6 months after surgery. No patients reported de novo incontinence, and all patients reported normal control. The median time for wound healing was 4 weeks.
Conclusion: LIFT Technique is quite, simple and excellent in long term control of trans-sphincteric fistula, but actually the corner stone in management of perianal fistula is the accurate diagnosis of the type of fistula, which need good preoperative imaging by both surgeon and radiologist, followed by good intraoperative assessment of the type of fistula for selection of the appropriate Technique of each type.
Intersphincteric Fistulas Tract
Transsphincteric Anal Fistula
2020
10
01
1551
1560
https://amj.journals.ekb.eg/article_120558_8c09de08411911a26a994cd0fbf96de1.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
COMPLICATIONS OF COLOSTOMY AFTER COLORECTAL SURGERY
Ahmed
Abd El-Wakeel Abd El-Aal Saied
Saied
Hosny Bendary
Ayman
Mohammed Abdul-mohaymen
Background: Significant morbidity is associated with stoma creation and these complications can be grouped into early and late-occurring complications. The literature reports the rate of stoma-related complications ranging from 20 to 70%. Early complications occur within the first 30 days of the stoma creation and include ischemia/necrosis, retraction, mucocutaneous separation, and parastomal abscess.
Objective: To evaluate complications of stoma after colorectal surgeries, both early and late complications of colostomy were assessed with respect to the frequency of complications, health-related quality of life (QoL), and length of hospitalization (LoH).
Patients and Methods: This was a randomized prospective trial evaluating early and late complications of colostomy after colorectal surgeries in Department of Surgical Oncology, Al-Azhar University Hospital. This study was started at June 2017 and ended at May 2019. Patients were included after they agree to be included in the study and an informed consent was taken. Screening for and inclusion of participants was made after the index surgery. Follow-up of patients was at the time of surgery and up to 6 months after index surgery. Fifty patients were included in this study and assessment of early and late complications was done. The risk of postoperative complications is dependent on patient-related factors and technical aspects of the operative procedure.
Results: Retraction was found to be the most common complication (16 % of all patients). Parastomal herniation was the most common late complication after colostomy creation and it affected about 16% of all patients.
Conclusion: Complications from colostomies are frequent, costly, and difficult to resolve, even after multiple operations. Prevention of complications occurred through sufficient time spent in siting and mobilization, with strict attention to detail and a meticulous technique.
Stoma
Rectal Cancer
Colorectal Surgery
pyoderma gangrenosum
2020
10
01
1561
1970
https://amj.journals.ekb.eg/article_120613_013ce5c61ed8e0a8247e0d6301fdeeeb.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
TREATMENT OF SUPRACONDYLAR FEMUR FRACTURES BY LOCKED PLATE
Haitham
Mahmoud Abd El-Halim Elwany
Ahmed
Ibrahim Akar
Mohamed
Abd El-Rahman Alnahas
Background: Locked plates have more advantages than conventional plates especially when dealing with complex supracondylar femur fractures or osteoporotic bone. Objective: To evaluate the supracondylar femur fractures treated by locked plates. Patients and Methods: During the period between July 2019 and July 2020, a prospective study was conducted on twenty patients having supracondylar femur fractures and managed by surgical fixation by "locked plates". They were followed up for 6 months. Results: The mean age of patients was 57 years, 70% of them were males and 30% were females. The cases were divided into two equal parts 50% were left sided and the other 50% were right sided. Knowing that seven patients have extra-articular fractures and thirteen patients has intra-articular fractures. The result of radiological union.8 was variable 50% of the patients achieved their radiological union in 3 months, 35% patients in 4 months and the remaining 10% achieved their radiological union in more than 6 months which was considered "delayed response", and only one patient did not achieve any type of union. These results reflected that 35% of patients were excellent, 25% good, 30% fair and only 10% had poor results. Conclusion: Locked plate is a safe procedure for supracondylar femur fractures with an excellent functional outcome and both early clinical and radiological union.
Supracondylar femur fracture
Locked plates
2020
10
01
1971
1582
https://amj.journals.ekb.eg/article_120614_4a8c119e7dc49f0fd234359258d58c37.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
AUTOLOGOUS TRANS-OBTURATOR (ATO) RECTUS FASCIA SLING IN TREATMENT OF FEMALE STRESS URINARY INCONTINENCE
Mohamed
Fawzy Salman
Mohamed
Mabrook Badr
Ayman
Kotb Korietnah
Background: stress urinary incontinence is a common problem affecting females; treatment varies between Burch colposuspension and traditional tot using synthetic materials.
Objective: To evaluate efficacy and safety of autologous transobturator (ATO) rectus fascia sling as a primary treatment for female stress urinary incontinence.
Materials and Methods: We evaluated the outcomes of 56 consecutive females who underwent ATO sling placement with rectus fascia for stress incontinence from July 2017 to September 2019 at the urology department – Al Azhar university hospitals (Alhussien – Sayed Galal university hospitals). Patients were followed in the outpatient clinic after one week, two weeks, 3 months and 6 months postoperatively. Outcomes were measured subjective by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score, and patient reported outcome and objective by cough stress test.
ICIQ-FLUTS were compared between pre- and postoperative responses using Wilcoxon signed-rank test. Retreatment-free survival rates were evaluated via Kaplan-Meier method.
Results: The mean age of patients was 43.4 ± 7.04 years (29-56 years), 40 patients (71.5%) were premenopausal, and 16 patients (28.5%) were postmenopausal. The mean BMI was 29.2 ± 4.1 kg/m². The technique was performed and the patient was discharged the next day after surgery. Follow up for patients was carried out at one week, two weeks, three and six months postoperatively. All patients completed ICIQ-FLUTS at the last follow-up. Compared to preoperative scores, patients who completed ICIQ-FLUTS questionnaires at 6 months (N = 56) showed significant improvement in all domains: frequency, voiding, and incontinence, and in quality of life related to frequency, voiding and incontinence. Among those who completed questionnaires both at 3 months and 6 months after surgery (N = 56). There was no significant deterioration in ICIQ-FLUTS scores. Overall retreatment-free survival rate was 93% at six months. Notably, none of our patients suffered from severe (Clavien III-V) complications or required sling release.
Conclusion: ATO sling placement appeared safe and effective, with promising short-term outcomes. However, long term follow-up is needed.
ATO sling
autologous TOT
SUI
Transobturator
Urinary incontinence
stress incontinence
2020
10
01
1583
1598
https://amj.journals.ekb.eg/article_120616_bb696e9129936c8999be4b0629585e1e.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
PRONATOR QUADRATUS MUSCLE PEDICLED BONE GRAFT FOR DELAYED UNION SCAPHOID
Khaled
Ahmed Abo Al-Fadl
Ibrahim
Ahmed Hussein
Faisal
Hassan Zayed
Background: The human scaphoid bone is one of the carpal bones of the wrist. Its fracture is the most common type of carpal bone fracture. Scaphoid nonunion is a well-known and common problem. Both clinical and biological factors contribute to the development of nonunion. Several techniques of bone grafting have been used in the management of scaphoid fracture nonunion. The union rate achieved with standard nonvascularized bone grafts was poor, especially in case of avascular necrosis and pseudarthroses, whereas the use of vascularized bone grafts results in better union rates. Pronator quadratus pedicled bone graft is described as one of the successful techniques that treat delayed union of the scaphoid fracture.
Objective: To evaluate the outcomes and results of pronator quadratus muscle pedicle bone graft for patients who were suffering from delayed union or nonunion of scaphoid bone fracture.
Patients and Methods: Ten patients suffering from delayed and non-united scaphoid fractures, seven males and three females, aging from 17 to 54 years old. We used the pronator quadratus muscle pedicled bone graft to treat all these patients.
Results: Complete union was achieved in seven patients, 6 patients of them were suffering from waist non united scaphoid fracture, and one patient of four patients suffering from non-united proximal pole scaphoid fracture.
Conclusion: The use of the pronator quadratus pedicled bone graft in delayed union of the scaphoid waist fractures achieved a high rate of union with excellent and good functional outcomes. A poor result occurred on using the pronator quadratus pedicled bone graft in delayed union of the scaphoid proximal pole fracture.
Scaphoid fracture
nonunion
pronator quadratus pedicled graft
internal fixation
2020
10
01
1599
1610
https://amj.journals.ekb.eg/article_120617_74a4d62c0c703456c7499d8587bbaa5c.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
ARTHROSCOPIC MANAGEMENT OF MENISCAL ROOT TEAR INJURY
Mahmoud
Maher Mahmoud
Younus
Mahmoud Akl
Emad
Mohamed Zayed
Background: Meniscal root tears are becoming increasingly recognized. They can cause rapid progressive arthritis.
Objective: The purpose of this study was to document the radiological and functional outcome of arthroscopic management of meniscal root tears injuries.
Patients and Methods: The study was conducted on 15 patients with 15 meniscal root tears from January, 2017 till January, 2019 presenting to AL - Hussein hospital treated by partial meniscectomy or pullout sutures repair. This study included 9 males (9 knees) and 6 females (6 knees).
Results: The mean age for repair was 36.53 ± 9.12 years (range, 23 to 50 years) and for partial meniscectomy was 56.2 ± 3.96 years (range, 50 to 60 years). Of the 15 knees, 10 were right knees and 5 were left. All clinical outcome measures significantly improved after surgery according to Lysholm and IKDC score. The mean Lysholm score for group of meniscal root repair (group A) increased from 64.5 ± 12.35 to 88.10 ± 10.07 (P ˂ 0.001), and the mean Lysholm score for partial meniscectomy (group B) increased from 47.20 ± 11.32 to 86.80 ± 9.41 (P ˂ 0.001) postoperatively. The mean IKDC score for root tear repair increased from 56.10 ± 10.97 to 76.70 ± 8.55 (P ˂ 0.001), and the mean IKDC score for partial meniscectomy increased from 41.40 ± 10.85 to 59.60 ± 8.33 (P ˂ 0.001).
Conclusions: Meniscal root repair has increased in popularity and when done in selected patients resulted in a high rate of healing and restoring the ability of the meniscus to dissipate axial tibiofemoral loads, thereby slowing or halting arthritic progression.
Root tears injury
partial menisectomy
pullout suture repair
2020
10
01
1611
1618
https://amj.journals.ekb.eg/article_120618_2409d56249138bbbbaee3b012f7390fe.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
OUTCOMES OF VAC VERSUS CONVENTIONAL DRESSING IN MANAGEMENT OF DIABETIC FOOT ULCER
Hussein
Abd El-Raouf Ali Hussein
Al-Sayed
Ahmed Hamdy
Abd El-Aziz
Ahmed Abd El-Hafez
Background: Foot wounds in people with diabetes mellitus (DM) are common and serious global health issue. Negative pressure wound therapy can be used to treat these wounds and a clear and current overview of current evidence is required to facilitate decision-making regarding its use.
Objective: To assess the efficacy of vacuum assisted closure dressings as compared to conventional moist wound dressings in improving the healing process in diabetic foot wounds.
Patients and methods: This prospective randomized comparative study was conducted in the General and Vascular Surgery Departments at Al-Azhar university hospitals and Al-Ahrar teaching hospital, in the period from January 2019 to May 2020. The study included 30 patients randomized into two equal groups: VAC therapy and conventional dressing suffering from diabetic foot wounds. All chronic wounds where conventional dressings indicated were included in the study.
Results: Wound bed showed signs of healing by granulation tissue formation in 11 among 15 patients (73.3%) in VAC therapy group. In conventional treatment, 4 showed granulation among 15 patients (26.7%) one week after initiation of treatment. (P=0.01). There was a statistically significant difference between average granulation as % of ulcer area and it was significantly high in vacuum dressing. It was 50.2 ± 18.9 in Conventional treatment compared with 77.4 ± 19.3 in NPWT group (p- value = 0.005). Also, at the end of the study, we found that the total mean cost in conventional dressing group was 1993 ± 193 EP compared to 2261 ± 183 EP in VAC group. There was a difference in the total cost finally. Being higher in cost, VAC therapy although has a shorter hospital stay and faster healing time in comparison with conventional dressing.
Conclusion: Negative pressure wound therapy (NPWT) using vacuum-assisted closure (VAC) was more efficacious than conventional therapy in the management of foot ulcers in diabetic patients. Hospital stay was significantly shorter in NPWT patients, so less consuming of hospital service than conventional dressing. This is finally decreasing the total budget to the hospital.
diabetic foot ulcer
NPWT
VAC
2020
10
01
1619
1628
https://amj.journals.ekb.eg/article_120619_53a9d173cde6e6c83cc318835bfc5bd5.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
THE METABOLIC OUTCOME OF SINGLE ANASTOMOSIS SLEEVE ILEAL OPERATION
Hatem
M. El-Mahdy
Ashraf
A. Abd El-Monem
Abd El-Fatah
M. Saied
Tarek
A. El-Dahshan
Background: Obesity is considered a health hazard for metabolic disorders including diabetes mellitus (DM), dyslipidemia, hypertension and other related comorbidities. Laparascopic sleeve gastrectomy is considered more efficient bariatric procedure for weight loss compared with nonsurgical interventions. Single anastomosis sleeve ileal (SASI) bypass has been established as a new bariatric and metabolic procedure.
Objective: To show metabolic disorders (DM, hyperlipidemia and hypertension) after SASI operation, and to detect short outcomes as regard weight loss and to assess complications as malnutrition.
Patients and Methods: An interventional prospective study was carried at Bab Alshaariya university hospital, Cairo from May 2019 till November 2019.This study was conducted on 20 patients with body mass index (BMI) ≥ 48 kg/m2 underwent SASI bypass surgery and were followed for 6 months postoperatively. Changes in BMI, excess weight loss (EWL), routine lab investigations (FPG, HbAIC, triglyceride, cholesterol, HDL), and comorbidities improvement were recorded on six months follow-up post operation.
Results: The main results of the study revealed that mean±SD age of the patients at the time of operation were 38.3 ± 3.61, mean BMI was 48.7 ± 7.6, 25% of cases were males and 75% were females. 65% of cases were diabetic, 40% hyperlipidmic, and 30% were hypertensive patients. There was a high significant difference between pre and post-surgery as regard FPG, HbAIC, triglyceride, cholesterol, HDL and LDL. There was a high significant difference between before and after surgery as regard BMI. Mean amount of blood loss was 76.1 ± 15.2 with a range of 50-150ml. During surgery, leak during methylene blue test was in 5% of cases, and no post-operative stenosis in cases.
Conclusion: SASI bypass is an effective bariatric and metabolic surgery for achieving satisfactory weight loss in patients suffering other metabolic disorders with minimal surgical complications.
Bariatric surgery
Obesity
BMI
Metabolic disorders and SASI bypass
2020
10
01
1629
1638
https://amj.journals.ekb.eg/article_120620_b045de38c05e8085312c0b1663ffbde1.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
EFFICACY OF POSTOPERATIVE PARENTERAL TRIMEBUTINE MALEATE IN RECOVERY OF BOWEL FUNCTION FOLLOWING CESAREAN SECTION
Ahmed
S. Kamal
Ismael
M. El-Garhy
Mofeed
F. Mohammad
Background: Postoperative ileus remains a serious clinical problem. It is one of the most important contributors to increased length of hospitalization and consumption of the health care system resources. Attempts have been made to treat several causes simultaneously to quickly restore normal postoperative bowel motility.
Objective: The aim of this study was to estimate the effectiveness of postoperative parentally administered Trimebutine maleate inducing intestinal motility after cesarean section.
Patients and Methods: This study included 200 patients who were selected from the outpatient clinic of Obstetrics and Gynecology at Alexandria Armed Forces Hospital. They were classified into two equal groups:
Group (1): Control group underwent traditional management (oral intake of clear fluids and I.V fluids), and Group (2): were infused intravenously by a total dose of 300mg of Trimebutine maleate per day divided into 100 mg every 8 hours till first passage of flatus. Each group was subdivided into two equal subgroups:
A) GA group < /strong> underwent cesarean section under general anesthesia,
B) SA group < /strong> underwent cesarean section under spinal analgesia.
Results: There was a significant difference between GA and SA of the control group in which the SA group decreased in the time in comparison to the GA group in all the outcome measures. There was a significant difference between GA of the cases group and GA of the control group in which the GA of the cases group decreased in the time in comparison to the GA group of the control in all the outcome measures. There was a significant difference between SA of the cases group and SA of the control group in which the SA of the cases group decreased in the time in comparison to the SA group of the control in all the outcome measures. Regarding pain and distension. There was a significant difference between GA and SA of the control group with more cases in the GA group, there was a significant difference between SA of the control and SA of the cases with more cases with the SA of the control.
Conclusion: Trimebutine maleate (GASTREG®) routinely administrated to patients after caesarean section speeds recovery of intestinal function postoperatively by stimulating gastrointestinal motility. So GASTREG is an inexpensive, tolerable and helpful measure to postoperative care after caesarean section and other abdominal surgery.
Bowel function
cesarean section
parenteral trimebutine
maleate
2020
10
01
1639
1652
https://amj.journals.ekb.eg/article_120621_f6b88b38ae382025475bc547d113bc56.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
MEASUREMENT OF FETAL ABDOMINAL SUBCUTANEOUS TISSUE THICKNESS BY ULTRASOUND IN PREDICTION OF BIRTH WEIGHT AT TERM PREGNANCY
Yousri
A. Oun
Mohamed
M. Gebril
Saged
M. El-Mazzaly
Background: Assessment of fetal weight is a vital and universal part of antenatal care, not only in the management of labor and delivery but often during the management of high risk pregnancies and growth monitoring. The common methods to estimate fetal birth weight are clinical and sonographic estimation with a wide range of accuracy.
Objective: To correlate fetal abdominal subcutaneous tissue thickness (FASTT) measured by abdominal ultrasound at term and birth weight measured immediately after delivery and to obtain a cut-off value of FASTT to predict large and small for gestational age babies in our population at Alsayed Galal Hospital and Damanhur medical national institute (D.M.N.I).
Patients and methods: This prospective observational study was carried out at Alsayed Galal Hospital and Damanhur medical national institute (D.M.N.I).A total of 200 pregnant women at term admitted to the labor ward for delivery at Alsayed Galal Hospital and D.M.N.I. between June 2019 and March 2020.
Results: Of the 200 neonates of the included women, 148 (74.0%) had birth weight (2500-4000) g 14 (7.0%) had birth weight<2500g, while 38 (19.0%) had birth weight>4000 g. There was a significant positive correlation between fetal anterior abdominal wall fat thickness and birth weight. FAST was a significant predictor of Birth weight > 4000 g, as indicated by the significant large area under the curve (AUC).
Conclusion: FASTT is a good indicator of birth weight. It is a better parameter for LGA than SGA. It showed a high statistically significant correlation with AC. Yet, it is less accurate than AC as an indicator of fetal macrosomia. FASTT is not affected by fetal gender and has no direct relation to the mode of delivery.
FAST can be combined with weight estimation formulas as a method to increase its accuracy especially at birth weight extremities. However, a large study conducted on a wider scale of Egyptian population should be done in attempt to generate formulas for the estimation of fetal weight based on the Egyptian ethnic group and be the reference of medical practice in Egypt.
FASTT
Ultrasound
Birth weight term pregnancy
LGA
SGA
2020
10
01
1653
1662
https://amj.journals.ekb.eg/article_120622_8b789353334a861e7bdd8f7927136516.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
SONOGRAPHIC IDENTIFICATION AND MEASUREMENT OF THE EPIPHYSEAL OSSIFICATION CENTERS IN THE PREDICTION OF FETAL LUNG MATURITY IN EGYPTIAN WOMEN
Amr
Awad Amin Abd El-Hady
Ismail
Mohammed Abd El-Azeam Mira
Farid
Ahmed Kassab
Background: The most common cause of mortality and neonatal morbidity in preterm and early term fetuses is lung immaturity. Respiratory distress syndrome (RDS) is a major cause of neonatal mortality and morbidity where the lung cannot provide sufficient oxygen.
Objective: Evaluating the distal femoral, proximal tibial and proximal humeral ossification centres as predictive tools of fetal lung maturity.
Patients and methods: This study was conducted at Obstetrics and Gynecology Department, Damanhur Teaching Hospital, from May 2019 to January 2020 and included a sample of 100 pregnant women. The mean age of mother in our study was 25.35±3.75 years, the mean BMI was 32.85±4.33. The mean gestational age by U/S was 38.01±1.65 weeks, the mean epiphyseal ossification centers was ranged from 2.4-6.8 with a mean of 4.53±1.22, and the epiphyseal ossification centres were parallel to gestational age.
Results: The results of this study showed that the relation between Mean Epiphyseal Ossification Centers and neonatal Respiratory distress syndrome. The mean Epiphyseal Ossification Centers were significantly low in neonatal with respiratory distress syndrome (p <0.05). It was found that there was a positive significant correlation between mean epiphyseal ossification centers and APGAR score at 5 min. It was found that the Mean Epiphyseal Ossification Centers were significantly increased with increasing gestational age.
Conclusion: The distal femoral, proximal tibial and proximal humeral ossification centers have good predictive values of fetal lung maturity.
Sonographic
Epiphyseal Ossification Centers
Fetal lung maturity
2020
10
01
1663
1672
https://amj.journals.ekb.eg/article_120623_6569ad784d4b67cd28b0191d12590ebe.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
THE EFFECT OF CARBETOCIN COMPARED TO RECTAL MISOPROSTOL IN THE MANAGEMENT OF BLOOD LOSS DURING THE THIRD STAGE OF VAGINAL DELIVERY IN LOW RISK PATIENTS FOR POSTPARTUM HEMORRHAGE
Ahmed
Sameer Abd El-Wahab
Abd Allah
Khalil Ahmed
Al-Refaai
Abd El-Fattah Marai
Background: Postpartum hemorrhage (PPH) or excessive bleeding at or after childbirth is a potentially life-threatening complication and is one of the major contributors to maternal mortality and morbidity worldwide.
Objective: To compare the effect of IV Carbetocin and Rectal Misoprostol to decrease blood loss in third stage of vaginal delivery in low risk patients for postpartum hemorrhage.
Patients and Methods: A randomized controlled trial was performed at Beni Suef Specialized Hospital in Obstetric Unit. The study included 160 healthy women with viable normal singleton pregnancy achieving normal vaginal delivery at or beyond 37 gestations from March 2019 till August 2019. Women were randomized to receive either a single dose Of Carbetocin 100 mcg following delivery of the anterior shoulder of baby or rectal misoprostol 800 mcg (4 tabs) at the crowning in the second stage of labor.
Results: There was non-statistically significant difference in the estimated mean blood loss between the carbetocin and misoprostol groups with blood loss of 203 ml higher in misoprostol group. The mean drop of hemoglobin concentration 12h after delivery was 0.63g/dl in carbetocin group and 1.1g/dl in misoprostol group and drop in hematocrit value was 1.9% in carbetocin group and 3.3% in misoprostol group. These differences were statistically non-significant in both groups. Women in the carbetocin group were more likely to experience abdominal pain than misoprostol group. Headache and tachycardia were predominate in carbetocin group, women needed other uterotonic drugs more in misoprostol group. Blood transfusion was needed in some misoprostol group cases.
Conclusion: Single dose of carbetocin 100 mcg was with the same effect to 800 mcg (4 tablets) misoprostol to decrease blood loss in third stage of normal vaginal delivery of low risk patients for postpartum hemorrhage, with no significant drop in hemoglobin and hematocrit in two groups but with more side effects and more cost in carbetocin group than misoprostol group.
carbetocin
misoprostol
blood loss
Third Stage of Vaginal Delivery
Postpartum Hemorrhage
2020
10
01
1673
1682
https://amj.journals.ekb.eg/article_120624_22809135eac5abdf7f3303b3c5d916d9.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
COMMON PREGNANCY COMPLICATIONS IN RELATION TO VITAMIN D DEFICIENCY
Mostafa
Ahmed Essawi El-Zahaby
Ismail
Mohammed Abd El-Azeam Mira
Hani
Maged Abd El-Aal
Abd El-Aleem
Abd El-Aleem El-Gendy
Background: Maternal vitamin D deficiency is a widespread public health problem as the prevalence of inadequate and deficient vitamin D status in pregnant women ranges from 5 to 84% globally.
Objective: To assess risk factors for vitamin D deficiency and investigate the relation between maternal vitamin D level, and development of gestational diabetes mellitus, gestational hypertension, intrauterine growth retardation, and preterm labor.
Patients and methods: Our prospective observational study included 100 pregnant women divided into 2 equal groups: group A had insufficient vitamin d level and group B had sufficient vitamin D level in serum with no risk factors. Vitamin D levels were measured on the MiniVidas (Biomerieux, France).
Results: The incidence of preterm labor was 22%. There was a statistically significant association between hypovitaminosis D and preterm labor. There was no significant association between hypovitaminosis D and gestational diabetes mellitus, gestational hypertension and intrauterine growth retardation.
Conclusion: There was an association between hypovitaminosis D in pregnancy and preterm deliveries, No association between vitamin D deficiency and common pregnancy complications as gestational diabetes, gestational hypertension and intra uterine growth retardation.
hypovitaminosis D
preterm labor
Gestational diabetes mellitus
gestational hypertension and intrauterine growth retardation
2020
10
01
1683
1690
https://amj.journals.ekb.eg/article_120625_b8575f0a7eec7cbf28f6c01bdff2121b.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
CLINICAL STUDY OF THE IMPACT ON OVARIAN RESERVE BY DIFFERENT HEMOSTASIS METHODS IN LAPAROSCOPIC CYSTECTOMY FOR OVARIAN ENDOMETRIOMA
Ismail
A. Mira
Ihab
H. Mohamed
Ibrahim
M. Mohamed
Background: Endometriosis is the presence of endometrial glands or stroma in sites other than the uterine cavity such as the ovaries, fallopian tubes and the pelvis. The most common location of endometriosis is the ovary, occurring in 17-44% of patients affected by endometriosis.
Objectives: To explore the impact of laparoscopic ovarian cystectomy versus aspiration and coagulation on ovarian reserve in cases of ovarian endometrioma.
Patients and Methods: This randomized controlled prospective study was conducted on ninety two patients presenting with unilateral ovarian endometrioma at Obstetrics and Gynecology Department, Al-Azhar University Hospitals during the period from April 2018 to October 2019. FSH, LH, E2, AMH, AFC (antral follicular count); all were determined before and after laparoscopic surgery (postoperative three months); for two groups: Group A for cystectomy and Group B for aspiration and coagulation, performed randomly using closed envelope. Histopathological examination was done to the cystectomy group to confirm endometriosis and detect the presence of healthy ovarian tissue in the excised cyst wall.
Results: There were postoperative significant decreases in FSH, LH, E2, AMH and AFC in each group compared with the preoperative values but were within normal ranges, and this decrease was of no statistically significant difference between both groups as regarding (FSH, LH, E2, AMH). There was a statistically significant difference between both groups in AFC which was more decreased in the cystectomy group. So, AFC was more accurate in predicting ovarian reserve loss than AMH.
Conclusion: Ovarian reserve decreased by both techniques; but the decrease was more frequent in cystectomized ovaries.
Ovarian endometrioma
laparoscopic surgery
ovarian reserve
2020
10
01
1691
1702
https://amj.journals.ekb.eg/article_120626_45af89b5200ad3681157927b27e010bd.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
BISHOP SCORE VERSUS ULTRASONOGRAPHIC TECHNIQUES FOR PREDICTION OF SUCCESSFUL INDUCTION OF LABOR
Ahmed
Al-Sayed Ibrahim Basha
Ashraf
Hamdy Mohamed
Abd El-Moneim
Mohamed Zakaria
Background: The process of labor has always been elusive and difficult to grasp till this current era. What is even more elusive knows when it would happen and when to intervene. Throughout the medical literature there has been reliance on clinical examination to predict successful induction. with the advent of ultrasonography this process of relying on subjective clinical data has shifted towards combining both the skills of the examiner with the subjective information from ultrasonography.
Objective: Comparing between Bishop Score and transvaginal cervical assessment of prior to induction of labor in prediction of successful.
Patients and methods: This study was conducted at Obstetrics and Gynecology Department, Damanhour Teaching Hospital, from January of 2018 and December of 2018 and included a sample of 200 pregnant women. The mean age of mother in our study was 24±3.75 years, the mean BMI was 25.85±4.33. The mean gestational age by U/S was 38.9±2 weeks. The mean bishop score was 7.20 ± 1.80, the mean cervical length was 17.54 ± 4.64, the mean posterior cervical angle was 116.3 ± 14.23.
Results: The results of this study showed that the correlation between labor induction prediction of success using bishop score and ultrasound. The mean bishop score was 7.20 ± 1.80, the mean cervical length was 17.54 ± 4.64, the mean posterior cervical angle was 116.3 ± 14.23. it was found that there was a positive significant correlation between successful induction and pre-induction bishop score , posterior cervical angle and cervical length.
Conclusion: In this study we found that successful induction correlated significantly with the Bishop score and ultrasonographic cervical length & posterior cervical angle.
Sonographic
Bishop Score
Cervical length
Posterior Cervical Angel
2020
10
01
1703
1712
https://amj.journals.ekb.eg/article_120627_5c6ae0701fb811201bfc3e3cb5d39f5b.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
THE VALUE OF MIDDLE CEREBRAL TO UMBILICAL ARTERY DOPPLER RATIO IN THE PREDICTION OF NEONATAL OUTCOME AMONG WOMEN WITH PREGNANCY INDUCED HYPERTENSION
Ahmed
Abdelrazik abdelfattah
Taher
Mohammed Moustafa
El-Sayed
Mohammed Taha
Background: Hypertensive disorders complicating pregnancy are common and form one of the deadly triad, along with hemorrhage and infection that contribute greatly to maternal morbidity and mortality. Objective: To evaluate the role of middle cerebral artery and umbilical artery pulsatility index (PI) ratio in predicting neonatal outcome in pregnancies induced hypertension. Patients and methods: This study which included 100 women with severe preeclampsia admitted to Alsayed Galal University Hospital during the period between November 2018 and July 2019. Were evaluated the accuracy of middle cerebral/umbilical artery pulsatility index ratio in predicting admission to neonatal intensive care unit (NICU), acidemia and low Apgar score at 5 minutes after birth in neonates of severe preeclamptic pregnant women. Results: The best cut off value of middle cerebral artery (MCA) / umbilical artery (UA) PI ratio for prediction of NICU admission was sensitivity 62.5%, specificity 71.43%, positive predictive value (PPV) 29.41%, negative predictive value (NPV) 90.91% and the accuracy 70%. The cut off value of MCA/UA PI ratio for prediction of low Apgar score at 5 min was 50% sensitivity and 88.10% specificity. Estimated positive predictive value =44.44 and negative predictive value =90.24, and the cut off value of MCA/UA PI ratio for prediction of low UA PH were 43.75% sensitivity, 69.05% specificity, estimated positive predictive value =21.21, and negative predictive value =86.57. Conclusion: Doppler data combining both umbilical and cerebral velocimetry provides information on consequences of the placental abnormality; Hence, Doppler can be a useful tool in the management of patients with preeclampsia and can help in deciding the time of delivery so that the fetus can be saved.
Value of Middle Cerebral
Umbilical Artery Doppler Ratio
Prediction of Neonatal Outcome
Pregnancy
Hypertension
2020
10
01
1713
1722
https://amj.journals.ekb.eg/article_120629_55daecf77c13d987c313d892c6694c0d.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
CORRELATION OF PLACENTAL THICKNESS ESTIMATED BY ULTRASONOGRAPHY WITH GESTATIONAL AGE IN THE SECOND AND THIRD TRIMESTER OF PREGNANCY
Hamada
Ali Abou Zeid
Mofeed
Fawzy Mohamed
Wael
Soliman Taha
Background: Normal development of placenta during gestation is necessary for supporting of a healthy fetus. On the other hand, any impairment in its development may have a profound impact on fetal development and pregnancy outcome.
Objective: To study the placental thickness by ultrasonography in relation to gestational age (GA).
Patient and Methods: The present prospective study was conducted on 100 pregnant females attending antenatal clinics in both Damanhour Educational Hospital and Eldelngat central Hospital in the period from August 2018 to August 2019. The placental thickness in mm was measured at the level of cord insertion site. Placental thickness was calculated from the echogenic chorionic plate to placental myometrial interface near the mid-placental portion.
Results: There was a positive correlation between increase in placental thickness (mm) in total sample, 2nd trimester, and 3rd trimester and GA, as GA increase Placental thickness increase.
Conclusion: Placental thickness measured at the level of umbilical cord insertion can be used as an accurate sonographic indicator in the assessment of gestational age because of its linear correlation. Therefore, it can be used as an additional sonographic tool in correlating gestational age in cases where last mestrual period (LMP) is not known and in detecting patients developing intrauterine growth retardation (IUGR).
Gestational age
Placental thickness
intrauterine growth retardation
2020
10
01
1723
1730
https://amj.journals.ekb.eg/article_120630_b87ba331a428a9a57e4af13f7d08e15a.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
A COMPARATIVE STUDY OF CONTINUOUS VERSUS INTERRUPTED EPISIOTOMY REPAIR AFTER VAGINAL BIRTH IN PRIMIGRAVIDAE
Mohamed
Fawzy Abd El-Halem Amin
Hassan
Abdrabboh
Mohamed
Farahat
Background: The use of continuous sutures are associated with lower short-term pain intensity assessed compared to the interrupted sutures; 2 days after repair and 10 days after repair.
Objective: To assess the effects of continuous versus interrupted suturing methods on short and long term postpartum maternal morbidity experienced by primiparous women following repair of episiotomy after vaginal birth.
Patients and methods: This comparative study was conducted in the Emergency Unit of Obstetrics and Gynecology at Desouk general Hospital. The study involved 200 primigravid women prepared for vaginal delivery with episiotomy).
Results: In the current study, episiotomy repair with continuous sutures was more economic; it required a significantly shorter time and lesser number of Vicryl sutures. Repair of episiotomy wound using continuous suturing technique of the vaginal mucosa and perineal muscles results in a better post-procedural pain recovery.
Conclusions: Continuous suturing technique consumed significantly shorter procedure time and less cost owing to fewer vicryl sutures.
Continuous suturing
Interrupted sutures technique
repair
Episiotomy
2020
10
01
1731
1740
https://amj.journals.ekb.eg/article_120631_6809e8d3e2f1757f7f19dc15c1196a88.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
THE ROLE OF UMBILICAL CORD THICKNESS AND GLYCATED HEMOGLOBIN (HBA1C) LEVELS FOR PREDICTION OF FETAL MACROSOMIA IN PATIENTS WITH GESTATIONAL DIABETES MELLITUS
Mahmoud
Fayez Mohamed Fathi
Taher
Mohammed Moustafa
Ibrahim
Ramadan Alsawy Rady
Background: Diabetes with pregnancy is a known clinical risk factor associated with fetal macrosomia. The rationale for performing an elective cesarean section includes a potential reduction in perinatal complications, especially those related to macrosomia.
Objective: This study aimed to assess the accuracy of Glycated hemoglobin (HbA1c) and umbilical cord thickness in prediction of fetal macrosomia in diabetic pregnant women.
Patients and methods: The study included 100 diabetic pregnant, 27 - 28 weeks gestation, gathered from Inpatients and Obstetric Outpatient Clinic of Bab Alshariya University Hospital during the period between November 2018 and August 2019, attending for routine antenatal care.
Results: At a criterion of > 211 mm2, the umbilical cord area measured at 27 – 28 weeks of gestation was able to predict high birth weight (macrosomia), with a sensitivity of 90.5% and a specificity of 91.7%. The area under the curve for the receiver operating characteristic (ROC) was 0.9294, with a 95% confidence interval of 0.8608 to 0.9702, which was found to be statistically significant. When compared the ROC curves of both the umbilical cord area and the glycated hemoglobin, it was found that umbilical cord area was more reliable in predicting fetal macrosomia at the right criterion, the difference between the predictive efficiency for both parameters was found to be statistically significant.
Conclusion: Macrosomia is a cause of the worst of obstetric emergencies such as shoulder dystocia, birth asphyxia and postpartum haemorrhage. Shoulder dystocia cannot always be predicted accurately. However, predicting macrosomia can help to identify the population at risk of such complications.
Umbilical cord thickness
Glycated hemoglobin (HbA1c)
Macrosomia
Gestational diabetes mellitus
2020
10
01
1741
1752
https://amj.journals.ekb.eg/article_120632_c68db2f2e8f3f4ebe6f6de05da5b4a3b.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
ROLE OF OFFICE HYSTEROSCOPY IN EVALUATION OF PERIMENOPAUSAL BLEEDING PATIENTS ATTENDING OUTPATIENT GYNECOLOGIC CLINIC
Alaa
H. Mohamed
Mohammed
T. Ismail
Yousef
A. Abu Shady
Taher
M. Mostafa
Background: Perimenopausal bleeding is a real clinical challenge facing gynecologists, which should indicate suspicion of endometrial malignant changes development and needs accurate evaluation of endometrium and uterine cavity.
Objective: To provide a clear understanding of the value of office hystroscopy as a diagnostic tool during assessment of women with perimemnopausal bleeding.
Patient and Methods: This prospective study included case records of 50 women with perimenopausal bleeding undergone office hysteroscopy and endometrial biopsy between 2017 and 2019 at Al Sayed Galal Hospital, Al-Azhar University, Cairo, Egypt.
Results: Sonographic findings of malignant or premalignant endometrium showed 25% sensitivity and 100% specificity for endometrial thickness ≥ 17 mm and 100% sensitivity and 58.7% specificity for endometrial thickness ≤ 10 mm. Sonographic findings of abnormal endometrial pathology showed 37.06% sensitivity and 100% specificity for endometrial thickness ≥10 mm and 88.24 % sensitivity and 57.14 specificity for endometrial thickness ≤ 7 mm. Hysteroscopic findings of malignant or premalignant showed 100% sensitivity and 76.09% specificity for endometrial thickness, 60% sensitivity and 93.48 specificity for endometrial polyp , 100% sensitivity and 100% specificity for endometrial mass and 50% sensitivity and 95.6% specificity for hypervascular endometrium .Hystroscopic findings of abnormal endometrial pathology showed 77.8% sensitivity and 92.7% specificity for thick endometrium , 80% sensitivity and 92.6% specificity for endometrial polyp , 22.2% and 100% specificity for endometrial mass, 22.2% sensitivity and 95.1% specificity for hypervascular endometrium.
Conclusion: Office hysteroscopy can be considered as a golden standard tool in diagnosis and management of perimenoipausal bleeding. It is valuable in assessment of endometrium and helpful in management planning.
office hysteroscopy
perimenopausal bleeding
gynecologic clinic
2020
10
01
1753
1764
https://amj.journals.ekb.eg/article_120633_0f882e2d0653e4ea1194da82a0b9e4ee.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
NIH STROKE SCALE CHANGES FOLLOWING CAROTID ARTERY STENTING
Hossam
El-Din Hassan Hussien Hassan
Magdy
Assad El-Hawary
Mohammed
Sayed Ismail El-Shandawelly
Background: Traditionally, carotid endarterectomy (CEA) has been the primary method of treating high-grade asymptomatic and symptomatic carotid artery stenosis. A carotid endarterectomy involves exposure of the carotid artery and removal of plaque, most typically from the carotid bulb and the proximal internal carotid artery, via a neck incision. However, in vascular surgery, as in many other surgical specialties, minimally invasive techniques have evolved over the years. These techniques offer the advantages of smaller incisions, reduced postoperative pain, reduced potential for postoperative wound complications, and a shorter length of stay in the hospital.
Objective: To assess the outcome of carotid stenting for carotid stenosis by assessing the changes in NIH stroke scale before and after carotid artery stenting.
Patients and Methods: This clinical trial study was conducted on 15 patients who underwent 15 carotid artery stenting (CAS). The study was carried at Al-Azhar University Hospitals and Mabart Masr Elkadema hospital in the period between July 2019 and July 2020. All patients with carotid stenosis with high-grade asymptomatic (more than 70%) or symptomatic carotid artery stenosis treated with carotid artery stenting were included in this study, All patients with carotid stenosis treated with carotid artery end arterectomy, patients with unfavorable aortic arch anatomy including heavily calcified aortic arch or a type 3 aortic arch, and Patients with a common carotid artery length of less than 5 cm from the clavicle were excluded from our study. Cases were subjected to National Institute of Health Stroke Scale (NIHSS) before and after carotid artery stenting.
Results: Most of the current study participants were males (66.7%) with a mean age of 58.9±8.9 years, 80% were symptomatic and 20% were asymptomatic. Most of patients in our study had hypertension (HTN) (80%), (53.3%) had diabetes mellitus (DM) and ischemic heart disease (IHD) and (46.7%) were smokers as males were higher than females. Also, 73.3% had dyslipidemia, 20% of patients were asymptomatic and 80% were symptomatic. Motor weakness was common especially on the left side (47.7%) of patients and right side (20%). Also, dysarthria was presented among 20% of patients, while transient ischemic attack (TIA) was presented among 13.3% of patients. Syncopal attack and deterioration of consciousness were among 6.7% of patients. In our study the degree of stenosis by diagnostic Cathter angiography (DCA) ranged from 60% to 90% with a mean of 72.67%±9.2. Right side was more affected (60%) than left side (40%). As regard National Institute of Health Stroke Scale (NIHSS) constructs, our patients had statistically significant improvement in level of consciousness, level of consciousness (loc) questions, loc commands, sensation and extinction/inattention occurred after 3 months. Also, our patients showed statistical significant improvement in best gaze, motor drift, best language and dysarthria after 3 months. Motor power of left arm and left leg showed statistically insignificant mild deterioration immediately after stenting. Visual field, facial palsy and limb ataxia constructs showed insignificant differences among our study patients as no improvement occurred.
Conclusion: CAS showed a high technical success rate and a good short term clinical outcome. CAS is a safe and efficacious procedure especially with the availability of proper materials and experienced staff.
NIH Stroke Scale
Carotid Artery Stenting
2020
10
01
1765
1776
https://amj.journals.ekb.eg/article_120634_47e81f8bf939598786f2bbe1754d2823.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
ASSESSMENT OF LEFT VENTRICULAR SYSTOLIC FUNCTION AFFECTION IN PATIENTS WITH FREQUENT PREMATURE VENTRICULAR COMPLEXES BY REAL-TIME THREE-DIMENSIONAL SPECKLE TRACKING ECHOCARDIOGRAPHY
Ahmed
El-Sebae Kasem
Abd El-Mohsen
M. Aboualia
Taher
Said Abd El-Kareem
Mohamed
Samy Abd El-Samie
Background: Premature ventricular contractions have been described in 1% of clinically normal people as detected by standard ECG and 40–75% of apparently healthy persons as detected by 24–48 hour ambulatory ECG recording (Holter). In the absence of structural heart diseases, it is thought to be relatively benign. However, PVC-induced cardiomyopathy has been a subject of great interest over the last decade.
Objective: To evaluate subtle and early premature ventricular complex (PVC)–induced ventricular impairment in patients with frequent PVCs and without structural heart disease by real-time 3-dimensional speckle tracking echocardiography (RT3D-STE).
Patients and Methods: Forty patients were included in this study with asymptomatic frequent PVCs. Patients without structural heart disease was excluded. Detailed history, physical examination, full laboratory investigations, resting ECG, 24 hours Holter monitoring, conventional 2D echocardiography assessment of left ventricular ejection fraction (LVEF), strain imaging with measurement of LV-GLS, 2D speckle tracking and RT3D-STE (global longitudinal, area, radial, and circumferential strain (GLS, GAS, GRS, and GCS)). The study was performed at Islamic Cardiac Centre of Cardiology, Al-Azhar University during the period from September 2019 to April 2020.
Results: RT3D-STE modalities detectap early subtle LV dysfunction better than conventional echocardiographic and showed a significant correlation with PVCs burden, origin, focality, interpolated PVCs and duration of the complex of ectopic beat.
Conclusion: Frequent premature ventricular complexes could produce LV dysfunction and cardiomyopathy independently of any pre-existing underlying structure heart disease and early detection of subtle LV dysfunction can be done by RT3D-STE modalities even in asymptomatic patient.
Premature Ventricular Complexes
Echocardiography
Real-Time 3-Dimensional Speckle Tacking echocardiography
Left Ventricular Function
2020
10
01
1777
1788
https://amj.journals.ekb.eg/article_120635_8717b4d689438830435699b511caf25e.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
PRECLINICAL DETECTION OF CHEMOTHERAPY INDUCED LEFT VENTRICULAR DYSFUNCTION IN PATIENTS WITH CANCER COLON BY TRANSTHORACIC ECHOCARDIOGRAPHY
Mohammed
Abd El-Ghafar Salim
Wael
Mohammed Attia
Ayman
Sadek El-Saied
Background: Cancer colon is one of the most common malignancies which treated by chemotherapy. Cardiotoxicity is one of the most important adverse reactions of chemotherapy, leading to an important increase in morbidity and mortality; it can appear early or late in the course of the disease.
Objective: To detect early changes in LV mechanics and to determine if 2D-STE could predict preclinical cardiotoxicity from chemotherapeutic treatment in patients with cancer colon.
Patients and methods: The study included 30 patients with cancer colon, age ranged from 36 – 55 years and 20 healthy controls with age ranged from 32 – 55 years. Both groups were matched in age and sex. Clinical evaluation (included full history taking general and local examination) and transthoracic echocardiographic examination (TTE), 2-D speckle tracking echo (2D-STE) were performed to all subjects.
Results: 2D-STE showed that apical 2, 3, and 4 chambers longitudinal strain percent as well as Global longitudinal strain (GLS) of the studied patients and controls showed statistically significant difference between controls, pre- and post-chemotherapy. In comparison between control and pre-treatment showed statistically non-significant difference, while comparison between control and post-treatment as well as pre- and post-treatment showed statistically highly significant difference.
Conclusion: A substantial impairment of LV systolic function was detecting in cancer colon patients receiving chemotherapy with apparently preserved LV systolic function as evidenced by reduction in global longitudinal strain using two-dimensional speckle tracking echocardiography.
Chemotherapy
left ventricular dysfunction
cancer colon patient
transthoracic echocardiology
2020
10
01
1789
1802
https://amj.journals.ekb.eg/article_120636_41a21e3dca9b5ee040f5a8b48f5565cd.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
CHA2DS2-VASC SCORE AS A PREDICTOR FOR CONTRAST-INDUCED NEPHROPATHY IN PATIENT WITH ISCHEMIC HEART DISEASE TREATED WITH PERCUTANEOUS CORONARY INTERVENTION
Islam
S. Abd-Allah
Osama
A. Khamis
Mostafa
A. Al-Sawasany
Ebrahim
F. Said
Background: CHA2DS2-VASC risk score (CVRS) is useful in predicting the occurrence of contrast induced nephropathy (CIN) among patients with Ischemic heart disease undergoing percutaneous coronary Intervention. CIN was defined an absolute increase in serum creatinine levels by ≥0.3 mg/dL from baseline, or a relative increase in serum creatinine by ≥50% from baseline, within 48 h after PCI, according to Acute kidney Injury Network (AKIN) definition.
Objective: To evaluate CHA2DS2-VASC score as a predictor of contrast induced nephropathy (CIN) in patient with ischemic heart disease undergoing percutaneous coronary intervention (PCI).
Patients and Methods: A total of 200 consecutive patients presenting to Cardiology Department, Almogama Alteby Hospital at Tanta city ,during the period from January 2019 to January 2020, diagnosed as IHD and underwent PCI, They were divided into two groups: Group I: Those who developed CIN 48h after PCI (28%) and Group II: Those who did not (72%). CHA2DS2-VASc score (age, sex, diabetes, hypertension, heart failure on admission, previous ischemic event, vascular event) was calculated for each patient. Serum creatinine level and estimated Glomerular Filtration Rate (eGFR) were estimated for all patient before and 48h after PCI.
Results: CIN was reported in 56 patients (28%). Patients with CIN had a higher frequency of hypertension, diabetes mellitus, and had a lower left ventricular ejection fraction and baseline estimated glomerular filtration rate. The average CVRS in the CIN group was significantly higher than that in non-CIN group. CHADSVASC score cut off value was higher than 3 and the area under the ROC curve was equal to 0.906 which indicating that it is excellent predictor for contrast induced nephropathy cases. The sensitivity, Specificity, positive predictive value and negative predictive values of CHADSVASC score were 80.36, 89.58, 51.5, and 96.0 respectively.
Conclusion: The CVRS can be used as a simple pre-procedural predictor of CIN among patients with IHD undergoing PCI.
IHD
CHA2DS2-VASc score
contrast-induced nephropathy
percutaneous coronary intervention
2020
10
01
1803
1816
https://amj.journals.ekb.eg/article_120637_6b8157c30fadd38ce92515eb7fa575ef.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
THE RELATION OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND INCREASED LEFT VENTRICULAR MASS WITH BLOOD PRESSURE VARIABILITY IN NON-ESTABLISHED HYPERTENSIVE PATIENTS
Moataz
Abd Al-Rahman Abd Al-Salam Farag
Mohsen
Ali Mahmoud Salama
Yasser
El-Sayed Mohammed Hasan
Background: Long term high blood pressure is a major risk factor for coronary artery disease, stroke, heart failure, peripheral vascular disease, vision loss and chronic kidney disease.
Objective: To demonstrate the relation between left ventricular diastolic dysfunction increased left ventricular mass and ambulatory blood pressure recording in subjects not known to be hypertensive.
Patients and Methods: This was a- cross sectional study that carried out on (100) normotensive patients in Cardiology Department Clinic at Matrouh Specialized Cardiothoracic and Interventional Catheterization Center from October, 2017 to January 2019.
Results: there was a-significantly marked difference in left ventricular (LV) mass between two groups (normal blood pressure and latent hypertension) and significantly marked difference in diastolic dysfunction. According to normal circadian and impaired circadian, there was a- significant difference between the two major groups in sex, where male >female, and marked difference in LV mass between the two groups (normal circadian and impaired circadian), and in smoking.
Conclusion: Ambulatory blood pressure (AMBP) played an important role as a predictor to estimate prevalence of hypertension based on diastolic dysfunction and increased left ventricular mass in persons with normal blood pressure measures at office specially masked hypertension in white coat hypertensive patients.
Left ventricular diastolic
Blood Pressure Variability
2020
10
01
1817
1828
https://amj.journals.ekb.eg/article_120638_7e24f0588b4f65649ca0dff8486a169e.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
RELATION BETWEEN LEFT VENTRICULAR HYPERTROPHY AND SILENT ISCHEMIA DETECTED BY 24-HOUR HOLTER MONITOR IN HYPERTENSIVE AND TYPE 2 DIABETIC PATIENTS
Kareem
El-Deen Ahmed Said
Mostafa
Attia Al-Sawasany
Mohamed
Samy Abd El-Samei
Background: Hypertension is a prevalent and well-recognized cardiovascular risk factor that predisposes to the development of left ventricular hypertrophy (LVH), coronary heart disease and systolic and diastolic dysfunction. The presence of high left ventricular (LV) mass or a high left ventricular mass index (LVMI) is reportedly an independent predictor of increased cardiovascular morbidity and mortality both in the general populations and in hypertensive populations. Ambulatory ECG (Holter) monitoring is a very effective way of measuring ischemic events over 24 hrs. period, it has advantages over exercise testing.
Objective: To assess presence of silent ischemia in type 2 diabetic and hypertensive patients with LVH in comparison to type 2 diabetic and hypertensive patients with normal LV geometry.
Patients and methods: This study was a pilot one that was carried out on 60 type 2 diabetic and hypertensive patients (28 males and 32 females aged 53.5 ± 10.4). Thirty cases had LVH and the other 30 had normal geometry. This study was conducted from October 2018 to February 2020. All patients were subjected to complete history taking including comorbidities, risk factors and full clinical examination. Patients with baseline ST segment depression > 2 mm in 2 consecutive leads, mitral stenosis, aortic stenosis, congenital heart disease, atrial fibrillation, prior myocardial infarction (MI) or coronary artery bypass graft surgery (CABG), pericardial diseases, advanced renal or hepatic disease were excluded. Echocardiography was done and LV assessment alongside with measuring LVMI. Also, all patients were investigated by 24 hours continuous holter monitoring, and all of them underwent further investigation to assess the presence of CAD either by coronary angiography or multislice CT coronary angiogram.
Results: There was a statistically significant relationship between the presence of LVH and positive Holter findings for silent ischemia.
Out of 30 patients with normal geometry, 25 patients (83.3%) were negative and 5 patients (16.7%) were positive for silent ischemia. Out of the other 30 patients with abnormal geometry (LVH), 9 patients (30%) were negative and 21 patients (70%) were positive for silent ischemia. In 10 patients with mild LVH, 4 patients (40%) were negative and 6 patients (60%) were positive for silent ischemia. Out of 14 patients with moderate LVH, 4 patients (28.6%) were negative and 10 patients (71.4%) were positive for silent ischemia. As regards the last 6 patients with severe LVH, 1 patient (16.7%) was negative and 5 patients (83.3%) were positive for silent ischemia.
Conclusion: The prevalence of silent ischemia markedly increased amongst diabetic and hypertensive patients with LVH in comparison to those with normal left ventricular geometry. The incidence of silent ischemia increased with increased LVMI. Ambulatory ECG monitoring may have a use in the identification of those at greatest risk of cardiovascular complications and sudden death.
Hypertension
Diabetes mellitus
silent ischemia
Echocardiography
left ventricular mass index
24 hrs. continuous holter monitoring
2020
10
01
1829
1844
https://amj.journals.ekb.eg/article_120639_0b6973b6c4e844b29e5aedc703d8765d.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
HEART RATE RECOVERY TIME AFTER EXCERCISE STRESS TEST IN DIABETIC PATIENTS WITH SUSPECTED CORONARY ARTERY DISEASE
Ahmed
Zein Elabedin Mohammed
Mohammed
Osama Fathy Kayed
Mohammed
Samy Abd El-Samee
Background: Improving recovery after exercise is vital for decreasing cardiac mortality by dominance of parasympathetic nervous system control in recovery time.
Objective: To determine the influence of coronary artery disease on heart rate recovery after exercise in patients with diabetes mellitus.
Patients and Methods: The ethical approval was obtained from the hospital ethical research committee, in cardiology department in Al-Hussein university hospital from March 2019 to November 2019 and each patient signed an informed consent. Fifty patients were included in this study divided in 4 groups, all with no evident history of ischemic heart disease. Detailed history, physical examination, resting ECG, trans thoracic echocardiography, and finally treadmill exercise stress test was done. In this study we assessed heart rate recovery in 1st, 2nd& 3rd minute and also basal heart rate included.
Results: Significant delay in heart rate recovery time was detected in diabetic patients with positive stress ECG test for myocardial included ischemia.
Conclusion: Delayed recovery and reduced heart rate recovery after treadmill exercise stress test is an available and important index for detecting and revealing the extent of ischemic burden.
Treadmill exercise stress test
Transthoracic echocardiography
Heart rate recovery
Duke Treadmill Score
2020
10
01
1845
1852
https://amj.journals.ekb.eg/article_120640_79a6eb2908667f1616fc7245251170a4.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
ASSESSMENT OF ATHEROMATOUS PLAQUE BY MULTISLICE COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY IN PATIENT WITH ZERO CALCIUM SCORE
Abd El-Mohsen
Mostafa Abou Aalia
Ashraf
Al-Amir Abd El-Fattah
Background: Zero calcium score (CS) is associated with low risk for mortality but not low risk for acute coronary disease developments. Soft plaque is vulnerable to fissuring and rupture. Objective: To evaluate the frequency of coronary atheromatous plaque in patients with zero CS and the associated risk factors. Patients and methods: This was a cross-sectional, retrospective study with 235 consecutive individuals with zero CS at Islam Cardiac Center from August 2019 to August 2020. A significance level of 5% was adopted. Results: The frequency of atheromatous plaque in coronary arteries in 235 patients with zero CS was 26.81% (63 individuals). In the subgroup of atheromatous plaque with zero CS, mean age was 58±28 years, 40 (63.5%) were females, 29 (46.03%) hypertensive, 33 (52.38%) diabetics, 31 (49.2%) dyslipidemias, 12(19.05% had family history of premature coronary artery diseases (CAD), 20 (31.75%) smokers and body mass index (BMI) was 27.64±1.5. Fifteen patients (23.8%) had obstructive plaques (> 50%). Conclusions: The frequency of atheromatous plaques with zero CS was high. So, absence of calcification does not exclude the presence of plaques, one fourth of them were obstructive, especially with aged individuals.
Cardiovascular Diseases, Plaque, Atheromatous, Coronary Artery Disease, Calcium Score
risk factors
2020
10
01
1853
1862
https://amj.journals.ekb.eg/article_120641_54ccca2a0dc0b0d3dea278981254f1b7.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
PREDICTIVE ROLE OF CERULOPLASMIN AND HIGH SENSITIVITE C-REACTIVE PROTEIN AS INFLAMMATORY MARKERS IN ATHEROSCLEROTIC CORONARY ARTERY DISEASE PATIENTS
ashraf
mohammed swidan
Background: Coronary artery disease (CAD) remains the leading cause of morbidity and mortality in the industrialized world. The root cause of CAD is mainly atherosclerosis. It seems to be a chronic inflammatory condition, which later develops into an acute clinical event by the induction of plaque rupture, causing thrombosis. Ceruloplasmin is the major copper-carrying protein in the blood and in addition plays a role in iron metabolism.
Objective: To assess the predictive value of ceruloplasmin and high-sensitivite C-reactive protein in diagnosis of atherosclerotic coronary artery disease.
Patients and methods: The study was conducted on 60 patients presented with clinical features of coronary artery diseases, admitted to Cardiology Department at Sayed Galal University Hospital, throught the period from July 2017 and March 2020, and they were classified according to coronary angiography into 3 subgroups (one, two, multi-vessel disease). They were compared with 20 healthy individuals with identical demographic characteristics not suffering from any disease. Serum ceruloplasmin and serum hs-CRP levels were measured in both groups.
Results: A significant increase in serum ceruloplasmin and hs-CRP levels were observed in all patients of coronary artery disease as compared to control group (p=<0.001).
Conclusion: In patients of CAD, the serum ceruloplasmin and hs-CRP levels rise due to their property as acute phase proteins.
Coronary Artery Disease
Ceruloplasmin
hs-CRP
Acute phase protein
2020
10
01
1863
1870
https://amj.journals.ekb.eg/article_120642_e3f4dcf1614011b64902ecb925cdd69a.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
VALUE OF 3D SPECKLE TRACKING ECHOCARDIOGRAPHY IN ASSESSMENT OF LEFT VENTRICULAR SYSTOLIC MECHANICS BEFORE AND AFTER MITRAL VALVE REPLACEMENTIN PATIENTS WITH SEVERE PRIMARY MITRAL REGURGITATION
Ali
Alamin Oraby
Mohammed
Ismail Aldefitar
Taher
Said Abd Al-Kareem
Fares
Saad Nabeih El-Sharway
Background: The mitral valve repair or replacement is indicated for patients with symptomatic mitral incompetence. When operative treatment is being considered, the chronic and often slowly but relentlessly progressive nature of MR must be weighed against the immediate risks and long-term uncertainties attendant onsurgery, especially if mitral valve replacement (MVR) is required. Objectives: Tostudy and assess the left ventricular function in patients with mitral valve incompetence before and after mitral replacement. By real-time 3-dimensional (3D) speckle tracking echocardiography (RT3D-STE). Patients and methods: The ethical approval was obtained from the hospital ethical research committee and each patient entering the study signed an informed consent. The study involved 40 patient with severe primary mitral regurgitation collected from the Cardiology clinic of Al-Azhar University Hospitals. The patients were screened for the study enrolment prospectively. The study was performed at Islamic cardiac center of cardiology, Al-Azhar University at the period from June 2019 to April 2020.Detailed history, physical examination, resting ECG, conventional 2D echocardiography assessment, strain imaging with measurement of LV-GLS 2D speckle tracking and RT3D-STE (Left ventricular ejection fraction (LVEF), and global longitudinal, area, radial, and circumferential strain (GLS, GAS, GRS, and GCS). Results: Real time 3D speckle tracking echocardiography was an echocardiographic modality that could detect early and subtle LV dysfunction in patients with mitral regurgitation. Conclusion: Real time 3D speckle tracking echocardiography could detect early and subtle LV dysfunction in patients with mitral regurgitation and could predict prognosis of the patient and determine the time of surgery in which the patient could get the most value. Abbreviation: MVR: mitral valve replacement, LV: left ventricle, GLS: global longitudinal strain, GAS: global area strain, GCS: global circumferential strain, GRS: global radial strain
MVR
Echocardiography
Real-Time 3-Dimensional Speckle Tacking Imaging
Left Ventricular Function
2020
10
01
1871
1880
https://amj.journals.ekb.eg/article_120643_dadddc0f1afa5fe7b3ea8edab58cfb40.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
CORRELATION BETWEEN BRAIN MAGNETIC RESONANCE CHANGES AND RESPONSE TO FUNCTIONALLY BASED REHABILITATION PROGRAM IN CHILDREN WITH SPASTIC CEREBRAL PALSY
Abd El-Hamed
Fikry Abd El-Aziz
El-Sayed
Mohammed Al-Nagar
Abd El-Naby
Biomy Mohammed
Hassan
Mohammed Awwad
Background: Cerebral palsy (CP) is the most common cause of physical disability in childhood with prevalence rates of 2–3 per 1000 live births in developed countries. CP is the leading cause of physical disability in children. Thus, neuroimaging is currently recommended as a standard evaluation in children with cerebral palsy.
Objective: To investigate the relationship and inter-relation between functional profiles including; gross motor function and manual ability, with brain magnetic resonance imaging characteristics in children with CP before and at end of functionally based exercise program.
Patients and Methods: This study was carried out on twenty five spastic CP children of both genders at age ranged from 3 months old to 12 years old, attending the out-patient pediatric clinic of Bab Al Sha’reya University Hospital, during the period from May 2019 to December 2019.
Results: Diplegia was the most common represented type, followed by quadriplegia and hemiplegia. The common causes were hypoxic ischemic encephalopathy (52%), Post-kernicterus CP (32%), and Post traumatic CP (16%). History of mother drug intake, hypoxia, pre-mature birth, cyanosis and severe RDS, delivery with caesarian section, neonatal convulsion, jaundice and post-kernicterus complication, and head trauma were significantly associated with increased risk of CP.
Conclusion: History of mother drug intake, hypoxia, pre-mature birth, cyanosis and severe RDS, delivery with cesarian section, neonatal convulsion, jaundice and post-kernicterus complication, and head trauma were significantly associated with increased risk of CP. MRI scan was useful in revealing underlying brain abnormalities and speculating on the etiology of cerebral palsy.
Brain Magnetic Resonance
Based Rehabilitation Program in Children
Spastic Cerebral Palsy
2020
10
01
1881
1894
https://amj.journals.ekb.eg/article_120644_4783cf1451b3116ba0d1a01ec2bcbdd6.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
HEMODYNAMIC CHANGES ASSOCIATED WITH SPINAL ANESTHESIA FOR CESAREAN DELIVERY IN SEVERE PREECLAMPSIA
Mahmoud
El-Sayed Rashad Turkey
Abd El-Nasser
Ahmed Hussein
Ali
Abdallah Al-Kumity
Background: Sever pre-eclampsia is defined as a disorder that occurs in pregnancy which manifests as hypertension and proteinuria with at least one maternal organ dysfunction involvement.
Objectives: To determine how pre-eclampsia affects maternal hemodynamics during cesarean delivery after spinal anesthesia.
Patients and Methods: This prospective randomized study was carried out on 30 normotensive females and 30 pre-eclamptic females admitted to Hospital for elective cesarean section using spinal anesthesia. The study was conducted in the Obstetrics Department of Al-Azhar University Hospitals, from January 2019 till December 2019.
Results: Incidence of hypotension after spinal anesthesia in group A (normotensive) was 66.7% and in group B (preeclampsia) was 30%. The total dose of Ephedrine required to correct hypotension when it happen mean dose ± SD in group A was 9.83 ± 9.30 and in group B was 3.00 ± 5.15. Neonatal outcomes (APGAR score and umbilical artery blood gases) were comparable. There was increased incidence of headache and blurring of vision among severe preeclampsia parturient.
Conclusion: Incidence of hypotension after spinal anaesthesiawas less frequent and less severe in preeclampsia patients and required lower dose of ephedrine than normotensive population. There was increased incidence of headache and blurring of vision among severe preeclampsia parturient. No difference in neonatal outcome between normotensive and severe preeclampsia population following spinal anesthesia.
hemodynamic
Spinal anesthesia
Cesarean delivery
severe preeclampsia
2020
10
01
1895
1904
https://amj.journals.ekb.eg/article_120645_5edc18c15c66ac850067cebcee546398.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
RISK STRATIFICATION OF ACUTE UPPER GI BLEEDING BY ROCKALL, GLASGOW BLATCHFORD AND AIMS 65 SCORES
Amr
Abd El-Monem Mohamed El-Mohr
Mohamed
Amer Afify
Sherif
Ali Abd El-Aziz
Background: Prognostic scales should be used for early stratification of patients according to risk. Several risk scores have been developed, most of which include endoscopic findings.
Objective: To compare three scores "Rockall, Blatchford and AIMS65 scores" to identify the most accurate score used in predicting unfavorable outcomes during patient hospitalization, and for about 1 week after discharge.
Patients and methods: A prospective study was conducted on Egyptian patients presented by upper gastrointestinal bleeding, (UGIB) recruited from the emergency department (ED) of Nasser institute hospital for research and treatment, over a period from January 2019 to July 2019.
Results: About half of cases had chronic liver disease. The most frequent clinical condition was Melena; present in about half of cases. Stigmata were in more than half of cases. Cases with need for interventional endoscopy had significant higher hepatic disease, severe comorbidities, melena, syncope, shock and worser laboratories& endoscopic findings.
Conclusion: Risk stratification and decision to perform interventions including therapeutic endoscopy is often a subjective matter.
Risk scoring systems
upper gastrointestinal bleeding
Upper endoscopy
risk stratification
2020
10
01
1905
1918
https://amj.journals.ekb.eg/article_120646_e53b877807d83d914d3e8c481ff94452.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
CORRELATION BETWEEN VITAMIN D LEVEL AND BONE MINERAL DENSITY IN EGYPTIAN PATIENTS WITH SECONDARY HYPERPARATHYROIDISM
Mohamed
Kamal Gomaa
Abdulmaguid
Abdulaty Elashmawy
Abd El-Shafi
Ahmed Hasseb
Ahmed
Mohamed Tahoun
Background: There is still limited data on the association between 25-hydroxyvitamin D, parathyroid hormone (PTH) and bone mineral density (BMD) in Egypt.
Objective: To correlate between vitamin D level and bone mineral density in Egyptian patients with secondary hyperparathyroidism.
Patients and Methods: Fifty female patients with secondary hyperparathyroidism recruited for the study from Rheumatology and Rehabilitation Outpatient Clinic of Al-Azhar University Hospitals, in addition to another fifty age matched control group healthy individuals after an informed consent from all subjects starting from November 2019 till may 2020. In this study, we measure parathormone hormone level, 25-Hydroxyvitamin D, serum calcium (total and ionized). Assessment of bone mineral density measured by dual-energy x-ray absorptiometry at lumbar spine, left proximal femur, and left distal forearm.
Results: Lt Forearm BMD was significantly lower in the 50 women with secondary hyperparathyroidism than in the 50 with normal PTH levels. The mean t-score ± SD was -1.2 ± 0.93, and 0.5 ± 1.37 respectively. Thirty five (70%) was vit D deficient with mean t-score of the Lt Forearm -1.6 ± 1.48 (osteopenia), and fifteen (30%) was vit D insufficient with normal t-score of all bone parameters in this group.
Conclusion: Our study revealed that positive correlation and significance between Vit D with serum calcium (total and ionized), BMD and t score (AP spine, Lt Femur, and Lt forearm), while negative correlation and significance between BMD (AP spine, Lt femur, and Lt forearm) with PTH, and negative correlation and significance between vit D with PTH.
secondary hyperparathyroidism
Parathyroid Hormone
Vitamin D
Bone Mineral Density
2020
10
01
1919
1930
https://amj.journals.ekb.eg/article_120648_440d10716baa23c39145b227abd77ab0.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
EMPIRICAL VERSUS SUSCEPTIBILITY-BASED ERADICATION THERAPY FOR HELICOBACTER PYLORI INFECTION IN EGYPT
Amr
El-Gazzar
Mohamed
Al-Boraie
Sawsan
Hanem El-Tayyeb
Adel
El-Rakeeb
Background: The eradication rate of Helicobacter pylori has declined, mainly due to antimicrobial resistance.
Objectives: To test the effectiveness of susceptibility guided therapy vs. the empirical triple therapy for first: line H pylori treatment in a region with high antimicrobial resistance.
Patients and methods: The study was performed on 82 dyspeptic H. pylori patients arranged for esophagogastroduodenoscopy at Al-Hussein University Hospital between March 2019 to march 2020. Patients were randomly divided into two groups: group A consisted of 52 patients underwent endoscopy and gastric biopsies for culture and sensitivity and treated according to sensitivity results and group B consisted of 30 patients treated by empiric triple therapy. Eradication rates and drug compliance owing to adverse effects were compared between the two groups.
Results: In total, 82 patients were enrolled (52 in culture and sensitivity-based therapy group and 30 in empirical therapy group) and 50 patients (60.1%) completed the protocols. The overall resistance rates to clarithromycin, amoxicillin, metronidazole, levofloxacin, tetracycline, nitrofurantoin and rifampicin were 32.1%, 32.1%, 78.6%, 7.1%, 17.9%, 17.9% and 21.4% respectively. Empirical triple and antimicrobial susceptibility-guided eradication rates were, respectively, 53.3% and 85.7% by intention-to-treat and 64% and 96% by per-protocol analysis. Adverse events were reported in 16.6% of patients on empirical triple therapy and 21.4% of those on susceptibility-guided therapy.
Conclusions: Culture-based eradication strategy demonstrated superior eradication efficacy than empirical therapy as a first-line therapy in a region with high levels of antimicrobial resistance.
antibiotics
eradication
Helicobacter pylori
resistance
clarithromycin
2020
10
01
1931
1942
https://amj.journals.ekb.eg/article_120649_36ab3d9ca56c28f71349f4fffc34c7d4.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
AN ASSOCIATION BETWEEN HELICOBACTER PYLORI INFECTION AND DYSMETABOLIC SYNDROME IN ADULT EGYPTIAN POPULATION
Mohammed
Yehia Mohammed Awad-Allah
Abdella
Hussien El-Sadek
Tarek
Moustafa Emran
Saad
El-Deen Mohamed El-Shreef
Background: Helicobacter pylori (H. pylori) infection is considered to be one of the most popular infections worldwide, affecting more than 50% of the world's population, principally in the developing countries.
Objective: To determine the possible association between Helicobacter pylori infection and dysmetabolic syndrome in adult Egyptian population, principally cardio-metabolic components. Patients and Methods: Adult patients aged more than 18 years and presented with dysmetabolic syndrome or being metabolically healthy obese were enrolled in the study. All participants were subjected to meticulous history assessment and clinical evaluation.
Results: An overall 60 patients who fulfilled the inclusion criteria were enrolled in the present study. Of them, 30 patients had metabolic syndrome, whereas the remaining 30 patients were metabolically healthy obese. There was a statistically significant difference between both groups regarding the levels of systolic and diastolic blood pressure, lipid profile, and glycemic status. There was an equal proportion of patients had positive Helicobacter Pylori infection among patients with metabolic syndrome and metabolically healthy obese patients. Furthermore, among patients with metabolic syndrome, correlation analysis revealed that; BMI showed a statistically significant positive correlation with Helicobacter Pylori infection.
Conclusion: Helicobacter Pylori infection was highly prevalent infection in patients with metabolic syndrome. Metabolic syndrome patients with Helicobacter Pylori infection have higher blood glucose levels together with disturbed lipid profile. Being positively correlated with H. Pylori infection, patients with high BMI should be laboratory evaluated to role out the presence of Helicobacter Pylori infection.
H. Pylori infection
Metabolic syndrome
2020
10
01
1943
1954
https://amj.journals.ekb.eg/article_120650_ff48ad2cb5a6af686ecaf85953e64b33.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
PREVALENCE OF VANCOMYCIN RESISTANT ENTEROCOCCI AMONG PATIENTS WITH NOSOCOMIAL INFECTIONS IN INTENSIVE CARE UNIT
Al-Mahdy
M. Alatrouny
Mohamed
A. Amin
Hosamalden
S. Shabana
Background: Enterococcus has increasingly become a major nosocomial pathogen worldwide. It has been well documented that intensive care units (ICUs) are the major reservoirs of vancomycin resistant enterococci (VRE) in the health care setting. It is a matter of concern due to its ability to transfer vancomycin resistant gene to other organisms.
Objective: Evaluation of the incidence of VRE as a cause of nosocomial infection in ICU patients, to analyze their antibiotic resistance profile, and to search for resistance genes of VanA and VanB in VRE isolates from these patients.
Patients and methods: Four hundred ICU patients with nosocomial infections were studied during the period between Jan, 2016 and Feb, 2017 at Misr University for Science and Technology Hospital.
Results: Enterococci were isolated from 12% of patients, of whom 66.7% E.faecalis and 33.3% E. facium. 41.7% isolates exhibited resistance to vancomycin. Among these isolates, 60% of strains were E. faecium, while 40% were E. faecalis. Polymerase chain reaction (PCR) detection of Van A and Van B resistance genes showed that Van A gene was detected in 85% of the VRE isolates, while Van B gene not found in any of the VRE isolates.
Conclusion: VRE and Van A gene were important as a cause of nosocomial infections in ICU patients. All VRE were multidrug resistant and few treatment options were available. Effective infection control measures against VRE are required.
Nosocomial Infections
Enterococcal Species
Vancomycin resistance
Intensive Care Units
Antibiotic Susceptibility
genotypes
2020
10
01
1955
1964
https://amj.journals.ekb.eg/article_120651_28ebea8fc27c8949cb9e90df8995c54a.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
COMPARATIVE STUDY BETWEEN INTRAVENOUS KETAMINE OR MAGNESIUM SULFATE OR BOTH ON POSTOPERATIVE MORPHINE CONSUMPTION AFTER MAJOR ABDOMINAL SURGERY
Ibrahim
Abd El-Raof Mohamed
Tarek
Abd El-Salam Seleem
Abd El-Wahab
Abd El-Sattar Saleh
Background: Intravenous patient-controlled analgesia (IV-PCA) with morphine is commonly used for postoperative pain control following major abdominal surgery. However, large amounts of morphine may lead to significant adverse events. Multimodal analgesia using a non-opioid analgesic, in addition to an opioid analgesic, has been suggested as a way to improve postoperative pain control and to reduce opioid use.
Objective: To compare the difference between intravenous Ketamine or Magnesium Sulfate or both on postoperative morphine consumption after major abdominal surgery.
Patients and Methods: This study included 100 patients of both sexes admitted for major abdominal surgery. They were randomly allocated into four equal groups. Group I: Control group, Group II received only ketamine, Group III received only magnesium sulfate and Group IV received both ketamine and magnesium sulfate. The following parameters were assessed in the four groups: Heart rate (HR), blood pressure (BP), respiratory rate (RR), end tidal Co2, the severity of pain on modified Ramsay sedation scale, time to first request for analgesia postoperatively, the number of rescue analgesia given, , adverse events, the level of the patient satisfaction and total dose of morphine consumption postoperatively (mg/48h).
Results: This study showed that the hemodynamics of the patients were more stable in (ketamine + magnesium sulfate) and ketamine only group than in magnesium sulfate only group and control group throughout all 48 hours postoperative. Usage of ketamine decreases postoperative pain and analgesic consumption in the first 48 hours after surgery along with longer pain free period compared to patients who were given magnesium sulfate only and control group. Ketamine is highly effective in postoperative pain control in major abdominal surgery without any hazards on patients. The total consumption of morphine, and additional analgesic requirements were less, while the satisfaction level of patients were higher in (ketamine+ magnesium sulfate) and ketamine only group.
Conclusion: Ketamine is one of the most advantageous adjuvant drugs for treating postoperative pain, while magnesium sulfate alone is less effective, with increase in opioid side effect. Combination of ketamine+ magnesium sulfate is better in treating postoperative pain and preserve patient hemodynamics with decrease in opioid side effect.
Ketamine
magnesium sulfate
postoperative morphine consumption
major abdominal surgery
2020
10
01
1965
1980
https://amj.journals.ekb.eg/article_120652_5739fc4d1d49938dda41b128e415d532.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
EFFECT OF SUCTION USING MORIA MICROKERATOME ON MACULAR AND RETINAL NERVE FIBER LAYER THICKNESS DURING LASIK USING OPTICAL COHERENCE TOMOGRAPHY
El-Saied
El-Mahdy El-Saied
Younis
El-Saied Abd El-Hafez
Ahmed
Mohamed Sobhy
Background: Laser in situ keratomileusis (LASIK) combines keratomileusis with the accuracy of the excimer laser and is used worldwide for correction of a broad range of refractive abnormalities.
Objective: To asses structural and functional changes of macular and NFL using spectral domain optical coherence tomography (SD-OCT) following LASIK surgery using moria microkeratome.
Patients and Methods: A total of 50 were enrolled in our study to be examined before and one month after operation using OCT device Al-Azhar University Hospital (Damietta). A complete ophthalmological examination included uncorrected visual acuity; best corrected visual acuity, full slit lamp examination and corrected tonometery. Examination was done by optical coherence tomography to record macular and NFL thickness.
Results: There was no effect on the thickness of the project before the operation (13.66 ± 18.99) and after the operation (13.31 ± 18.87). The results also showed that there was no effect on the thickness of the nerve fibers before the operation (5.31 ± 40.18) and after the operation (5.33 ± 39.90).
Conclusion: LASIK is a safe procedure on posterior segment of the eye, Suction with no effect on macular and retinal nerve fiber layers thickness.
Moriamicrokeratome
Suction
LASIK
Optical Coherence Tomography
Retinal nerve fiber layer
Macular Thickness
2020
10
01
1981
1988
https://amj.journals.ekb.eg/article_120653_112d6aef41c06fb330d330837f09063f.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
CHANGES IN CORNEAL TOPOGRAPHY AFTER SMALL INCISION LENTICULAR EXTRACTION FOR MYOPIC PATIENTS
Omar
Ibrahim
Sayed
Abbas Sayed
Mahmoud
Mohamed Saleh
Background: SMILE does not require the creation of a flap. This reduces the risks associated with flap creation such as dry eye and traumatic flap dislocation.
Objective: To assess corneal curvature changes of anterior and posterior surfaces in terms of corneal power, the radius of curvature, and asphericity following SMILE procedure for myopic patients.
Patients and Methods: Thiswas A prospective comparative study which included 20 eyes of 10 myopic patients. Spherical equivalent (SE) refraction was from -3 to -8 diopters (D) and refractive astigmatism was ˂ -3 D. All patients were treated for myopia and myopic astigmatism using SMILE procedure in AL NOUR EYE HOSPITAL using (500 kHs, Visumax, Carl Zeiss, Meditec, Jena, Germany) starting from January 2018 till June 2019.
Results: A statistically significant decrease in mean keratometric power in the 5 mm zones of the anterior corneal surface was detected after 1month compared with its pre- SMILE values. The mean posterior keratometry power showed insignificant change. The mean anterior corneal curvature (mean radii of curvature) showed a statistically significant increase after 1-month compared to preoperative values. The mean postoperative posterior curvature showed an insignificant change. Asphericity (Q-value) of the anterior corneal surface changed significantly 1-month postoperatively. Q-value of the posterior corneal surface showed insignificant change. A statistically significant decrease in mean spherical equivalent (SE) was detected after 1month compared with its preoperative value.
Conclusion: SMILE is safe; give effective high successful refractive results, good stability and the incidence of intraoperative or postoperative complications remains minimal after one month follow up. SMILE causes significant increase in anterior corneal curvature power, Q-value and significant decrease in anterior keratometry, spherical equivalent and, central corneal thickness.
FLEX
SMILE
Central Corneal Thickness
and pentacam
2020
10
01
1989
2000
https://amj.journals.ekb.eg/article_120654_d1c5adb7a6114e3cee854d5e8e63ee36.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
SURGICAL OUTCOME OF INFERIOR RECTUS RECESSION IN MANAGEMENT OF MONOCULAR ELEVATION DEFICIT
Tamer
Tawheed Mohamed Abd El-Salam
Attiat
Mostafa El-Sayed Mostafa
Mahmmoud
Mohamed Saleh
Background: Monocular Elevation Deficiency (MED) is an inability to elevate one eye in all field of gazes usually resulting in one eye that is pointed downward relative to the other eye.
Objective: To evaluate the efficacy of inferior rectus recession in management of monocular elevation deficit (MED) with +ve or –ve forced duction test (FDT).
Patients and Methods: Our study was carried out on 20 patients complaining of MED who were selected from out-patients clinic in Sayed Galal and Al-Hussein University Hospitals. From January 2017 to May 2019. The patients were divided into 2 equal groups. Group A with +ve FDT, and group B with -ve FDT. Both groups had inferior rectus recession (IRR).
Results: Preoperatively, 40% of patients in group A were -4 (limited elevation), and 60% of patients were -3. All those patients improved to -1 postoperatively. On the other hand, 90% of patients in group B were -4, and 10% of patients were -3 (limited elevation). They improved postoperatively to -3 and -2 respectively. In group (A), the average of preoperative hypotropia was 19.40 ± 1.43PD. All the patients had IRR: the postoperative average of hypotropia was 1.10 ± 1.91PD with average of correction 18.30 ± 1.42PD. In group (B) having MED with -ve FDT were operated by IRR. A reliable and effective correction of hypotropia in 7 patients with preoperative mean deviation of 19.86 ± 1.68PD, and postoperative mean deviation of 2.71 ± 2.56 PD with average of correction 17.14 ± 1.86PD. Partial correction of hypotropia in 3 patients underwent Knapp’s procedure with preoperative mean deviation of 50.0 ± 5.00, postoperative average of correction of 18.00 ± 0.00 PD, post Knapp procedure the deviation was 3.00 ± 2.65 with average of correction of 29.00 ± 2.65.
Conclusion: Although the MED is etiologically multifactorial, satisfactory surgical results can be achieved by IRR as a simple and reliable 1ry intervention for both types (+ve FDT and –ve FDT).
Inferior rectus recession
Monocular Elevation Deficiency (MED)
2020
10
01
2001
2010
https://amj.journals.ekb.eg/article_120655_3b199efc0a0fe816acf92b90935871b1.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
ULTRASOUND GUIDED TIBIAL NERVE BLOCK IN MANAGEMENT OF PAINFUL DIABETIC NEUROPATHY
Hosny
Abo Zied Farg
Ali
Abd Allah Eissa
Wafaa
Gaber Ahmed
Background: Diabetic neuropathy (DN) refers to signs and symptoms of neuropathy in patients with diabetes in whom other causes of neuropathy have been excluded. Distal symmetrical neuropathy is the most common form accounting for 75 % of DN.
Objective: To determine the pain relief efficacy of three successive ultrasound guided tibial nerve block at the ankle with bupivacaine and betamethasone, as a primary outcome in the management of chronic painful diabetic neuropathy of the foot resistant to medical management, compared to ultrasound guided placebo tibial nerve block. Serum glucose levels for assessment of diabetes control and patients satisfaction were measured as a secondary outcome.
Patients and Methods: After obtaining the Ethics Committee’s approval of Anesthesia Department of Al-Zahra’a University Hospital, and the patients’ written informed consent, 40 Patients (aged 18-60y) with chronic painful distal diabetic polyneuropathy were prospectively enrolled in this double blind and random study. The patients were classified randomly into two equal groups: Group (I): Control group: patients who received ultrasound guided tibial nerve injection by sterile cold normal saline (28 C), and Group (II): Steroid group: Patients received ultrasound guided tibial nerve injection by betamethasone (7mg amp) which was diluted in 7ml saline, then 1mg was diluted in 0.25% bupivacaine. Each limb was injected in both groups by three successive injections each other week in alteration with other limb, then followed up monthly for 3 months.
Results: Three successive ultrasound guided tibial nerve block at ankle level with 1mg betamethasone in 0.25% bupivacaine decreased LANSS score and analgesic requirements with more patient satisfaction in distal painful diabetic neuropathy resistant to medical treatment.
Conclusion: The therapeutic benefits provided by ultrasound guided tibial nerve block with bupivacaine and betamethasone more effective than placepo block. Pain and other symptoms decrease abruptly after the first tibial nerve block and disappear after the third tibial nerve block.
Diabetic neuropathy
painful diabetic peripheral neuropathy
Betamethasone
2020
10
01
1011
2022
https://amj.journals.ekb.eg/article_120656_c5f114324169f74e2d2064049fd13f27.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
STUDY OF THE ROLE OF SERUM CD163 AS A PROGNOSTIC TOOL IN MYCOSIS FUNGOIDES THERAPY
Tarek
Salah El-Din Mohammed
Hussein
Mohamed Hassab-El-Naby
Mohammed
Dardiri El-Hariri
Background: Mycosis fungoides (MF) is the most common cutaneous T cell lymphomas (CTCL). Discrepancies between clinical and histopathological response to MF therapy led to search for more objectively tools to determine the presence of residual/recurrent skin involvement. Therefore, Cluster of Differentiation 163 (CD163) could be an interesting prognostic tool in evaluation of MF therapy.
Objective: To evaluate the relationship between serum CD163 level and staging of early MF and its prognostic value in treatment of early MF.
Patients and methods: This study was carried out at Dermatology Department, Al-Hussein University Hospital, Faculty of Medicine, Al-Azhar University, during the period from January 2016 to May 2018.
This study included 41 individuals (22 diagnosed as early MF and 19 healthy volunteers). Detection of sCD 163 by ELISA was done in MF patients twice. The first was done before starting treatment and the second was done 6 months after continuous therapy. Detection of sCD 163 of healthy volunteers was done.
Results: sCD 163 was significantly higher in MF patients than control group. It significantly reduced after treatment in MF patients, and it reduced significantly in patients received PUVA more than NB-UVB.
Conclusion: sCD 163 was elevated in MF patients and a useful follow up marker in early MF.
mycosis fungoides
Serum CD163
Cutaneous T cell lymphomas
2020
10
01
2023
2032
https://amj.journals.ekb.eg/article_120657_2bea35cb74191df793a24d6b9b08da87.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
PREVALENCE OF BREASTFEEDING AND FACTORS AFFECT ITS PRACTICE IN WOMEN ATTENDING PRIMARY HEALTH CARE UNITS IN CAIRO
Heba
Tollah Mostafa Farag
Noura
Essam El-Din Mohamed Ammar
Mohamed
Yahia El-Awady
Background: Breastfeeding is the healthiest way for providing young infants with the nutrients they need.
Objectives: To determine the prevalence of breastfeeding among women attending primary health care units in Cairo and identified factors affecting it.
Subjects and Methods: A cross-sectional study was conducted among 400 mothers attending in two different primary heath care centers El Tagamoa El Khames and El Zawia.
On the other side focus group discussions (FGD) were conducted within the same two primary health care units, they included a total of 33 mothers who participated in four focus group discussion.
Results: An interview questionnaire was done to identify the prevalence and factors affecting breastfeeding. The prevalence of breast feeding was 94.5% from which more than half of the infants 66.5% were mixed fed, 28% were exclusively breastfed, and only 5.5% of the infants were not breastfed. There were many factors that negatively affected breastfeeding and had a significant importance in this study including father’s educational level, family income, maternal knowledge about importance of breastfeeding, health education about breast feeding in the hospital and time of breastfeeding initiation within 1- 24 hours after birth. Focus group discussions were done to detect farther factors which affect breastfeeding which include: Mother's belief that her milk was not enough, nipple abrasions and ulcers. Maternal employment act as barrier to breastfeeding was also stated.
Conclusion: Many factors affected breastfeeding especially maternal employment which plays a major role in breastfeeding continuation or cessation.
breastfeeding
Socio-Demographic Factors
Maternal knowledge
Father Work
health education
2020
10
01
2033
2040
https://amj.journals.ekb.eg/article_120658_f621d0bdcf41c43d445ef410d308d0ee.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
PREDICTIVE FACTORS OF HEMORRHAGIC ISCHEMIC STROKE DETECTED BY CT AND MRI GRADIENT-ECHO T2 WEIGHTED IMAGE (GRE)
Hamed
G.H. Ibrahim
Tarek
I. Menicie
Khaled
I.El- Noueam
Mohamed
A. Ahmed
Ahmad
Farag Ibrahim
Background: Risk of hemorrhage is significantly increased in large infarcts, with mass effect supporting the importance of edema for tissue damage and the deleterious effect of late reperfusion when edema resolves. In some instances, the rupture of the vascular wall secondary to ischemia-induced endothelial necrosis might cause an intra-infarct hematoma. Vascular rupture can explain very early hemorrhagic infarcts and early intra infarct hematoma (between 6 and 18 hours after stroke), whereas hemorrhagic transformation usually develops within 48 hours to 2 weeks. Intra cerebral hemorrhage (ICH) occurs as a result of bleeding from an arterial source directly into the brain parenchyma and accounts for 5–15% of all strokes.
Objective: The aim of this study was to determine the predictive factors of hemorrhagic transformation in patient with acute ischemic stroke detected by brain CT and MRI gradient echo T2 weighted image (GRE).
Patients and Methods: This was a cross sectional randomized prospective study carried out on 60 patients (32 males and 28 females), admitted at Neurology Department and Stroke Unit of Mostafa Kamel Military Hospital, within the first 24 hours of their symptoms. The study was carried out during the period from 1st of January 2018 till the end of December 2018.
Results: The results of this study showed that the size of infarction was small in 27 (45.0%) patients and large in 33 (55.0%) patients, the micro bleeds were found in 32 (53.3%) of the studied patients, and the hemorrhagic transformation was found in 11 (18.3%) of the patients. The results showed that there was a significant relation between micro bleeds and hypertension, diabetes mellitus, dyslipidemia, past history of stroke, cardiac disease and hemorrhagic transformation. The small size infarction showed a higher percent of micro bleeds. Regarding the hemorrhagic transformation, the risk factors were the size of infarction, anticoagulant use, hypertension, diabetic and cardiac diseases.
Conclusion: The most predictive factors of hemorrhagic transformation was the size of infarction (higher in large), micro bleed, anticoagulant use, hypertension, dyslipidemia and cardiac disease, while the most predictive factors of micro bleeds were the size of infarction (higher in small), age, hypertension, dyslipidemia, past history of stroke, diabetes mellitus, and cardiac disease.
2020
10
01
2041
2052
https://amj.journals.ekb.eg/article_120659_d2d5bec26abcb1a0b47c6db0cfb653a3.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
EVALUATION OF TOPICAL 30% POTASSIUM HYDROXIDE VERSUS 30% TRICHLOROACETIC ACID IN THE TREATMENT OF PLANE WARTS
Attia
Attia Ali Attia Alawady
Hamed
Mohamed Abdo
Mohammed
Abd El-Mawgoud Amer
Background: Warts are benign proliferation of skin and mucosa that result from infection with human papilloma virus (HPV) which are double stranded deoxyribonucleic acid (DNA) viruses that replicate inside the nucleus. Infection with HPV may be clinical, subclinical, or latent.
Objective: To compare the efficacy and safety of potassium hydroxide 30% (KOH) versus trichloroacetic acid 30% (TCA) in treatment of plane warts.
Patients and methods: Our study was carried out on 60 patients complaining of plane warts divided into A and B from November 2019 to March 2020, Group A: thirty patients treated by potassium hydroxide (KOH 30%) weekly and Group B: thirty patients treated by trichloroacetic acid (TCA 30%) weekly for maximum period of 12 weeks, with pointed end of a wooden applicator to the center of all the lesions until a white frost appeared. Patients were selected from out-patient clinic of Dermatology, Venereology and Andrology Department of Al-Azhar University Hospitals.
Results: The present study showed complete cure rates of 7 patients (23.3%) in group A and 7 patients (23.3%) in group B. Partial cure rates occurred in 15 patients (50%) in group A and 16 patients (53,3%) in group B after 12 weeks of treatment. No response occurred in 8 patients (27.6%) in group A and 7 patients (23.3%) in group B. All nonresponsive patients had lesions in sites other than face except for 2 patients, one in each group had facial lesions.
Conclusion: Based on our findings, both potassium hydroxide (KOH 30%) and trichloroacetic acid (TCA30%) are equally effective in treatment of plane warts without statistically significant difference at end of treatment period and follow up, but TCA (30%) was safer than KOH (30%).
30% Potassium Hydroxide
30% Trichloroacetic Acid
Plane warts
2020
10
01
2053
2064
https://amj.journals.ekb.eg/article_120660_dbd45e55d838ef8d2140a73f7ca52b59.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
COMPARATIVE STUDY BETWEEN ENDOSCOPIC TRANSCANAL MYRINGOPLASTY VERSUS MICROSCOPIC MYRINGOPLASTY IN MIDDLE AGE GROUP (20-40 YEARS)
Hossam
Mohammed Esam
Wael
Hassan Abo El-Wafa
Mohammed
Kamel Ibrahem Al-Awady
Background: Myringoplasty (tympanoplasty type I) is usually the treatment of choice for tympanic perforations, whether or not associated with non-suppurative chronic otitis media. Objective: To determine the advantages and disadvantages of endoscopic as compared to microscopic myringoplasty surgery and to compare the results of both groups. Patients and methods: This study was carried out at the Otorhinolaryngology Department, Al-Azhar University Hospitals. The study included 40 patients. The age of all patients was between 20 - 40 years old with a diagnosis of chronic suppurative otitis media of tubo-tympanic type, divided into two equal groups. Results: The difference in age, gender, side of diseased ear and size of perforation between the two groups was not significant. In group (A) the circumference of the perforation was clearly visualized in all patients, while in group (B) the circumference of the perforation could not be visualized in 35% of patients. 25% required external auditory canal curettage and 10% required endoscope assisted microscopic myringoplasty to evaluate the ossicular chain. The difference between the 2 groups was significant. The graft was obtained from the tragal cartilage. In endoscopic group, the graft was uptaken in 85% of patients, while in microscopic group the graft was uptaken in 80% of patients with no statistical significant difference between the two groups. Conclusion: Comparison of microscopic and endoscopic views revealed superior visualization of the endoscopic approach as opposed to microscopic myringoplasty as endoscopic myringoplasty can be performed, regardless of the perforation size and the narrowness and/or protrusion of external ear canal. So, external auditory canal curettage and canalplasty can be avoided in endoscopic technique.
Myringoplasty
Endoscopic
microscopic
2020
10
01
2065
2074
https://amj.journals.ekb.eg/article_120661_7ebfb5f67c9713911514e362106d437f.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
MARVELOUS BABY: AN OUTCOME OF MULTIDISCIPLINARY APPROACH TO TRAUMATIC BRAIN INJURY IN PREGNANCY DUE TO ROAD TRAFFIC ACCIDENT (CASE REPORT)
Taha
Mohammad Rashad Amer
Yasmine
Harby Sadek
Abd El-Hammeed
Ezzat Gaber
Background: Several literatures supported that trauma complicates 6-7% of all pregnancies. Despite the rapid progressiveness of traumatic brain injury (TBI) worldwide, there is paucity in literatures regarding the exact incidence of TBI in pregnancy. Management poses a great challenge; the anatomical and physiologic maternal changes due to pregnancy, added to the consideration of existence of two lives till the end.
Objective: To increase the awareness about the management of pregnancy in cases presented with traumatic brain injury during pregnancy.
Case report: We described the management and follow up of a case of 30 years old multiparous female who presented in Sharm International Hospital, on 25-8-2019, at 18weeks gestation, post Road Traffic Accident (RTA) with Glasgow Coma Scale (GCS); 9T (eye opening, localize pain and endotracheal intubated).She was referred from nearby hospital (El Toor General Hospital) with endotracheal tube fixed since about 3 weeks, for tracheostomy and management. The patient was admitted to ICU with file No: 3384, on 25-8-2019. The patient was very carefully managed in the intensive care unit (I.C.U.) in Sharm International Hospital up to successful vaginal delivery of a live female weighed 1500 grams, at +/-30 weeks gestation. As the mother was severely ill and the fetus was extremely premature, we preferred the vaginal mode of delivery which we supposed to be less risky for the mother. The Marvelous baby was handled by pediatrtion team and neonatology doctor. After 3 weeks the baby went home with good crying and on bottle feeding. Unfortunately the mother died 10 days after labor.
Road Traffic Accident (RTA)
Traumatic Brain Injury (TBI)
Glasgow coma scale (GCS)
intensive care unit (ICU)
Pregnancy
fetus
2020
10
01
2075
2082
https://amj.journals.ekb.eg/article_120662_8e3010b2c0984f65f79a0bcae5e6a0bd.pdf
Al-Azhar Medical Journal
1110-0400
1110-0400
2020
49
4
Role of CT in Assessment of Blunt Chest Trauma
Ahmed
Abouzeid Metwally Mohamed Galal
Abd El-Nabi
Bayoumi Mohamed
Ahmed
Mohamed Abd El-Ghaffar Zidan
Background: Blunt chest trauma is a significant problem affecting mainly young males between 20-40 years and it is usually caused by motor vehicle accidents. It is common and contributes significantly to morbidity and mortality of trauma patients. It has an overall fatality rate of 15-25%.
Objective: To evaluate the role of multi-detector computed tomography in assessment of patients with blunt chest trauma.
Patients and Methods: This study involved 50 patients; 40 males (70%) and 10 females (30%). Their ages range was 2-75 years (mean age= 51.4 years). They were exposed to blunt chest trauma and referred to the Emergency Radiology Department in Nasr City Hospital and Al-Azhar University Hospitals for multi detector computed tomography (MDCT) of the chest over a period of 6 months starting from November 2019 to April 2020.
Results: Multi-planner and 3D reconstruction images were sensitive in the evaluation of different skeletal injuries especially dorsal spine, scapular and sternal fractures. Its high resolution provides more sensitivity in the evaluation of lung contusion that helped in predicting the need for mechanical ventilation. MDCT was more accurate and sensitive in the diagnosis and characterization of different types of pleural and mediastinal injuries. Multidetector CT generated virtual bronchoscopy represented one of the most recent developments in three-dimensional (3D) visualization technique which allowed a 3D evaluation of the airways down to the sixth- to seventh-generation. MDCT not only detected small diaphragmatic discontinuities, but also identified the herniated fat or viscera.
Conclusion: The information provided by MDCT may lead to critical changes in patients’ management, so that clinicians, radiologists, and radiology residents should be familiar with the different aspects of MDCT evaluation of this non-negligible group of patients.
Blunt chest trauma
CT
MDCT
2020
10
01
2083
2092
https://amj.journals.ekb.eg/article_120663_8f39568d1593c065b4f9f57c07aa3654.pdf