Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401COMPARED STUDY BETWEEN THE USE OF IETROZOLE AND METHOTREXATE FOR THE MEDICAL TREATMENT OF EARLY SUSPECIOUS UNDISTURBED TUBAL ECTOPIC PREGNANCY85186023045310.21608/amj.2022.230453ENAtefNabil El-SayedDepartment Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMahmoudA. SultanDepartment Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityEl-SayedM. TahaDepartment Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20220411<strong>Background:</strong> The most common site of ectopic pregnancy is the fallopian tube. Most cases of tubal ectopic pregnancy that are detected early can be treated successfully either with minimally invasive surgery or with medical management using methotrexate.
<strong>Objective:</strong> To study the effectiveness of letrozole in management of early suspicious undisturbed ectopic pregnancy compared to Methotrexate.
<strong>Patients and Methods:</strong> A non-randomized prospective cohort study carried out on 50 pregnant woman with early suspicious undisturbed tubal ectobic pregnancy who were hemodynamically stable, and did not have heterotopic pregnancy. Twenty five of patients were treated with letrozole (2.5 mg bid) for 10 days, and the other 25 patients were treated with methotrexate (1mg\kg IM, maximum 50mg single dose), and follow up by β-hCG on day 4 and day 7 of first dose at Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University Hospitals from April 2020 to March 2021.
<strong>Results:</strong> The mean age of group 1 was 28.36 (±3.33 SD) with range (22-36) while the mean age of group 2 was 30.28 (±4.34 SD) with range (22-35). According to residence in group 1 there were 10 (40%) rural resident, and 15 (60%) urban resident, while in group 2 there were 11 (44%) rural resident and 14 (56%) urban resident. There was no statistically significant difference between the studied groups as regard age or residence. There was no statistically significant difference between the studied groups as regard BMI, parity, and history of assisted reproductive. Presented by vaginal bleeding or presented by abdominal pain. There was significant difference between the different studied periods in group 1 as regard abdominal US, and significant difference between the different studied periods in group 2 as regard abdominal US.
<strong>Conclusion:</strong> Letrozole was as effective as methotrexate, with success rates of 86% for both treatment arms. b-Human chorionic gonadotropin levels even appeared to decrease more rapidly for women treated with letrozole than methotrexate, although the difference was statistically significant.https://amj.journals.ekb.eg/article_230453_405f2951b802e3c990f403d49501d1ca.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401EFFECT OF THREATENED ABORTION ON FETAL GROWTH AND PREMATURE RUPTURE OF MEMBRANES86187023045410.21608/amj.2022.230454ENSamirAbd El-Razek El-Sayed AhmedObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityAbd El-SameaKhalifaObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityTamerFaresObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20220411<strong>Background:</strong> Threatened abortion is the incidence of first trimester bleeding from the uterus, characterized by closed os cervix and a viable fetus. As many cases of threatened abortion pregnancy continue until term, therefore it is crucial to determine the complications of threatened abortion.
<strong>Objective:</strong> To evaluate the effect of threatened abortion on fetal growth, preterm premature rupture of membrane (PPROM), and adverse pregnancy outcomes as preterm labor, placenta previa, pregnancy-induced hypertension (PIH), intrauterine growth restriction (IUGR) and cesarean section.
<strong>Patients and methods:</strong> One hundred ongoing pregnant cases who experienced first trimester threatened abortion and an age matched control group who had no threatened abortion signs until delivery were recruited in this prospective case-control study, and assessed for eligibility at the Outpatient Clinic and Causalities of the Obstetrics and Gynecology Department, Al-Monira General Hospital from October 2018 till September 2019.
<strong>Results:</strong> Adverse fetal outcomes were significantly higher among threatened abortion group in comparison with control group including the incidences of neonatal admission to NICU, preterm birth and low birth weight (p < 0.001), and IUGR (p=0.01). There were no significant differences between both groups regarding PPROM, PIH and placenta previa (p>0.05).
<strong>Conclusion:</strong> The incidences of low birth weight, PROM, PIH, placental previa and IUGR rates increased in threatened abortion group in comparison with control group.https://amj.journals.ekb.eg/article_230454_9726aea64b7107e0c125c6f4cfd0e4bb.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401EARLY VERSUS LATE LAPAROSCOPIC CHOLECYSTECTOMY POST ERCP IN PATIENT WITH CHOLEDOCHOLITHIASIS87187823045510.21608/amj.2022.230455ENMohamedKhaled Abd El-RahmanDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohammedIbrahem El-AnanyDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMahmoudAbd El-Hady Abd El-AzeezDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20220411<strong>Background:</strong> Ten to fifteen percent of all patients with gall bladder stones presented with CBD stones. Endoscopic Retrograde Cholangiopancreatography (ERCP) is one of the modalities used in biliary tree stones. Many studies revealed that this protocol particularly prior to laparoscopic cholecystectomy (LC). The time interval-between ERCP and LC is a matter of debate.
<strong>Objective:</strong> To evaluate the safety of early over late laparoscopic cholecystectomy post ERCP in patients with choledochocystolithiasis.
<strong>Patients and Methods:</strong> This prospective randomized study was carried out from May 2020 to October 2020 at the Department of General Surgery Al-Azhar University Hospitals, Cairo, Egypt. It included 40 adult patients with cholelithiasis and a possibility of choledocholithiasis who underwent ERCP. ERCP patients were classified into two equal groups: Early group in whom LC was done immediately after ERCP, and Late group in whom LC was done after 4 weeks. Comparison was applied between the two groups.
<strong>Results:</strong> This study clearly revealed that performing immediate LC post, ERCP in comparison to delayed LC after ERCP had better outcome. It had the lower conversion rate, less operative time, shorter hospital stay, and less postoperative complications. The comparison between two groups revealed that immediate LC post ERCP had the upper hand of the advantages and the least disadvantages rather than the other group.
<strong>Conclusion:</strong> Early LC after ERCP was considered as an adopted policy in the management of the patient with calcular obstructive jaundice.https://amj.journals.ekb.eg/article_230455_27da90970e5e6055b29a50cc2bbb1ff1.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401IMPACT OF INTERRUPTED VERSUS CONTINUOUS SUTURING IN EPISIOTOMY REPAIR AFTER VAGINAL BIRTH IN PRIMIGRAVIDAS87989023045610.21608/amj.2022.230456ENMohamedFoly El-SayedDepartment of Obstetrics and Gynecology Faculty of Medicine Al-Azhar UniversityAbd AllahKhalil AhmedDepartment of Obstetrics and Gynecology Faculty of Medicine Al-Azhar UniversityAl-RefaaiAbd El-fattah MaraiDepartment of Obstetrics and Gynecology Faculty of Medicine Al-Azhar UniversityJournal Article20220411<strong>Background:</strong> Short and long-term maternal morbidity associated with perineal repair can lead to major physical, psychological and social problems, affecting the woman’s ability to care for her new baby and other members of the family. complications depend on the severity of perineal trauma and on the effectiveness of treatment. The type of suturing material, the skill of the operator and the technique of repair are the three main factors that influence the outcome of perineal repair.
<strong>Objective:</strong> To compare the impact of interrupted versus continous suturing in episiotomy repair after vaginal birth in primigravidas.
<strong>Patients and Methods:</strong> A randomized controlled trial was performed at EL-Minia general hospital and AL-Hussin university hospital in Obstetric unit the study included 160 healthy women with viable normal singleton Pregnancy achieving normal vaginal delivery at or beyond 37 gestation from April 2019 till December 2019 women were randomized to repair either interrupted or continous suturing after episiotomy done at the crowning in the second stage of labor.
<strong>Results:</strong> In the present study, the mean participant’s age in continuous group was 25.l+5.03 and in interrupted group was 242+4.68. As regard parity, all patients were prinigravidae. None of these groups revealed any statistically significance differences indicating that the two groups were well matched. There was no statistically significant difference could be detected between continuous and interrupted groups as regard participant’s age, wound dehiscence and infection, hematoma formation and amount of blood loss during the repair measured by number of soaked gauze towels. The results showed that there was highly statistically significant difference could be detected between continuous and interrupted groups as regard number of units of sutures material that it was higher in interrupted group compared to continuous group. The results showed that there was no statistically significant difference could be detected between continuous and interrupted groups as regard perineal pain at 48 hours 10 days 42days measured by VAS.
<strong>Conclusion:</strong> The use of continuous knotless technique for perineal repair is associated with less number of units of sutures material used.https://amj.journals.ekb.eg/article_230456_14c2fd8aa3009bc3a8cc9993cdc1152d.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401SURGICAL MANAGEMENT OF TETHERED CORD SYNDROME89190423045710.21608/amj.2022.230457ENSaiedB. Al-AskaryDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMostafaM. Abo El-KheirDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAbd El-HaleemA. MousaDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20220411<strong>Background:</strong> Tethered cord syndrome is a progressive anomaly resulting in neurological, orthopedic and urological dysfunction caused by the anchoring of the spinal cord by deferent pathologies. The underlying pathophysiological processes include decreased blood flow impaired oxidative metabolism and abnormal glucose metabolism.
<strong>Objective: </strong>To evaluate clinical outcome of surgical detethering for cases of tethered cord syndrome at Al-Azhar University Hospitals.
<strong>Patients and Methods: </strong>We worked on 25 cases Adults and children with symptomatic tethered cord syndrome operated by microscopic detethering and treatment of the associated pathology using intraoperative neurophysiologic monitoring at Al-Azhar university hospitals between February 2017 and October 2020 and follow up was done forat least6 months postoperatively. All cases were subjected to History, clinical examination and MRI LSS pre and postoperatively.
<strong>Results:</strong> Untethering procedures were performed in 25 patients (age range, 3 months-26 years), 13 males and 12 females. The most common preoperative sign or symptom was pain (94%), followed by motor deficits (94%), sphincter affection (62.5%), and foot deformity (32%).The level of conus in the preoperative MRI was low lyingin 24 patients (96%).After detethering, pain was the most responsive to surgery with 86.7%improvement, followed by weakness (66.7%), then sphincters (50%). Foot deformity showed no spontaneous improvement but was stationary in 62.5% of cases, and still progressive in 37.5 % 0f cases.
<strong>Conclusion:</strong> The surgical outcome was excellent for the resolution of pain and good for motor deficits, but disappointing for bladder dysfunction. So, Early diagnosis and adequate surgical release might be the keys to a successful outcome in school aged children, adolescents, and young adults with TCS.https://amj.journals.ekb.eg/article_230457_bf396d20a32dadf90a332f169bf4145b.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401EFFICACY OF PRP IN PRIMARY FLEXOR TENDON HEALING OF THE HAND90591423045810.21608/amj.2022.230458ENAhmedRami MajeedDepartments of Plastic and Burn Surgery, Faculty of Medicine, Al-Azhar UniversityMohamedIbrahim ZeidanDepartments of Plastic and Burn Surgery, Faculty of Medicine, Al-Azhar UniversityMohamadOsama OufDepartments of Plastic and Burn Surgery, Faculty of Medicine, Al-Azhar UniversityMohamedSalah El-FeshawyDepartments of Radiology, Faculty of Medicine, Al-Azhar UniversityAhmedAbd El-Moez AliDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityJournal Article20220411<strong>ABSTRACT</strong>
<strong>Background:</strong> Tendon injury represents a common cause of morbidity worldwide and is one of the commonest causes of disability especially among the worker group. Many theoretical and clinical studies support the efficacy of platelet rich plasma (PRP) in augmenting healing in different human body aspects.
<strong>Objective:</strong> Assessing the efficacy of PRP in primary flexor tendon repair.
<strong>Patients and methods:</strong> The study was prospective controlled clinical study included 40 patients visiting Al-Azhar University Hospital’s emergency departments 20 of them treated with the conventional method the other 20 patients treated in the conventional method + PRP injection the cases treated and followed over period of December 2019 till October 2020.
<strong>Results:</strong> When comparing patient’s characteristic in the two groups, there was no statistical difference between study groups regarding age, sex, affected side, zone of injury and tendon affected. However, there was a statistical difference between studied groups as regards 2nd and 3rd week pain scale follow up. There was no statistical difference between studied groups regarding 1st, 2nd & 3rd week TAROM%, and between studied groups regarding U/S assessment. There was a statistical difference between studied group regarding time of resuming activities with median of 4 SD 4-6 in group 1 (PRP Group) (p-value < 0.05), and median of 6 weeks SD 6-8 in group 2 (Non-PRP).
<strong>Conclusion:</strong> PRP injection is a simple, cost-effective procedure that shows significant promise in improving postoperative healing and pain.https://amj.journals.ekb.eg/article_230458_51c8054b56fc70534952bc08b3fedd14.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401DIOSMIN VERSUS CABERGOLINE FOR PREVENTION OF OVARIAN HYPERESTIMULATION IN ICSI91592623045910.21608/amj.2022.230459ENMahmoudAli Mohammed AshourObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityMohammedTaher IsmailObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityMohammedMohammed FarahatObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityAliAbd El-Moez DahiObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20220411<strong>Background:</strong> Ovarian hyperstimulation syndrome is the most serious iatrogenic complication of ovarian stimulation, usually self-limited, but occasionally life threatening. Although the pathophysiology of this syndrome has not been completely elucidated, the underlying mechanism responsible for the clinical manifestations of OHSS appears to be an increase in capillary permeability of mesothelial surfaces. Many preventive strategies have been tried but there is as yet no means of completely preventing it.
<strong>Objective:</strong> To prevent ovarian hyperstimulation syndrome (OHSS) in high risk patients undergoing intracytoplasmic sperm injection (ICSI) cycles by using diosmin and cabergoline.
<strong>Patients and Methods:</strong> This study was conducted on 100 infertile female patients of high risk for developing OHSS undergoing intra-cytoplasmic sperm injection (ICSI) cycle.The cases were then be divided into2 groups:(Group A will be given 2 tab (500mg)/8hs diosmin orally, for two weeks starting at the day of HCG injections and group B will recieve 1 tab. (0.5 mg)/day cabergoline orally for 14 days starting at day of HCG injection). All patients accepted and consented to the IVF/ICSI program Group.
<strong>Results:</strong> Our results revealed that: there were no statistical significant differences between the two studied groups regarding BMI, patients' age, infertility duration, type and cause of infertility. Estradiol levels on day of HCG showed no statistical significant difference between the 2 groups with a mean of 4343.5 ± 628.53 and 4390.6 ± 724.9 for diosmin and cabergoline groups respectively. Among the two studied groups, there was no statistical significant difference between the mean of the number of oocytes retrieved and injected. Also there was no statistical significance as regards total number of embryos or embryos transferred between the two groups. In our study, hospitalisation rate showed no significant difference in diosmin and cabergoline-treated groups (6%, 12% respectively).
<strong>Conclusion:</strong> The primary approach in the prevention of OHSS involved individualized ovarian stimulation protocols, judicious administration of gonadotropins, and careful monitoring of follicular development and serum E2 level. Using dopamine agonists of the strategies discussed, the incidence of OHSS can be significantly reduced. However, none of the strategies is universally successful.https://amj.journals.ekb.eg/article_230459_70bac4ea25e363eeea0f43d7d44fcded.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401QRLISTAT (THE LIPASE INHIBITOR) THERAPY IN OVERWEIGHT AND OBESE SUB-FERTILE WOMEN92793823046010.21608/amj.2022.230460ENMoazAbdulaty Abdulaty Al-QahwajyObstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, EgyptAbdallahKhalil Ahmed EissaObstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, EgyptWaelSoliman TahaObstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, EgyptMuhamedAhmed AbdelmoatyObstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20220411<strong>Background:</strong> Obesity remains an important risk factor for women planning for pregnancy because of its adverse effects on reproductive outcome. In individuals who experience difficulty in reducing significant weight with lifestyle intervention alone, the use of anti-obesity drugs can be an adjunct.
<strong>Objective:</strong> To evaluate the efficacy of Orlistat (a pancreatic lipase inhibitor) therapy on achieving pregnancy in overweight and obese sub-fertile women.
<strong>Patients and methods:</strong> This prospective study was carried out, involving 120 case of obese and overweight sub-fertile and primary infertility women that attend to antenatal care in obstetrics and gynecology clinics in both Al- Hussein Hospital and Kom-Hamada Hospital, They were divided into 2 groups: Group I: Patients received Orlistat (120 mg) twice daily for 6 months period, and Group II: Patients counseled for life style modification only. The duration of the study ranged between April 2019 and October 2020.
<strong>Results:</strong> In group I with BMI less than 30, there were 9(30%) with pregnancy outcome, 5(16.7%) with pregnancy outcome with BMI more than 30. In group II with BMI less than 30, there were 2(6.9%) with pregnancy outcome, 2(6.5%) with pregnancy outcome with BMI more than 30. There was a significant difference between 2 groups as regard pregnancy outcome.
<strong>Conclusion:</strong> Orlistat improved ovulation as it acted indirectly by weight reduction more than life style modification alone.https://amj.journals.ekb.eg/article_230460_8b7ef0929ed42b67f52d0501f26a84b9.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401COMPARISON BETWEEN UTERINE EXTERIORIZATION AND IN-SITU REPAIR OF UTERUS IN CAESARIAN SECTION93995223046110.21608/amj.2022.230461ENIslamMohamed Ali ElwanyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityEmadAbd El-Rahman El-TamamyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityAshrafHamdy MohamedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20220411<strong>Background:</strong> Cesarean delivery (CD) is one of the most common surgeries performed throughout the world. Many surgical techniques exist to perform CD, but the most optimal technique to limit maternal morbidity is still subject to debate. One aspect of this debate relates to the method of uterine repair following delivery and its potential impact on maternal morbidity.
<strong>Objective: </strong>To compare uterine exteriorization with in situ repair with duration of surgery and blood loss as primary outcome and postoperative or intraoperative complications of cesarean delivery as the secondary outcome.
<strong>Patients and methods:</strong> The current study is a double-blinded randomized clinical trial was conducted at Beni-suef General Hospital between December 2019 and December 2020. This study was planned to be conducted on 200 pregnant females that were undergoing an elective cesarean section at full term. The patients were randomly allocated into two equal groups: Group 1: 100 women with in-situ repair of uterine incision. Group 2: 100 women with exteriorization of the uterus for repair of uterine incision.
<strong>Results:</strong> Hemoglobin levels showed that the mean reduction in hemoglobin level was in the in-situ group more than the exteriorization group. As regard duration of the operation, exteriorization of the uterus had a significant less time than in-situ uterine repair. The occurrence of intra-operative nausea & vomiting increased markedly in the exteriorization group than in the in-situ group. Regarding post-operative pain, it was significantly more in the exteriorization group than in the in-situ group. There was no significant difference between in-situ and exteriorization groups regarding the post-operative febrile illness, wound complications, time of mobilization, time of return of bowel habits, time of oral intake and duration of hospital stay.
<strong>Conclusion:</strong> Exteriorization of the uterus has less time consuming in the operation, decrease blood loss and decrease the post-operative drop in the hemoglobin level. On the other hand, in-situ uterine repair has much less post-operative complications (nausea, vomiting, pain and febrile illness) than the exteriorization group.https://amj.journals.ekb.eg/article_230461_8eab7267755e0bde355e0d14378e544c.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401COMPONENT SEPARATION TECHNIQUE FOR LARGE INCISIONALHERNIA WITH AND WITHOUT MESH REPAIR (Comparative Study)95396623046210.21608/amj.2022.230462ENMohammedAli Abdulraheem Abu-QuoraDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAshrafAbd El-Hameid Abd El-MonemDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAbd El-RahmanSafwat El-KadyDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20220411<strong>Background: </strong>Component separation technique is an ideal method to repair large incisional hernia with wide fascial gap, as it allows sliding of the abdominal wall layers giving length to close the abdomen after return abdominal contents without tension and return of midline linea alba.
<strong>Objective: </strong>To compare between component separation technique with or without mesh repair in the treatment of large incisional hernia.
<strong>Patients and Methods:</strong> The current study included 40 patients with large midline incisional hernia had repaired the hernia by component separation technique at the Department of Surgery, Al-Azhar University Hospitals during the period from November 2018 to October 2020.The patients were divided into two equal groups: Group A had component separation technique with mesh, while group B had component separation technique without mesh.
<strong>Results: </strong>There were significant increase inseroma and post-operative infection in group B (35% and 25% respectively) than patients in group A (15% and 10% respectively). Chronic pain significantly increased in group A patients (25%) than group B (10%).Recurrence significantly increased in group B patients (40%) than group A patients (10%).
<strong>Conclusion:</strong> Post-operative hernia recurrence, wound seroma and infection in group B patients were higher than group A, but chronic pain is higher in group A.https://amj.journals.ekb.eg/article_230462_291041ccb14f76d064bee523f829a6de.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401COMPARATIVE STUDY BETWEEN ANATOMICAL AND VISUAL OUTCOMES OF SILICONE OIL VERSUS GAS TAMPONADE FOR MACULAR HOLE SURGERY96797623046310.21608/amj.2022.230463ENAhmedAbd El-Gawad Ahmed MohamedDepartments of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityMohamedAnwar Al-MassryDepartments of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityAhmadEl-Sayed HodiebDepartments of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityJournal Article20220411<strong>Background:</strong> Anatomical and surgical outcomes of macular hole surgery are influenced by multiple factors. These factors include the size and chronicity of the macular hole, use of biologic adjuvants, peeling of internal limiting membrane (ILM), the choice of intraocular tamponade and duration of postoperative positioning.
<strong>Objective:</strong> To compare the effectiveness of pars plana vitrectomy (PPV) with either silicone oil or gas tamponade for the treatment of macular holes on visual and anatomical outcome.
<strong>Patients and methods:</strong> This study included 10 eyes whom were operated on by PPV with ILM peeling for repair of macular holes with either silicone oil tamponade (five patients) (50%) or sulfur hexafluoride (SF6) gas tamponade (five patients) (50%). The age of patients ranged from 24 to 72 years (mean 59 ± 14). Female to male ratio was 6 to 4. Following up, the visual acuity and anatomical outcomes by Optical coherence tomography (OCT) have been done at 1 month and 6 months postoperatively.
<strong>Results:</strong> The rate of hole closure after the primary operation showed a higher closure rate for gas-treated eyes 100% (5 of 5) than for silicone oil tamponade 80% (4 of 5). The final postoperative improvement in visual acuity for the gas group was better than for the oil group by 1 line in Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart.
<strong>Conclusion:</strong> Gas tamponade was more successful in anatomical closure of macular holes than silicone oil tamponade. Eyes with macular holes surgically repaired with gas tamponade showed more improvement in visual acuity compared with eyes treated with silicone oil tamponade.https://amj.journals.ekb.eg/article_230463_c1af434e07d5771dcce0c86b24900586.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401CORRELATION BETWEEN GANGLION CELL COMPLEX AND RETINAL NERVE FIBER LAYER IN DIAGNOSIS OF GLAUCOMA97798823046410.21608/amj.2022.230464ENIslamAbd El-Moneim MahmoudDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAhmedGomaa El-MahdyDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHosnyHassan MohammadDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20220411<strong>Background:</strong> Glaucoma is a group of diseases of different etiologies with progressive optic nerve degeneration as well as loss of retinal ganglion cells (RGCs) with a subsequent visual impairment. It remains a primary cause of irreversible blindness. So, early diagnosis and treatment of glaucoma has been demonstrated to reduce the rate of disease progression and improve cases’s quality of life. Spectral domain-optical coherence tomography (SD-OCT) technologies play an essential role in glaucoma management.
<strong>Objective:</strong> To determine and compare the use of thickness of macular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (ppRNFL) using OCT in diagnosis of glaucoma.
<strong>Patients and methods:</strong> This was a comparative study carried out on 40 eyes. The eyes were classified into two groups: Group A that represented: 10 normal eyes as a control of the study, and Group B that included 30 eyes with glaucoma classified as regards disease severity into: 10 eyes with early glaucoma, 10 eyes with moderate glaucoma, and 10 eyes with severe glaucoma as regards Hodapp, Parrish, and Anderson (H-P-A) classification. Comprehensive ophthalmic examination, white-on-white perimetry and SD-OCT were done for entire cases. The OCT was done using 3D-OCT (Topcon) 2000 to evaluate the following: RNFL parameters average (total, superior and inferior) thickness and GCC parameters average (total, superior and inferior) thickness.
<strong>Results:</strong> There was a positive statistically significant association of high probability between the two groups regarding RNFL thickness, GCC thickness, intraocular pressure (IOP), and vertical and linear cup-to-disc ratio (P<0.001).
<strong>Conclusion:</strong> Early diagnosis of glaucoma and initiation of therapy was of high significance, as additional vision loss can be stopped or slowed down. RNFL and GCC measurement with SD-OCT could provide essential data for detection and assessment of glaucoma. GCC thickness and RNFL thickness demonstrated comparable diagnostic value as markers of early, moderate, and severe glaucoma. There was a strong positive association between the RNFL thickness and the GCC thickness in the glaucomatous cases.https://amj.journals.ekb.eg/article_230464_2c0d5c92aa916aaf98c3bb8f20f4d85f.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401THE EFFECT OF MATERNAL OBESITY ON SONOGRAPHIC FETAL WEIGHT ESTIMATION98999823046510.21608/amj.2022.230465ENAhmedSalah AliDepartment Obstetrics and Gynecology, Faculty of Medicine, Al- Azhar UniversityMofeedFawzy MohamedDepartment Obstetrics and Gynecology, Faculty of Medicine, Al- Azhar UniversityWaelSoliman TahaDepartment Obstetrics and Gynecology, Faculty of Medicine, Al- Azhar UniversityJournal Article20220411<strong>Background:</strong> Obesity is one of the most serious public health challenges of the 21st century. Obesity has reached epidemic proportions worldwide. American College of Obstetricians and Gynecologists committee opinion, estimated that at least one- third of pregnant women are obese, and 8% are extremely obese.
<strong>Objective:</strong> To detect the possible effect of maternal obesity on the accuracy of ultrasound fetal weight estimation during the third trimester shortly before labor.
<strong>Patients and Methods:</strong> A prospective, comparative study was conducted at Om El Masryeen Hospital from August 2019 to August 2020. One hundred and fifty (150) singleton pregnant women who fulfilled the inclusion criteria were included in the study. All pregnant participants were between 37 and 42 weeks of gestation with a singleton cephalic presentation, and none of the participants had any medical or obstetrical problems. In the present work, women were classified into five BMI categories based on their current BMI each group included 30 patients. The study population was drawn from consecutive patients who underwent sonographic fetal weight estimation within 7 days of delivery and actual birth weight within thirty minutes after delivery.
<strong>Results:</strong> By comparison between groups, we found that the mean of age was 27.4 ± 6.03 years, 27.8 ± 4.9 years, 28.8 ± 4.3 years, 28.6 ± 5.2 years and 28.6 ± 4.88 years in the normal weight, overweight, class I, class II and class III groups, respectively. Estimated fetal weight by ultrasound was 2.89±0.30kg, 3.00± .28kg, 3.21 ± .35kg, 2.99 ± 0.39kg and 3.31 ± 0.55kg in the normal weight, overweight, class I, class II and class III groups, respectively. Regarding actual birth weight was 2.95 ± 0.35kg, 3.09 ± 0.30kg, 3.23±0.34kg, 2.92 ± 0.45kg and 3.13±0.55kg in the normal weight, overweight, class I, class II and class III groups, respectively. Statistically significant difference between ultrasound (US) estimated fetal weight (EFW) and birth weight versus body mass index in obesity class II and III.
<strong>Conclusion:</strong> Maternal obesity decreased the accuracy of sonographic fetal weight estimation. Clinicians should be aware of the limitations of sonographic fetal weight estimation, especially in obese patients.https://amj.journals.ekb.eg/article_230465_f648ff8a7674422c7d89c30301c2f35a.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401COMPARATIVE STUDY BETWEEN SERUM CALCIUM AND MAGNESIUM LEVELS IN PRE ECLAMPSIA VERSUS NORMAL PREGNANCY999101423046610.21608/amj.2022.230466ENMohammedGamal Mohammed El-MaghrabyObstetrics and Gynecology resident at Kafr El-Shiekh General Hospital, EgyptAbd El-MonaemMohammed ZakaryaObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University, EgyptMahmoudAbd EL-Latif HashishClinical Pathology Department, Faculty of Medicine, Al-Azhar University, EgyptAdelAly El-BoghdadyObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20220412<strong>Background:</strong> Numerous clinical studies had clarified the alliance between preeclampsia and disturbances in maternal biochemical macronutrients, involving serum calcium (Ca+2) and magnesium (Mg+2). Up till now, there is an escalated concern in benefitting from nutritional approach in the preeclampsia management with respect to calcium and magnesium supplementation.
<strong>Aim of the work:</strong> To assess serum levels of calcium and magnesium in pregnant females who suffered from pre-eclampsia in comparison with normal pregnant ladies.
<strong>Patient and methods:</strong> This study was a case-control one that recruited 100 pregnant women (50 pregnant preeclampsia cases and 50 normal pregnant females) from obstetrics clinics of Kafr El-Sheikh General hospital and El-Sayed Galal Hospital of Al-Azhar University after the 20<sup>th</sup> week of gestation during the period of research from February 2020 to December 2020 for estimation off serum calcium and magnesium.
<strong>Results:</strong> The mean serum calcium level in the control group was 8.99 ± 0.52 mg/ dl and mean serum magnesium level was 2.21 ± 0.3 mg/ dl both were higher than those in the patients group as the mean serum Ca+2 was 8.05 ± 0.51 mg / dl and mean serum Mg+2 level was 1.86 ± 0.25 mg / dl (P<0.001). The present study showed that calcium had significantly higher diagnostic accuracy than magnesium to differentiate normotensive pregnant women from preeclamptic pregnant women. ROC curve showed that the optimum cut off for calcium was 8.55 (mg/dL) with sensitivity of 80 % and specificity of 84%, PPV of 83.3%, NPV of 80.8%. Calcium had largest area under the curve (AUC= were 0.898; CI :( 0.840-0.956) (P<0.001), indicating its importance for predicting preeclampsia. While the cut off value of magnesium was less than 2.15(mg/dL), the sensitivity was 88%, specificity was 60%; an area under the ROC curve (AUROC) 0.806(95% CI: 0.721-0.891). In addition, ROC curve showed the optimum cut off for serum calcium was 8.15 (mg /dL) for predicting adverse outcome of pregnancy with sensitivity 60.6% and specificity 86.6%; an area under the ROC curve (AUROC) 0.792(95% CI: 0.701-0.883). While the cut off value of serum magnesium was less than 1.945(mg/dL), the sensitivity was 69.7%, specificity was 67.2% %; an area under the ROC curve (AUROC) 0.726(95% CI: 0.618-0.834).
<strong>Conclusion:</strong> Both serum calcium and serum magnesium in preeclamptic pregnant women were lesser in comparison to their healthy pregnant counterparts. These outcomes support the postulation that there is a cause- consequence liaison between hypocalcaemia and hypomagnesaemia as potential etiologic factors incriminated in of preeclampsia pathogenesis.https://amj.journals.ekb.eg/article_230466_4683fb7f507acbbf8f69a5193af8f8b4.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401UTERINE ARTERY DOPPLER AND UTERO PLACENTAL VASCULATURE IN RECURRENT UNEXPLAINED FIRST TRIMESTER PREGNANCY LOSS1015102423046710.21608/amj.2022.230467ENSherifAktham Mohamed FathyObstetrics and Gynecology Department, Faculty of Medicine, Al Azhar University, Cairo, EgyptEmadAbd El-Rahman El-TemamyObstetrics and Gynecology Department, Faculty of Medicine, Al Azhar University, Cairo, EgyptMofeedFawzy MohamedObstetrics and Gynecology Department, Faculty of Medicine, Al Azhar University, Cairo, EgyptJournal Article20220412<strong>Background:</strong> Recurrent pregnancy loss (RPL) is three or more consecutive pregnancy losses before 20 weeks gestation. After a thorough evaluation, a cause is found in a little more than half of the cases and the rest remain unexplained. Theories suggest that impaired uterine perfusion may be a cause of recurrent unexplained pregnancy loss.
<strong>Objective:</strong> To investigate the color Doppler sonographic parameters, using transvaginal imaging, of uterine artery and utero placental vasculature (retro chorionic vessels), and comparing them between women with no history of pregnancy loss and women with recurrent first trimester pregnancy loss of unexplained cause.
<strong>Patients and Methods:</strong> This study was done in outpatient clinic of Om El Masryeen General hospital, from March 2019 to September 2019. One hundred pregnant women were divided equally into two groups: Group I (study group) included women suffering from recurrent unexplained first trimester pregnancy loss, and Group II (control group) included women with no history of pregnancy loss and at least one live birth at term. Age ranged from 18-40 years, and gestational age ranged from 6-13 weeks.
<strong>Results:</strong> There was a significant increase in mean values of resistance index (RI) and pulsatility index (PI) of both uterine arteries in the study group compared to the control group. In addition, there was a significant increase in mean values of both RI and PI of uterine spiral arteries in the study group compared the control group.
<strong>Conclusion:</strong> Transvaginal Doppler studies detected increased uterine blood flow resistance in recurrent unexplained first trimester pregnancy loss compared to normal population. Therefore, increased uterine blood flow impedance may serve as a cause for recurrent pregnancy loss.https://amj.journals.ekb.eg/article_230467_17a7b1bd38e7f7c42367d55b6f2a6ec3.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401EVALUATION OF YOLK SAC DIAMETER AND SHAPE AND EMBRYONIC HEART RATE AS PROGNOSTIC FACTORS OF FIRST TRIMESTER OUTCOME1025103823046810.21608/amj.2022.230468ENAhmedM. I. SakrResident of Obstetrics and Gynecology, Elmenshawy HospitalMohammedM. GebreelDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityAbdallaK. AhmadDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20220412Approximately 30-40% of implanted pregnancies result in spontaneous abortion during the first trimester. Intrauterine gestational sac appears sonographically, followed by the yolk sac and the fetal pole with cardiac activity. Yolk sac and early embryonic heart rate (EHR) are detected easily by transvaginal sonography. Our purpose was to examine whether yolk sac diameter (YSD) and early EHR could serve as prognostic factors in evaluating pregnancy outcome in 200 pregnant women, examined using 2D transvaginal ultrasonography in the first trimester. Fetal heart rate was measured by M-mode and YSD was determined by placing the calipers on the inner limits of the longer diameter. 184(92%) resulted in an ongoing pregnancy and entered the 2nd trimester successfully, while 16 (8%) resulted in miscarriages. Of the 16 fetal losses, 6 were missed abortions, 4 blighted ovums, 4 incomplete abortions and 2 complete abortions. The maximal embryonic heart rates presented at 9 weeks of gestation were 159 bpm, and then the fetal heart rates gradually decreased to 136 bpm at 12 weeks of gestation. According to yolk sac out of 194 cases with round and regular yolk sac shape, 184 had normal outcome and 10 had failed pregnancy. 6 cases had irregular shaped yolk sac and were diagnosed as abortion on follow up. Therefore, the important ultrasonographic findings suggestive of a poor outcome for the first trimester were the finding of: a small for date CRL, small gestational sac diameter, irregular shape of yolk sac and fetal bradycardia.https://amj.journals.ekb.eg/article_230468_8625c25bdba5ab9640e1e64f77f73076.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401FRAMELESS VERSUS FRAME-BASED STEREOTACTIC BRAIN BIOPSY1039105023046910.21608/amj.2022.230469ENMohammedEmad KhalifaDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityEl-SayedAbd El-Rahman El-MorDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityMohamedHasan MansourDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityAlaaRashad IbrahemDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20220412<strong>Background:</strong> There are several cost issues separating the use of surgical navigation systems and stereotactic frames for simple biopsy which may have implications in this era of health care cost control.
<strong>Objective:</strong> To evaluate the diagnostic, therapeutic role, efficacy, safety, complications and cost of stereotactic brain biopsy performed with a frameless versus a frame-based method.
<strong>Patients and Methods:</strong> This was a prospective study including 20 patients with deep seated brain lesion, morphological stereotactic surgeries performed with frame based stereotaxy (Group A) and frameless stereotaxy (Group B) as main management modality of their treatment, over two years from January 2019 to January 2021. All patients were examined and checked at Al-Azhar University Hospitals, Egypt. Data were collected regarding patient demographics, type of anesthesia, diagnostic yield, total operating room time, length of hospitalization and complication of the two procedures performed.
<strong>Results:</strong> There were no significant differences between the frame-based and frameless biopsy groups with regard to patient demographics, overall histopathology, proportion of nondiagnostic biopsies, incidence of complications. All the cases underwent frame-based stereotactic procedures done under local anesthesia, while the cases underwent frameless stereotactic procedures done under general anesthesia in 9 cases (90%), and local anesthesia in one case (10%). The total operating room time in frame-based biopsies ranged from 90 to 130 min (Mean 106.00, SD =14.30), while in frameless biopsies ranged from 120 to 195 min (Mean 167.00, SD = 22.75). The total time of hospitalization in frame-based stereotactic brain biopsy ranged from 1 to 3 days, mean 1.90+ SD = 0.56), while the total time of hospitalization in frameless stereotactic brain biopsy ranged from 3 to 8 days (Mean 5.1+ SD = 1.37).
<strong>Conclusion:</strong> Frame-based and frameless stereotactic biopsy approaches were equally effective at providing a tissue diagnosis with minimum morbidity and mortality. The frame-based approach, however, required significantly less anesthesia resources, less operating room time and shorter hospital stays, and thus should still be considered a first line approach for stereotactic brain biopsy.https://amj.journals.ekb.eg/article_230469_16e2144102337b965aa8ec080f690895.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401A COMPARATIVE STUDY OF PEDICLE SCREW FIXATION IN DORSOLUMBAR SPINE BY FREEHAND VERSUS IMAGE-ASSISTED TECHNIQUE1051106423047010.21608/amj.2022.230470ENAbdallahA. Abd El-AzizDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMostafaM. Abo El-KheirDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptIbrahimG. EwissDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20220412<strong>Background:</strong> Pedicle screw instrumentation has been used to stabilize the thoracolumbar spine for several decades. Although pedicle screws are originally placed via a freehand technique, there has been a movement in favor of pedicle screw placement with the aid of imaging.
<strong>Objective:</strong> To evaluate the safety and accuracy of pedicle screws placement with a freehand technique versus image-assisted technique.
<strong>Patients and methods:</strong> Patients of this study were divided into two groups: Free-hand group (group I). 18 patients and 108 screws and image assisted (group II) 32 patients and 264 screws). There were mainly for spondylolisthesis, fractures and deformity from March 2019 to November 2020 at Al-Azhar University Hospitals. Incidence and extent of cortical breach by misplaced pedicle screw was determined by a review of postoperative computed tomography (CT) images.
<strong>Results:</strong> A total of 50 patients received 372 free-hand and image assisted placed pedicle screws in the thoracic and lumbar spine. In free hand technique, a total of 8 screws (3.7%) were identified as breaching the pedicle laterally in 4 patients, and 4 screws (4.4%) breaching medially in 2 patients. In image assisted technique, a total of 14 screws (5.3%) were identified as breaching the pedicle laterally in 3 patients and 2 screws (0.75%) breaching medially in one patient. Upper thoracic spine was the most frequent location of screw breach (10.8%). The accuracy rate in our work was 89%% in the free-hand group compared to 94% in the image assisted technique group (p < 0.01).
<strong>Conclusion:</strong> Freehand technique was as good as the image-assisted technique in comparison to safety and accuracy, using both techniques together this can result in high accuracy and efficacy that can reach up to 100%.https://amj.journals.ekb.eg/article_230470_38f0a0e2a12852233e9caa65632c6e5c.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401CHANGES IN UMBILICAL ARTERY DOPPLER INDICES AFTER LOADING DOSE OF MAGNESIUM SULPHATE IN PATIENTS WITH SEVERE PREECLAMPSIA1065107423047110.21608/amj.2022.230471ENKarimHossam El-Din Ahmed ShalabyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMohamedMohamed Ibrahim GebrilDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMohamedMohamed Ibrahim FarahatDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityAliAbd El-Moezz Dahi AliDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20220412<strong>Background:</strong> Preeclampsia is a disease that commonly develops during the 2nd half of pregnancy. There were many attempts to test a variety of biological, biochemical and biophysical markers to predict the occurrence of the disease, but so far there is no reliable screening tests for that as well as no prevention measures could be efficacious for the disease. Doppler ultrasound is considered one of the most important tools for assessment of fetal wellbeing through applying Doppler velocimetry studies on the umbilical artery.
<strong>Objective:</strong> To compare between umbilical artery Doppler indices (resistance index, pulsatility index and the systolic/diastolic ratio) before and after use of loading dose of magnesium sulfate over 20 minutes in pregnant women with severe preeclampsia, and the possible effects of such changes on the mode of delivery and neonatal outcome.
<strong>Patients and Methods:</strong> A prospective observational cohort study in 100 pregnant women was conducted at the Obstetrics and Gynecology Department, Al-Galaa Teaching Hospital. Cases were recruited from the emergency unit during the period from November 2019 to July 2020. Doppler ultrasonography of the umbilical artery underwent before and after intravenous administration of 6 g of magnesium sulfate (loading dose) over 20 minutes. The variables studied were the Doppler velocimetry parameters of the umbilical artery. The comparison of means between the measurements (before and after) of each individual was performed.
<strong>Results:</strong> There was a significant difference between umbilical artery resistance index (RI) before, and 20 minutes after administration of the loading dose of MgSO4. It was found that the loading dose of MgSO4 elicited a slight reduction in umbilical artery resistive index (RI) from before taking it and 20 minutes after (0.69 ± 0.05 vs 0.65 ± 0.05). There was a significant difference between umbilical artery pulsatility index (PI) before, and 20 minutes after administration of the loading dose of MgSO4. There was a statistically highly significant difference of means of umbilical artery Doppler indices after magnesium sulfate. Magnesium sulphate did not affect the neonatal Apgar score, and the need for resuscitation and intensive care unit (ICU) admission.
<strong>Conclusion:</strong> Intravenous administration of magnesium sulfate in pregnant women with severe preeclampsia resulted in a reduction in umbilical artery Doppler indices with reduced resistance to blood flow in these vessels.https://amj.journals.ekb.eg/article_230471_c19371e59f525bee413cdf30f6db4c1b.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401EFFECT OF MODERATE IRON DEFICIENCY ANEMIA DURING PREGNANCY ON MATERNAL AND FETAL OUTCOME1075108623047210.21608/amj.2022.230472ENHaythamB. M. LabibDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAbdullahK. AhmedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMuhamedA. Abd El-MoatyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20220412<strong>Background:</strong> Iron deficiency is the most common nutritional deficiency worldwide, particularly among pregnant women. Because of the increased iron requirements during pregnancy, pregnant women are recognized as the group most vulnerable to iron deficiency anemia.
<strong>Objective:</strong> To evaluate the effect of moderate maternal iron deficiency anemia on maternal outcome (Atonic postpartum hemorrhage or postpartum infections after delivery), and fetal outcome (neonatal weight and Apgar score).
<strong>Patients and methods:</strong> This was a prospective cohort study carried out at Om El-Masryeen General Hospital on 100 pregnant females, during the period from June 2020 to December 2020 who were admitted to the labor ward for delivery, Before delivery blood samples were collected. They were classified into two equal groups according to hemoglobin level. Group 1 (non-anemic group) included pregnant women with hemoglobin level 11 g/dl or more and group 2 (anemic-Group) which included pregnant women with moderate iron deficiency anemia who had hemoglobin level ranging from 7 to <10 g/dl. The patients were delivered either vaginally or by cesarean section according to obstetric indication. After delivery, maternal outcome was assessed for atonic postpartum hemorrhage or postpartum infections after delivery and all newborns were assessed for neonatal weight and Apgar score.
<strong>Results:</strong> There was a significant difference of the demographic residence between both study groups (P<0.05) with higher number of candidates with moderate anemia residing in rural areas. After delivery, the rate of atonic postpartum hemorrhage among anemic group (10%) was higher than that among the non-anemic group (2%). The rate of postpartum endometritis among anemic group (6%) was found to be also higher than that among non-anemic group (2%). The rate of post-cesarean wound infection among anemic group (6.3%) was found to be also higher than that among non-anemic group (0%). The rate of episiotomy wound infection among anemic group (4%) was found to be also higher than that among non-anemic group (0%). There were positive correlations between the maternal parameters (maternal serum hemoglobin, mean corpuscular volume, means corpuscular hemoglobin, serum iron and serum ferritin) and the fetal outcomes (neonatal weight, Apgar score at 1st and 5th minute). There were negative correlations between maternal total iron binding capacity (TIBC) and the fetal outcomes (neonatal weight, Apgar score at 1st minute and 5th minute).
<strong>Conclusion:</strong> Maternal iron deficiency anemia affected both maternal outcome (atonic postpartum hemorrhage and postpartum infections after delivery), and also fetal outcome (neonatal weight, Apgar score at 1st and 5th minutes).https://amj.journals.ekb.eg/article_230472_53bcf54e78e3bb8b7f6d60c039f0f44b.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401CALCIUM LOADING IMPACT ON ENDOVASCULAR MANAGEMENT OF INFRAGENICULAR BLOCK IN DIABETIC PATIENTS1087109623047310.21608/amj.2022.230473ENEmanYoussef El-AzonyDepartment of Vascular Surgery, Faculty of Medicine (Girls), AL-Azhar University, Cairo, EgyptSamehEl-Sayed El-ImamDepartment of Vascular Surgery, Faculty of Medicine (Girls), AL-Azhar University, Cairo, EgyptYahiaKamal SadekDepartment of Vascular Surgery, Faculty of Medicine (Girls), AL-Azhar University, Cairo, EgyptJournal Article20220412<strong>Background:</strong> Diabetes mellitus (DM) is one of the strongest predictors of peripheral arterial occlusive disease, and a significant risk factor for the progression of an asymptomatic disease or claudication into critical limb ischemia (CLI). (CLI) is the most advanced stage of peripheral arterial occlusive disease. The prognosis is poor, with amputation rates up to be 30%.
<strong>Objective:</strong> To assess the calcium burden of infragenicular native vessels in diabetic patients, to clarify its impact on primary and secondary patency rate (1ry and 2ry) and efficacy of endovascular management.
<strong>Patients and Method:</strong> Between 2018 and 2020, data from 30 consecutive diabetic patients with tibial arteries calcifications, at Al-Zahra’a University Hospital. All patients underwent lower extremity computed tomographic angiography (CTA) before the intervention. Based on CTA, tibial artery calcification (TAC) severity was categorized into three groups: minimal calcification (12 patients), intermediate calcification (10 patients), or extensive calcification (8 patients), with a total number of 42 limbs (12 patients were affected bilaterally). Immediate and late outcomes of the interventions were compared.
<strong>Results:</strong> There was a high correlation between calcification of tibial arteries and both DM and smoking. Claudication, rest pain, and major tissue loss presentation between all groups were higher in patients with extensive calcifications. Technical success rate was 88.1%, and primary patency rate was 83.3%. The 2-year patency rate for minimal calcification was 100%, 92.9% in the intermediate group, and 71.4% in the extensive group.
<strong>Conclusion:</strong> The outcomes of endovascular treatment (EVT) for patients with TAC were acceptable, with better technical success in minimal and intermediate calcification than extensive calcified lesions.https://amj.journals.ekb.eg/article_230473_5f6378c5c433009f616406317fb5feb4.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401CORNEAL BIOMECHANICAL CHANGES POST-FLAPLESS FEMTO REFRACTIVE PROCEDURE VS FEMTO-LASIK IN MYOPIC EYES1097111223047410.21608/amj.2022.230474ENHaythamMedhat Siam Abd El-HaleemOphthalmology Department, Faculty of Medicine, Al Azhar UniversityAliAhmed KhalifaOphthalmology Department, Faculty of Medicine, Al Azhar UniversityAhmedGomaa El-MahdyOphthalmology Department, Faculty of Medicine, Al Azhar UniversityJournal Article20220412<strong>Background:</strong> Refractive errors are the most common ocular problem affecting all age groups. They are considered a public health challenge. Recent studies and WHO reports indicate that refractive errors are the first cause of visual impairment and the second cause of visual loss worldwide as 43% of visual impairments are attributed to refractive errors.
<strong>Objective:</strong> To evaluate and compare corneal deformation amplitude in patients prior to and following small incision lenticule extraction (SMILE), and femtosecond laser in situ keratomileusis (Femto-LASIK) using non-contact-tonometer with visualization, and measurement of the corneal deformation response to an air pulse with an ultra-high-speed scheimpflug camera (Corvis®ST).
<strong>Patients and Methods:</strong> The present study included 40 eyes of 20 patients randomly selected from outpatient clinic of Al-Azhar University Hospital and International Femto-Lasik Center from November 2018 till January 2021, divided into 2 equal groups: Group (1) for patients undergoing small incision lenticule extraction (SMILE), and Group (2) for patients undergoing Femtosecond laser in situ keratomileusis (Femto-LASIK).
<strong>Results:</strong> There was a highly statistically significant difference between pre-operative, post-operative 1 month, and Post-operative 3months regarding CCT (µm), MRSE (D), DA (mm), IOPg(mmHg), A1 length (mm), A2 length (mm), A1 time (ms), A2 time (ms), HC Time (ms), HC radius (mm), and Peak distance (mm) in Femto-LASIK, while there was a highly statistically significant difference found between pre-operative, post-operative 1 month, and post-operative 3 months regarding CCT (µm), MRSE (D), DA (mm), IOPg (mmHg), A1 length (mm), A2 length (mm), A1 time (ms), A2 time (ms), HC time (ms), HC radius (mm), and peak distance (mm) in SMILE.
<strong>Conclusion:</strong> Both Femto-LASIK, and SMILE substantially decreased the corneal biomechanical properties with less reduction in the SMILE group. SMILE was more effective, safe, and predictable manner as Fs-LASIK with better outcomes.https://amj.journals.ekb.eg/article_230474_f0d07669e37e51425453b3fb6b90be88.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401TRANSTHORACIC ECHOCARDIOGRAPHY AND TISSUE DOPPLER IMAGING AS PREDICTORS FOR WEANING CRITICALLY ILL PATIENTS FROM MECHANICAL VENTILATION1113113223047510.21608/amj.2022.230475ENEssaHamed MohammedDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar UniversityWealEl-MahdiDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar UniversityMohamedSayed BashandyDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityMostafaIbrahim ShalabyDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar UniversityJournal Article20220412<strong>Background:</strong> The use of invasive mechanical ventilation (MV) sometimes is an inevitable lifesaving step in management of critically ill patients. However, being associated with numerous complications, the invasive MV should be discontinued at the earliest possible time in the course of a patient's illness. Successful, timely weaning and extubation of critically ill patients has a considerable bearing on ultimate outcome.
<strong>Objective:</strong> To evaluate the use of transthoracic echocardiography (TTE) and tissue Doppler imaging (TDI) in predicting failure of weaning of critically ill patients from mechanical ventilation due to cardiac origin.
<strong>Patients and Methods:</strong> This study was done on ninety adult patients of both sexes admitted to the units of anesthesia intensive Care Department at Al-Hussein and Bab El-Sharia Hospitals, Al-Azhar University. The included patients were selected from those who were mechanically ventilated for more than 48 hours, TTE & pulsed tissue Doppler imaging (TDI) performed at the lateral mitral annulus just before initial spontaneous breathing trial and E/E' index should be calculated in patient eligible for weaning. The study conducted during the period from December 2018 to December 2020.
<strong>Results:</strong> Cardiogenic pulmonary edema was the most frequent cause (65.4%) for weaning failure among the studied population and mainly among patients with systolic dysfunction. There were no statistical significant differences between successfully weaned and failed weaning groups regarding demographic data, positive pressure used for ventilation, and the use of diuretics within 48 hours before the SBT.
<strong>Conclusion:</strong> TTE and pulsed wave tissue Doppler imaging performed at the lateral mitral annulus before initiating the spontaneous breathing trial (SBT) were considered a useful bedside tool helping predict failure of weaning from mechanical ventilation in critically ill patients due to cardiac origin.https://amj.journals.ekb.eg/article_230475_7eedb002fb137a03d90142b112fe620b.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401AUDIOMETRIC EVALUATION FOR CHILDREN WITH IDIOPATHIC NEPHROTIC SYNDROME1133114423047610.21608/amj.2022.230476ENAhmedFaisal AminDepartments of Pediatrics and Audiology, Faculty of Medicine, Al-Azhar University, CairoMoftahMohamed RabeeaDepartments of Pediatrics and Audiology, Faculty of Medicine, Al-Azhar University, CairoGehanAbd El-Rahman ElzareaDepartments of Pediatrics and Audiology, Faculty of Medicine, Al-Azhar University, CairoSamehAbd El-Aziz AhmedDepartments of Pediatrics and Audiology, Faculty of Medicine, Al-Azhar University, CairoJournal Article20220412<strong>Background:</strong> The nephrotic syndrome (NS) is a glomerular disease, in which the glomerular capillary wall becomes no longer impermeable to proteins. The organs of the inner ear bear a physiological similarity to the kidney, both being concerned with maintaining the electrolyte concentration gradient. There is an association between renal and inner ear disorders, either genetically determined as in Alport syndrome and branchio-oto-renal syndrome or acquired as in acute kidney injury and chronic kidney disease.
<strong>Objective:</strong> To evaluate hearing status in children with idiopathic nephrotic syndrome and to identify the underlying etiology.
<strong>Subjects and methods:</strong> This was a case controlled study which included 40 patients with idiopathic nephrotic syndrome. Patients were selected according to a certain inclusion and exclusion criteria from those attending the pediatric nephrology clinic, Al-Hussein University Hospital. Those patients have been classified into 2 equal groups: Group 1: Steroid sensitive nephrotic syndrome (SSNS) and Group 2: Steroid resistant nephrotic syndrome (SRNS). Twenty apparent healthy age and gender matched children were included as a control group (group3).
All patients and control subjects were subjected to detailed history, full clinical examination and laboratory assessment including CBC, renal function, serum electrolytes (Na, K, Ca), investigations specific for nephrotic syndrome and audiometric evaluation, and repeated after remission for those who were in relapse.
<strong>Results:</strong> Sensorineural hearing loss (SNHL) was detected in 8 of the 40 patients (20%). Six out of the 20 patients with SRNS (30%) had SNHL (4 mild, 2 moderate) and 2 out of 20 patients with SSNS (10%) had mild sensorineural loss.
<strong>Conclusion:</strong> Hypocalcemia, hypercholesterolemia, and hyponatremia seemed to affect hearing and should be followed up in childhood nephrotic syndrome. Disease flare and steroids using for a long period may also be risk factors for SNHL in children with NS.https://amj.journals.ekb.eg/article_230476_9a3f1ac68942de1733cb0cf2b891724e.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401ROLE OF CHEST ULTRASOUND AND INFERIOR VENA CAVA DIAMETER IN ASSESSMENT OF VOLUME STATUS IN HEMODIALYSIS PATIENTS1145115423047710.21608/amj.2022.230477ENMabroukMokhtar Mabrouk El-AtarDepartments of Internal Medicine Faculty of Medicine, Al-Azhar UniversityNabilFathy Esmael HasanDepartments of Clinical Pathology Faculty of Medicine, Al-Azhar UniversityFareedShawky BasionyDepartments of Chest Diseases Faculty of Medicine, Al-Azhar UniversitySafwatFarrag AhmedDepartments of Internal Medicine Faculty of Medicine, Al-Azhar UniversityJournal Article20220412<strong>Background:</strong> Fluid balance is important in hemodialysis patients. ‘‘Dry’’ weight is usually assessed clinically, and also biochemical markers is considered reliable. The use of chest ultrasound to assessment of volume status received growing attention in clinical research in hemodialysis patients. Ultrasonographic lung comets (counting B-lines artifact) evaluate extravascular lung water, while ultrasonography of inferior vena cava (IVC) estimates central venous pressure. So, ultrasound is considered as a useful tool to evaluate the volume status of hemodialysis patients.
<strong>Objective:</strong> To assess the role of chest ultrasound and inferior vena cava diameter in assessment of volume status before and after a dialysis session in hemodialysis patients.
<strong>Patients and Methods:</strong> This was across-sectional study carried out at Hemodialysis Unit, Al-Hussein University Hospital, over a period of one year from September 2019 to September 2020, and conducted on 50 hemodialysis patients. Demographic data and clinical information were recorded. Laboratory data including CBC, urea, creatinine, calcium, phosphate and albumin were evaluated. Radiological examination included ultrasound lung B-lines score and diameter of inferior vena cava (IVC) before and after dialysis session.
<strong>Results:</strong> The mean lung B-lines score before dialysis was high and decreased significantly after dialysis. There was a significant improvement of pulmonary congestion manifested by reduction in number of B lines after hemodialysis. There was a significant positive correlation between the mean lung B-lines score and IVC diameter both before and after dialysis. There was no significant relation between clinical data of studied patients and degree of U/S finding after hemodialysis as regards age, sex, smoking, and associated disorders.
<strong>Conclusions:</strong> Chest US is a well‐validated simple and low‐cost technique, and can be easily applied by nephrologists at the bedside to assess of volume status before and after a dialysis session and detect pulmonary congestion at a pre-clinical stage that is associated with a high death risk, and to justify dry weight in hemodialysis patients.https://amj.journals.ekb.eg/article_230477_65fe53fbc92e73d7387d6ed24bdb43e6.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401SERUM VASCULAR CELL ADHESION MOLECULE-1 PREDICTS SIGNIFICANT LIVER FIBROSIS IN NON ALCOHOLIC FATTY LIVER DISEASE1155117023047810.21608/amj.2022.230478ENAhmedReyad IbrahimDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamedNabil RaafatDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHendawyAbd El-Moaty ZidanDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAbd El-RaofAbd El-Raof MahmoudDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20220412<strong>Background:</strong> Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide and is strongly associated with obesity, dyslipidemia and insulin resistance. NAFLD often presents as simple steatosis (NAFL) but can progress to non-alcoholic steatohepatitis (NASH) and fibrosis. Current non-invasive biomarkers are not tailored to identify significant (≥F2) fibrosis, although recent guidelines recommend a stringent follow-up of this patient population.<br /> <strong>Objective:</strong> To investigate the applicability of Vascular Cell Adhesion Molecule-1 (VCAM-1) as non-invasive diagnostic tools for identifying nonalcoholic steatohepatitis -associated fibrosis.<br /> <strong>Patients and Methods:</strong> This study recruited 100 patients attending at Al-Hussein Hospital, Al-Azhar University and Six October University Hospital between June 2019 and June 2020, divided into four equal groups including patients presented with steatosis, patients presented with steatohepatitis, patients with viral cirrhosis and healthy controls. All participants were subjected to full history, clinical examination, laboratory investigations, abdominal ultrasound, fibroscan, and serum VCAM-1.<br /> <strong>Results:</strong> Our study identified serum vascular cell adhesion molecule-1 (VCAM-1) as an independent predictor for ≥F2 fibrosis (median 15.33 vs. 11 ng ml−1 in patients with and without significant fibrosis) with an area under the curve (AUROC) for prediction of ≥ F2 fibrosis which had a good predictive value, and the best cutoff for VCAM-1 was 13 ng ml− 1, with a sensitivity of 70.59% and specificity of 100%.<br /> <strong>Conclusion:</strong> VCAM-1 levels are able to accurately predict significant (≥F2) fibrosis in NAFLD patients.https://amj.journals.ekb.eg/article_230478_a9b75752c5ec26ead08f08079400387c.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401URINARY ANGIOSTATIN AS AN INDICATOR OF LUPUS NEPHRITIS1171118223047910.21608/amj.2022.230479ENAhmedMahmoud Ahmed YassinDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityFawzyHamed HassanDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityMohamedAhmed El-Sayed AhmedDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityAhmedAli AliDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityJournal Article20220412<strong>Background:</strong> Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multi‐organ involvement; among which kidney is one of the most commonly affected organs. Approximately, 35% of adults show signs of lupus nephritis (LN) at the time of SLE diagnosis and 50–60% will develop LN during the first 10 years of disease. LN remains the major cause of morbidity and mortality in SLE patients, either as a result of renal failure or secondary to the side effect of aggressive immunosuppressive therapies.
<strong>Objective:</strong> To early diagnose lupus nephritis, and predict its outcome by assessing urinary level angiostatin.
<strong>Patients and methods:</strong> This was a cross sectional study on 65 patients at the Nephrology Unit of Internal Medicine Department at Al-Hussein University Hospital and Armed forces hospitals between April 2019 and October 2019. Patients in this study were classified into three groups: Group (A): twenty patients clinically active renal systemic lupus erythematosus, Group (B): twenty patients non-active renal systemic lupus erythematosus and Group (C): 25 healthy subjects as a controls.
<strong>Results:</strong> There was a statistically significant difference in urinary angiostatin with p value 0.0001, in addition the linear regression model that showed significant correlation with ISN/RPS, SLEDAI score, and number of organ damaged with a p value < 0.05.
<strong>Conclusion:</strong> Urinary angiotensin can be used as non-invasive method for determination of renal damage in lupus nephritis.https://amj.journals.ekb.eg/article_230479_9f000124c505806a5a49be5c70a3cbc3.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401NEUTROPHIL TO LYMPHOCYTE RATIO AS A PREDICTOR OF PERIPHERAL ARTERIAL DISEASES AMONG REGULAR HEMODIALYSIS PATIENTS1183119223048010.21608/amj.2022.230480ENAmrAbd El-Khaleq El-HashashDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptSafwatFarragDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHazemAyoubDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamedEl-FeshawyDepartment of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20220412<strong>Background:</strong> Peripheral arterial disease (PAD) is common in patients with end-stage renal disease on regular hemodialysis. Neutrophil to lymphocyte ratio (NLR) is considered an indicator of the severity and extent of systemic inflammation and atherosclerosis in patients with renal and cardiovascular disorders.
<strong>Objective:</strong> To assess neutrophil to lymphocyte ratio as a predictor of peripheral arterial diseases in regular hemodialysis patients.
<strong>Patients and Methods:</strong> This cross-sectional study was carried out at Hemodialysis Unit of Al-Hussein University Hospital over a period of six months from January to July 2020, and conducted on 40 hemodialysis patients. Demographic data and clinical information were recorded. Laboratory data including CBC, calcium, phosphate, albumin, cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, iron profile were evaluated. The ankle-brachial index was measured in all patients. PAD was diagnosed if ankle-brachial index (ABI) ≤ 0.9. Duplex ultrasound for arterial system of both lower limbs was done for patient with ankle-brachial index≤ 0.9.
<strong>Results:</strong> There were 29 males (72.5%) and 11 females (27.5%). The mean age of all patients was 43.2 ± 10.3 years. There were 7 diabetic (17.5%) patients, and 27 hypertensive (67.5%) patients. Regarding CBC, the mean of white blood cells (WBCs), neutrophils, lymphocytes, NLR, hemoglobin (Hb) and platelets (PLT) were 6.5 ± 1.7 (x10³/ul), 4.3 ± 1.5 (x10³/ul), 1.74 ± 0.53 (x10³/ul), 2.73 ± 1.3, 10.8 ± 2.3 (g/dl), and 234.7 ± 95.9 (x10³/ul) respectively. Regarding lipid profile, the mean of total cholesterol, high density lipoprotein (HDL) and triglycerides were 214.7 mg/dL, 41.9 mg/dL, 172.2 mg/dL, respectively. Regarding serum albumin, corrected serum calcium (Ca), serum phosphorus (PO4), serum Ca X PO4 product, and parathyroid hormone (PTH), the means were 3.99 ± 0.5 (g/dl), 8.3 ± 0.6 (mg/dl), 5.22 ± 1.1 mg/dl, 43.7 ± 11.2 and 722.1 ± 477.7 (ug/ml) respectively. Regarding to ABI, there were 13 patients (32.5%) ≤ 0.9, while there were 27 patients (67.5%) > 0.9.
<strong>Conclusion:</strong> Neutrophil-lymphocyte ratio (NLR) could be considered as a predictor of peripheral arterial diseases (PADs) among regular haemodialysis patients.https://amj.journals.ekb.eg/article_230480_cf1e68de193ee7da031d1571f9331408.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401STUDY OF SERUM TUMOR NECROSIS FACTOR ALPHA LEVEL IN PREDIABETICS AND TYPE 2 DIABETIC EGYPTIAN PATIENTS1193119823048110.21608/amj.2022.230481ENMahmoudEzzat Abd El-Raouf MohamedDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, CairoYoussefKhalil AhmedDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, CairoEsamMohammed GhamryDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar University, CairoMohamedAbd El-Hamid KhedrDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar University, CairoJournal Article20220412<strong>Background:</strong> Inflammatory cytokines have potential to enhance insulin resistance, prediabetes and hence type 2 diabetes mellitus (T2DM). Tumor necrosis factor alpha (TNF-α) is a cytokine that is released by adipocytes and inflammatory cells in response to chronic inflammation. The current research was taken to study the role of TNF-α in pathogenesis of prediabetes and new onset T2DM in Egyptian subjects.
<strong>Objective: </strong>Measurement of TNF-α level in prediabetics, treatment naive T2DM patients, and healthy persons to assess its possible role in management.
<strong>Subjects and methods: </strong>This study included 30 patients with treatment naive T2DM, 30 prediabetics and 30 control subjects. We assessed serum TNF-α level in all groups by enzyme linked immunosorbent assay (ELISA).
<strong>Results: </strong>Our study showed a significantly higher level of TNF-α in T2DM patients compared to prediabetics and control subjects. TNF-α showed positive correlation with HBA1c.
<strong>Conclusion:</strong> TNF-α is associated with concurrent prediabetes and T2DM and correlates positively with HBA1c.https://amj.journals.ekb.eg/article_230481_7e12a84c61ae49ed59d9451963ec2335.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401EFFECT OF VOLUME, PRESSURE AND PRESSURE CONTROL-VOLUME GUARANTEED VENTILATION ON CARDIOVASCULAR PARAMETERS AND PULMONARY MECHANICS IN OBESE PATIENTS UNDERGOING LAPAROSCOPIC SLEEVE GASTRECTOMY1199120823048210.21608/amj.2022.230482ENHishamMohammed AhmedDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityMaamounMohammed IsmaelDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityMohammedAli SalemDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar UniversityJournal Article20220412<strong>Background:</strong> Optimization of intraoperative mechanical ventilation can decrease the incidence of pulmonary postoperative complications and improve outcome in obese patients.
<strong>Objective:</strong> To study the effect of different modes of ventilation [volume control, pressure control and pressure control volume-guaranteed] with pneumoperitoneum on pulmonary mechanics and cardiovascular parameters and the incidence of post-operative pulmonary complications.
<strong>Patients and methods:</strong> This study was carried out on 90 patients subjected to laparoscopic sleeve gastrectomy operation at Al-Azhar University Hospitals from March 2020 till October 2020. The participants were divided into 3 equal groups according to mode of mechanical ventilation: Group Ⅰ: Volume control ventilation, Group Ⅱ: Pressure control ventilation and Group Ⅲ: Pressure control volume-guaranteed ventilation. Intraoperative parameters (SaPo2, EtCO2, PaCO2, Ppeak, Pplateau, dynamic compliance, exhaled tidal volume, oxygenation index, heart rate, mean ABP) were measured before pneumoperitoneum, 15 minutes after pneumoperitoneum and 5 minutes after desufflation. Postoperative parameters (SaPo2 and PaO2/FiO2 ratio) were measured for 24 hours, every hour during the first six hours, then every 2 hours during the next six hours and every 4 hours during the next 12 hours.
<strong>Results:</strong> Volume control group was the highest group in peak airway pressure, and the lowest group in dynamic compliance before and after pneumoperitoneum and after desufflation. The difference between volume control group and the other two groups [pressure control group, pressure control volume-guaranteed group] was statistically significant.
<strong>Conclusion:</strong> Pressure control ventilation and pressure control volume-guaranteed was lower in peak airway pressure and higher in dynamic compliance compared to volume control ventilation.https://amj.journals.ekb.eg/article_230482_e39950dddd8f72a0c32c4d8c2500e1a8.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401ROLE OF PRI-MIR-34 B/C AND MIR-146A POLYMORPHISM IN THE DEVELOPMENT OF HEPATOCELLULAR CARCINOMA IN EGYPTIAN PATIENTS INFECTED WITH HEPATITIS C1209121823048310.21608/amj.2022.230483ENKhaledE. TawfikDepartment of Hematology, Theodor Bilharz Research Institute, Cairo, EgyptSalamaS. Abd El-LatifDepartment of Clinical Pathology, Faculty of medicine, Al-Azhar University, Cairo, EgyptManalY. ZahranDepartment of Hematology, Theodor Bilharz Research Institute, Cairo, EgyptMostafaM. ShaabanDepartment of Clinical Pathology, Faculty of medicine, Al-Azhar University, Cairo, EgyptRababFouadDepartment of Hematology, Theodor Bilharz Research Institute, Cairo, EgyptJournal Article20220412<strong>Background:</strong> Hepatocellular carcinoma (HCC) is a common trouble all over the world, with highest mortality rate in both males and females. Hepatocarcinogenesis caused by Hepatitis C virus (HCV) results from alterations that may be caused from viral causes or immune mediated as a consequence of chronic inflammation. MicroRNAs (miRNAs) are collections of noncoding RNA contain around 18–25 nucleotides long to influence post-translational gene expression, have been revealed to become involved in HCC outcome.
<strong>Objective:</strong> To determine the association of pri-miR-34b/c rs4938723 (T>C) and miR-146a rs2910164 (C>G) polymorphisms of the Egyptian patients with the risk of the development of HCC which might serve as biomarkers for early diagnosis/prognosis of HCC.
<strong>Patients and Methods:</strong> Thirty five HCC patients, thirty five HCV infected patients, and thirty age and gender matched healthy controls included in this work. Pri-miR-34b/c rs4938723 (T>C) and miR-146a rs2910164 (C>G) polymorphisms were assayed with real time-PCR genotyping assays. This study was carried out over a period from January 2019 and April 2020, at Theodor Bilharz research institute (TBRI).
<strong>Results:</strong> A significant increase in miR-34b/c TT genotype within HCC group and HCV group in comparison to control group was observed (p value = 0.01 and 0.001 respectively). In addition, there was a significant increase in pri-miR-34b/c T alleles in HCC group (p value = 0.03) and HCV group (p value = 0.01) compared to control group.
<strong>Conclusion:</strong> Pri-miR-34b/c TT genotype might serve as a risk factor for HCC development in HCV infected Egyptian population.https://amj.journals.ekb.eg/article_230483_c2587ef4e02e4756920e7a66635c2b10.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401CORRELATIONS HELICOBACTER-PYLORI STOOL ANTIGEN AND ENDOSCOPIC FINDINGS IN PATIENTS WITH PERSISTENT UPPER ABDOMINAL COMPLAINTS1219123323048410.21608/amj.2022.230484ENYasserAbou El-Soud MohammedDepartment of Hepatology and Gastroenterology National Liver Institute- Menoufia UniversityEmanAhmed RewishaDepartment of Hepatology and Gastroenterology National Liver Institute- Menoufia UniversityEl-SayedTharwaDepartment of Hepatology and Gastroenterology National Liver Institute- Menoufia UniversityMahmoudHelmy AllamDepartment of Hepatology and Gastroenterology National Liver Institute- Menoufia UniversityJournal Article20220412<strong>Background:</strong> Helicobacter pylori (H. pylori) is of major concern today because of its causal relationship with gastro duodenal disease. One half of the world’s population has H. pylori infection, with an estimated prevalence of more than 90% in developing countries. Dyspepsia is a prevalent complaint in general practice and gastrointestinal clinics. Since its discovery and H. pylori was attributed for being responsible for many of upper GIT symptoms. The gold standard test for diagnosis is the upper GIT endoscopy with biopsy, however it isn’t available not in all health care facilities beside its invasive nature which is not accepted by many patients.
<strong>Objective:</strong> The aim of this study was to compare the diagnostic accuracy of H. pylori antigen in stool with endoscopic finding in patients with upper abdominal symptoms.
<strong>Patients and methods:</strong> This study included 150 with upper abdominal complaints referred from outpatient as well as inpatient department who had undergone gastric biopsy during upper GI endoscopy for various dyspeptic symptoms. The cases were recruited from Liver Institute, Al Mahalla Al Kobra, Gharbia Governerate, Egypt.
<strong>Results:</strong> Regarding the presenting symptoms, the most common presenting symptom was dyspepsia (53 cases – 39.3%), followed by epigastric pain (53 cases – 35.5%). Abdominal fullness was reported in 15 cases (10%). Stool antigen test was positive in 91 cases (60.7%). Moreover, campylobacter-like organism (CLO) test was positive in 98 cases (65.3%). Endoscopy revealed no abnormality in 29 cases (19.3%). The most common encountered finding was mosaic antral appearance. Antral erosions were diagnosed in 15 cases (10%) whereas erosive gastritis was present in 13 cases (8.6%). Biopsy findings were positive in 115 (76.7%) cases and negative in 35 (23.3%) cases. As compared with results of biopsies, stool antigen test revealed 77.8% sensitivity, 90% specificity and total validity of 85%, with high significant level of agreement between the two techniques.
<strong>Conclusion:</strong> Dyspepsia is the common presentation among cases complaining from upper GIT symptoms. Stool antigen test for H. Pylori revealed high sensitivity in comparison with histopathological findings in diagnosis cases with upper GIT symptoms.https://amj.journals.ekb.eg/article_230484_774b221ac6a07984d9cc96348d30357d.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401ROLE OF IDENTIFICATION AND STIMULATION OF RECURRENT LARYNGEAL NERVE IN THYROID SURGERY1234124823048510.21608/amj.2022.230485ENBahaaEl-Deen El-Sayed Mohamad Abo-ZaidDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar UniversityMostafaShams El-Deen KhafagiDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar UniversityMohamadMahmoud El-SawyDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar UniversityAymanYehia AbbasDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar UniversityJournal Article20220412<strong>Background:</strong> Thyroid surgery was associated with high mortality rates in the early nineteenth century. Recurrent laryngeal nerve injury (RLNI) is a disabling complication of thyroid surgery. Because of the close anatomical relation between thyroid gland and laryngeal nerves, impairment of laryngeal function is a well-known possible complication of thyroid surgery.
<strong>Objective:</strong> To assess the routine identification and stimulation of the recurrent laryngeal nerve (RLN) during thyroid operation, and to assess the risk of recurrent laryngeal nerve injury after the operation.
<strong>Patients and methods:</strong> A prospective study was carried out on cases of thyroid swelling undergoing total thyroidectomy in the Otorhinolaryngology and General Surgery Departments, Al-Azhar University Hospitals. This study included 50 cases: 27 females (54%) and 23 males (46%) ranging in age from 18 to 62 years with a mean of 34.6 years. We did identification of RLN in all cases in both sides with use of intra operative nerve monitoring.
<strong>Results:</strong> There were statistically significant differences between the right and left lobes in the relation between recurrent laryngeal nerve (RLN) and inferior thyroid artery (ITA). In the right lobe, 58.0% of the patients had the RLN placed in between ITA branches, 28.0 % had the RLN posterior to ITA branches, and 14.0 % had the RLN anterior to ITA branched. On the other hand, in the left lobe, 64.0% of the patients had the RLN placed posterior to the ITA, 20% had the RLN placed in between branches of the ITA and 16.0 % had the RLN anterior to the ITA. No statistically significant difference between the right and left lobe in postoperative vocal cord paresis. 2.0% of the studied patients had hoarseness of voice in early postoperative. This percentage disappeared after 48 hours with IV steroid therapy. Only 4.0% of the studied patients had hypocalcemia in early postoperative. This percentage decreased with time till it disappeared after three months. Only one patient had a surgical site infection (5 days after the operation). After histopathology, 88.0% of the studied patients had multinodular goiter, 10.0% had a colloid goiter, and only 2.0% had papillary thyroid carcinoma.
<strong>Conclusion:</strong> Proper assessment of vocal cord functions by indirect and direct laryngoscopy, pre-and post-operatively, is necessary to rule out injuries to these nerves during surgery. Current practice used anatomical dissection to identify and preserve the RLN during thyroid surgery, but nerve stimulation has been suggested as a more effective alternative.https://amj.journals.ekb.eg/article_230485_d6ea39a51d2fda42cb8193dc2f836f2f.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401AUDITORY EVOKED POTENTIAL P300 IN TINNITUS PATIENTS WITH NORMAL HEARING1249126223048610.21608/amj.2022.230486ENNagwaAhmed ShalabyAudio vestibular Unit, E.N.T Department, Faculty of Medicine (girls), Al-Azhar University, Cairo, EgyptMadihaMohamed El-MouslyAudio vestibular Unit, E.N.T Department, Faculty of Medicine (girls), Al-Azhar University, Cairo, EgyptShaimaaEl-Shahat KabilAudio vestibular Unit, E.N.T Department, Faculty of Medicine (girls), Al-Azhar University, Cairo, EgyptJournal Article20220412<strong>Background:</strong> Tinnitus is defined as the perception of sound in the absence of acoustic events. This sound perception or noise emanating from the ears or head ranges from a barely noticeable annoyance to a debilitating chronic condition.
<strong>Objective:</strong> To assess the P300 response in subjects with tinnitus and normal hearing and compare that response with normal hearing subjects without tinnitus.
<strong>Patients and Methods:</strong> In this study we assessed P300 in 20 normal hearing subjects and compared their results with the results of P300 in 20 tinnitus subject with normal hearing. All study subjects underwent full history taking, otological examination, basic audio logical evaluation, otoacoustic emission and electrophysiological test (P300). No significant difference was found between both groups as regard hearing threshold, speech audiometry, immittancemetry and otoacoustic emission.
<strong>Results:</strong> Tinnitus patients had longer P300 latencies than normal subjects which was not significant, and lower P300 amplitude which was significant. These results reflected that tinnitus patients have poor attention ability as the components of long latency auditory evoked potential were influenced by the degree of attention to the stimulus, involvement of the central auditory nervous system, suggesting a participation of the auditory cortex in the generation, and/or tinnitus maintenance.
<strong>Conclusion:</strong> P300 test may be a useful tool for objective assessment of tinnitus patient and to evaluate the neurocognitive status of tinnitus patient.https://amj.journals.ekb.eg/article_230486_d16a9d7f9778cac96f05799ac96d337c.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401EFFECTIVENESS OF ENDOSCOPIC POSTERIOR NASAL NEURECTOMY FOR THE TREATMENT OF INTRACTABLE RHINITIS1263127223048710.21608/amj.2022.230487ENAhmedEl-Sayed Ali MohamedDepartment of Oto-Rhino-Laryngology, Faculty of Medicine, Al-Azhar University, (Cairo and Damietta)MohamedAli AhmedDepartment of Oto-Rhino-Laryngology, Faculty of Medicine, Al-Azhar University, (Cairo and Damietta)MohamedAbd El-Kawy FathallaDepartment of Oto-Rhino-Laryngology, Faculty of Medicine, Al-Azhar University, (Cairo and Damietta)Journal Article20220412<strong>Background:</strong> The Posterior nasal nerve is responsible for nourishing the mucous membrane of the nose with the parasympathetic nervous system.
<strong>Objective:</strong> To evaluate the outcome of posterior nasal neurectomy in patients who have intractable chronic rhinitis by measuring subjective symptoms improvement after surgery, and assess for possible complications.
<strong>Patients and Methods:</strong> This study was conducted on 15 patients above 15 years old with two or more symptoms of rhinitis, refractory to maximum medical therapy for a period of at least 3 or more years and whose quality of life was significantly affected will be randomly selected from the outpatient clinic. Posterior nasal neurectomy was performed in those patients who were eligible for the study after applying the inclusion criteria.
<strong>Results:</strong> The mean symptoms scores for sneezing, rhinorrhea, nasal obstruction and total severity were all decreased from pre-operative levels after the third and sixth month postoperatively. We observed a significant improvement in patients’ quality of life at the end of 6 months post-operatively.
<strong>Conclusion:</strong> Endoscopic resection of the posterior nasal nerve is a safe and less invasive procedure, which can provide a significant relief in of the symptoms of intractable rhinitis, particularly rhinorrhea and nasal obstruction. Fewer complications and better results make it superior over vidian neurectomy.https://amj.journals.ekb.eg/article_230487_cc679607a3e87f557fc5b0fa9f330797.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401SLEEP DISORDERS IN A SAMPLE OF EGYPTIAN PATIENTS WITH MULTIPLE SCLEROSIS (CLINICAL AND POLYSOMNOGRAPHIC STUDY)1273128423048810.21608/amj.2022.230488ENAhmedAbd El-Fattah Mohammed NassarDepartments of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptNabilHussien Mohammed IbrahimDepartments of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohammadAli Saeed HassanDepartments of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20220412<strong>Background:</strong> Sleep disturbances are common symptoms of multiple sclerosis (MS). Patients with multiple sclerosis (MS) often have unrecognized sleep disorders at higher frequency than the general population such as insomnia, sleep disordered breathing, circadian rhythm disorder, restless legs syndrome (RLS), narcolepsy, and rapid eye movement (REM) sleep behavior disorder.
<strong>Objective:</strong> To assess different types of sleep disorders in patients with multiple sclerosis in order to ensure early diagnosis and adequate treatment of such patients.
<strong>Patients and Methods:</strong> All patients with clinically confirmed MS were included in the current study from the MS unit of Neurology Department, Al-Azhar University Hospitals, during the period from October, 2018 to October, 2020. Those patients were furtherly assorted based on McDonald's Criteria, 2017.
<strong>Results:</strong> In the present study, 44 patients with confirmed diagnosis of multiple sclerosis were enrolled. Thirty one (70.45%) of the MS patients were classified as poor sleepers. They had decreased sleep efficiency, increased sleep latency, increased periodic limb movement (PLM) index, respiratory disturbance index (RDI), decreased REM sleep percentages, and decreased depth of sleep.
<strong>Conclusion:</strong> Sleep disorders are frequent in MS patients, prompt recognition and treatment, which is tailored toward the individual’s clinical issues and potential underlying causes, are necessary to optimize functional status and quality-of-life.https://amj.journals.ekb.eg/article_230488_9bffff61bb0f4b5f12703aefb9e50ce8.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401Fractional carbon dioxide laser assisted delivery of topical tazarotene versus topical tioconazole in the treatment of onychomycosis1285129623048910.21608/amj.2022.230489ENRaniaEbrahim MostafaDepartment of Dermatology and Venereology, Faculty of Medicine (Girls), Al-Azhar University, Cairo, EgyptHananMohamed AliDepartment of Dermatology and Venereology, Faculty of Medicine (Girls), Al-Azhar University, Cairo, EgyptHodaKamal Al-SebaayDepartment of Dermatology and Venereology, Faculty of Medicine (Girls), Al-Azhar University, Cairo, EgyptAymanA. FarragDepartment of Dermatology and Venereology, Faculty of Medicine (Girls), Al-Azhar University, Cairo, EgyptJournal Article20220412<strong>Background:</strong> Onychomycosis treatment is still challenging as multiple treatment options are available but there is no fully curative or preventive treatment.<br /> <strong>Objective:</strong> To evaluate the clinical and mycological efficacy of fractional carbon dioxide laser assisted delivery of topical tazarotene versus topical tioconazole in the treatment of onychomycosis.<br /> <strong>Patients and methods:</strong> Forty patients with mycological confirmed onychomycosis. Patients were recruited From the Dermatology outpatient clinic at Al-Zahar, a University Hospital in the period from October 2019 to October 2020. Patients were randomly divided into two equal groups: First group was treated by fractional CO2 laser for 4 sessions at 3-weeks interval plus topical tazarotene 0.1% gel applied once a day on the affected nail plates and nail folds for 12 weeks, and second group was treated by both fractional CO2 laser for 4 sessions at 3-weeks interval plus topical tioconazole solution applied once a day on the affected nail plates and nail folds for 12 weeks. Patients were evaluated in terms of clinical improvement and mycological care. Treatment outcome was evaluated through physician’s evaluation of improvement using physical examination in each follows up session, score clinical index of onychomycosis, and possible side effects.<br /> <strong>Results:</strong> At the end of treatment, Fr CO2 + Tazarotin group, OSI became mild in 10%, moderate in 30%, and severe in 40% after treatment, while in Fr CO2 + Ticonazol group, it became mild in 40%, moderate in 10% and severe in 10% after treatment.<br /> <strong>Conclusion:</strong> Fractional CO2 laser was expected to be an excellent choice for patients in whom systemic antifungals were contraindicated.https://amj.journals.ekb.eg/article_230489_9fdce8a939e74582f04235e77cb94bea.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401Role of Preoperative Vaginal Dinoprostone Versus Misoprostol in Reducing Blood Loss during Abdominal Myomectomy1297131023049010.21608/amj.2022.230490ENAmlAtef MohammedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut), EgyptAhmedAli M. NasrDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut), EgyptMahmoudAhmed M. BadawyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut), EgyptJournal Article20220412<strong>ABSTRACT</strong><br /> <strong>Background:</strong> Myomectomy is a common gynecological procedure that can be approached, depending on fibroid location, hysteroscopically or abdominally. The impact of excessive blood loss can range from anemia and blood transfusion to hysterectomy, prolonged hospital stay and potentially death. In addition to preoperative patient optimization, it is crucial to be proactive to minimise intraoperative blood loss.<br /> <strong>Objective:</strong> To compare the efficacy of preoperative administration of dinoprostone 21 mg versus 400 ug misoprostol vaginally in reducing the amount of blood loss during abdominal myomectomy.<br /> <strong>Patients and methods:</strong> The current study was a prospective randomized double blind controlled study. The study included 90 patients complaining of uterine myoma and indicated for myomectomy selected from the outpatient clinic of Al-Azhar and the outpatient clinic of Al-Eman General Hospital- Assiut. Patients were divided into three equal groups: Group I received 21 mg of Dinoprostone vaginally 2 hours before surgery, Group II received 400 ug of Misoprostol vaginally 2 hours before surgery, and Group III received a placebo vaginally 2 hours before surgery.<br /> <strong>Results:</strong> Estimated intra-operation blood loss was highest among the control group as compared to the Dinoprostone and Misoprostol groups. However, the estimated intra-operation blood loss difference between Dinoprostone and Misoprostol groups was statistically non-significant. Need for intra-operative blood transfusion was significantly highest in the control group (9 cases vs. 3 cases in Dinoprostone and 3 cases in Misoprostol groups). The number of transfused blood units ranged from one to three units without a statistically significant difference between the three studied groups. Post-operative hospital stay ranged from one to three days with non-statistically significant differences between the three studied groups.<br /> <strong>Conclusion:</strong> The use of vaginal misoprostol or dinoprostone is an effective method to reduce intraoperative hemorrhage during abdominal myomectomy. Also, a single, preoperative dose of dinoprostone administered intravaginally could be safe and a reliable method to help decrease blood loss during abdominal myomectomy.https://amj.journals.ekb.eg/article_230490_aac84feac5d31a425e2c08e371113a37.pdfAl-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040051220220401Comparative Effects of Olive Leaves Extract and Silymarin on Hepatic Redox State in Experimentally Carbon Tetrachloride-Induced Liver Injury in Adult Male Albino Rats1311132423322610.21608/amj.2022.233226ENAbd El-LateefSaeed Abd El-LateefPharmacology Departments, Faculty of Medicine, Al-Azhar University (Cairo-Egypt)RedaAbd Rabou FayyadPharmacology Departments, Faculty of Medicine, Al-Azhar University (Cairo-Egypt)AshrafMohamed Mohamed AlgendyMedical Physiology Departments, Faculty of Medicine, Al-Azhar University (Cairo-Egypt)Journal Article20220424<strong>Background:</strong> Liver cirrhosis is the final common pathway of many pathological conditions that affect hepatic tissue. Its prevalence is increasing globally with the highest age-standardized cirrhosis mortality rates in Egypt. Many drugs that were used in the management of hepatic diseases can induce further liver cirrhosis.<br /> <strong>Objective:</strong> To assess the possible hepatoprotective activity of olive leaves extract, and silymarin on experimentally induced liver damage caused by Carbon Tetra Chloride (CCL<sub>4</sub>)-induced liver damage.<br /> <strong>Materials and methods:</strong> Fifty male adult albino groups were randomly assigned into five equal groups: Group (I): control saline (CS) rats were given normal saline orally by gavage as 1 ml/kg/day for 5 weeks, Group (II): control corn oil(CCO) were given corn oil orally by gavage as 1 ml/kg/day twice a week for four weeks Group (III): CCL<sub>4 </sub>- treated group (CCL<sub>4</sub>) were given CCL<sub>4</sub> at a dose of 1ml/kg body weight 4 weeks, twice weekly orally by gavage, diluted with corn oil (1:1) to induce liver fibrosis<em>, </em>Group (IV): Olive leaf extract and the CCL<sub>4 </sub>- treated group (OLE+ CCL<sub>4</sub>) were given olive leaf extract only by oral gavage as100 mg/kg per day for one weak then, olive leaf extract by oral gavage as100 mg/kg per day simultaneously with CCl<sub>4</sub> for 4 weeks, and Group (V): Silymarin & CCL<sub>4 </sub>- treated group (S+ CCL<sub>4</sub>) were given Silymarin only by oral gavage as100 mg/kg per day for one weak, then sylimarin by oral gavage as100 mg/kg per day simultaneously with CCl<sub>4</sub> for 4 weeks. <strong>Results:</strong> CCl<sub>4 </sub>produced marked hepatic injury through inducing oxidative stress in hepatic tissues. This was evidenced by a significant increase in serum AST, serum ALT, and hepatic MDA as well as a significant decrease in serum albumin, hepatic GSD, SOD, and CAT with CCl<sub>4</sub> treatment compared to the control. Both Olive leaves extract and Silymarinprotected hepatic tissue against the hazardous effects of CCl<sub>4</sub> by restoring a balanced redox state of hepatic tissue. This was evidenced by a significant decrease in serum AST, serum ALT, and hepatic MDA as well as a significant increase in serum albumin, hepatic GSD, SOD, and CAT with OLE+ CCL<sub>4 </sub>and S+ CCL<sub>4 </sub>treatment compared to CCl<sub>4</sub>. No significant changes were noted between OLE+ CCL<sub>4 </sub>and S+ CCL<sub>4</sub>. <strong>Conclusion:</strong> Both Silymarin and olive leaves extract have prophylactic protection and ameliorate the hepatotoxic effects of CCl<sub>4 </sub>as both have antioxidant properties. No significant difference was noted between OLE+ CCL<sub>4 </sub>and S+ CCL<sub>4</sub>.https://amj.journals.ekb.eg/article_233226_e58ca56e3dfcdd5387592eb2fac1ca8f.pdf