Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EVALUATION OF HERNIORRHAPHY FOR PARA - UMBILICAL HERNIA ASSOCIATED WITH LAPAROSCOPIC CHOLECYSTECTOMY82183015822810.21608/amj.2021.158228ENAhmedRadwan Ali AhmedDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversitySelimSaied Abd El-Rahman El-NemrDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityMahmoudAbd El-Hady Abd El-AzizDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20210321<strong>Background:</strong> Para-umbilical hernia repair (PUHR) combined with LC result in longer operating time, longer anesthesia, and risk of increased blood loss. But it has the advantages of single hospital stay, single anesthesia exposure, less post-operative pain and morbidity, early return to work, better cosmesis and more convenient , efficacy and cost effective for the patient.<br /> <strong>Objective:</strong> To evaluate the selected repair methods for para-umbilical hernias that already exist or are encountered incidentally and to present data regarding potential problems that may occur during laparoscopic cholecystectomy.<br /> <strong>Patients and Methods:</strong> During period of January 2017 to January 2019, laparoscopic cholecystectomy was attempted in 25 patients suffering from chronic calcular cholecystitis accompanied by para-umbilical hernia, patients were assigned to two groups according to occurrence of recurrence. A retrospective analysis of parameters, including patient demographics, laboratory values, radiologic data, and intraoperative findings, was performed.<br /> <strong>Results:</strong> The operating time, postoperative pain, length of hospital stay, wound infection and the time needed for return to work were less in patients without recurrence than patients with recurrence. Recurrence occurred in cases with BMI 35.5±8.08, patient with comorbidities (DM and hypertension) and size of the defect 2.4±.07 cm. Cases with recurrence have longer operational time and hospital stay than cases without recurrence and take more days to return to work. Cases with recurrence have also other complication such as hematoma and wound infection. There was a moderate positive correlation between BMI and both operating time and length of hospital stay. There was strong positive correlation between size of hernia and both operating time and length of hospital stay. There was a strong positive correlation between comorbidity and both operating time and length of hospital stay.<br /> <strong>Conclusion:</strong> Para-umbilical hernia repair combined with laparoscopic cholecystectomy resulted in longer operating time, longer anesthesia, and risk of increased blood loss. But it has the advantages of single hospital stay, single anesthesia exposure, less postoperative pain and morbidity, early return to work, better cosmesis and more convenient, efficacy and cost effective for the patient. However, the outcomes of the para-umbilical defect repair with mesh after laparoscopic surgeries appeared to be better for either obese or non-obese patients than primary suture techniques in recurrence rates.https://amj.journals.ekb.eg/article_158228_2dddb307038f3b50abd83eea704acd8c.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401OUTCOME OF SURGICAL EXCISION OF ACCESSORY BREAST TISSUE IN THE AXILLA83184215822910.21608/amj.2021.158229ENMohammedRefaat Hasan El-BermawyDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityAdelMohammad Abdul-Haleem LasheenDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityWalidRaafat Abd El-AteyDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20210321<strong>Background:</strong> The axilla is the most common site for accessory breasts. Although they may be asymptomatic, axillary accessory breasts can cause cosmetic concerns, pain, or restriction in arm movements. The radiological methods used for diagnosis include ultrasonography and MRI. The main concerns about the surgical treatment of accessory breasts are leaving any breast tissue unresected and cosmetic problems resulting from a bad scar or contour deformities.<br /> <strong>Objective:</strong> To evaluate the surgical outcome after excision of prominent accessory breast in the axilla.<br /> <strong>Patients and Methods:</strong> The current study included 50 female patients, presented to Al-Azhar University Hospitals, in Cairo, for elective excision of uncomplicated axillary accessory breast, in which an axillary swelling was noticed by themselves following pregnancy and lactation, during the period from May 2019 till April 2020. Their ages ranged from ranged between 18-40 years with a mean of 28.76 ± 5.7 years.<br /> <strong>Results:</strong> The local examination of the axillary breast revealed that its size ranged between 4-10 cm with a mean of 6.8 ± 2.3 cm. Consistency was firm in 40% of patients, hard in 40% of patients and soft in 20% of patients, fixed in 40% of patients and mobile in 60% of them, with an extension beyond the axilla in 40% of cases, whereas no extension was found in 60% of cases. Ultrasound examination of the axillary breast revealed that the mass was hyper-echoic in 60% of patients and hypo-echoic in 40% of them. Size ranged between 5-12 cm with a mean of 8 ± 2.6 cm. Wound healing was good in 82% of patients and was delayed in 18% of them. It was affected by hemoglobin level, but not with albumin level. Postoperative complications ranged from mild scar hypertrophy in 3 patients (6%), medial arm pain in 2 patients (4%), allergy to sticking plaster in 2 patients (4%), and hematoma in 1 patient (2%).<br /> <strong>Conclusion:</strong> Proper surgical excision provided numerous advantages as an option in treating an accessory axillary breast with virtually no postoperative complications.https://amj.journals.ekb.eg/article_158229_c8dfa931a6c880c615655fd180bec5ca.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401BLOOD TRANSFUSION REQUIREMENTS IN CARDIAC SURGERY84385415823010.21608/amj.2021.158230ENAmr IbrahimAbd El Aaldepartment of cardiothoracic surgery, Faculty of medicine, Alexandria universityEl-HusseinyEl-Husseiny GamilDepartment of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar UniversityHossamFouad FawzyDepartment of Cardiothoracic Surgery, Faculty of Medicine, Tanta UniversityYousryZaki Al-ZohairyDepartment of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210321<strong>Background:</strong> The effect of restrictive blood transfusion in comparison to liberal red cell transfusion strategy on clinical outcome in cardiac surgery remains undetermined.<br /> <strong>Objectives:</strong> The aim of this work is to evaluate the restrictive blood transfusion strategy versus the liberal strategy in open heart surgery in terms of vital organ functions (heart, brain, lung, and kidney) and mortality.<br /> <strong>Patients and Methods:</strong> After approval of Institutional ethical committee and obtaining written informed consent from the patient, in this multicenter randomized prospective study, we assigned 100 adult cardiac surgery patients with Euro score I of 6 or more to a restrictive red cell transfusion trigger (transfuse if hemoglobin level was <7.5g/dl starting from the induction of anesthesia) and liberal red cell transfusion trigger (transfuse if hemoglobin level was <9.5g/dl in the operative room or intensive care unit or <8.5g/dl in the ward). The primary outcome was composite of any cause death, myocardial infarction, stroke, or new onset renal failure with dialysis by discharge from hospital or by day28 whichever came first.<br /> <strong>Results:</strong> There was a significant decrease in RBC transfusion in the restrictive group intraoperative, in the postoperative day (1), and in the ward stay. There was significantly less fresh frozen plasma transfused in the restrictive group during the ward stay only. There were a significant decrease in ventilator time, ICU stay, chest tube drainage, and rapid AF occurrence in the restrictive.<br /> <strong>Conclusion:</strong> The restrictive transfusion strategy showed efficacy and safety in decreasing transfusion requirements in cardiac surgery, thus decreasing morbidities and mortality associated with blood transfusion. It also showed cost effectiveness.https://amj.journals.ekb.eg/article_158230_6d7123a40449e99dac811dd7ce54b260.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EVALUATION OF THE DISTAL RESECTION MARGIN VASCULARITY IN THE SUPERIOR RECTAL ARTERY PRESERVATION IN SIGMOIDECTOMY FOR SIGMOID COLON CANCER85586215823110.21608/amj.2021.158231ENMohammedL. Abd El-MawgodDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversitySaeedH. El-BendaryDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityMohammedM. AhmedDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20210321<strong>Background:</strong> Colorectal surgery has gained wide acceptance, especially in the treatment of cancer colon. Several techniques and modifications have been proposed to improve morbidity and mortality associated with left hemicolectomy.<br /> <strong>Objective:</strong> To evaluate the technique of superior rectal artery preservation in sigmoidectomy for sigmoid colon cancer, as regard impact on both radicality and vascularization in the remaining rectum.<br /> <strong>Patients and Methods:</strong> A prospective study had been conducted on Bab El Sharia University Hospital and El-Sahel Teaching Hospital from March 2019 to March 2020. Thirty patients who are posted for sigmoidectomy with preservation of superior rectal artery had been included in the study.<br /> <strong>Results:</strong> That mean of intraoperative blood loss was 35.64 ml and 6.7% of patients have intraoperative bleeding. The mean of harvested lymph nodes was 19.27. One patient needed conversion to open surgery. As regard mean of operation time, it was 190.73 min.<br /> <strong>Conclusion:</strong> Superior rectal artery preservation sigmoidectomy for colon cancer was a beneficial technique guarding against post-operative anastomosing leakage, important oncologic principles as lymph node (LN) metastasis and recurrence should be taken in consideration should be kept in mind before performing that procedure.https://amj.journals.ekb.eg/article_158231_f75035f552205486d54014a7b8df8c3f.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401STUDY OF THE EFFECT OF LACTOBACILLUS ACID FAST AS A PROPHYLAXIS FOR ENTER-COLITIS FOLLOWING SURGERY FOR HIRSCHSPRUNG’S DISEASE IN CHILDREN86387415828110.21608/amj.2021.158281ENHusseinAhmed Mohamed Abd El-LattifDepartment of Pediatric Surgery, Faculty of Medicine, Al-Azhar UniversityMagedMohamed Mohamed IsmailDepartment of Pediatric Surgery, Faculty of Medicine, Al-Azhar UniversitySamirHamed GoudaDepartment of Pediatric Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20210321<strong>Background:</strong> Hirschsprung’s associated enterocolitis (HAEC) after surgery is a common problem. The exact pathogenesis of HAEC still remains unclear. Considering the complex interrelation between the epithelium, the immune system, and the micro biome of the intestine, disturbances of the intestinal microbial composition may predispose a patient to develop HAEC. Surgery reduces, but does not eliminate the risk of enterocolitis, as up to 40% of the patients continue to suffer from HAEC despite correct surgical treatment.<br /> <strong>Objective:</strong> To evaluate use of the lactobacillus acid fast (probiotic) as a prophylactic treatment for enter-colitis following surgery for Hirschsprung’s disease (HD) .<br /> <strong>Patients and Methods:</strong> This numerical randomized control study was done on fifty patients. Their ages ranged from 0 day up to 10 years. All of them had undergone surgical treatment for Hirschsprung’s disease in Al-Azhar University Hospitals, Al Sheikh Zayed specialized Hospital and Al haram Hospital, during the period from January 2017 to December 2019. They were classified into 2 equal groups; Group A received lactobacillus acid fast (probiotic) as a prophylactic treatment for two years post-operative compared to group B did not.<br /> <strong>Results:</strong> Treatment with probiotics did not only significantly diminish the incidence, but also decreased the severity of HAEC.<br /> <strong>Conclusion:</strong> The use of probiotics as a prophylactic treatment following surgery for Hirschsprung’s disease did not only significantly diminish the incidence, but also decreased the severity of Hirschsprung-Associated Enter-colitis (HAEC).https://amj.journals.ekb.eg/article_158281_9c2f0ac721f221f84d562a57424a2989.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401PREOPERATIVE EVALUATION OF THE SCORING SYSTEM DEVELOPED BY ATEMA TO DISTINGUISH COMPLICATED FROM UNCOMPLICATED ACUTE APPENDICITIS87588415828410.21608/amj.2021.158284ENAbd El-KaderHamdy Mohammed Abd El-KaderDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohammedHafez MahmoudDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMahmoudAbd El-Hady Abd El-AzizDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210321<strong>Background:</strong> The diagnosis of acute appendicitis is purely based on history, clinical examination and some laboratory investigations (e.g. WBC count). Certain diagnosis can only be obtained at surgery and after pathological examination of surgical specimen. The Atema scoring system can distinguish complicated from non-complicated appendicitis preoperatively.<br /> <strong>Objective:</strong> To evaluate the validity and diagnostic accuracy of the Atema scoring system in differentiating complicated from non- complicated appendicitis before surgery.<br /> <strong>Patients and Methods:</strong> A prospective study was carried out on 60 patients complaining of acute abdominal pain, diagnosed as acute appendicitis using the Alvarado score and undergoing open appendectomy operation in the Emergency Department, Faculty of Medicine, Al-Azhar University from December 2019 to July 2020. Routine clinical and laboratory work up were done, the Atema Score was calculated to every patient in the study preoperatively. The decision to operate was made by a senior surgeon (consultant). The intraoperative finding whether the acute appendicitis was complicated or not was recorded. Post operatively, the histo-pathological examination results were recorded for each patient. The ROC curve was done, the cut-off point of the Atema scoring system was detected based on the ROC curve. The area under the ROC curve and the p-value were calculated. The sensitivity, specificity, positive predictive value and negative predictive value of the Atema scoring system above the level of the cut-off point were calculated.<br /> <strong>Results:</strong> In total of 60 patients, 37 patients (61.7%) had complicated appendicitis and 23 patients (38.3%) had non-complicated appendicitis. The sensitivity of the Atema score has a diagnostic accuracy of 0.944 (Area under the curve) with sensitivity 86.96% and specificity 89.19% with positive predictive value 83.3% and negative predictive value 91.7%.<br /> <strong>Conclusion:</strong> The Atema score can significantly differentiate between complicated and non-complicated acute appendicitis. A higher score denotes increased probability of the presence of complications as perforation and gangrene.https://amj.journals.ekb.eg/article_158284_6166676e2c4498900ea46f20aee71fb3.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401COMPARATIVE STUDY BETWEEN TRANSBRACHIAL VS TRANSFEMORAL ANGIOPLASTY OF CHRONIC COMPLETE ILIAC ARTERY OCCLUSION88589615828510.21608/amj.2021.158285ENHaythamYousef AliDepartment of Vascular Surgery, Faculty of Medicine, Al-Azhar UniversityAlaaEl-Dein SharabyDepartment of Vascular Surgery, Faculty of Medicine, Al-Azhar UniversityMohamedHamzaDepartment of Vascular Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20210321<strong>Background:</strong> Critical limb ischemia (CLI) is the most advanced stage of peripheral arterial occlusive disease; the prognosis is poor, with amputation rates up to 30 % and mortality up to 25% after 1 year.<br /> <strong>Objective:</strong> To compare between transbrachial approach and ipsilateral transfemoral approach either ultrasound guided or road map technique in common iliac artery occlusion angioplasty.<br /> <strong>Patients and Methods:</strong> A retrospective study conducted at the Department of Vascular Surgery, Faculty of Medicine, Al-Azhar University Hospitals from January 2019 till October 2020. The 88 patients who are candidates for study were subdivided into to three groups: Group A: Including 31 patients for whom transbrachial iliac angioplasty, Group B: Including 30 patients for whom transfemoral ultrasound guided iliac angioplasty and Group C: Including 27 patients for whom transfemoral road map guided iliac angioplasty. All lesions were categorized according to the Trans-Atlantic Inter-Society Consensus II (TASC) classification.<br /> <strong>Results:</strong> Transbrachial success rate was 90.32% compared with 96.6 in transfemoral access. No statistical difference was found. Patency rate reached 90.3%, 90.0% and 85.2% in transbrachial, transfemoral ultrasound and transfemoral road map guided groups respectively (X2:0.462; P=0.794). Peri-procedural complication rate reached 16.1%, 6.7% and 74.1% in Tran brachial, transfemoral ultrasound and transfemoral road map guided groups, respectively. Complications were statistically higher significantly in transfemoral road map guided group (X2:0.462; P=0.794). Thirty days mortality rate reached 11.1%, 23.8% and 17.4% in Tran brachial, transfemoral ultrasound and transfemoral road map guided groups, respectively. This was not statistically different among the three access groups (X2: 1.362; P=0.506). Amputation rate reached 9.7%, 6.7% and 3.7% in transbrachial, transfemoral ultrasound and transfemoral road map guided groups, respectively. No statistically significant difference was found (X2: 6.207; P=0.145).<br /> <strong>Conclusion:</strong> The technical success of all approaches is high, with higher success rate in transfemoral access. While we found more bleeding complications with transfemoral access.https://amj.journals.ekb.eg/article_158285_d2ddeb7cce675528f46984fc30733217.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401PREDICTIVE FACTORS FOR CONSERVATIVE TREATMENT OF LIVER TRAUMA89790415829110.21608/amj.2021.158291ENAhmedMasoud Abd El-Wahab MohammedDepartment of General Surgery Faculty of Medicine, Al-Azhar University, EgyptAL-SayedAhmed MustafaDepartment of General Surgery Faculty of Medicine, Al-Azhar University, EgyptBasmaAhmed MohamedDepartment of General Surgery Faculty of Medicine, Al-Azhar University, EgyptJournal Article20210321<strong>Background:</strong> Injuries are a major public health problem. The liver is the most commonly injured intra-abdominal organ. Conservative treatment thereby not only decreases the number of non-therapeutic laparotomies but also achieves a reduction in morbidity and mortality.<br /> <strong>Objective:</strong> To evaluate the management of patients with liver injury and the possible predictive factors for conservative treatment.<br /> <strong>Patients and methods:</strong> Prospective outcome analysis was done for 30 patients who were candidates for conservative management of liver trauma at Al-Azhar University Hospitals and Damanhur TeachingHospital from December2019 till October2020. Patients information’s had been collected from the hospital data and connection with them had been through phone calling and hospital follow up visits. Patients had been subjected to clinical and radiological examination.<br /> <strong>Results:</strong> The mean age of the included cases in the study group was 33.63 years (range, 6 – 75), The group included 8 females (26.7%) and 22 males (55%)ss regard type of hepatic injuries of the studied group, 8(26.7%) were isolated hepatic injuries and 22(73.3%) were combined hepatic and other organs, The success rate of the studied group showed that 21(70%) were successful and 9(30%) were unsuccessful.<br /> <strong>Conclusion:</strong> Conservative management of traumatic liver injuries is safe when the decision is based on careful initial evaluation.https://amj.journals.ekb.eg/article_158291_2ad294bab5dccb1a2db6c4d41678a16c.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401TEMPORARY VESICOSTOMY IN CHILDREN WITH VOIDING DYSFUNCTION: POSSIBLE PREDICTORS OF MORPHOLOGICAL AND FUNCTIONAL IMPROVEMENT OF UPPER URINARY TRACT90591415829410.21608/amj.2021.158294ENAhmedH. OkashaDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHusseinA. GalalDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptEl-SayedM. SalihDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210321<strong>Background:</strong> Chronic retention in infancy and childhood is induced secondary to lower urinary tract obstruction or dysfunction.<br /> <strong>Objectives:</strong> To evaluate the outcomes of temporary vesicostomy in children with voiding dysfunction, and to assess the possible predictors of morphological and functional improvement of upper urinary tract.<br /> <strong>Patients and Methods:</strong> This retrospective study included 69 patients who underwent cutaneous vesicostomy during the period from January 2014 to December 2019 at Al-Azhar University hospitals (Al-Hussein and Sayed Galal) Cairo; Egypt. Patients were evaluated by clinical history, examination, urine analysis, s.creatinine, ultrasonography, voiding cystourethrogram, magnetic resonance urography and renal scan before and 12 months after vesicostomy.<br /> <strong>Results:</strong> There was significant clinical, morphological and functional improvement. The mean serum creatinine before vesicostomy was 1.75±1.12mg/dl and improved gradually to 0.97 ±0.63 mg/dl after 12 months. Number of pus cells decreased gradually from 44.35±33.23 cell/ HPF to 2.65±1.74 cell/ HPF. The mean glomerular filtration rate (GFR) was 25.0±11.5 and 50.8±21.7ml/ minute pre and 12 months after vesicostomy respectively. Forty four (63.8%) cases were not complicated, 7 (10.1%) cases (5 male and 2 females) were complicated with prolapse, 8 (11.6%) cases complicated with stenosis and all of them were males, and 10 (14.5%) cases complicated with peristomal dermatitis and all of them were males.<br /> <strong>Conclusion:</strong> Vesicostomy is a simple urinary diversion, showing encouraging results towards safeguard of kidney function and morphology. Furthermore, the procedure has received rave reviews from the caregivers, and therefore, it has become a viable choice for children with neurological or other voiding dysfunctions or those that do not respond to conservative treatment.https://amj.journals.ekb.eg/article_158294_26211bc3e89b2638e08fe7576be63e8b.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EVALUATION OF POSTERIOR LUMBER INTERBODY FUSION WITHOUT INSTRUMENTATION IN LUMBER DEGENERATIVE DISC DISEASES91592215829510.21608/amj.2021.158295ENAhmedIsmael Mohamed Ismael KhattabDepartment of Orthopedic Surgery, Faculty of Medicine of Al-Azhar University, Cairo, EgyptEissaRaghebDepartment of Orthopedic Surgery, Faculty of Medicine of Al-Azhar University, Cairo, EgyptMohamedNegmDepartment of Orthopedic Surgery, Faculty of Medicine of Al-Azhar University, Cairo, EgyptJournal Article20210321<strong>Background:</strong> Degenerative disc disease represents a common cause of chronic low back pain that makes some disabling and requires surgical intervention. Posterior lumbar interbody fusion (PLIF) represents one of the techniques used to deal with this disabling.<br /> <strong>Objective:</strong> To assess the results of the posterior lumbar interbody fusion (PLIF) without instrumentation in cases of degenerative disc diseases without instability.<br /> <strong>Patient and method:</strong> This was a prospective study of twenty patients who underwent surgical lumbar laminectomy and discectomy with interbody fusion and graft for degenerative lumbar diseases that not responsive to medical treatment for 6 months at Sayed Galal Hospital, Al-Azhar Faculty of Medicine.<br /> <strong>Result:</strong> There was a highly statistically significant decrease in the level of pain (VAS score) one week postoperatively compared to preoperative level with p-value < 0.001, and a statistically significant difference was found between preoperative pain (VAS score) level ,and post 6 months level with p-value < 0.001.<br /> <strong>Conclusion:</strong> Posterior lumbar interbody fusion technique without instrumentation showed several potential benefits in the treatment of degenerative disc disease (DDD).https://amj.journals.ekb.eg/article_158295_312fec989484ad6cb66e4ee425804436.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401PREVALENCE OF LIGAMENTOUS INJURY ASSOCIATED WITH EXTRA ARTICULAR DISTAL RADIUS FRACTURE92393015829610.21608/amj.2021.158296ENAhmedAbdallah MohamedDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar UniversityAlyMohamed El-GeoushyDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar UniversityGalalMohamed MansourDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20210321<strong>Background:</strong> The radius is the most commonly broken bone in the arm. Distal radius fractures are very common and are commonly associated with ligament injuries and chondral damage.<br /> <strong>Objective:</strong> To report the incidence of ligaments and cartilage lesions associated with extra-articular distal radius fracture.<br /> <strong>Patients and methods:</strong> Fifty consecutive patients with extra-articular distal radius fractures, who attended at Al-Azhar University Hospital during the study period, were included in the study. 42.0% of the patients were males, 58.0% of them were females, and their mean age was 45.5 ± 5.24 years.<br /> <strong>Results:</strong> The affected wrist was the right wrist in 56% of cases and on plain radiographs. 46% of cases had A2 fractures, and 54% of them had A3 fractures. Ligament and cartilage lesions were found in 88% of cases. No significant statistical association was found between the intracarpal soft tissue injury and the different types of fractures.<br /> <strong>Conclusion:</strong> Using arthroscopy is recommended in distal radius fractures for verification of the degree of associated injuries and larger studies are needed to confirm our results.https://amj.journals.ekb.eg/article_158296_a78c9dc3ef0079c24d5c5cd368502358.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401MINIMALLY INVASIVE TREATMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES93194215830010.21608/amj.2021.158300ENAhmedMohamed Ahmed SelimOrthopedic Department, Faculty of Medicine, Al-Azhar University, EgyptMohamedIbrahim AbulsoudOrthopedic Department, Faculty of Medicine, Al-Azhar University, EgyptMahmoudSeddik HassanOrthopedic Department, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20210321<strong>Background:</strong> Calcaneal fractures have considerable debate of the appropriate methods of management and how to lessen potential complications.<br /> <strong>Objective:</strong> Evaluation of intra-articular calcaneal fractures that treated by minimally invasive methods.<br /> <strong>Patients and Methods:</strong> A prospective study has been conducted on twenty patients having intra-articular calcaneal fractures and were managed by minimally invasive methods of fixation at Al Azhar university hospitals, Cairo, Egypt, after that they have been followed up for 6 months.<br /> <strong>Results:</strong> According to the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hind foot Score. There was: excellent (5 feet (25%), good (11 feet (55%), fair (2 feet (10%) and poor (2 feet (10%). The average score was 83 with a range of 68 to 95. No patient in this series experienced any failure of hard-ware, or developed deep infections. Complications included: superficial pin tract infection, varus heel deformity, flexion deformity of the big toe, reflex sympathetic dystrophy, subtalar arthritis and painful heel.<br /> <strong>Conclusion:</strong> Management of calcaneal, intra-articular, fractures by minimally invasive techniques is a viable surgical alternate as it provides shorter time of surgery, nominal invasiveness, less serious wound problems, and no residual hardware (in case of pinning). Their drawbacks include technical issues and inadequate reduction fracture fragment.<br /> <strong> </strong>https://amj.journals.ekb.eg/article_158300_47dc0ab42c0402399994e47694c856b6.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401MICRO-ALBUMINURIA AT MID PREGNANCY IN THE PREDICTION OF PREECLAMPSIA94395015830310.21608/amj.2021.158303ENMahmoudA. FawazDepartment of Obstetrics & Gynecology, Faculty of Medicine - Al-Azhar UniversityTamerFaresDepartment of Obstetrics & Gynecology, Faculty of Medicine - Al-Azhar UniversityAhmedEl-TabakhDepartment of Obstetrics & Gynecology, Faculty of Medicine - Al-Azhar UniversityJournal Article20210321<strong>Background:</strong> Proteinuria has classically been an important finding in the diagnosis of preeclampsia and eclampsia, so in our study we use measearing microalbuminuria as a predictor of preeclampsia.<br /> <strong>Objective:</strong> To evaluate microalbuminuria at mid pregnancy, as a predictor of preeclampsia.<br /> <strong>Patients and Methods:</strong> This prospective observational study was carried out on 200 normotensive women, aged 18-35years, and live singleton pregnancy between 24-28 weeks at Embaba General Hospital during the period between April 2019 and February 2020. Microalbuminuria was measured in urine samples of the first micturition of the day. All were followed till delivery.<br /> <strong>Results:</strong> Negative microalbuminuria was present in 154 patients, 6 (3.89%) developed preeclampsia. Forty six women had positive microalbuminuria and 12 (26%) of them developed preeclampsia. The sensitivity was 66.7%, specificity 81.3%, the positive predictive value was 26.1%, and the negative predictive value was 96.1%.<br /> <strong>Conclusion:</strong> Microalbuminuria at mid pregnancy could be a significant predictor of preeclampsia.https://amj.journals.ekb.eg/article_158303_c41c6aed9a90668b9ccee6eff3679bcc.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401ROLE OF MIDDLE CEREBRAL ARTERY DOPPLER AND AMNIOTIC FLUID INDEX IN PREDICTING PERINATAL OUTCOME IN POSTDATED PREGNANCIES95196215830510.21608/amj.2021.158305ENAhmedAli El-SebahyDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityMohammedTaher IsmailDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityMohammedSalah El-Din HassanienDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityAhmedShaaban MohammedDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210321<strong>Background:</strong> Post-date pregnancy carries many fold problems for both pregnancy and fetal outcome. Abnormal middle cerebral artery Dopplers are strongly associated with preterm delivery and antenatal steroid administration.<br /> <strong>Objective:</strong> To identify the relationship between middle cerebral artery Doppler, Amniotic fluid index and perinatal outcomes in postdated pregnancies.<br /> <strong>Patients and Methods:</strong> This study was performed on 50 pregnant women whose gestational age was 40–42 weeks’ gestation attending the antenatal clinic of Zefta General Hospital. The study was done during the period between December 2017 and August 2019.Inclusion criteria included singleton living fetuses with vertex presentation in postdated pregnancies (40 – 42) week gestation. Exclusion criteria included cases with premature rupture of membranes, antepartum hemorrhage and maternal medical disorders as hypertension, diabetes mellitus, hepatic, cardiac, renal or anemia with pregnancy, patients with uterine scar. All patients were subjected to detailed history taking, physical examination and routine investigations including complete blood picture, Rh typing, fasting blood sugar, liver functions, kidney functions and urine analysis. Ultrasound and Doppler study were done twice weekly till the onset of labor or termination of pregnancy in order to assess GA, estimated fetal weight (EFW), placental site and grading, amniotic fluid volume (AFV) (oligohydramnios was diagnosed if the largest vertical pocket less than 2 cm), Doppler study of the MCA. The study population was divided into two groups based on the presence or absence of adverse perinatal outcome.<br /> <strong>Results:</strong> Expected fetal weight (EFW), resistive Index of middle cerebral artery (MCA) and resistive Index of umbilical artery (UA) were not significantly predicting perinatal outcome of postdated pregnancies among the studied pregnant women. Amniotic fluid index (AFI) and biophysical profile (BPP) were significant predictors for perinatal outcome of postdated pregnancies.<br /> <strong>Conclusion:</strong> Resistive Index of (MCA) was not significant predictor for perinatal outcome of postdated pregnancies. Amniotic fluid index was significant predictor for perinatal outcome of postdated pregnancies.https://amj.journals.ekb.eg/article_158305_4bb5454e384295bb90742d3e0c5d9698.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EFFECT OF SURGICAL OPERATION FOR BENIGN OVARIAN TUMORS ON ANTI MULLERIAN HORMONE96397415844310.21608/amj.2021.158443ENMohammedAboul-Fotouh Abd El-MageedObstetrics and Gynecology Dept., Faculty of Medicine, Al-Azhar University, Cairo, EgyptMahmoudS. ZakiObstetrics and Gynecology Dept., Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmedA. El-TabaakhObstetrics and Gynecology Dept., Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210322<strong>Background:</strong> Surgical operation for benign ovarian tumors creates a potential risk for the ovarian reserve. Ovarian procedures including excision of cysts (cystectomy) are very commonly performed worldwide for various disorders.<br /> <strong>Objective:</strong> To study the long term effect of ovarian surgery on blood level of anti mullerian hormone.<br /> <strong>Patients and Methods:</strong> The present study was a prospective cohort study of patients who have benign ovarian tumor which carried on Patients from December 2019 to October 2020 at Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University.<br /> <strong>Results:</strong> There was a significant decrease in Anti mullerian hormone ( AMH ) post operatively by 25.79%. There was a significant relation between level of AMH and age of the patients. The old age had a low level of AMH. Also, the bilateral lesion showed a low level of AMH less than the unilateral lesions. The cyst size more than 5 cm showed a negative relation with level of AMH. The log duration of surgery had a negative effect on the level of AMH. The endometeriotic type showed a significant decrease in AMH level more than the other histopathological findings.<br /> <strong>Conclusion:</strong> Serum AMH levels could be preferred in determining the indication and selection of operative methods for benign gynecologic conditions, especially endometriomas.https://amj.journals.ekb.eg/article_158443_b4074b44b6862d7513a675395ce4e78c.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401COMPARATIVE STUDY BETWEEN DIFFERENT TYPES OF VAGINAL PROGESTERONE IN LUTEAL PHASE SUPPORT IN ICSI CYCLES97598815844510.21608/amj.2021.158445ENAliS.A. AhmedDepartments of Obstetrics and Gynecology,
Faculty of Medicine, Al- Azhar UniversityJournal Article20210322<strong>Background:</strong> Assisted reproductive techniques (ART) include all fertility treatments in which the gametes (egg and sperm) are handled outside the human body with the aim of achieving a healthy conception. Common ART procedures include in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI), fresh or frozen embryo transfer, and IVF with donor oocytes. Luteal phase support through pharmaceutical drugs has been universally agreed.<br /> <strong>Objective:</strong> To compare the effectiveness of different types of vaginal progesterone preparations for luteal support in patients undergoing Intracytoplasmic Sperm Injection.<br /> <strong>Patients and Methods:</strong> The current randomized controlled clinical trial study was conducted on 300 patients who were following at the Assisted Reproductive Technology (ART) unit of the International Islamic Center for Population Studies and Research (IICPSR) of Al-Azhar University over the period from May 2016 to January 2018 after being approved by the ethical committee. The patients were divided into 3 equal groups received Prontogest vaginal suppositories 400 mg once per day, Group B received Crinone 8% (90 mg) vaginal gel once per day and Group C received Endometrin vaginal suppositories once per day.<br /> <strong>Results:</strong> Comparison between studied group A (Prontogest), group B (Crinone) and group C (Endometrin) as regards demographic characteristics revealed no statistically significant differences. As regards the cause of infertility, a statistically significant increase in the number of patients with male and tubal factors in group B (Crinone) than group A (Prontogest). Concerning the laboratory hormonal profile of the studied groups before ICSI, there was a statistically significant increase in FSH and LH levels in group A (Prontogest) than group B (Crinone) and group C (Endometrin). On the other hand, there was a difference between the studied groups as regards prolactin and estrogen levels, but did not reach statistical significance. Comparison between studied groups, as regards Endometrial thickness, number of retrieved oocytes and number of transferred embryos revealed no statistically significant difference. Comparison between the studied groups, as regards pregnancy rates, revealed a statistically significant increase in pregnancy rates in group C than group A.<br /> <strong>Conclusion:</strong> The use of Endometrin vaginal suppositories in patients undergoing ICSI had a statistically significant higher clinical pregnancy rates in comparison to Prontogest vaginal suppositories. On the other hand, Crinone vaginal gel had a higher clinical pregnancy rate than Prontogest.https://amj.journals.ekb.eg/article_158445_fa80848cc5612d4b46adc5f41f9dc0b3.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401COMPARATIVE STUDY BETWEEN TOTAL DOSE OF IRON INFUSION AND INTRAMUSCULAR IRON ADMINISTRATION IN TREATMENT OF IRON DEFICIENCY ANEMIA IN PREGNANT WOMEN98999815844810.21608/amj.2021.158448ENMohamedEl-Shahat El-Saied Abd El-KhalekDepartments of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityAbdallaKhalil AhmedDepartments of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityAbd El-RaoufAbd El-Raouf Abo-NarDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversitySamirKhamis GalalDepartments of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> Iron deficiency anemia (IDA) is the most common problem of nutritional deficiency in pregnant women worldwide. There is a concern about the high prevalence of iron and other micronutrient deficiencies among women during pregnancy in developing countries, and maternal anemia continues to cause significant perinatal morbidity and mortality.<br /> <strong>Objective:</strong> To compare between total dose of iron infusion and intramuscular iron administration from 12-32 weeks in pregnant women with moderate iron deficiency anemia.<br /> <strong>Patients and Methods:</strong> The study was held on 100 patients in the Obstetrics and Gynecology Department at Al-Hussien University Hospital Al- Azhar University on pregnant women at 12-32 weeks gestation attending the antenatal care unit from September 2019 to March 2020.<br /> <strong>Results:</strong> <strong>Group A</strong> was received I.V iron, Hb (pretherapy) ranged from 7.1-9 g%, elevated to 10.1-12 g%, the ferritin ranged from 15-30 ng/ml, elevated to 32-49 ng/ml. <strong>Group B</strong> was received I.M-iron, Hb (pretherapy) ranged from 7-9 g%, elevated to 8.5-10.9 g%, and ferritin ranged from 16-29ng/ml, elevated to 24-35ng/ml.<br /> <strong>Conclusion:</strong> Intravenous iron showed high effectiveness in the treatment of iron deficiency anemia during pregnancy. No side effects were detected and thus, it can be considered as a useful and alternative formulation for the treatment of iron deficiency.https://amj.journals.ekb.eg/article_158448_7dd5aac45331a430f141ea071125cfc4.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401COMPARISON OF OBSTETRICAL OUTCOME WITH LABOR INDUCTION AGENTS USED AT TERM999100615844910.21608/amj.2021.158449ENMohamedEl-Sebaey El-AwdyObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmedMohamed Al-SadekObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMofeedFawzy MohamedObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210322<strong>Background:</strong> Induction of labour has risen gradually in modern obstetrics all over the world. It is more predominant in developed countries (around 20%) than developing countries.<br /> <strong>Objectives:</strong> To evaluate the outcome of induction of labor in primiparous, multiparous women and the risk of cesarean delivery associated with induction.<br /> <strong>Patients and methods:</strong> This study included 200 patients attending to Obstetrics and Gynecological Department at Al-Hussein University Hospital for delivery and Al-Sinblawein General Hospital from September 2019 to April 2020. The patients were classified into two equal groups according to success of induction:<br /> <strong>Group 1</strong> was given misoprostol vaginally after rupture of membrane, <strong>group 2</strong> patients was give oxytocin by slow infusion after rupture of membrane. Patients with gestational age less than 37 weeks, previous cesarean delivery, with breech presentation and age above 40 years were excluded.<br /> <strong>Results:</strong> There was a statistically significant difference between group 1(misoprostol) and group 2 (oxytocin) regarding induction of labor with mean interval between hours was higher in group 2.<br /> <strong>Conclusion:</strong> Vaginal misoprostol was effective, easy to administer, safe method and superior to oxytocin for induction of labor.https://amj.journals.ekb.eg/article_158449_ac7efc6d4587478596ddd6cd53e0da86.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401BODY MASS INDEX IN PATIENTS WITH POLYCYSTIC OVARIAN SYNDROME AND ITS RELATION TO DOSE AND DURATION OF HMG, OVULATION RATE AND PREGNANCY RATE1007101615845010.21608/amj.2021.158450ENAbdallahG. MohammadDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityIsmailT. El-GarhyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityNohaM. SabryDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> Polycystic ovary syndrome (PCOS) is one of the most common causes of endocrinological disorders affecting 5-10% of women in reproductive age. It is the most important cause of anovulation and infertility.<br /> <strong>Objective:</strong> To examine the relation of body mass index in PCOS patients with dose and duration of Human Menopausal Gonadotropin (HMG), ovulation rate and pregnancy rate.<br /> <strong>Patients and Methods:</strong> The study was retrospectively conducted on 150 women selected from patients attending the infertility clinic of Al-Azhar hospitals, Faculty of Medicine, Al-Azhar University during the period from August 2018 till July 2020, and we revised and collected that data from the records. All cases were selected after fulfilling inclusion and exclusion criteria. The patients were divided into three equal groups according to their body mass index, Group A: patients with normal body mass index (BMI 19-24.9), Group B: patients with overweight (BMI 25-29.9) and group C: patients with obesity (BMI equals or more than 30).<br /> <strong>Results:</strong> There was a statistical significance as regards pregnancy rates between studied groups. In the current study there was a statistical significant difference between three groups as regards the mean age. There was no statistical significant difference between three groups as regards the mean Follicular Stimulating Hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2), Prolactin (PRL) and Thyroid stimulating Hormone (TSH). According to the days of stimulation, group C showed a significant increase than group A and B. The dose of HMG used in the three studied groups, showed a significantly higher dose used in group C than group A and B. The ovulation rate was 68% in group A, 56% in group B and 28% in group C. The results were compared with other studies of similar scope and most of them were recent ones. In our study, obesity had negative impact on ovulatory functions. It seemed that obesity was a negative prognostic factor for women referred to vitro fertilization (IVF) treatment. They should be encouraged to change lifestyle habits in order to lose weight before starting fertility treatment. Although our findings did not support a policy of excluding obese and overweight women from IVF treatment on the grounds of likely failure of ovulation induction or IVF, Beyond the IVF results, obesity increased morbidity for both mother and fetus. There was an increased risk in pregnancy hypertension, toxemia, gestational diabetes, Cesarean section, increased hospitalization, and the risk to their offspring of their abnormality in BMI.<br /> <strong>Conclusion:</strong> Programs of weight loss are recommended for obese women undergoing in vitro fertilization, and the institution of a process of weight loss where appropriate, HMG can be given to patients with PCO adjusting dose according to their BMI and response with expecting satisfactory ovulation, and pregnancy rate.https://amj.journals.ekb.eg/article_158450_aa360b54fe127a84d33e929cb29efc66.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401A COMPARATIVE STUDY BETWEEN GENERAL AND SPINAL ANESTHESIA REGARDING MATERNAL BLOOD INDICES CHANGES AFTER LOW RISKY ELECTIVE CEASAREAN SECTION (A PROSPECTIVE CONTROLLED RANDOMIZED STUDY)1017102615845110.21608/amj.2021.158451ENEl-SayedEl-DesoukyDepartment Of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityOsamaKamal RaslanDepartment Of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityIbrahimAbo El-MagdDepartment Of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityShadyM. HassanDepartment Of anesthesia and ICU, Faculty of Medicine, Zagazig UniversityJournal Article20210322<strong>ABSTRACT</strong><br /> <strong>Background:</strong> Delivery by ceasarean section is one of the most common surgical procedures nowadays. However, Choosing of anesthesia is a matter of controversy among obstetrician.<br /> <strong>Objective:</strong> To study the effect of two types of anesthesia on maternal hemoglobin and hematocrit level after elective cesarean section.<br /> <strong>Patients and methods:</strong> This was a randomized controlled study done at Sayed Galal University hospital and private centers (Tbarak Private Hospital Group) including 100 pregnant women underwent elective first time ceasarean section for variables causes. Changes in maternal hemoglobin and hematocrit indices were measured.<br /> <strong>Result:</strong> There was statistically significant difference between both groups after 48th hour post ceasarean section. Mean 48 hours postoperative hemoglobin and hematocrit parameter differences were significantly lower in the group with spinal anesthesia.<br /> <strong>Conclusion:</strong> Spinal anesthesia was better and has a greater advantage for maternal condition than general anesthesia as regard post-operative blood indices changes. So, whenever it is not contraindicated, spinal anesthesia should be recommended for elective ceasarean section.https://amj.journals.ekb.eg/article_158451_210108c5beb8d03b0fafa99782d64dd5.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401COLOPOSCOPY AND OFFICE HYSTEROSCOPY FOR CERVICAL ASSESSMENT FOR EVALUATION OF SUSPICIOUS CERVIX1027103615845210.21608/amj.2021.158452ENMohammedMamdouh SayedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut)FaisalAli MustafaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut)HusseinA.H. GadallahDepartment of Pathology, Faculty of Medicine, Al-Azhar University (Assiut)Abd El-HalimMohammed Abd El-HalimDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut)Journal Article20210322<strong>Background:</strong> Cervical cancer is the second most common cancer among women in developing countries. Cervical cancer is a deadly disease once it reaches the invasive stages but out of all the female genital tract cancers. It is the only preventable cancer if detected in its early stages, and the disease is almost 100% curable with accurate screening and early detection.<br /> <strong>Objective:</strong> To evaluate efficacy of both office cervicoscopy and colposcopy directed biopsy in evaluation of clinically suspicious cervix.<br /> <strong>Patients and methods:</strong> Prospective cohort study on 200 patients with clinically suspicious cervix attending the outpatient Department of Obstetrics and Gynecology, at the Hospital of Al-Azher Assiut University. Results: Colposcopy had a sensitivity of 60% and a specificity of 91.1%. Office cervicoscopy showed a sensitivity of 75% and a specificity of 89.3%.<br /> <strong>Conclusions:</strong> Office cervicoscopy is more sensitive than stationary colposcopy for detection of cervical lesions in cases with suspicious cervix as an example of high risk group for cervical cancer. Its small caliber allows easy, simple and fast diagnostic out-patient evaluation of the cervix.https://amj.journals.ekb.eg/article_158452_77cd983b19e1ccf5f9a62701be05dc40.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EFFECT OF MAGNESIUM SULFATE ON DOPPLER INDICES AND FETAL CIRCULATION IN CASES OF SEVERE PRE-ECLAMPSIA1037104615845410.21608/amj.2021.158454ENAhmedA. MoussaObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityAbd El-MoneimM. ZakaryaObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityAhmedO. Abd El-MotaalObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> In women with severe PE, the use of magnesium sulfate (MgSO<sub>4</sub>) is indicated for prevention and control of acute convulsions. Several randomized trials have compared the efficacy of MgSO<sub>4</sub> with other anticonvulsants in women with eclampsia, and the rates of recurrent seizures and maternal death significantly reduced with MgSO<sub>4</sub> as compared with other anticonvulsants.<br /> <strong>Objective:</strong> To assess the effect of magnesium sulfate injection on Doppler indices and fetal circulation in cases of severe pre-eclampsia.<br /> <strong>Patients And Methods:</strong> This was a prospective study that conducted on one hundred pregnant women suffering from pre-eclampsia, selected from the Obstetrics and Gynecology Department of Al-Hussein University Hospital from January 2018 to December 2018, evaluated before and after administration of magnesium sulfate, Doppler ultrasound was carried out to measure umbilical artery blood flow.<br /> <strong>Results:</strong> The results showed that a significant improvement in Doppler measurements and out come with treated groups (MgSO<sub>4</sub>) group more than the control group.<br /> <strong>Conclusion:</strong> MgSO<sub>4</sub> proved to cause many hemodynamic changes as it has a vasodilator effect on maternal and fetal blood vessels. Doppler indices in the umbilical arteries significantly changed after administration of MgSO<sub>4</sub> in patients with severe preeclampsia.https://amj.journals.ekb.eg/article_158454_e6c432b8af5115d2064e3ded3298e2eb.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401ROLE OF MIDDLE CEREBRAL ARTERY AND DUCTUSVENOSUS DOPPLER IN EVALUATION OF INTRAUTERINE GROWTH RESTRICTION1047105815845510.21608/amj.2021.158455ENAhmedAbd El-Sattar Al-Sayed YakoutDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAbd El-MonaemMohamed ZakariaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmedMohammed SaeedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210322<strong>Background:</strong> World over, intrauterine growth restriction (IUGR) is observed in about 24% of newborns. Approximately, 30 million infants suffer from IUGR every year. IUGR is associated with stillbirth, neonatal death, and perinatal morbidity as well as delayed effects including cerebral palsy (CP) and adult diseases.<br /> <strong>Objective:</strong> To assess the role of umbilical artery, middle cerebral artery and ductus venosus doppler in evaluating the neonatal outcome of growth restricted fetuses.<br /> <strong>Patients and methods:</strong> Our study was conducted on 100 pregnant women attended at the department of Obstetrics and Gynecology, Al-Azhr University Hospitals from January 2019 to December 2019. The cases were allocated into 2 main groups: Group I: thirty two pregnant women with intrauterine growth restriction (IUGR), Group II: sixty eight normal pregnant women without IUGR.<br /> <strong>Results:</strong> The presence of high statistical significance correlation between neonatal outcome and Doppler indices of umbilical artery, middle cerebral artery (PSV, PI, RI) in IUGR group. There were also high statistical significance correlation between neonatal outcome and Ductus venosus Doppler with high specificity and sensitivity of A wave RI, PI in IUGR group.<br /> <strong>Conclusion:</strong> The umbilical artery Doppler indices (RI, PI) were abnormally high in IUGR, in addition with S/D ratio have significant relation with poor neonatal outcome in IUGR fetuses. Middle cerebral artery Doppler indices (PSV, S/D ratio, RI and PI) are abnormally high in IUGR and have high significant relation with poor neonatal outcome in IUGR group.https://amj.journals.ekb.eg/article_158455_4204e9397e9a3731a7ec66c8d164d54a.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401FIRST-TRIMESTER NEUTROPHIL-TO-LYMPHOCYTE AND PLATELET-TO-LYMPHOCYTE RATIOS AS INDICATORS FOR EARLY DIAGNOSIS OF PREECLAMPSIA1059107415845610.21608/amj.2021.158456ENAhmedGamal El-Din MahmoudDepartments of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamedAli MohamedDepartments of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptEl-SayedAhmed El-DesoukyDepartments of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamedSaad El-Din RadwanDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210322<strong>Background:</strong> Preeclampsia is a popular obstetric complication. Neutrophil to lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have gained notable attention as systemic inflammatory response indicators in diverse clinical settings.<br /> <strong>Objective:</strong> To evaluate the diagnostic worth NLR and PLR during the first trimester of gestation to forecast the subsequent occurrence of preeclampsia.<br /> <strong>Patients and methods:</strong> The present study was a prospective cohort study that enrolled 300 pregnant ladies. Initial CBC was done for all eligible cases at 7-14 weeks of gestation then cases were followed up till delivery.<br /> <strong>Results:</strong> The results showed progressively statistically increase in the mean NLR in PE cases compared to control cases and a statistically significant difference between the control and PE cases s regard PLR. Cut off value 1.7538 NLR can differentiate normotensive pregnant women from preeclampsia women with sensitivity of 86.5 %, specificity of 91.6% %, PPV of 64 %, and NPV of 97.5 %. However, PLR can differentiate normotensive pregnant women from preeclampsia women at a cut off value 80.70 with sensitivity of 81.1 %, specificity of 95.1 %, PPV of 28.6 %, and NPV of 64.6 %.<br /> <strong>Conclusion:</strong> Neutrophil to lymphocyte ratio and platelet to lymphocyte ratios is cheap, simple, rapid, and readily accessible marker that may be beneficial to predict preeclampsia in early pregnancy. Hence, these easy applicable parameters can be applied as low-cost predictive factors for the development of PE.https://amj.journals.ekb.eg/article_158456_7a0137e70492ccb4ca8cf7649a2668f2.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401CARBETOCIN VERSUS COMBINED OXYTOCIN AND METHERGINE FOR PREVENTION OF POSTPARTUM HEMORRHAGE AFTER VAGINAL DELIVERY IN HIGH RISK PREGNANCY1075108815845710.21608/amj.2021.158457ENMohamedGamal Nasr El-ShennawyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMohamedMohamed GebreelDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityAlrefaaiAbd El-Fattah MaraiDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background: </strong>Around the world, one woman every minute dies as a result of postpartum hemorrhage (PPH) and it remains the single major cause of maternal mortality and morbidity. The early identification of risk factors and effective prevention and management of PPH are critical to minimize the impact of PPH. Carbetocin, a new drug for the prevention of uterine atony, is a synthetic analogue of oxytocin with a half-life of up to 4 to 10 times longer than that of oxytocin. In comparison with oxytocin, it is used as a single-dose injection instead of an infusion and can be given intravenously or intramuscularly.<br /> <strong>Objective:</strong> To evaluate the effect of carbetocin in preventing postpartum hemorrhage after vaginal delivery in comparison with combined oxytocin and methergine.<br /> <strong>Patients and methods:</strong> This study was conducted at Al-Galaa Maternity Hospital during the period from 1 June to 1 December 2020. The study included 100 candidates between 37 to 40 weeks with a risk factor to develop PPH divided randomly into two equal groups: Group A received a single 100 mg IM dose of carbetocin (Pabal<sup>®</sup>) and Group B received 5 IU IM oxytocin (Syntocinon<sup>®</sup>) combined with 1 mL, 0.2 mg IM methylergonovine maleate (Methergine<sup>®</sup>).<br /> <strong>Results: </strong>Carbetocin was more effective, with significant difference, in reducing the time of 3rd stage of labor, reducing amount of blood loss and drop of both HB% and hematocrit levels with significant decreased incidence of side effects.<br /> <strong>Conclusion:</strong> A single 100 mg IM dose of carbetocin (Pabal<sup>®</sup>) may be more effective as compared to 5 IU IM oxytocin (Syntocinon<sup>®</sup>) combined with 1 mL, 0.2 mg IM methylergonovine maleate (Methergine<sup>®</sup>) in reducing postpartum blood loss with a smaller drop in hemoglobin levels.https://amj.journals.ekb.eg/article_158457_86f82454a777fa7172f91e9b194f7160.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401COMPARISON OF RECURRENCE INCIDENCE AFTER PTERYGIUM EXCISION BY USING PEROPRATIVE SUBCONJUNCTIVAL BEVACIZUMAB INJECTION VERSUS CONJUNCTIVAL AUTO GRAFT1089110215845810.21608/amj.2021.158458ENMohamedEl-Sayed Mohamed Abd El-WahabOphthalmology Department, Faculty of Medicine, Al-Azhar University Cairo, EgyptHishamFawzy KhalelOphthalmology Department, Faculty of Medicine, Al-Azhar University Cairo, EgyptAbd Al-MagidMohamed Tag Al-DinOphthalmology Department, Faculty of Medicine, Al-Azhar University Cairo, EgyptJournal Article20210322<strong>Background:</strong> A pterygium is a fleshy, wing-shaped growth from the conjunctiva, crossing over the limbus onto the cornea. The tissue is fibrovascular and can occur over the nasal or temporal cornea. It can be a bilateral process and asymmetric with one eye affected by a larger pterygium than the other.<br /> <strong>Objectives:</strong> To compare between Subconjunctival injection of bevacizumab (Avastin) and conjunctival autograft in the treatment of primary pterygium.<br /> <strong>Patients and Methods:</strong> This study was performed on 40eyes of 40 patients with primary pterygia of variable durations. The eyes were randomly classified into two equal groups: group A patients to be treated by Subconjunctival Bevacizumab (avastin) 0.2 ml (5 mg) for Primary Pterygium Excision, group B patients treated by conjunctival auto graft. Best corrected visual acuity, occurrence of recurrence, IOP and postoperative complications were compared. Patients were evaluated preoperatively then 1 day, 1 week, 1 month, 3 months after surgery. Eye photography was done before surgery and during the follow up period. This study was conducted at Department of Ophthalmology Al-Azhar University Hospital and Kobry El Kobba Military Hospital, from August 2018 to July 2020.<br /> <strong>Results:</strong> When the two groups were compared together, we found no statistically significant differences among them in multiple compared items, but the recurrence rate in group A (bevacizumab group) occurred in (10%), while in group B conjunctival auto graft no recurrence occurred and this was statistically insignificant difference among the 2 groups. There were no statistically significant differences regarding improvement in visual acuity, intraocular pressure change and postoperative complications among the two groups.<br /> <strong>Conclusion:</strong> A single preoperative subconjunctival injection of bevacizumab had decreased the recurrence rate befor primary pterygium excision, but did not give a more desirable recurrence rate. On the other hand conjunctival autograft was more effective than bevacizumab in reducing the recurrence rate of primary pterygium after surgical excision.https://amj.journals.ekb.eg/article_158458_b17cafdd01e05cad1fb09d19fffb5fd9.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401MACULAR THICKNESS CHANGES IN DIABETIC VERSUS NON DIABETIC PATIENTS AFTER UNCOMPLICATED PHACOEMULSIFICATION1103111815845910.21608/amj.2021.158459ENMahmoudMohammed Madeeh HassaninDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityMohamedKhedr MohamedDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityMohamedMohamed-Aly IbrahimDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> In recent years, there has seen great progress in cataract surgery, both in the surgical technique as well as with modern phacoemulsifiers. Optical Coherence Tomography (OCT) is a noninvasive and noncontact diagnostic tool with high resolution to assess macular changes.
<strong>Purpose:</strong> To assess the impact of uncomplicated phacoemulsification on the changes of central macular thickness (CMT) values in diabetic and non-diabetic patients.
<strong>Methods:</strong> Thirty eyes of 30 subjects who underwent uneventful phacoemulsification were divided into 3 equal groups: Group I: Non diabetic patients, Group II: Diabetic patients without retinal changes and Group III: Diabetic patients with mild to moderate non-proliferative diabetic retinopathy (NPDR). Each patient was subjected to routine examination, best corrected visual acuity and CMT was assessed by OCT one day before operation, one week, one month and six months after the operation.
<strong>Results:</strong> According to CMT, significant difference was reported after one month and six months between all groups. This study showed statistically significant differences between groups one week, one month and six months postoperatively according to BCVA. Also there were statistically significant differences over the periods through BCVA in the each group, negative significant correlations between CME and BCVA after 1 month and 6 months. The mean BCVA improved progressively in the postoperative period, and it was non-significant correlated with duration of DM one week postoperatively. However, the correlations were significant after one month and six months. The CMT increased progressively in the postoperative periods and it significantly correlated with the duration of DM after one month and six months.
<strong>Conclusion:</strong> Diabetes influenced the central macular thickness in diabetic patients, who were more liable to changes in central macular thickness after cataract surgery even with uncomplicated cataract surgery.https://amj.journals.ekb.eg/article_158459_b9d14072fdf606a594f1a262197d35bb.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401CORNEAL TOPOGRAPHIC CHANGES AFTER EYELID PTOSIS SURGERIES MEASURED BY CORNEAL TOPOGRAPHY1119112615846110.21608/amj.2021.158461ENZakariyaAbd El-Ghany MohammedDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityMohamedAmin Anwar El-MasryDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityEhabAbd El-Samie El-ShiekhDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> The cornea is a complex structure which has a protective role, and responsible for about three-quarters of the optical power of the eye. Pressure from the eyelids has been implicated in a range of short- and long-term corneal topographical changes.<br /> <strong>Objective:</strong> To evaluate corneal topographic changes after eyelid ptosis surgeries measured by corneal topography by the Sirius system (CSO, Florence, Italy).<br /> <strong>Patients and Methods:</strong> A total of 50 eyes of patients were enrolled in the study to be examined before and 6 weeks after ptosis surgeries using corneal topography device at Al-Azhar University Hospitals in the period extending from December 2018 to December 2019. A complete ophthalmological examination included uncorrected visual acuity, best corrected visual acuity, full slit lamp examination and evaluation of eyelid. Examination was done by the Sirius system to evaluate corneal topographic changes.<br /> <strong>Results:</strong> Apical keratometry front (AKF) was changed from (44.63 ± 1.34D) to (44.06 ± 1.47D) with statistically significant (P value=0.002). Changes in central corneal thickness (CCT), corneal astigmatism (CYL), average simulated keratometry (average K), and symmetry index front (SIF) obtained from Sirius were not statistically significant.<br /> <strong>Conclusion:</strong> The pressure of upper eyelid in patients with ptosis appeared to inducing steepening of the superior cornea along this axis. The surgical correction of ptosis induces flattening of superior cornea as shown by significant decrease in AKF value postoperatively restoring corneal topography to a more regular state.https://amj.journals.ekb.eg/article_158461_186409e70b004eb73d33e14f1a5bac17.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401DIABETIC MACULAR ISCHEMIA DIAGNOSIS: COMPARISON BETWEEN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AND FLUORESCEIN ANGIOGRAPHY1127113815846210.21608/amj.2021.158462ENSaraHammam MohamedDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityAhmedShafeq AbdallahDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityZeinabSayed HasanDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityMohamedMohamed-Aly IbrahimDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> Diabetic retinopathy (DR) is a common complication of diabetes mellitus and is a leading cause of blindness worldwide. Diabetic macular ischemia is recognized as an important cause of visual disability. DMI is characterized by enlargement of the physiological capillary-free zone (FAZ).<br /> <strong>Objective:</strong> To compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) of foveal avascular zone (FAZ) in patients with diabetic retinopathy (DR) with and without diabetic macular ischemia (DMI).<br /> <strong>Patients and methods:</strong> Our study included 60 patients with diabetic retinopathy, divided into 2 groups: Group I: 80 eyes of diabetic patients with diabetic retinopathy and DMI and Group II: 40 eyes of diabetic patients with. Diabetic retinopathy and no DMI (diagnosed clinically and FA). All of them underwent full history taking, complete ophthalmological examination including FFA & OCTA during the period from October 2017 to December 2018.<br /> <strong>Results:</strong> Regarding the comparison of OCTA with FA in diagnosis of DMI according to ETDRS DMI grading. The present study found that moderate agreement between both devices (Kappa agreement k = 0.560 FAZ area was measured in DMI group and non DMI group. Group I Mean FAZ area ± SD was (0.57 ± 0.29 mm2) in OCTA6x6, (0.61 ± 0.28mm2) in FFA. Statistically, the difference in FAZ area between the OCTA and FFA was insignificant. The horizontal and vertical diameter was (650 ± 0.32Mm & 490 ±0.26) in OCTA6x6, (690 ± 0.25Mm & 530 ± 0.31Mm) in FFA. Statistically, the difference in horizontal and vertical diameter between the OCTA and FFA was insignificant.<br /> <strong>Conclusion:</strong> OCT angiography was a valid, reliable and easy-to-use method to detect and quantify DMI changes without use of dye .with a moderate degree of agreement between FFA and OCTA in evaluating DMI.https://amj.journals.ekb.eg/article_158462_4eac5f267febac776559bcab40d32278.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EFFECT OF MITOMYCIN C VERSUS BEVACIZUMAB ON CORNEAL ENDOTHELIAL CELLS FOLLOWING TRABECULECTOMY IN PRIMARY OPEN ANGLE GLAUCOMA1139115215846310.21608/amj.2021.158463ENMahmoudSamir Ali El-RifaiDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityHassanMohamed HegazyDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityMahmoudHamed AllamDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> Trabeculectomy is the standard treatment for patients with primary open angle glaucoma who had failed maximal tolerated medical therapy. The use of Mitomycin C (MMC) or Bevacizumab as adjuvant during trabeculectomy reduces fibrosis which in turn increases the possibility of success in filtrating surgery. However, MMC or Bevacizumab can lead to adverse effects, such as corneal toxicity especially on corneal endothelium, hypotony, formation of avascular cystic blebs, leaks, blebitis, and endophthalmitis.<br /> <strong>Objective:</strong> To evaluate and compare corneal endothelial cell changes before and after trabeculectomy with subconjunctival Mitomycin C versus trabeculectomy with sub conjunctival Bevacizumab in primary open angle glaucoma patients (1 month and 6 months postoperatively).<br /> <strong>Patients and methods:</strong> In this study, 20 patients (with 20 eyes) were divided into two equal groups: (Group A) included patients who underwent subscleral trabeculectomy with adjuvant intraoperative use of 0.2mg/ml MMC for 2 min, and (Group B) included patients who underwent subscleral trabeculectomy with subconjunctival injection of 1.25 mg/0.1 ml Bevacizumab.<br /> Non-contact specular microscope (Topcon sp-1p, Topcon Medical Inc., Japan) was done preoperatively, one month postoperatively and six months post-operatively to assess the corneal endothelium as regard ECD (cells/mm²), CV in cell size, HEX and CCT.<br /> This prospective comparative study was done at Department of ophthalmology, Sayed Galal University Hospital, Cairo, Egypt, and it was carried out from February 1ˢͭ 2019 to October 30ͭ ͪ 2020.<br /> <strong>Results:</strong> Six males (60%) and four females (40%) in group A while five males (50%) and five females (50%) in group B. The patients’ ages ranged from {25 to 47 years} (mean age35.70±6.70) in group A, and ranged from {20 to 45 years} (mean age 31.20±8.70) in group B. MMC and Bevacizumab did not have the same effect on corneal endothelium.<br /> <strong> </strong>There was a significant decrease in endothelial cell density (ECD) after six months post-operatively in both groups with significant difference between the two groups, and insignificant increase in central corneal thickness (CCT) after six months post-operatively in both groups, Also there was a significant changes in coefficient of variation (CV), and percentage of hexagonal cells (HEX), an increase in CV (polymegathism), and decrease in hexagonality (pleomorphism) in both groups, with significant difference between the two groups.<br /> <strong>Conclusion:</strong> MMC affected all parameters of endothelial cells more than Bevacizumab.https://amj.journals.ekb.eg/article_158463_c8c0468e9b7b6469edba355517efc149.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401OCT ASSESSMENT OF MACULAR THICKNESS IN NON-PROLIFERATIVE DIABETIC RETINOPATHY IN RELATION TO GLYCOSYLATED HEMOGLOBIN1153116815846410.21608/amj.2021.158464ENAmrMuhammad Badr Salah El-DeenOphthalmology Department, Faculty of Medicine, Al-Azhar UniversityHanyMahmoud Baiomy SammorOphthalmology Department, Faculty of Medicine, Al-Azhar UniversityMohammedAl Taher Abd El-WahabOphthalmology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> Diabetic retinopathy (DR), also known as diabetic eye disease, is a retinal damage that occurs due to diabetes. Blindness can be the end result of diabetic retinopathy.<br /> <strong>Objective:</strong> To evaluate the relation of macular thickness to glycosylated hemoglobin in patients with non-proliferative diabetic retinopathy.<br /> <strong>Patients and Methods:</strong> This study included 100 eyes of 100 patients with a diagnosis of type 2 DM. This was designed as an observational, cross-sectional and non-cohort study during the period from 6/2019 to 3/2020. One hundred eyes were divided into two equal groups: one group included diabetic patients with no diabetic retinopathy and the other group included diabetic patients with non-proliferative diabetic retinopathy. Patients were recruited from Retinal clinic in Al-Azhar University Hospital and asked to participate in this study.<br /> <strong>Results:</strong> The results showed that non-proliferative diabetic retinopathy (NPDR) group and group of no DR were comparable as regard age, sex and best corrected visual acuity (BCVA). There was a statistically insignificant difference between group of no DR and NPDR group, but group of no DR had shorter duration of DM, lower HbA1c level, lower macular thickness in all of the 9 standard early treatment diabetic retinopathy study (ETDRS) subfields, lower total macular volume (TMV) than NPDR Group. The results showed that central subfield macular thickness (CST) is positively and significantly related to glycosylated hemoglobin (HbA1c) level in each group of no DR and NPDR, and that severity of DR stage was significantly increased with increased HbA1c levels. The results also showed that there’s significant positive association between severity of DR stage and macular thickness in all of the nine standard ETDRS subfields. There was a positive significant relation between duration of DM and HbA1c level in type 2 diabetic patients, while there was no significant relation between duration of DM and macular thickness. The results also showed significant inverse relation between insulin use and HbA1c level, and significant inverse relation between insulin use and prevalence of DR in type 2 diabetic patients.<br /> <strong>Conclusion:</strong> Increased incidence of DR, increased macular thickness and increased incidence of diabetic macular edema were associated with increased level of glycosylated hemoglobin in type II diabetic patients.https://amj.journals.ekb.eg/article_158464_145a39273600cb175b91baaab7f18afb.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY CHANGES IN MYOPIC CHOROIDAL NEOVASCULARIZATION BEFORE AND AFTER INTRAVITREAL RANIBIZUMAB INJECTION1169118615846510.21608/amj.2021.158465ENMohamedMedhat SakhsoukhOphthalmology Department, Faculty of Medicine, Al-Azhar UniversityAhmedM. YoussefOphthalmology Department, Faculty of Medicine, Al-Azhar UniversityAbd El-GhanyIbrahim Abd El-GhanyOphthalmology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> Progressive and excessive elongation of the globe may lead to many complication one of them is myopic choroidal neovascularization which can be diagnosed with FFA, OCT and OCTA and treated with intravitreal injection of Ranibizumab.<br /> <strong>Objective:</strong> To investigate morphological changes in myopic choroidal neovascularization (mCNV) using optical coherence tomography-angiography (OCT-A) after treatment with ranibizumab.<br /> <strong>Patients and methods:</strong> This study is prospective cross sectional interventional study on 50 high myopic eyes with naive mCNV. All patients were imaged at baseline with color pictures, FFA, OCT and OCT-A at baseline and after treatment.<br /> <strong>Results:</strong> There was a significant improvement of best corrected visual acuity and decrease in central foveal thickness after intravitreal injection of Ranibizumab. Optical coherence tomography angiography can detect myopic choroidal neovascularization with high sensitivity with different patterns (sea-fan, medusa and tree-in-bud) but after treatment this abnormal vascularization may not be detected in some cases and lower number of injection needed in tree-in-bud pattern.<br /> <strong>Conclusion:</strong> OCTA can be used in diagnosis of mCNV with high sensitivity (88 %) with three patterns tree-in-bud, medusa and sea-fan with tree-in-bud represents the most common pattern of mCNV. Ranibizumab intravitreal injection is an effective treatment in mCNV using 1+PRN protocol with significant improvement of BCVA and decrease in CFT. Unlike CNV due to AMD mCNV may regress with single or double injection with improvement of BCVA and larger number of injection is usually needed in older age patients and with mature patterns (medusa and sea-fan) of mCNV.https://amj.journals.ekb.eg/article_158465_585e90b68e93883c66d2910752bace51.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401SUBFOVEAL CHOROIDAL THICKNESS CHANGES IN DIABETIC MACULAR EDEMA WITH CYSTIC CHANGES BY USING SPECTRAL DOMAIN-OPTICAL COHERENCE TOMOGRAPHY1187119815846610.21608/amj.2021.158466ENAbdelghany IbrahimAbdelghanyAL-azhar universityJournal Article20210322<strong>Background:</strong> Diabetic macular edema (DME) results from breakdown of retinal vasculature integrity and hemodynamic abnormalities. Choroidal thickness is an important metric for the blood flow and choroidal health.<br /> <strong>Objective:</strong> To correlate Subfoveal Choroidal Thickness (SFCT) with central macular thickness (CMT) in DME with and without cystic changes by using spectral domain optical coherence tomography (SD-OCT).<br /> <strong>Patients and Methods:</strong> A prospective study was conducted on 120 eyes of 68 diabetic patients, divided according to OCT macula into three equal groups: Group A: Diabetic patients with normal CMT, Group B: Have non-cystic diabetic macular edema and Group C: Have cystic diabetic macular edema. Measurements of CMT and SFCT by using spectral domain optical coherence tomography (SD-OCT). This study was conducted at Ophthalmology Department, Bahteem hospital for specialized surgery, Health Insurance, during the period from August 2018 to February 2020.<br /> <strong>Results:</strong> Sixty-eight patients had a mean age of 54.96 ± 8.36 years. The mean SFCT have insignificant correlation could be demonstrated between SFCT and CMT (r= –0.323, P= 0.45), in group B, a positive correlation was observed (r= 0.614, P=0.027), while in group C a negative correlation with CMT (r= –0.875, P=0.02). There was insignificant correlation could be demonstrated between SFCT and BCVA (LogMAR) in all groups: in group A (r= –0.251, P= 0.35), in the group B (r= –0.318, P=0.15), and in group C (r= –0.735, P=0.23).<br /> <strong>Conclusion:</strong> Mean SFCT decrease with cystic changes in DME patients.https://amj.journals.ekb.eg/article_158466_fb44ed243e2bad0d754665f476ba691b.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401CONSERVATIVE MANAGEMENT OF EXTRA DURAL HEMORRHAGE1199120816038510.21608/amj.2021.160385ENAmrAli El-Saghir ZedanDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityEl-SayedAbd El-Rahman El-MorDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityAlaaRashad Ibrahim HassanDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20210401<strong>Background:</strong> Extra Dural hematoma (EDH) is a blood clot that develops between the dura mater and the skull, found in 2.5% to 5% of head injured patients. Patient with small EDH may be treated conservatively through close observation is advised, yet sudden neurological deterioration may occur.<br /> <strong>Objective:</strong> To review the literature and to evaluate safety and efficacy of conservative management of extradural hematoma (EDH) in trauma patients with selected criteria.<br /> <strong>Patients and methods:</strong> This was a hospital based study which was done at the Department of neurosurgery at Al-Azhar University Hospitals and Luxor International Hospital during the period from September 2017 to September 2019. It was conducted on 15 patients with extradural hemorrhage who fulfilling the criteria (volume<30ml, thickness8), with exclusion of patients with extradural hematoma who needs surgical evacuation, patients with bleeding tendency and patients with temporal or occipital extradural hematoma. All cases records were reviewed and the pertinent data (clinical history, age, sex, mode of injury) analyzed.<br /> The patients were subjected to conservative treatment through Neurosurgery ICU admission and follow up CT Brain done at 6 hours, 12 hours, 24 hours and 48 hour after admission. Patients were given Analgesics, Antibiotics and Anti epleptics if needed .All patients stayed at ICU for 3 days until they had good conscious level then transferred to Neurosurgery ward for one day then discharged to home. Final CT Brain was done for all patients before discharge to ensure resolution of hemorrhage. Follow up of Patients continued for one month after discharge at clinic.<br /> <strong>Results:</strong> In our study of 15 patients, the conservative management of extradural hematoma continued in all patients (100%). This means that conservative management increased, and the mentioned protocol of conservative management gives successful results in the treatment of EDH.<br /> <strong>Conclusion:</strong> The conservative management gives successful results so we can avoid surgical evacuation in patients with selected criteria.https://amj.journals.ekb.eg/article_160385_964f186897a17b17db65d73346dd0d10.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401TYMPANOMETRIC CHANGES IN GASTRO ESOPHAGEAL REFLUX DISEASE PATIENTS1209121615846710.21608/amj.2021.158467ENAhmedMostafa Abd El-Moniem AliDepartment of Otorhinolaryngology Faculty of Medicine, Al-Azhar University, EgyptAhmedMohamed AhmedDepartment of Otorhinolaryngology Faculty of Medicine, Al-Azhar University, EgyptMostafaShams El-Din Abd El-HaliemDepartment of Otorhinolaryngology Faculty of Medicine, Al-Azhar University, EgyptJournal Article20210322<strong>Background:</strong> Gastroesophageal reflux (GERD), in particular extra-esophageal reflux, has been associated with a variety of upper aerodigestive tract symptoms or diseases, such as sinusitis and otitis. Many studies showed the role of reflux in chronic otitis media in children.<br /> <strong>Objective:</strong> To survey tympanometric changes in gastro esophageal reflux disease patients by tympanometry.<br /> <strong>Patients and methods:</strong> Prospective cross-sectional study included 40 cases with GERD and 20 persons without GERD as a control group. All cases were subjected to history taking and ENT examination. Moreover, tympanometry was performed for all cases.<br /> <strong>Results:</strong> The mean age of the included cases were 32.7 years. Patients were 25 females (62.5%) and 15 males (37.5%). The mean value of GERD score was 11.18 (range, 10 – 12). The four tympanogram types did not differ in age and gender, all the cases with type B and C tympanometry in the right ear was with GERD score of 11 and 12.<br /> <strong>Conclusion:</strong> GERD may induce type B and C tympanometric changes, suggestive of eustachian tube dysfunction.https://amj.journals.ekb.eg/article_158467_8ba67e253145cad47d5046b4a7112bbf.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EVALUATION OF TRANS-NASAL ENDOSCOPIC CROSS-OVER FLAP TECHNIQUE IN THE REPAIR OF CHOANAL ATRESIA1217123015846810.21608/amj.2021.158468ENMohamedAhmed El-Saeed AliDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar UniversityWafaeyAbdul Rasol MohamedDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar UniversityMarwanAhmed IbrahimDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> Choanal atresia (CA) is a widely recognized craniofacial disorder characterized by the obliteration of the posterior nasal opening, due to the imperforation of the oronasal membrane and overgrowth of the horizontal and vertical process of the palatine bone during weeks 4-11 of the gestation process.<br /> <strong>Objective:</strong> To evaluate the efficacy of trans-nasal endoscopic cross-over flap technique in the repair of choanal atresia with long-term follow-up.<br /> <strong>Patients and methods:</strong> This study was conducted on 20 choanal atresia cases that were managed by the endoscopic transnasal approach using cross-over flap technique at the Department of Otorhinolaryngology, Bab EL-Sharia and AL-Hussein Hospitals, Faculty of Medicine, AL-Azhar University from December 2018 to January 2020.<br /> <strong>Results:</strong> The study included 20 cases: 13 females and 7 males, 5 cases were bilateral, 15 cases were unilateral. Four cases were bony atretic plate, and 16 cases were mixed atretic plate. Four cases (20%) needed post-operative revision repair due to restenosis of the choana. Revision was more common in bilateral cases than unilateral cases and in bony type than mixed type. Also, revision was common in patients with associated malformations, and in patients done before 10 days.<br /> <strong>Conclusion:</strong> Transnasal endoscopic surgery using cross-over flap technique is one of the best choices in the management of the choanal atresia. Endoscopy and CT are the methods of choice for diagnosis.https://amj.journals.ekb.eg/article_158468_8c3bc00922a3155fadfa211a146e42ed.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401ASSESSMENT OF MYOCARDIAL LEFT VENTRICULAR FUNCTIONS USING 2D SPECKLE TRACKING IN NORMAL PREGNANT FEMALES IN COMPARISON TO NORMAL NON-PREGNANT FEMALES1231124215846910.21608/amj.2021.158469ENMohammadEl-Sayed NofalDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityMoheyEl-Din Mansour Al-AbbadyDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversitySaadEbrahim Deef-Allah EL-ZoghbyDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityAhmedMohammed Salah El-Din AhmedDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> While the hemodynamic changes occurring during pregnancy have been reasonably well characterized, the impact of pregnancy on cardiac contractile function has not been fully elucidated.<br /> <strong>Objective:</strong> To assess myocardial left ventricular functions in normal pregnant females using 2D speckle tracking echocardiography in comparison to non-pregnant adult females.<br /> <strong>Patient and methods:</strong> The study was a prospective observational study that was carried out at Cardiology Department, Al-Azhar University Hospitals throughout the period between August 2016 and July 2019. The study involved 15 healthy control unpregnant women in addition to 45 pregnant ladies (15 in each trimester). All the included subjects underwent thorough clinical examination, routine laboratory investigations, resting electrocardiogram (ECG), resting conventional trans-thoracic echocardiography, and speckle tracking echocardiography.<br /> <strong>Results:</strong> The two groups showed no-significant difference between them in accordance with age, systolic, and diastolic blood pressure. Left ventricular (LV) internal dimensions at end diastole (LVEDD) had significantly higher values in the third trimester cases. Moreover, the control group had the lowest value among the study groups. No significant changes were detected in LVESD. LVEDV and LVESV showed a significant increase during pregnancy. All readings were significantly higher than controls. The two groups showed no significant difference between them in accordance with ejection fraction. Global longitudinal strain was significantly different between the study groups. It decreases from 20.73% in the first trimester down to 18.33 and 16.67% in the second and third trimesters respectively. Besides, two-, three-, and four-chamber strain showed the same changes as well.<br /> <strong>Conclusion:</strong> Cardiac adaptation throughout normal pregnancy is characterized by LV longitudinal thickening reduction.https://amj.journals.ekb.eg/article_158469_44f11465a6f27ae5b8133ddc692ceff0.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401PREDICTING UNSUCCESSFUL ELECTRICAL CARDIOVERSION FOR ACUTE ATRIAL FIBRILLATION (FROM THE AF-CVS SCORE)1243125615847110.21608/amj.2021.158471ENHamdiSobhi Ramadan El-AdawiDepartment of Cardiology, Faculty of Medicine Al-Azhar UniversityAbd El-HalemMohamed Abo El-MagdDepartment of Cardiology, Faculty of Medicine Al-Azhar UniversityMansourMohamed SallamDepartment of Cardiology, Faculty of Medicine Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> Despite good progress in the management of patients with atrial fibrillation, this arrhythmia remains one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity in the world. Furthermore, the number of patients with AF is predicted to rise steeply in the coming years.<br /> <strong>Objective:</strong> To validate a clinical risk stratification tool (AF-CVS score) for identifying patients at high risk for unsuccessful outcome after electrical cardio-version for acute AF.<br /> <strong>Patients and Methods:</strong> The present study was a cohort study conducted between March 2018 and March 2019. We enrolled 100 consecutive patients admitted at Al-Hussain University, Al-Azhar University, presented with acute onset atrial fibrillation (AF) requiring direct current electro-version (DC electro-version). An informed consent obtained from every patient after full explanation of the research objectives and the purpose of this study.<br /> <strong>Results:</strong> A binary logistic regression was run to evaluate AFCVS score as a predictor for the recurrence among the patients in the study population. There was homoscedasticity and normality of the residuals. The binary logistic regression model was statistically significant (χ2= 28.01, df 1, p= < 0.001) with insignificant Hosmer and Lemeshow test (p 0.114). AFCVS score was a significant predictor for the AF recurrence in the studied population (p < 0.001). The diagnostic efficacy and cut off point of AFCVS for prediction of AF recurrence in the studied sample was determined using a receiver operating characteristic curve (ROC) and the AFCVS score cut off point was 5 . The score showed 83.8% sensitivity, 68.3% Specificity, 87.8% negative predictive value, 60.8% positive predictive value and 74% accuracy.<br /> <strong>Conclusion:</strong> Atrial fibrillation provokes important economic burden along with significant morbidity and mortality. Our study showed that the risk of unsuccessful outcome of ECV can be predicted using five simple clinical variables: A-- Age. F-- not First time AF. C-- Cardiac failure. V-- Vascular disease. S-- Short duration from previous AF (within 1 month before electrical cardio-version (ECV)).https://amj.journals.ekb.eg/article_158471_2fff79f45c707f0e3a98828e1a55a78e.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401CORRELATION BETWEEN MYOCARDIAL PERFUSION IMAGING AND CAROTID ULTRA-SONOGRAPHY IN PATIENTS WITH CHEST PAIN1257127015847310.21608/amj.2021.158473ENAhmedAbd El-Aziz Hassan Abd El-AzizDepartments of Cardiology, Faculty of Medicine, Al-Azhar UniversityAbd El-HalimMohammed Abo El-MagdDepartments of Cardiology, Faculty of Medicine, Al-Azhar UniversityAymanEl-Saeid SadekDepartments of Cardiology, Faculty of Medicine, Al-Azhar UniversityMohamedTalaat MohamedDepartments of Radiology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> Atherosclerosis is a major risk factor for coronary artery disease (CAD). Carotid ultrasound (U/S) may be a useful method for prediction of CAD through measurement of intimio-media thickness (IMT) of right and left common carotic arteries.<br /> <strong>Objective:</strong> To emphasize the correlation between myocardial perfusion imaging using single photon emission computed tomography (SPECT) and carotid ultrasound through measuring IMT in early prediction and diagnosis of CAD.<br /> <strong>Patients and methods:</strong> The study included 80 patients complaining from chest pain. Single photon emission computed tomography (SPECT) and carotid U/S were done to each of them. All Patients were recruited from El-Hussein university hospital outpatient clinic and Kobry El-Koba military hospital outpatient clinic between February 2020 and November 2020.<br /> <strong>Results:</strong> The study included 80 patients, 57 of them were males while 23 of them were females. 52 patients were hypertension (HTN), 31 patients were diabetes mellitus (DM), 33 patients were smokers, 15 patients of them had positive family history. 52 patients had positive SPECT stress test revealing CAD “ischemic group”, while 28 of them had negative SPECT stress test “Non-ischemic group”. For the ischemic group, 43 patients (82.7%) had increased intimio-media thickness IMT. Right IMT mean ± SD “0.69±0.10”, t-test “7.771”, weighted Kappa test 0.655 substantial agreement and P-value “p <0.001”. Lefy IMT mean ± SD “0.77±0.12”, t-test “5.122” , weighted Kappa test 0.614 substantial agreement and p-value “p <0.001”. Only 9 patients (17.3%) from the ischemic group had below 75th percentile IMT. For Non-ischemic group, only 9 patients (32.1%) had abnormal IMT while the other 19 patients (67.9%) had normal IMT.<br /> <strong>Conclusion:</strong> Carotid ultrasound and intimio-media thickness are good predictors and highly correlated to coronary artery disease.https://amj.journals.ekb.eg/article_158473_9f4537478ab3f483db052d47e99c5f1a.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EFFECT OF COLLOID VS CRYSTALLOID PRELOAD ON HEMODYNAMIC STABILITY IN ELDERLY PATIENTS UNDERGOING LOWER LIMB ORTHOPEDIC SURGERY UNDER SPINAL ANESTHESIA1271128015829910.21608/amj.2021.158299ENAhmedSultanDepartment of Anesthesia, Nasser Institute HospitalHassaninAbd Al-KaremDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al Azhar UniversityAhmedSaidDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al Azhar UniversityAhmedM. El-GarhyDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al Azhar UniversityJournal Article20210321<strong>Background:</strong> Hypotension is commonly occurred with Spinal anesthesia. Colloids and Crystalloids are used preoperatively to prevent hypotension.<br /> <strong>Objective:</strong> To examine the effect of fluid (crystalloid vs. colloid) preloading on hemodynamic stability in old patients planned for lower limb orthopedic operations with spinal anesthesia.<br /> <strong>Patients and methods:</strong> Eighty patients undergoing orthopedic surgery under spinal anesthesia were included in this work. Their age ranged between 60-80 years. Patients were allocated randomly to either Crystalloid (Ringer solution RS group) or Colloid (hydroxyethyl starch solution HES group). Intravenous preload of 10 mL/kg of either lactated Ringer's solution in the RS group or hydroxyethyl starch solution (6% HES 130/0.4; Voluven) in the HES group was infused over 20 min before spinal anesthesia.. Hemodynamic parameters were recorded, and all results were compared.<br /> <strong>Results:</strong> More than 20% drop in systolic blood pressure occurred in 45% patients in the crystalloid group compared to 15% patients in the colloid group. This difference was significant statistically (p < 0.01). Regarding requirement of ephedrine to treat hypotension, (45% of patients in crystalloid group required Ephedrine compared to 15% patients in colloid group). This was also statistically significant (p < 0.01).<br /> <strong>Conclusion:</strong> Colloid solution was better than crystalloid solution in controlling blood pressure, ephedrine requirements and heart rate changes.https://amj.journals.ekb.eg/article_158299_76350cdb740e1e95f8b8a84633436218.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401RENAL HISTOPATHOLOGICAL PROFILE IN PATIENTS WITH SILENT LUPUS NEPHRITIS1281129215847210.21608/amj.2021.158472ENKazemMohamed El-SayedDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptEmadAllam MohamedDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAl-SayedMohamed RashedDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamedSaid Abd El-Aziz ShehataDepartments of Radiology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptEssamMohamed Ragab MandourDepartments of General Pathology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210322<strong>Background:</strong> Silent lupus nephritis (SLN) is a life menacing consequence of systemic lupus erythematous (SLE). This condition is characterized by pathological impairment of the kidney in the obscurity of clinical or laboratory manifestations.<br /> <strong>Objective:</strong> To reveal the existence of SLN along with the potential differences between overt lupus nephritis (OLN) and SLN among a sample of Egyptian patients based on histopathological assessment.<br /> <strong>Patients and Methods:</strong> It is a prospective case-control study which was performed at nephrology units, internal medicine department, Elhussein and Sayed Galal university hospitals, faculty of medicine, Al-Azhar University, Cairo, Egypt, throughout the entire period April 2016 to November 2019. Patients aged more than 18 years (216 months) and fulfilled at least 4 of the American College of Rheumatology criteria for the classification of systemic lupus erythematosus (SLE) were enrolled in the current study. Patients were further assorted into two groups; patients with SLN and those with OLN.<br /> Patients were subjected to the following investigations: 1.Complete blood count, using Coulter counter Max-M (Coulter Cooperation, Florida, USA) 2.Erythrocyte sedimentation rate, (Wester green method) (Ref: < 20mm/hr) 3.S. Albumin, S. Creatinine. Albumin/Creatinine ratio. Creatinine clearanc & eGFR using the Modification of Diet in Renal Disease (MDRD) formula. 4. Liver function tests. 5. Coagulation profile. 6. Urine analysis (Fresh morning midstream urine) to exclude infection. 7. Quantitative assessment of proteinuria by Pr/creat. Ratio (Ref. <0.2).<br /> Assessment of auto-antibodies and complement system: Autoantibodies to ds-DNA, RNP. SSA, SSB, Sm and Scl-70, C4 and C3 serum levels were assessed in all of the included patients. In particular, the titer of anti-dsDNA antibodies was evaluated by enzyme-<br /> Radiological evaluation: Patients were subjected to pelvi-abdominal ultrasound in order to obtain valuable data about the morphological appearance of the kidney and to detect any urological abnormality.<br /> <strong>Renal biopsy:</strong> Percutaneous renal biopsy was carried out under local anesthesia.<br /> <strong>Results:</strong> An overall 40 patients with SLE who developed lupus nephritis were enrolled in the current study. Among them, 20 patients had OLN, whereas 20 patients were SLN. Based on ISN/RPS Classification, stage II was the predominant stage, 13 patients, among patients with SLN, whilst stage V was the predominant stage among the OLN patients. Additionally, five and three patients were stage III among the SLN and OLN groups, respectively. Furthermore, the presence of RBCs Cast (r=0.479, P=0.032) in urine and decreased levels of complement (r=0.676, P=0.001) showed a statistically significant positive correlation with the high grades of lupus nephritis among SLN group.<br /> <strong>Conclusion:</strong> Patients with SLE should be subjected to close follow up evaluation and renal biopsy for early detection of SLN to determine the activity, severity, and chronicity of LN.https://amj.journals.ekb.eg/article_158472_72f88c7ee9d506564bffc19c172f46b0.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401STUDY OF CORRELATION BETWEEN SEVERITY OF ISCHEMIC MITRAL VALVE REGURGITATION BY ECHO DOPPLER AND ECG CHANGES IN ACUTE MYOCARDIAL INFARCTION1293130415847010.21608/amj.2021.158470ENMohamedGamal Abd El-AzeemDepartment of Cardiology, Faculty of Medicine Al-Azhar UniversityYasserRadwan MohammedDepartment of Cardiology, Faculty of Medicine Al-Azhar UniversityYasserAl-Sayed MohammedDepartment of Cardiology, Faculty of Medicine Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> Myocardial infarction (MI) accompanies with different mechanical complications including ischemic mitral regurgitation (IMR) which is correlated with increased risk of mortality and heart failure. IMR existence and its severity had significant prognostic effect on patients’ mortality following acute myocardial infarction (AMI). Echocardiography is the choice imaging modality for the diagnosis and assessment of IMR and establishing its etiology. IMR usually results from papillary muscle displacement, ventricular dilation and remodeling with reduced closing forces.<br /> <strong>Objective:</strong> Assessment of the correlation between echocardiographic severity of ischemic mitral valve regurgitation following acute myocardial infarction and its electrocardiographic location.<br /> <strong>Patients and methods:</strong> This was a prospective study that included 100 patients admitted to CCU OF Beni-Suief General Hospital in the period from October 2019 to May 2020 . Those patients were divided on two equal groups: Group I: patients with STEMI and no, trivial or mild MR and Group II: patients with STEMI and moderate or severe MR.<br /> <strong>Results:</strong> Mean age of group I involved in the study was 55.44 ± 7.23 years and 70% of them were males. Mean age of group II was 58.38 ± 7.8 and 56% were males. 70 % of the group II had inferolateral STEMI compared to group I who had more anterior STEMI. Group II were more smokers with hyperlipidemia. Group II was with higher previous stable and unstable angina, with less streptokinase treatment, with higher abnormal chest radiogrgh and higher killip class. Group II had significantly lower EF and higher LVEDD, LVESD, LA diameter, RV diameter, MV A velocity, tricuspid valve excursion TAPSI and pulmonary artery pressure and more diastolic dysfunction. Mechanism of IMR in case group was mono leaflet tethering in 43 cases, both leaflet tethering in 7 cases and ring dilation in 30 cases. MR jet direction was medial commissure posterior in 31 (62%), lateral commissure anterior in 12 (24%), and both commissures central in 7 (14%) cases.<br /> <strong>Conclusion:</strong> Mitral regurgitation is common after acute myocardial infarction, especially in cases with inferior mitral regurgitation. The echocardiographic findings are indicative of left ventricular remodeling and abnormality of mitral valve apparatus.https://amj.journals.ekb.eg/article_158470_329405c19ae8fbefe025722771b92234.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401ADMISSION HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS WITH SEPSIS; HIGH IL6 AND ITS RELATION WITH OUTCOME1305131615847610.21608/amj.2021.158476ENDiaaA. Abd El-MonemDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityGamalA. BadrDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityFaragK. FaragDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityAshrafA. AhmedDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> Hyperglycemia has long been recognized as a common occurrence in critically ill patient, even without history of diabetes mellitus (D.M). Although there are few studies investigating the prevalence of stress hyperglycemia, one study reported that 38% of patients admitted to general hospitals had hyperglycemia episodes, 16% of which had no previous history of D.M.<br /> <strong>Objective:</strong> To investigate the role of high IL6 in patients with sepsis admitted to medical I.C.U with acute hyperglycemia and its relation to 30 days outcome.<br /> <strong>Patients and Methods:</strong> This study was conducted on 100 adult septic patients who were admitted to medical I.C.U at Al-Hussein University Hospital, the study was carried in the period between January 2018 and June 2019. 80 patients with evidence of hyperglycemia and 20 patients with euglycemic state.<br /> <strong>Results:</strong> non-significant difference was found according to mean values of Na+, K+, creat, TLC, HB%, PLT, ALT, AST. On the other hand, the hyperglycemic group showed a significant increase regarding mean value of HbA1c compared to control group. The comparative study between the 2 groups revealed a significant increase of mean value of CRP in the hyperglycemic group compared to the control group. As regards the vital signs, the hyperglycemic group showed a significant increase in mean values of systolic blood pressure, diastolic blood pressure, MAP & HR compared to the control group. While there was no significant difference between the 2 groups regarding temperature and RR. This study showed statistically significant decrease in mean values of GCS in hyperglycemic group compared to control group, while APACHE II and qSOFA showed a significant increase in hyperglycemic group compared to control group. The mean values of ABG parameters revealed no statistically significant difference between the 2 groups. On the other hand, mean values of RBS and IL6 showed a statistically significant increase in hyperglycemic group compared to control group. The comparative study between the 2 groups showed a significant increase in mean values of hyperglycemic group compared to control group according to duration of ICU stay (days), Insulin therapy, AKI and Outcome and non-significant difference according to ILD, CLD, CKD, stroke, pneumonia, IHD, COPD & HF.<br /> <strong>Conclusion:</strong> Stress hyperglycemia with high IL6 is strongly associated with adverse outcomes in patients with sepsis who were admitted to the medical ICU. Sepsis patients with hyperglycemia showed increased incidence of mortality and AKI.https://amj.journals.ekb.eg/article_158476_b967ab8cd10f991db81bd6c5541b9eeb.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401ASSESSMENT OF THE SERUM LEVEL OF COMPLEMENT C3 AND C4 IN CHRONIC VIRAL HEPATITIS C INFECTION AND THEIR CORRELATION WITH RESPONSE TO DIRECT ACTING ANTI-VIRAL AGENTS1317132615847710.21608/amj.2021.158477ENMohamedAbd El-wahed RamadanDepartment of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar University, EgyptSabahIbrahim Abd El-RehiemDepartment of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, EgyptAhmadAl-Saeed Al-SehrawyDepartment of Clinical Pathology, Faculty of Medicine, Al-Azhar University, EgyptMohamedHiezaDepartment of Hepatology, Gastroenterology and Infectious diseases, Damietta Faculty of Medicine, Al-Azhar University, EgyptJournal Article20210322<strong>Background:</strong> The interactions between hepatitis C Virus (HCV) and the host immune system have a major role in HCV pathogenesis.<br /> <strong>Objective:</strong> To estimate complement C3 and C4 serum levels in patients with chronic HCV patients and to correlate its levels with response to directly acting anti-viral agents (DAAs) in those patients.<br /> <strong>Patients and methods:</strong> The study included 80 individuals classified into two groups: Group (I): 40 patients with chronic HCV infection, Group (II): Control group which included 40 healthy individuals. Measurement of the level of complement C3 and C4 has done by nephelometry immunoassay before and after treatment with DAAs.<br /> <strong>Results:</strong> All patients with chronic HCV infection in group (I) showed significant reduction in serum levels of complement C3 and C4 compared to the control group (II). Moreover, those patients who treated with DAAs showed significantly higher levels of C3 and C4 when compared to chronic HCV patients before treatment with DAAs.<br /> <strong>Conclusion:</strong> Serum levels of complement C3 and C4 serum may be used in the follow up of the course of the disease and may be used as a predictor for the response to treatment with DAAs.https://amj.journals.ekb.eg/article_158477_2a5c16ed5a719560a2e22ed14184a3a1.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EFFICACY OFPLATELET RICH PLASMA VERSUS AUTOLOGOUS EMULSIFIED FAT IN THE TREATMENT OF INFRAORBITAL DARK CIRCLES1327133415847910.21608/amj.2021.158479ENAhmedKadry Nabih AttiaDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityAbd El-RaoufMohammed Al-MohsenDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityShadyMahmoud AttiaDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> Periorbital hyperpigmentation, generally called dark circles, is a condition characterized by relatively dark coloration of the periorbital eyelids. It is a common worldwide problem which makes a person appear tired, sad, and aged. Although this condition does not cause physical morbidity, it can pose a substantial cosmetic problem and, eventually, affect the quality of the effected individual.<br /> <strong>Objective:</strong> To evaluate the efficacy of platelet rich plasma versus autologous emulsified fat in the treatment of infraorbital dark circle.<br /> <strong>Patients and methods:</strong> Our study was carried out on 30 patients presenting with infraorbital dark circles of different etiological factors divided into A and B from December 2019 to July 2020.All patients were recruited from the Dermatology outpatient clinic of Al-Azhar University Hospitals. Patients were divided into two equal groups: Group A treated with platelet rich plasma (PRP) and Group B treated by autologous fat injection.<br /> <strong>Results:</strong> The present study showed excellent response of 3 patients (20%) in group A, and 7 patients (46.7%) in group B. Moderate response occurred in 2 patients (13.3%) in group A, and 4 patients (26.7%) in group B. Mild response occurred in 2 patients (13.3%) in group A, and 3 patients (20%) in group B. No response occurred in 8 patients (53.3%) in group A and 1 patient (6.7%) in group B.<br /> <strong>Conclusion:</strong> Both PRP and emulsified fat were effective in treatment of infraorbital dark circles with statistically significant difference as regard the improvement, patient satisfaction and postoperative complications at the end of treatment period and follow up for six months.https://amj.journals.ekb.eg/article_158479_f9954b7bf8e5358ab7ada4ad69553bd8.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401HEPATOTOXIC AND CARDIOTOXIC EFFECTS OF TESTOSTERONE ENANTHATE ABUSE ON ADULT MALE ALBINO RATS1335134815848010.21608/amj.2021.158480ENMohamedAbd El-Aziz El-GendyDepartments of Forensic Medicine & Clinical Toxicology, Al-Azhar Faculty of Medicine, EgyptFouadHelmy El-DabbahDepartments of Forensic Medicine & Clinical Toxicology, Al-Azhar Faculty of Medicine, EgyptAshrafIbrahim HassanDepartments of Forensic Medicine & Clinical Toxicology, Al-Azhar Faculty of Medicine, EgyptNaserAbd El-Naby AwadDepartments of Pathology, Al-Azhar Faculty of Medicine, EgyptJournal Article20210322<strong>Background:</strong> Anabolic androgenic steroids (AASs) represent a group of synthetic derivatives of testosterone created to maximize anabolic effects and minimize the androgenic ones. Athletes use anabolic androgenic steroids (AAS) to enhance performance regardless of the health risk they may impact in some persons.<br /> <strong>Objective:</strong> To study the histopathological and biochemical changes that could occur on liver and cardiac muscle after administration of doping dose (supraphysiological dose) of testosterone enanthate (one of AAS).<br /> <strong>Materials and Methods:</strong> One hundred (100) male albino rats were included in the present study and divided into six groups. Group (1a); negative control group, Group (1b) positive control group treated with therapeutic dose of testosterone Enanthate (10 mg /Kg body weight intramuscular / I.M weekly for 12 weeks), group (2) was treated with doping dose of testosterone enanthate (60 mg /Kg body weight/ I.M for 4 weeks), group (3) was treated with treated with doping dose of testosterone enanthate (60 mg /Kg body weight / I.M weekly for 8 weeks), group (4) treated with doping dose of testosterone enanthate (60 mg /Kg body weight / I.M weekly for 12 weeks), group (5a) treated with doping dose of testosterone enanthate (60 mg /Kg body weight/ I.M/ weekly for 12 weeks followed by 2 weeks of treatment discontinuation) , group (5b) treated with doping dose of testosterone enanthate (60 mg /Kg body weight/ I.M weekly for 12 weeks followed by 4 weeks of treatment discontinuation). Blood samples were collected at the start and at the end of study. Liver and cardiac enzymes were measured by usual methods. At the end of study for each group, animals were sacrificed and deeply anesthetized by diethyl ether then specimens from the heart and liver were processed for histological study using light microscope.<br /> <strong>Results:</strong> There was no statistical significant difference in the body weight between negative and positive control group. In contrast, animals administering doping dose of testosterone enanthate for 8 and 12 weeks (group III-IV) showed a significant decrease in the body weight compared with animals of control group and group II (P < 0.05). There was a significant decrease in the body weight of recovery group (group Va and group Vb) when compared with control group (p value < 0.05). In the current study as regard the level of liver biomarkers (ALT-AST) had gradual significant increase all through the experimental periods. There was a significant increase in the level of creatinine kinase (CK) and CK-MB in treated groups versus control in most of experimental groups at P <strong>Conclusion:</strong> Chronic use of testosterone enanthate in supraphysiological dose (doping dose) has a toxic effect on rat cardiac muscle and liver in the form of alteration of normal histology, hypertrophy and fibrosis at both histological and biochemical levels which may lead to loss of their functions. This effect was partially reversible after cessation of the treatment.https://amj.journals.ekb.eg/article_158480_61d003d92840e20206ccfa77f3d7d183.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401A STUDY OF THE EFFECT OF MUSCULAR EXERCISE WITH CINNAMON EXTRACT AND/OR FLAXSEEDS EXTRACT ON DIABETIC ADULT MALE ALBINO RATS1349136415848210.21608/amj.2021.158482ENMahmoudAhmed MohamedDepartment of Medical Physiology, Al-Azhar Faculty of MedicineGamalAhmed ShawerDepartment of Medical Physiology, Al-Azhar Faculty of MedicineAl-BayoumiAli FoudaDepartment of Medical Physiology, Al-Azhar Faculty of MedicineJournal Article20210322<strong>Background:</strong> Diabetes is one of the most common endocrine disorders. Muscular exercise possesses antioxidant property and can be a candidate in the treatment and prevention of diabetes complications. Cinnamon is a plant which displays antioxidant and glucose lowering effects. Flaxseeds are a promising alternative to reduce the risk of diseases associated with increased body weight as diabetes mellitus.<br /> <strong>Objective:</strong> To study the effect of muscular exercise with cinnamon extract and/or flaxseeds extract on diabetic adult male albino rats.<br /> <strong>Materials and Method:</strong> The present study was conducted on 72 adult male albino rats of a local strain divided into 9 equal groups:<br /> Group I: Control received distilled water only.<br /> Group II: Treated with flaxseeds extract (400 mg/kg orally).<br /> Group III: Treated with cinnamon extract (200 mg/kg orally).<br /> Group IV: Control practiced swimming program.<br /> Group V: Diabetic control rats.<br /> Group VI: Diabetic rats practiced swimming program.<br /> Group VII: Diabetic practiced swimming program and received flaxseeds extract.<br /> Group VIII: Diabetic practiced swimming program and received cinnamon extract.<br /> Group IX: Diabetic practiced swimming program and received both flaxseeds and cinnamon extract.<br /> Rats submitted to swimming program, received flaxseeds and cinnamon extracts after induction of diabetes according to the study groups, and submitted to body weight and food consumption assessment. At the end of the study, fasting plasma glucose level, blood insulin level, HbA1c, lipid profile, reduced glutathione (GSH) and malondialdehyde (MDA) were measured.<br /> <strong>Results:</strong> In diabetic rat’s submitted to swimming and received flaxseeds and cinnamon extracts, body weight relative to food consumption decreased. Fasting plasma glucose level and blood insulin level improved. No change in HBA1c. Lipid profile improved, reduced glutathione (GSH) increased in flaxseeds and cinnamon diabetic groups. Malondialdehyde (MDA) decreased in swimmed, flaxseeds and cinnamon diabetic groups. Histo-pathological architecture improved. The effect of combination of swimming, flaxseeds and cinnamon improved all parameters.<br /> <strong>Conclusion:</strong> Exercise with receiving flaxseeds extract or cinnamon extract in adult male diabetic rats improve body weight, glucose and insulin level, lipid profile, oxidative stress markers and tissue pathology, and the combination was more potent than each one alone.https://amj.journals.ekb.eg/article_158482_553d2ebcef7c96e610c9e0b79bbb427a.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401PREDICTORS OF RESPONSE TO PLASMAPHERESIS IN AUTOIMMUNE NEUROPATHIES1365137415848410.21608/amj.2021.158484ENYasserEl-Sayed MukhtarNeurology Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptTarekIbrahim MnecieNeurology Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHassanKawashti GadNeurology Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohammedAhmed ZakiNeurology Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210322<strong>Background:</strong> Immune-mediated neuropathies represent a significant portion of cases encountered by neurologists. The scope of responsive neuropathies, the extent of response to plasmapheresis and its predictors varies widely.<br /> <strong>Objective:</strong> To recognize predictors of response to plasmapheresis in autoimmune-neuropathies.<br /> <strong>Patients and Methods:</strong> Seventy-six subjects; 61 Guillain-Barre syndrome (GBS) patients and 15 chronic inflammatory demyelinating polyneuropathy (CIDP) patients were recruited and evaluated using Medical Research Council sum score (MRCSS) and Modified Neuropathy Disability Score (NDS); on admission, 2 weeks and 3 months after six session of plasmapheresis. Different clinical, laboratory and neurophysiological variables were evaluated as possible predictors of response.<br /> <strong>Results:</strong> Of 61GBS patients, after 3 months, 41% (n=25) of them were poor-responders to plasmapheresis (<50% increase in MRCSS), and 59% (n=36) were good-responders. Older age, higher MRCSS on admission, lower NDS on admission, cyto-albuminous dissociation, electro-physiological evidence of axonal nerve affection and low NLR were predictors for poor response to plasmapheresis in GBS patients. Of 15 CIDP patients, after 3 months, 53.3% (n=8) of them were poor-responders to plasmapheresis (< 30% increase in MRCSS), and 46.7% (n=7) were good-responders. Higher MRCSS on admission, low CMAP amplitude, low MCV and long time between onset of the health problem and start of plasmapheresis were predictors for poor response to plasmapheresis in CIDP patients.<br /> <strong>Conclusion:</strong> Response to plasmapheresis in autoimmune neuropathies is variables and depends on several factors that can predict it.https://amj.journals.ekb.eg/article_158484_b9def69c41c5d964a0bd7cf720422f50.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401`COMPARISON BETWEEN LINEZOLID VERSUS VANCOMYCIN IN TREATMENT OF DIABETIC PATIENTS WITH NOSOCOMIAL PNEUMONIA CAUSED BY METHICILLIN RESISTANT STAPH AUREUS1375139415848510.21608/amj.2021.158485ENIslamNomeir Mohamed El-MorsyDepartment of Chest diseases Faculty of medicine, Al-Azhar UniversityAbu BakrHelal El-AsmarDepartment of Chest diseases Faculty of medicine, Al-Azhar UniversityAbdallahSoliman AyoobDepartment of Chest diseases Faculty of medicine, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> The optimal antibiotic therapy for the treatment of hospital acquired pneumonia (HAP) caused by Methicillin-resistant Staphylococcus aureus (MARSA) is controversial especially in diabetes mellitus patients. However, certain researches recommended that linezolid is superior to vancomycin in management of HAP.<br /> <strong>Objective:</strong> To assess the effect of treatment outcomes in patients with nosocomial pneumonia caused by methicillin- resistant staph aureus in diabetic patients and non-diabetic patients.<br /> <strong>Patients and Methods:</strong> This study was conducted on 120 patients at Mansoura Chest Diseases Hospital, Mansoura, Egypt, in the period between December 2019 and August 2020 among patients whose age more than 18 years old. Group A (n=60): Diabetic cases which further subdivided into two subgroups: Group A1 (n=30): Diabetic patients with nosocomial pneumonia receiving linezolid. Group A2 (n=30): Diabetic patients with nosocomial pneumonia receiving vancomycin. Group B (n=60): Non- diabetic cases, which further subdivided into two subgroups: Group B1 (n=30): Non-diabetic patients with nosocomial pneumonia receiving linezolid. Group B2 (n=30): Non-diabetic patients with nosocomial pneumonia receiving vancomycin.<br /> <strong>Results:</strong> APACHE score and duration of hospital admission were higher in diabetic cases in comparison with non-diabetic cases with statistically significant differences. Diabetic cases were more liable for complications with a subsequent high mortality rates in comparison with non-diabetic ones irrespective of the current usage of antibiotics (weather linezolid or vancomycin). Treatment outcomes were comparable among Linezolid and vancomycin used groups. The need for mechanical ventilation was comparable among all groups with no statistically significant difference.<br /> <strong>Conclusion:</strong> Diabetic comorbidity remains the main factor that affects the outcomes and prognosis of HAP cases. Higher complications and mortality rates were more in diabetic cases owing to their renal condition and uncontrolled diabetic status. Linezolid and vancomycin have similar efficacy and safety profiles in management of HAP cases.https://amj.journals.ekb.eg/article_158485_1db5dccefb5a93fb8564bbbcb21b91bf.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401RELATIONSHIP BETWEEN SERUM MAGNESIUM AND ERYTHROPOIETIN RESPONSIVENESS IN HEMODIALYSIS PATIENTS1395140415847510.21608/amj.2021.158475ENKhalidGamal El-HadyDepartments of Internal Medicine, Faculty of Medicine in Cairo, Al-Azhar UniversityFawzyHamid HassanDepartments of Internal Medicine, Faculty of Medicine in Cairo, Al-Azhar UniversityMohammedAhmed Al-SayedDepartments of Internal Medicine, Faculty of Medicine in Cairo, Al-Azhar UniversityAhmedAli Ali AssemDepartments of Clinical Pathology, Faculty of Medicine in Cairo, Al-Azhar UniversityJournal Article20210322<strong>Background:</strong> Serum magnesium is associated with anemia. But the roles of magnesium in anemia and erythropoietin (EPO) responsiveness remain not well knwon in maintenance hemodialysis (MHD) patients.<br /> <strong>Objective:</strong> to study the level of serum magnesium and its relationship with EPO responsiveness in MHD patients.<br /> <strong>Patients and methods:</strong> This study was done in hemodialysis unit at Bab El-Shaareya University Hospital, during the period of January 2020 to June 2020. A total of 60 regular hemodialysis (RHD) patients were recruited for this survey. Their anthropometrics and laboratory data were collected. EPO responsiveness was evaluated by the erythropoietin resistance index (ERI). The patients were divided into 2 groups according to EPO resistance Index (ERI) Group A, the patients with higher ERI than 1.52, and group B with lower ERI than 1.52. Multivariate logistic regressions were conducted to evaluate the factors that may be associated with EPO responsiveness.<br /> <strong>Results:</strong> The mean serum magnesium level was higher than normal levels in RHD patients, while nearly no hypomagnesemia was observed. A multivariate logistic regression model revealed that lower serum magnesium levels were correlated with a high ERI. The OR of a high ERI was found to be 2.89 (93% CI 1.197–4.715, p = 0.005) for group A and 1.57 (94% CI 0.779––2.941, p > 0.05) for group.<br /> <strong>Conclusion:</strong> Serum magnesium levels were found to be higher than normal levels in RHD patients. A high serum magnesium level was shown to be correlated with good EPO responsiveness and it has a protective role from EPO hyporesponsiveness.https://amj.journals.ekb.eg/article_158475_bd4f14f24f312c0bf72582e9cccb3387.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EFFECT OF HELICOBACTER PYLORI INFECTION ON NON VARICEAL BLEEDING IN PATIENTS WITH LIVER CIRRHOSIS1405141415861910.21608/amj.2021.158619ENSamyMohamed El-SayedDepartment of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar UniversityNaderFarid MostafaDepartment of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar UniversityAbdallahHendawi El-ShahatDepartment of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar UniversityJournal Article20210323<strong>Background:</strong> Variceal bleeding in chronic liver disease has been studied extensively. However, 30-40% of upper digestive hemorrhages in cirrhotic patients are non variceal (NVUGIB). Clinical features and endoscopic findings of this population have rarely been reported.<br /> <strong>Objective:</strong> To determine the prevalence of H. pylori infection in cirrhotic patients with non variceal upper gastrointestinal bleeding.<br /> <strong>Patients and methods:</strong> This was carried out at Hepatology, Gastroenterology and Infectious Diseases Department of Al-Azhar University Hospitals, and conducted on 150 patients infected by H. pylori From May 2019 till November 2019.<br /> Pateints were selected and divided into three equal groups: Group A: Patients with recent active bleeding (maximum within two days) of non variceal origin diagnosed endoscopically. Group B Matched cirrhotic patients without history of upper gastrointestinal bleeding, and group C Non-cirrhotic patients without history of upper gastrointestinal bleeding. Upper GI Endoscopy was done for all patients of the studied groups. Multiple biopsies were taken and H.pylori infection was determined by Histopathology.<br /> <strong>Results:</strong> The mean age of participants was 54.3 years. Males were 79 (52.6%) while females were 71 (47.3%). 58 of 150 patients (38.6%) were positive for H. pylori. there was no significant relation between H. pylori positivity and cause of cirrhosis. there was significant relation between H. pylori positivity and Sex of the studied cases. And there was high significant difference between the studied groups as regard H. pylori distribution.<br /> <strong>Conclusion:</strong> There was significant association between H. pylori infection and non variceal upper gastrointestinal bleeding. Eradication therapy has a role in reducing the incidence of NVUGIB in cirrhotic patients.https://amj.journals.ekb.eg/article_158619_15b64cd1a714e4541d4f1aa8898d0137.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EVALUATION OF EFFICACY AND SAFETY OF TOPICAL NICOTINAMIDE FOR TREATMENT OF PSORIASIS VERSUS CALCIPOTRIOL-BETAMETHASONE: COMPARATIVE STUDY1415142415862110.21608/amj.2021.158621ENAhmedSaeed Mostafa AnbarDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityMohammedAhmed El-KhalawanyDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityAhmedHassan NouhDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210323<strong>Background:</strong> Psoriasis is a chronic skin disorder typically characterized by symmetrical erythematous papules and plaques with a silver scale.<br /> <strong>Objective:</strong> To compare the efficacy and safety of topical nicotinamide for the treatment of mild to moderate psoriasis in Interventional Clinical Trial study compared with calcipotriol-betamethasone.<br /> <strong>Patients and methods:</strong> Our study was carried out on sixty patients from November 2019 to March 2020, complaining of psoriasis thirty patients treated by topical nicotinamide 4% weekly and thirty patients treated by topical calcipotriol-betamethasone weekly. Patients were selected from out-patient clinic of Dermatology, Venereology and Andrology Department of Al-Azhar University Hospitals.<br /> <strong>Results:</strong> The present study using topical nicotinamide 4% weekly versus calcipotriol –betamethasone weekly showed lesions on both sides were similar regarding baseline Psoriasis Area and Severity Index (PASI) score (P = 0.148), while at 1 month and 3 months after therapy, PASI scores were significantly lower with calcipotriol betamethasone in the second group as compared with nicotinamide alone in first group (P < 0.001). At the end of the trial, PASI scores were reduced by 17.9± 7.8 points before treatment to 12.2± 5.08 after 12 weeks with nicotinamide as compared to 16.2 ± 5.5 before treatment to 9.1± 3.2 points with calcipotriol betamethasone (P < 0.001).<br /> <strong>Conclusion:</strong> Nicotinamide can be used for topical psoriasis treatment and may be a good adjuvant to be added to the treatment regimens of psoriasis and it was less effective than calcipotriol betamethasone regarding clinical response and patient's satisfaction.https://amj.journals.ekb.eg/article_158621_26a7ec702e6e4a7aaf4c6118eb1cdddc.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EVALUATION OF THE EFFICACY OF TOPICAL PIPERINE OIL COMBINED WITH EXCIMER LIGHT PHOTOTHERAPY IN THE TREATMENT OF NON-SEGMENTAL VITILIGO: COMPARATIVE INTRA INDIVIDUAL STUDY1425143215862410.21608/amj.2021.158624ENMahmoudAbd El-Ghany El-DyastyDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityMohamedAhmed Abd El-Rahman El-KhalawanyDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityIbrahimMohamed Abd El-Salam Abd El-KareemDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210323<strong>Background:</strong> Vitiligo is an acquired idiopathic disease that appears as skin depigmented patches due to a loss of melanocytes that are responsible for producing melanin pigment in the skin, hair, mucous membranes and retina.<br /> <strong>Objective:</strong> To evaluate the efficacy of topical piperine oil combined with excimer light phototherapy in the treatment of non-segmental vitiligo: comparative intra individual study.<br /> <strong>Patients and methods:</strong> Our study was carried out on 30 patients complaining of vitiligo from December 2019 to September 2020. Thirty subjects with two comparable patches were treated by excimer light phototherapy; one of them was randomly selected and treated with daily topical piperine oil at home. Patients were selected from out-patient clinic of Dermatology, Venereology and Andrology Department of Al-Azhar University Hospitals.<br /> <strong>Results:</strong> The present study showed improvement in patches treated with piperine plus excimer light phototherapy as excellent response in 60% of patients, good response in 6.6% of patients, fair response in 26.6% of patients and poor response in 6.6% of patients. Improvement in patches treated with excimer light phototherapy only as excellent response in 6.6% of patients, good response in 46.6% of patients, fair response in 26.6% of patients and poor response in 20% of patients.<br /> <strong>Conclusion:</strong> Using piperine combined with Excimer light phototherapy was a promising method for vitiligo treatment.https://amj.journals.ekb.eg/article_158624_13dd15f952e5f8baaa0a606569285fca.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401ROLE OF MICRO RNA-21 IN EGYPTIAN PATIENTS WITH ISCHEMIC HEART DISEASE1433144615862910.21608/amj.2021.158629ENMohammedAbd El-Fattah Mokhtar KhalafDepartments of Clinical Pathology, Faculty of Medicine- Al-Azhar UniversityHassanAbd El-Aziz GaberDepartments of Clinical Pathology, Faculty of Medicine- Al-Azhar UniversityTarekAbd El-Kareim El-DahshanDepartments of Clinical Pathology, Faculty of Medicine- Al-Azhar UniversityAhmadFathey Abd El-AzizDepartments of Clinical Pathology, Faculty of Medicine- Al-Azhar UniversityAhmedKamal HarfoushDepartments of Cardiology, Faculty of Medicine- Al-Azhar UniversityJournal Article20210323<strong>Background:</strong> Ischemic heart diseases are major sources of morbidity and mortality worldwide. Several biomarkers have been suggested to aid in the diagnosis of myocardial infarction and unstable angina. Multiple micro-RNAs, a class of regulatory ribonucleic acids, have been studied in ischemic heart disease patients for a potential role in diagnosis.<br /> <strong>Objective:</strong> To study the role of micro RNA-21(miRNA21 or miR21) in Egyptian patients with ischemic heart diseases(IHD), myocardial infarction (MI) and unstable angina (UA) to evaluate its diagnostic value in IHDs.<br /> <strong>Patients and Methods:</strong> This prospective case-control study included 50 subjects, divided into two groups: Patient group including 30 subjects, and control group including 20 subjects. Subjects were subjected to full history taking and clinical assessment, routine lab investigations, cardiac markers assay, and determination of serum expression of Micro RNA-21 using real-time polymerase chain reaction (PCR). This study was conducted on patients attending at cardiology department, Al-Hussein University Hospital. Study started in March 2018, and ended in October 2018.<br /> <strong>Results:</strong> Micro-RNA expression profile showed that miR-21 was up-regulated in MI and UA patients in general, with a statistically extremely highly significant difference (p=<0.001). Its diagnostic performance was marvelous, but couldn’t distinguish between UA and MI.<br /> <strong>Conclusions:</strong> In conclusion, we found that Micro RNA-21 showed a statistically extremely high significant up regulation in MI and UA patients, with strong diagnostic performance, but couldn't distinguish between UA and MI. Micro RNA-21 might be biomarker for ischemic heart disease.https://amj.journals.ekb.eg/article_158629_4132c4a629b7b9c984e4e1a6574fe48a.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401ANALGESIC EFFICACY OF BILATERAL ULTRASOUND GUIDED ERECTOR SPINAE PLANE BLOCK IN LUMBAR SPINE SURGERIES1447145815863010.21608/amj.2021.158630ENAbd El-RahmanMohammed Abd El-Fattah El-MaghrabyDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar UniversityAymanHussein Fahmy Mohammed KahlaDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar UniversityOthmanSaad El-Deen Yahia MousaDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar UniversityJournal Article20210323<strong>Background:</strong> Pain after lumbar spine surgery is often difficult to control in the postoperative period. Traditionally, opioids have been the mainstay of treatment but are associated with many unwanted side effects and prolonged hospital stay. The ultrasound-guided erector spinae plane block (ESPB) is a relatively safe, simple technique. However, there are few controlled studies evaluating its efficacy.<br /> <strong>Objective:</strong> To evaluate the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in lumbar spine surgeries.<br /> <strong>Patients and Methods:</strong> This study included 50 patients of both sexes admitted for lumbar surgery at the Al-Hussein University Hospital from December 2019 to August 2020. They were randomly allocated into two groups: Control group (general anesthesia without ESPBP), and ESPB Group: included general anesthesia and bilateral ultrasound-guided erector spinae plane block. The following parameters were assessed in the two studied groups: Heart rate, mean arterial blood pressure, arterial oxygen saturation, end-tidal CO2, recovery profile, time of patient ambulation, visual analog score pain scores (VAS), Ramsay Sedation Scale scores, first request for postoperative analgesia, adverse events, the level of the patient satisfaction, and total dose of postoperative nalbuphine consumption.<br /> <strong>Results:</strong> This study showed a significant statistical difference regarding the postoperative VAS pain scores between the two groups. Patients who received ESPB had improved post-operative analgesia, better patients’ satisfaction, and earlier patient ambulation.<br /> <strong>Conclusion:</strong> Bilateral ultrasound-guided erector spinae plane block in lumbar spine surgeries is one of the most advantageous adjuvant blocks for improving post-operative pain relief and reducing opioid use and subsequently side effects.https://amj.journals.ekb.eg/article_158630_4e335f792cb690df57391c874c9d426a.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401COMPARATIVE STUDY OF DIFFERENT FORMULAE OF ULTRASONOGRAPHIC QUANTIFICATION OF THE AMOUNT OF PLEURAL EFFUSION1459146615863210.21608/amj.2021.158632ENMohamedSabri Ahmed AminDepartment of Chest, Faculty of medicine, Al-Azhar University, Cairo, EgyptAbo-BakrHelal Al-AsmarDepartment of Chest, Faculty of medicine, Al-Azhar University, Cairo, EgyptHoussamEl-Din Hassanin Abd El-NabyDepartment of Chest, Faculty of medicine, Al-Azhar University, Cairo, EgyptJournal Article20210323<strong>Background:</strong> Pleural effusion may be a result of a primary pulmonary illness. It also can be the pleural manifestation of numerous of diseases that primarily affect other organs. Quantification of pleural effusion is of great value in clinical practice, as it usually guides the plan of management. Chest ultrasound (U/S) is one of the helpful non-invasive means in estimating pleural fluid volume.<br /> <strong>Objective:</strong> To correlate the U/S estimated volumes of pleural fluid calculated by studied formulae, with the actual effusion volume, and to identify the most accurate formula in quantifying the pleural fluid volume.<br /> <strong>Patients and Methods:</strong> This prospective cross-sectional study was carried out in the department of Chest, Bab Al-sha'reia University Hospital, during the period from October 2019 to September 2020, and included forty patients with clinical and radiological diagnosis of pleural effusion. Ultrasound estimation of the amount of pleural effusion was done using 4 different formulae, followed by full pleural drainage through either simple aspiration or tube thoracostomy. Lastly, the ultrasonographically estimated fluid volumes were then compared to the actually drained fluid volume.<br /> <strong>Results: </strong>The supine formulae showed excellent correlation with the drained pleural fluid volume, with Pearson correlation coefficient(r) = 0.9607 and 0.9602 for Eibenberger and Balik formulae respectively (p-value <0.0001). On the other side, the erect formulae were found to have reasonable correlations with the drained volume, with r= 0.4017 (p-value= 0.0102) and 0.5729 (p-value <0.0001) for Goecke1 and Goecke 2 respectively. All studied formulae failed to quantify the pleural effusion volume accurately when comparing its estimated volume to the actually drained fluid volume.<br /> <strong>Conclusion:</strong> The 4 studied formulae had good correlations with the actually drained volume. However, supine formulae were better than erect formulae.https://amj.journals.ekb.eg/article_158632_84a962d0be41cc85dc72bd8850113f8d.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401CLINICAL COMPARATIVE STUDY BETWEEN INTRATHECAL DEXMEDETOMIDINE AND DEXAMETHASONE ON PROLONGING THE DURATION OF INTRATHECAL BLOCKADE IN LOWER LIMB ORTHOPEDIC SURGERY1467147815863310.21608/amj.2021.158633ENAhmedAbd El-Hamed HassanDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityAliAbd-Allah Al-KumityDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityAlaaEl-Deen Mahmoud Sayed AhmedDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityIsmaeilAbd El-Latif ShabaiekDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityJournal Article20210323<strong>Background:</strong> Spinal anesthesia is safer than general anesthesia during lower limb operations; many studies have been concerned about prolonging the duration of spinal anesthesia by adding different adjuvants.<br /> <strong>Objective:</strong> To compare the efficacy of intrathecal dexmedetomidine versus intrathecal dexamethasone in prolonging duration of spinal anesthesia, and postoperative analgesia, safety and hemodynamic stability.<br /> <strong>Patients and methods:</strong> Our study was carried out on 60 patients of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for orthopedic operation under spinal anesthesiadivided into A, B and C from March 2020 to November 2020. They were divided into 3 equal groups: Group A received 2ml bupivacaine (0.5%) and 10μg dexmedetomidine in 1ml normal saline intrathecal, Group B received 2ml bupivacaine (0.5%) and 4 mg dexamethasone in 1 ml normal saline intrathecal and Group Creceived 2ml bupivacaine (o.5%) and 1ml normal saline Intrathecal. The study was carried out at Al-Azhar University Hospitals (Al- Hussein and Sayed Galal Hospitals).<br /> <strong>Results:</strong> The present study showed statistically significant difference (P-value <0.001) between the three groups according to time of motor and sensory regression. The regression time of block (both sensory and motor) were prolonged in A (sensory 359.50±20.32, motor 319.00±21.06) and B (sensory 199.75±18.22, motor 170.00±20.00) when compared to the C group (sensory 149.55±10.83, motor 141.00±22.09). However, the duration was longest in A group among the three groups. According to amount of analgesic consumption postoperatively, there was significant decrease in amount in A group in comparison to B and C groups. The amount is insignificantly decreased in B group in comparison to C group. Regarding safety and hemodynamic stability there was no statistically significant difference between the three groups.<br /> <strong>Conclusion:</strong> Dexmedetomidine had prolonging the duration of spinal anesthesia more than dexamethasone and control group with statistically significant difference between the three groups and provided prolonged postoperative analgesia compared to dexamethasone and control group.https://amj.journals.ekb.eg/article_158633_7b27b55cb9466cb085b4c7186b59b474.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401ROLE OF IMAGING IN ACUTE ABDOMEN IN ADULT1479148815863710.21608/amj.2021.158637ENAhmedMahmoud Helmy MohammedDepartment of Radio diagnosis, Faculty of Medicine, Al-Azhar UniversityAbd El-MonemSayed RaghebDepartment of Radio diagnosis, Faculty of Medicine, Al-Azhar UniversityMahmoudKadry El-GendyDepartment of Radio diagnosis, Faculty of Medicine, Al-Azhar UniversityMohamedAbu El-Naga MohamedDepartment of Radio diagnosis, Faculty of Medicine, Al-Azhar UniversityJournal Article20210323<strong>Background:</strong> Acute abdominal pain is a common complaint of patients presenting at the Emergency Department. Approximately, 10% of presentations at the Emergency Department are because of acute abdominal pain which can be caused by a variety of diseases ranging from mild and self-limiting to life-threatening diseases.<br /> <strong>Objective:</strong> The purpose of this study was to collect data for constructing an optimal diagnostic algorithm for the wide spectrum of patients with acute abdominal pain at the Emergency Department (ED).<br /> <strong>Patients and methods:</strong> The study was carried out at the Department of Radiology, Al-Azhar University Hospitals, Cairo. The study was carried during the period between April 2019 and April 2020 a total of 30 patients were selected from those were referred to Radiology Department of Al-Azhar University Hospitals. All patients were subjected to conventional radiography, US and CT scan.<br /> <strong>Results:</strong> Out of 30 patients, there were 15 (50%) male patients, 15 (50%) female patients. The spectrum of diseases included in the study were bowel obstruction (23.3%), obstetric related causes (20.0%), urinary cause (20.0%), acute appendicitis (13.3%), abdominal malignancy (3.3%), acute cholecystitis (3.3%), Chron’s disease (3.3%), hepatic abscess (3.3%), pancreatitis (3.3%), perforated viscus (3.3%) and splenic abscess (3.3%).<br /> <strong>Conclusion:</strong> Radiological assessment has a main role in diagnosis and treatment of acute abdomen. CT proved to be a better imaging modality with high sensitivity and specificity in diagnosis than conventional imaging especially in acute appendicitis, Chron’s disease, hepatic abscess, pancreatitis and splenic abscess. X-ray was the standard in diagnosis of intestinal obstruction or viscus perforation.https://amj.journals.ekb.eg/article_158637_602c3b31154fd367f9685398183d3032.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401ROLE OF TRANSBRONCHIAL LUNG BIOPSY AND BRONCHOALVEOLAR LAVAGE IN DIAGNOSIS OF DIFFUSE PARENCHYMAL LUNG DISEASE1489149615863910.21608/amj.2021.158639ENAhmedRady Abd El-Azeem ErfanDepartment of Chest, Faculty of medicine, Al-Azhar University, Cairo, EgyptHamdyMohamed ZoairDepartment of Chest, Faculty of medicine, Al-Azhar University, Cairo, EgyptIbraheemHassan MohamedDepartment of Chest, Faculty of medicine, Al-Azhar University, Cairo, EgyptKhalidMohamed HalimaDepartment of Chest, Faculty of medicine, Al-Azhar University, Cairo, EgyptJournal Article20210323<strong>Background:</strong> Diffuse parenchymal lung diseases (DPLD) constitute a group of over 200 diverse etiologic entities which present with respiratory symptoms and diffuse lung infiltrates and account for 15% of patients seen by a pulmonary physician.<br /> <strong>Objective:</strong> To evaluate the role of transbronchial lung biopsy and bronchoalveolar lavage in diagnosis of diffuse parenchymal lung disease.<br /> <strong>Patients and Methods:</strong> This prospective cross-sectional study was carried out at the Department of Chest, Al-Hussein University Hospital, during the period from October 2019 to October 2020, and included sixty patients admitted in the inpatient wards with undiagnosed DPLD, after detailed history taking, physical examinations, routine labs, chest X-ray PA view, HRCT chest, pulmonary function tests (PFTs) as simple spirometry, ECG, echocardiography and Arterial blood gases evaluation. All of them were subjected to fibrooptic bronchoscope, transbronchial lung biopsy and bronchoalveolar lavage.<br /> <strong>Results:</strong> As regard comparison between bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) diagnostic yield there was a statistical significant difference between TBLB positive and negative patients, as regard BAL predominant cells and BAL microbiology. the comparison of histopathology as regard TBLB diagnostic yield showed a statistical significant difference between TBLB positive and TBLB negative patients.<br /> <strong>Conclusion:</strong> Bronchoalveolar lavage was a minimally invasive procedure performed during flexible bronchoscopy. BAL cellular analysis alone was insufficient to diagnose the specific type of DPLD, except in malignancies and some rare interstitial lung diseases (ILDs), and the yield of bronchoscopic lung biopsy was high in diseases where the lesions were peri bronchial in distribution such as in sarcoidosis, hypersensitivity pneumonitis and organizing pneumonias.https://amj.journals.ekb.eg/article_158639_30112d57e69fe44f38d6bf9b93fef103.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401THE EFFECT OF ALPHA LIPOIC ACID ON IDIOPATHIC ASTHENOZOOSPERMIC PATIENTS1497150615849010.21608/amj.2021.158490ENAhmedN. M. Abd El-HamidDepartments of Dermatology & Andrology, Faculty of Medicine, Al-Azhar University, EgyptYahyaM. I. HodeebDepartments of Dermatology & Andrology, Faculty of Medicine, Al-Azhar University, EgyptEmadM. El-RewinyDepartments of Dermatology & Andrology, Faculty of Medicine, Al-Azhar University, EgyptAbdullahM. GaafarDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20210322<strong>Background:</strong> Many infertile men have disorders correctable with the use of medication, and if diagnosed and treated properly, natural fertilization can be attained.
<strong>Objective:</strong> To evaluate the effect of ALA on semen parameters in idiopathic asthenozoospermia.
<strong>Patients and methods:</strong> This was a case-control study, including 80 patients presenting with primary infertility enrolled from outpatient Andrology Clinic Units of Al-Azhar University Hospitals. Patients were divided into two equal groups. One group was given oral ALA tablets at a dose of 300 mg twice/day, whereas the other group was given a placebo twice daily. The duration of the study ranged from March 2020 till September 2020.
<strong>Results:</strong> There was a significant difference between 2 groups as regard total motility after treatment progressive motility after treatment, and % vitality after treatment.
<strong>Conclusion:</strong> Medical therapy of asthenoteratospermia with ALA supplement could improve quality of semen parameters.https://amj.journals.ekb.eg/article_158490_4cc5b717a81f94f82559bdf0c4c07e55.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EVALUATION OF CD82/ (KAI-1) IMMUNOHISTOCHEMICAL EXPRESSION IN COLORECTAL CARCINOMA1507151615864210.21608/amj.2021.158642ENAnassFathi Shafiq Al-GazzarDepartment of Pathology, Faculty of Medicine, Al-Azhar UniversitySayedAbd El-Raheem Sayed AliDepartment of Pathology, Faculty of Medicine, Al-Azhar UniversityAl-SayedMohammed Ibrahim TealebDepartment of Pathology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210323<strong>Background:</strong> Colorectal carcinoma (CRC) is one of the most common human cancers. It is the fourth most common cause of death from cancer. Colorectal cancer is the third most common cancer in men and the second in women worldwide.<br /> <strong>Objective:</strong> To evaluate the immunohistochemical expression of KAI-1/CD82 in different stages of colorectal carcinoma and to evaluate the biological behavior of tumor and target therapy.<br /> <strong>Patients and Methods:</strong> Thirty formalin-fixed, paraffin-embedded tissue of colorectal carcinoma (obtained from archive of Al-Azhar University Hospital Labs and some private labs). Clinicopathological and histological features were taken from files and confirmed by H&E examination. Immunohistochemical study was done by using CD82/ (KAI-1) marker.<br /> <strong>Results:</strong> CD82 showed an insignificant relation with age, sex, site of tumor and degree of differentiation. A significant inverse relationship was detected between CD82 expression in tumor cells and tumor stage according to modified Duke's staging. Insignificant relation between age, sex, site and grade.<br /> <strong>Conclusion:</strong> The decreased membranous and/or cytoplasmic expression of CD82 might be used as a prognostic marker to monitor patient with colorectal cancer.https://amj.journals.ekb.eg/article_158642_38f62b3947b978d4abc2c268fa76772a.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401EFFECT OF ONLINE HEMODIAFILTRATION ON PATIENTS WITH SEPSIS AND ACUTE KIDNEY INJURY IN INTENSIVE CARE UNIT1517153015864510.21608/amj.2021.158645ENMahmoudMohammed Kasem IbrahemDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityMostafaAbd El-Fattah El-BallatDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityNagahMohamed Abo MohamedDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityMohamedAhmed El-SayedDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210323<strong>Background:</strong> Acute kidney injury is a common occurrence in critically ill patients, with incidence rates of occurrence varying from 5 to 60% and a trend towards higher rates (30 to 60%) when using the risk, injury, failure, loss of kidney function, end stage renal failure (RIFLE) or Acute Kidney Injury (AKI) Network (AKIN) classification.<br /> <strong>Objective:</strong> To compare between effect of online hemodiafiltration and conventional hemodialysis in patients with sepsis and acute kidney injury in intensive care unit.<br /> <strong>Patients and Methods:</strong> This study included forty (age and sex matched) patients with acute kidney injury (AKI) who were critically ill they were selected from the Nephrology Unit Ahmed Maher Teaching Hospital. The included patients were divided into two equal groups: Group (A) that included patients on online hemodiafiltration (OLHDF) and Group (B) that included patients on conventional hemodialysis.<br /> <strong>Results:</strong> There was a statistically significant difference found between two groups after dialysis regarding HB, WBCs, platelet, Na and albumin. Also, there was high statistically significant difference between two groups regarding urea, creat, K and PCT, and there was no statistically significant difference between the two groups regarding CRP.<br /> <strong>Conclusion:</strong> OL-HDF showed to be better than IHD-LI in many aspects but there was no statistically significant difference in mortality.https://amj.journals.ekb.eg/article_158645_5d94e005287de31846728097730b6687.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401CHILD-TURCOTTE-PUGH /ALBUMINURIA AS A PREDICTOR OF ACUTE KIDNEY INJURY AMONG HOSPITALIZED PATIENTS WITH LIVER CIRRHOSIS1531153815864610.21608/amj.2021.158646ENOthmanMohammed Ahmed OthmanDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityMohammadSad Al-Den RadwanDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversitySadekMostafa SadekDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityAshrafMohammed El-BahrawyDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityJournal Article20210323<strong>Background:</strong> The incidence of acute kidney injury (AKI) in cirrhotic patients about fifteen percent of hospitalized cirrhotic patient, Prediction of AKI indicated in all patients with liver cirrhosis. Albuminuria in cirrhotic patient can predict AKI.<br /> <strong>Objective:</strong> To assess the role of Child-Turcotte Pugh/Albuminuria (CTP-Alb), in prediction of AKI among hospitalized patients with liver cirrhosis.<br /> <strong>Patients and Methods:</strong> After departmental ethics committee approval and patient consents were obtained, 60 patients with liver cirrhosis screened for AKI during hospital admission at hepatogastroenterology unit, Department of Internal Medicine in Al-Hussein Hospital, Al-Azhar University, and The study was carried out during the period from September 2019 and September 2020, The diagnosis of liver cirrhosis based on clinical, biochemical and ultrasonography findings. Patients with Fib-4 ≥ 3.5 in the absence of liver decomposition were categorized as compensated liver cirrhosis. Severity of liver disease was assessed using the CTP score, model for end stage liver disease (MELD) score and CTP-Alb score. Diagnosis of acute kidney injury was based on the changes in serum creatinine. The baseline renal assessment at first day of hospital admission was included serum creatinine, estimated glomerular filtration rate (eGFR), albumin/creatinine ratio, and abdominal ultrasonography. AKI was categorized as hepatorenal syndrome (HRS), pre-renal azotemia, post-renal azotemia or intrinsic acute kidney injury.<br /> <strong>Results:</strong> A total of 60 patients included. They were 40 (66.66%) males and 20 (33.34%) females. Their mean age was 50 ± 33 years, of them 8 (13.33%) patients developed AKI during hospital admission with their mean age was 60.6 ± 10.9 years. They were 5 (62.5%) males and 3 (37.5%) females, Hypoalbuminemia, Child score at admission and Child-albuminuria score at admission were identified as independent risk factors for AKI by multivariate analysis (p < 0.05).<br /> <strong>Conclusion:</strong> Thirteen percent of cirrhotic patients developed AKI during hospital admission according to our results. The majority of patients were child C in our series; CTP/Albuminuria score, Hypoalbuminemia and ACLF has promising sensitivity, specificity and accuracy in prediction of AKI in hospitalized cirrhotic patient.https://amj.journals.ekb.eg/article_158646_69b7c2f53bde50a95539b4b1f6f74439.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401VALUE OF BREAST ELASTOGRAPHY IN EVALUATION OF BREAST MASSES DETECTED ON SCREENING ULTRASOUND1539155215864010.21608/amj.2021.158640ENWaleedRabiey MohammedDepartment of Diagnostic and Interventional Radiology, Faculty of Medicine, Al-Azhar UniversityAmrMahmoud ZiedDepartment of Diagnostic and Interventional Radiology, Faculty of Medicine, Al-Azhar UniversityHusseinMontaser RoshdyDepartment of Diagnostic and Interventional Radiology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210323<strong>Background:</strong> Breast cancer remains one of the leading causes of death in women over the age of 40 years. Breast cancer screening is used to identify women with asymptomatic cancer with the goal of enabling women to undergo less invasive treatments that lead to better outcomes, ideally at earlier stages, and before the cancer progresses.<br /> <strong>Objective:</strong> To evaluate the additional value of Elastography as complementary to conventional US in breast masses found on screening US.<br /> <strong>Patients and methods:</strong> The study was performed prospectively between April 2020 and October 2020 at Elsayed Galal University Hospital in 35 consecutive female patients with 39 breast lesions who met all inclusion criteria and no exclusion criteria.<br /> <strong>Results:</strong> This study included 35 female patients (with 39 breast lesions). Their ages ranged from 16 to 68 years old with mean age 46 ± 12.7 (mean ± SD). In this study, 8 /39 (20.5 %) cases were almost fatty (ACR “a”) in which 6/6 cases were malignant & 24/39 (61.5%) with scattered area of fibro-glandular tissue (ACR “b”) in which 8/24 cases were malignant and 7/39 (17.9 %) cases were heterogeneously dense breasts (ACR “c”) in which 3/7 cases were malignant. Lesions that scored 1, 2, and 3 were considered benign 24/39(61.5 %) cases, whereas lesions that scored 4 and 5 15/39 (38.5%) cases, were considered malignant. When considering lesions with strain ratio less than 3.0 as benign and lesions with strain ratio more than or equal 3.0 as malignant, 15/39 (38.5) lesions were benign, 24/39 (61.5 %) were malignant by strain ratio.<br /> <strong>Conclusion:</strong> US Elastography provides useful information about distinguishing benign and malignant lesions. Thus, consideration of lesion stiffness could increase positive predictive values and reduce unnecessary benign biopsies.https://amj.journals.ekb.eg/article_158640_8962ae84ca40f69bc9b9771319a5ca34.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401OCCULT HEPATITIS B INFECTION IN HEMODIALYSIS PATIENTS INFECTED WITH HEPATITIS C VIRUS1553156216038610.21608/amj.2021.160386ENAbd El-AzizMamdouh Mohamed Abd El-Aziz Mohamed BerbeshDepartment of Internal Medicine –Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210401<strong>Background:</strong> Occult hepatitis B infection (OBI) is defined as the existence of low-level HBV DNA in the serum ( <strong>Objective:</strong> To evaluate the prevalence of occult hepatitis B infection among hemodialysis patients infected with Hepatitis C Virus.<br /> <strong>Patients and Methods:</strong> Our study was conducted on 100 patients with end-stage renal disease who were positive Hepatitis C Virus undergoing regular hemodialysis from the dialysis unit related to the department of nephrology, Nasser Institute, Egypt, during the period from July to January 2018. Female ratio was |39%|, while male ratio was |61%|, age ranged from (18-60) with mean efficient |39.20±11.98|.HbcIgG was checked to all patients, and HBV PCR to positive HBcIgG patients.<br /> <strong>Results:</strong> The results of our study showed that 8% of the whole samples were Positive, and 92% were negative HbCIgG patients. From these 8% positive HBcIgG patients, HBV PCR was positive in only 2% patients.<br /> <strong>Conclusion:</strong> OBI was prevalent among chronic HCV patients on regular hemodialysis. However, more precise assessment of this infection requires regular patient follow up using HBV DNA detection methods.https://amj.journals.ekb.eg/article_160386_39f2201d339cc0ab2c2bacbcff2f2068.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050220210401STUDY OF THORACIC COMPLICATIONS IN PATIENTS WITH LIVER CIRRHOSIS1563157416038710.21608/amj.2021.160387ENEl-MoatazBellah Mohamed Mohamed El-DesoqyDepartments of Chest Diseases, Faculty of Medicine, Al-Azhar UniversityTaalatAbd El-Aziz ArafaDepartments of Chest Diseases, Faculty of Medicine, Al-Azhar UniversityMousaMohamed Mousa El-ShamlyDepartments of Chest Diseases, Faculty of Medicine, Al-Azhar UniversityAnwarGomaa MohamedDepartments of Tropical Diseases, Faculty of Medicine, Al-Azhar UniversityJournal Article20210401<strong>Background:</strong> Liver cirrhosis and its complications are a leading cause of death among adults. The diseased liver leads to many deleterious effects on multiple organ systems, including the pulmonary system.<br /> <strong>Objective:</strong> To determine the types and frequency of pulmonary complications in patients with liver cirrhosis and to assess the relation between the incidence of pulmonary complications and severity of liver cirrhosis according to Child-Pugh Score.<br /> <strong>Patients and Methods:</strong> This was a prospective cohort study that conducted on 100 cirrhotic patients. The study was carried in the period from January 2018 till February 2019, Patients included in this study were classified according to their Pugh score into class A with 71 patients, class B with 15 patients and class C with 14 patients. This study was conducted in Dekernes general hospital and Dekernes chest hospital/ Dakahlia Governorate.<br /> <strong>Results:</strong> 58% of the included patients were females and 42% of them were males. Their ages ranged from 38 to 77 years with a mean age of 56.24 ±9.39 years. The main findings of this study were that 65% of the liver cirrhosis patients had associated co-morbidities. Pulmonary complications in these patients were presented as cough, dyspnea, fever and dyspnea with wheezes. Hospitalization was needed in 12% of them for management of pneumonia, bronchitis, bronchial asthma and pleural effusion. 100% of the patients were HCV positive and by the end of the study 100% of the patients survived. When patients were classified based on Pugh score, those groups showed statistically significant differences as regards associated co-morbidities, incidence of jaundice at presentation, degree of ascites, results of investigations as well as incidence of different types of pulmonary complications.<br /> <strong>Conclusion:</strong> Liver cirrhosis was associated with unique pulmonary complications, which differ in incidence with progression of the disease.https://amj.journals.ekb.eg/article_160387_b6554fa1b2f65ecc80407fb45e99c34b.pdf