Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701SHORT TERM EFFECT OF LAPAROSCOPIC SLEEVE GASTRECTOMY ON TYPE 2 DIABETIC MORBID OBESE PATIENTS1575158417732110.21608/amj.2021.177321ENMohamedAbd El-Bary Abd El-LatifGeneral Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamedAhmed SaeedGeneral Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAshrafAbd El-Meneam SayedGeneral Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAl-SayedBasiony MoghazyClinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210613<strong>Background:</strong> Obesity is a medical condition in which excess body fat has accumulated to extend that it may has an adverse effect on health. Leading to reduction of life expectancy or increasing health problems.
<strong>Objective:</strong> To evaluate the improvement in plasma glucose level and lipid profile in type 2 diabetes mellitus obese patients after Laparoscopic Sleeve Gastrectomy (LSG).
<strong>Patients and methods:</strong> This prospective study was conducted at Surgery Department, Al-Azhar University Hospitals during the period between December 2019 and August 2020. Study included 30 cases of type 2 diabetes mellitus morbidly obese patients (with BMI ≥35 Kg/m²) and all of them had failed in trials of conservative management including dietary control, and they were bulky eater but non sweet eater. Laparoscopic sleeve gastrectomy technique was done for all cases.
<strong>Results:</strong> Our result showed that there was a significant improvement of the HbA1c measured at three and six months post-operatively. Five patients (17%) completely cured from T2DM, while 12 patients (40%) became pre-diabetic, and 13 patients (43%) remained diabetic with great improvement of their previous follow up of HbA1c.
<strong>Conclusion:</strong> LSG was efficient in the remission and/or improvement of symptoms of T2DM and other obesity-related comorbidities, with a significant reduction in serum HbA1c and lipid profile.
<strong> </strong>Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701COMPARATIVE EFFECTIVENESS OF MECHANICAL BOWEL PREPARATION WITH AND WITHOUT ORAL ANTIBIOTICS FOR ELECTIVE COLORECTAL SURGERY1585159817732310.21608/amj.2021.177323ENAbd AllahBarakat Abd Allah BassunyDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohammadMohsen SalemDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAymanHelmy EbrahimDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210613<strong>Background:</strong> Surgical site infections (SSI) are a major cause of morbidity after surgery and are associated with increased hospital length of stay, readmissions, costs, and mortality. Surgical site infections are disproportionally high in colorectal surgery and are estimated to affect between 15% and 30% of patients. Surgical site infections (SSIs) increase the cost of care and are associated with increased morbidity and mortality and it is the third most common nosocomial infection.
<strong>Objective:</strong> To clarify oral antibiotics (OAs) use together with mechanical bowel preparation (MBP) patients outcome following elective colorectal surgery.
<strong>Patients and methods:</strong> The current study was conducted at Al-Hussein University Hospital and Kafr Elsheikh General Hospital. We selected forty patients who underwent elective colorectal surgery. All the studied patients were divided into two equal groups: Group I received mechanical bowel preparation with oral antibiotics, and Group II received mechanical bowel preparation with oral antibiotics.
<strong>Results:</strong> We found that there was no significant difference between two groups of patients as regards mean age and sex distribution. Anterior resection was the most frequent surgical procedure done for the two studied groups of patients. The least frequent procedures done for group I patients were radical sigmoidectomy. Total colectomy and sigmoidectomy, the least frequent procedures done for group II patients, were total colectomy and extended right hemicolectomy. However, the difference between the two groups of patient as regards type of surgery and time of closure did not reach the significant value. All studied patients had ileostomy as a type of stoma. As regards complications after surgery, the most frequent complications among patients of group I were pneumonia and ileus. On the other hand, the most frequent complications among patients of Group II were ileus, leakage and intra-abdominal collection. The mean values of hospital stay in days significantly decreased among patients of group 1.
<strong>Conclusion:</strong> Current study suggested a potentially significant role for prophylactic preoperative oral antibiotic in addition to mechanical bowel preparation, in the prevention of postoperative complications during elective colorectal surgery.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701COMBINATION OF ULTRA DOSES BUPIVACAINE PLUS FENTANYL FOR SPINAL ANESTHESIA IN OUT-PATIENT ANAL SURGERIES1599161217824610.21608/amj.2021.178246ENMohammadSobhey Ibrahim Ahmed Al-BaharDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar UniversityAbdulhafezMohammad Al-HosainyDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar UniversityAhmedMahmoud Mohamed El-GarhyDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Minor Anal surgeries such as piles or fissures are common problems among populations which sometimes need surgical interventions and spinal anesthesia is the optimal option for these procedures.
<strong>Objective:</strong> To assess the efficacy of combination of ultra-dose of intrathecal Bupivacaine plus fentanyl as an analgesic procedure for out-patient anal surgeries.
<strong>Patients and Methods:</strong> After approval by the local ethical committee, a prospective, controlled, clinical, randomized study was carried out on 200 patients, and randomly allocated into two equal groups: Group A: received (2.5 mg) 0.5% bupivacaine plus (25μg) fentanyl, and Group B: received 5 mg 0.5% bupivacaine alone. An informed consent was taken from every patient subjected to this study.
<strong>Results:</strong> These studies showed that hemodynamics were more stable in (Fentanyl + Bupivacaine) group than in Bupivacaine only group. Usage of Fentanyl decreased postoperative pain and analgesic consumption in the first 6 hours after surgery along with longer pain free period compared to patients who were given Bupivacaine group.
<strong>Conclusion:</strong> Addition of (25μg) fentanyl to (2.5 mg) 0.5% bupivacaine prolonged the duration of sensory spinal block, and reduced the analgesic requirement during the early post-operative period without increasing the incidence of opioid-related side-effects except pruritus, or delaying hospital discharge in patients undergoing ambulatory anorectal surgery in comparison to using 5 mg 0.5% bupivacaine alone.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701EVALUATION OF BALLOON ANGIOPLASTY IN INFRAPOPLITEAL INTERVENTIONS FOR PATIENTS WITH CRITICAL LIMB ISCHEMIA1613162217824810.21608/amj.2021.178248ENMoaaz AbdallahRamadanDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohamedKamel Al-MezayenDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAbd Al-AzezAhmed Abd El-HafezDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210617<strong>Background:</strong> Peripheral arterial occlusive disease (PAOD) is a major disease that limits active aging in elderly people. Complications of PAOD are the leading cause of hospitalization and amputation for people with lower limb ischemia, and account for billion-dollar expenditures annually around the world.
<strong>Objective:</strong> To assess the balloon dilation angioplasty in limb salvage rate and patency in infra-popliteal arterial occlusive disease.
<strong>Patients and methods:</strong> This study was carried out as a prospective study, in Al-Azhar University Hospitals and 6 October HIO hospital on 20 diabetic patients with critical limb ischemia as defined by Rutherford classification, between Jan, 2019 and July, 2019. Written consents were obtained from all patients. Every patient received an explanation to the purpose of the study.
<strong>Results:</strong> The present study was conducted on 20 diabetic patients, 11 males (55%) and 9 females (45%).Their ages ranged between 50 years and 87 years with a mean age of 66.7. Limb salvage was defined as freedom from major amputation, toe, ray, or trans-metatarsal amputations were considered as minor amputations.
The limb salvage after 6 months was 70%, clinical successes were defined as relief of rest pain or improve healing of the ulcer and limb salvage, based on Rutherford categories. Of 3 patients (15 %) suffering from rest pain, Percutaneous Transluminal Angioplasty (PTA) succeeded in 2 patients (66.7%) and became non-disabling cludicants at more than 400m. PTA failed in one patient (33.3%), who underwent redo angioplasty, but failed again. He received conservative treatment in the form of anticoagulants, antiplatelets and vasodilators without improvement and ended by major amputation. Of 17 patients (85 %) suffering from minor tissue loss, PTA succeeded in 11 patients (64.7%) improve healing was achieved, PTA failed in 6 patients (35.3%) four patients underwent femoro-distal bypass surgery, but failed and diabetic foot infection with osteomyelitis reached up to ankle joint and ended by major amputation. Two patients underwent above knee amputation before six months. Two patients underwent below knee amputation at six months. The other 2 patients underwent above knee amputation before six months due their deterioration of their general condition.
<strong>Conclusion:</strong> Tibial angioplasty demonstrated its feasibility, safety and effectiveness in the treatment of diabetic patients with CLI.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701TEMPORAL LOBE EPILEPSY (PAST, PRESENT, AND THE FUTURE)1623163617824910.21608/amj.2021.178249ENEmadAbd El-Aal Abd El-HaresDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityHamdyMohammed BehairyDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityMohammedAhmed El-LabbadDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> The temporal lobe is the most epileptogenic region of the human brain. There are two types of temporal lobe epilepsy (TLE), the medial involves the medial or internal structures, and neocortical involves the outer portion of the temporal lobe. It can be associated with a magnetic resonance imaging (MRI) lesion or be non-lesional. The main causes of lesional TLE are Herpes simplex, benign tumors, vascular malformations, cortical development malformations, and post-traumatic or post-infectious gliosis.
<strong>Objective:</strong> To discuss temporal lobe epilepsy with all its different causes, evaluating different modalities of treatment, obstacles in applying all modalities in developing countries, and ways to overcome these obstacles with future scope of epilepsy treatment especially temporal lobe epilepsy.
<strong>Patients and methods:</strong> The study performed on twenty patients admitted to Al-Hussein and Sayed Galal University hospitals, and Al-Ahrar teaching hospital. There were pre-surgical evaluations by a multidisciplinary team of neurologists, clinical neurophysiologists, neuroradiologist, epileptologists, psychologists, psychiatrists, and neurosurgeons. Most of cases were temporal lobe lesional epilepsy. Surgical management was carried out for the included patients according to present pathology.
<strong>Results:</strong> Our patients' ages ranged from 7 to 55 years old with the mean age of 21.2 ± 13.79 years. 60% were in 2nd decade. 70% of patients were males and 30% were females, 90% were right handed and 10% left handed. The range of duration of the disease was 2-8 years with the mean 4.1 ± 2.125 years. As regard MRI pathological findings; 10% normal, 10% left temporal sclerosis, 10% right insular dysplasia, 5% right temporal encephalomalacia, 10% temporal covernoma, 10% temporal arachnoid cyst, 5% right temporal epidermoid cyst and 40% temporal neoplastic lesions of MRI findings. 55% Left temporal epileptic discharge, 25% right temporal epileptic discharge, 10% bilateral temporal epileptogenic activity with tendency to generalization and 10% normal of EEG. 65% lesional excision, 10% excision and fenestration of cyst to subarachnoid space, 15% amygdalohippocampectomy, and 15% temporal lobectomy. Among the patients surgically operated, 4 patients (20%) had temporarily complications.
<strong>Conclusion:</strong> Temporal lobe epilepsy surgeries provided a good chance for seizure control when the clinical and radiological data were concordant with seizure semiology, in particular with tumor-related epilepsy. TLE surgery can be safe when performed by experienced surgeons.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701SAFETY AND EFFICACY OF ULTRASOUND GUIDED RADIOFREQUENCY OF DORSAL NERVE OF THE PENIS IN LIFELONG PREMATURE EJACULATION REFRACTORY TO CONVENTIONAL TREATMENT1637164617825110.21608/amj.2021.178251ENAl-SyaadG. Al-SyaadDepartment of Urology Faculty of Medicine, Al-Azhar University, CairoHusseinH. MahmoudDepartment of Urology Faculty of Medicine, Al-Azhar University, CairoMohamedH. HamadaDepartment of Anesthesia, ICU & Pain Management, Faculty of Medicine, Al-Azhar University, CairoYasserA. BadranDepartment of Urology Faculty of Medicine, Al-Azhar University, CairoJournal Article20210617<strong>Background:</strong> Premature ejaculation (PE) is a significant and common medical problem affecting many men worldwide. While PE is not a life- threatening disorder, its effect on quality-of-life (QoL) issues is significant.<br /> <strong>Objective:</strong> To evaluate the feasibility, safety and efficacy of pulse radiofrequency (PRF) of dorsal nerve of the penis in lifelong premature ejaculation refractory to conventional treatment.<br /> <strong>Patients and Methods:</strong> In this prospective study, all adult males complaining from lifelong PE resistant to conventional treatment, and seeking treatment of PE, at Al-Azhar University Hospitals [Al-Hussein and Sayed Galal]; Cairo; Egypt during the period from December 2019 to July 2020 were studied. Detailed history, physical examination, serum testosterone, serum prolactin were obtained. Patients underwent ultrasound guided pulsed radiofrequency of dorsal nerve of the penis. Any operative complications were recorded. To assess the efficacy of the procedure, patients were evaluated by intra vaginal ejaculatory latency time (IELT) and sex satisfaction scale (SSS).<br /> <strong>Results:</strong> As regard SSS, 3 weeks before intervention, all the subjects (20 subjects) were unsatisfied. Three weeks post intervention, 9 (45%) of subjects were satisfied, while 11 (55%) were unsatisfied. Four months post intervention, 8 (40%) subjects were satisfied, and 12 (60%) were unsatisfied SSS 3 weeks post intervention was significantly different from SSS 3 weeks before intervention and 4 months post intervention (p < 0.001). The mean of IELT was 33.4±19, 188.4±154.9, and 141.5±129.7 seconds at 3 weeks before PRF, 3 weeks after PRF, and 4 months after PRF, respectively. A significant difference was found between IELT pre intervention, 3 weeks and 4 months post intervention (p < 0.001). A strong positive correlation was found between IELT and SSS at 3 weeks and 4 months post intervention (p < 0.001& r = 0.78) and (p < 0.001& r = 0.91) respectively. In our study, 4 (20%) patients had pain that relieved by analgesic and 2 (10%) patients had minimal bleeding at site of needle insertion & resolved by compression. No subjects complained of erectile dysfunction nor loss of sensation, while 2 (10%) patients reported superficial infection in first week post intervention which may contribute to uncontrolled DM, 4 (20%) patients had tingling within the first 3 weeks, and 2 (10%) had numbness within the first 3 weeks. All these complications resolved with conservative treatment.<br /> <strong>Conclusion:</strong> PRF is a hopeful treatments in life long PE. Objective data on change in sensation (biothesiometry) and the short term of objective follow-up data are the significant limitations of this study.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701MINI PERCUTANEOUS NEPHROLITHOTOMY VERSUS EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN TREATMENT OF NON LOWER POLAR HIGH DENSITY RENAL STONE 10-20 MM (A PROSPECTIVE RANDOMIZED STUDY)1647165817825310.21608/amj.2021.178253ENMahmoudA. El-MeseryDepartment of Urology, Faculty of Medicine, Al-Azhar University, CairoAbul-fotouhA. Abul-fotouhDepartment of Urology, Faculty of Medicine, Al-Azhar University, CairoHassanA. HassanDepartment of Urology, Faculty of Medicine, Al-Azhar University, CairoJournal Article20210617<strong>Background:</strong> The optimal management of medium sized renal stones differs from one patient to another according to different factors. Stone attenuation value (SAV) is one of these factors which affect stone free rate (SFR) after extracorporeal shock wave lithotripsy (ESWL) with limited effect on mini-percutaneous nephrolithotomy (mini-PCNL).
<strong>Objective:</strong> To compare safety and SFR of mini-PCNL and ESWL in the treatment of non-lower pole renal stones with high density and size of 10-20 mm.
<strong>Patients and Methods:</strong> This prospective randomized study was carried out at Sayed Galal, Al Azhar University Hospital, Cairo, Egypt from November 2019 to October 2020 and included 70 patients with non-lower pole renal calculi 10 to 20 mm. Patients were randomly allocated in 2 equal groups: Group A was treated by mini-PCNL and group B was treated by ESWL. The primary end point was SFRs (no stone or residual 3>mm) in ESWL and mini-PCNL in this category of stone. The secondary end points were the complication rate, retreatment rate, and need for auxiliary procedures in each group.
<strong>Results:</strong> The overall operative time was significantly lower in mini-PCNL group (median: 50.00; IQR: 20.00) compared to ESWL group (median: 55.00; IQR: 28.00) (p= 0.001). The overall fluoroscopy time was significantly lower in mini-PCNL than ESWL (3.2 versus 3.6 minutes, p=0.040). In mini-PCNL group, 32 out of 34 (94.1%) patients were stone free. In ESWL group, 10 out of 33 (30.1%) were rendered stone free after the third ESWL session. The SFR was significantly higher in mini-PCNL group (p < 0.001). In mini-PCNL group, none of cases needed a second look PCNL. The 2 failed cases had significant residual fragments that migrated into inaccessible calyx during pneumatic lithotripsy. In ESWL group, all cases had normal hemoglobin (Hb) level at each follow-up visit. In mini-PCNL group, when comparing pre- and post-operative Hb, a very highly significant differences were observed between pre- and post-operative Hb level (p < 0.001).
<strong>Conclusions:</strong> Mini-PCNL is superior to ESWL in treatment of non-lower pole medium sized renal stones of high density with high SFR, and low complication rate as need for re-hospitalization or need for auxiliary procedure.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701EFFECT OF TADALAFIL ADD-ON THERAPY IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS DUE TO BENIGN PROSTATIC HYPERPLASIA REFRACTORY TO TAMSULOSIN MONOTHERAPY: RANDOMIZED, CONTROLLED TRIAL1659167017825410.21608/amj.2021.178254ENOmarM. NasefDepartment of Urology, Faculty of Medicine, Al-Azhar UniversityAbd El-RhmanE. EbidDepartment of Urology, Faculty of Medicine, Al-Azhar UniversityAymanK. KoritenahDepartment of Urology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Benign prostatic hyperplasia (BPH) is a non-malignant hyperplasia of prostatic cells.Most of patients with BPH present with lower urinary tract symptoms (LUTS). LUTS and BPH are highly prevalent entities in aging men.<br /> <strong>Objectives:</strong> To assess the efficacy and safety of fixed-dose combination therapy of Tamsulosin 0.4 mg plus Tadalafil 5mg versus Tamsulosin 0.4mg, plus placebo once daily in the treatment of patients with LUTS related to BPH whose were refractory to tamsulosin monotherapy.<br /> <strong>Patients and Methods:</strong> In this randomized controlled clinical study, carried out at Al-Azhar University Hospitals, 80 patients complaining of LUTS related to BPH were randomly divided into two equal groups. Fortypatients received fixed-dose combinations therapy of Tamsulosin 0.4mg/day and tadalafil 5mg /day for 6 months (group A), and forty patients received Tamsulosin 0.4mg plus placebo/day for 6 months (group B). The International Prostate Symptom Score (IPSS), Qmax, Post void residual urine (PVRU) and International Index of Erectile Function (IIEF-5) score used at baseline before starting treatment, at 3 months and 6 months to assess the efficacy in both groups.<br /> <strong>Results:</strong> With combination therapy group, there was significant improvement in IPSS score P value (<0.001), significant increase in Qmax P value (<0.001), and significant decrease in PVRU P value (<0.001) compared with placepo group. IIEF- 5 score changes showed no statistically significant difference between bothgroups (P value) (0.102) in tadalafil group.<br /> <strong>Conclusion:</strong> The fixed-dose combination of Tamsulosin 0.4 mg/day and Tadalafil 5 mg/day are significantly superior to Tamsulosin 0.4 mg/day plus placebo for the treatment of LUTS related to BPH whose were refractory to tamsulosin, supporting favorable benefit-risk balance of the fixed-dose combinations therapy for the treatment of LUTS related to BPH because of its synergistic effects, well toleration and safety.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701PRONATOR QUADRATUS VASCULARIZED MUSCLE BONE PEDICLE GRAFT IN NONUNITED SCAPHOID FRACTURE WITH FIXATION1671168217825710.21608/amj.2021.178257ENAhmedMohamed El-NaggarDepartment of Orthopedic, Faculty of Medicine Al-Azhar UniversityIbrahimAhmed HusseinDepartment of Orthopedic, Faculty of Medicine Al-Azhar UniversityMohammedIbrahim Aboul SeoudDepartment of Orthopedic, Faculty of Medicine Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Left untreated, scaphoid nonunion can progress to carpal collapse and a predictable pattern of radiocarpal arthrosis. The goals of surgery for scaphoid nonunion include uniting the fracture and restoring carpal alignment.
<strong>Objective:</strong> To assess the effect of pronator quadratus vascularized muscle bone pedicle graft in scaphoid nonunion with fixation.
<strong>Patients and Methods:</strong> The study was conducted on 20 patients with a history of scaphoid fracture since three months ago and no clinical or radiological signs of healing at Al-Azhar University Hospitals from January 2018 till February 2019. The patients underwent pronator quadratus vascularized muscle bone pedicle graft in scaphoid nonunion with fixation.
<strong>Results:</strong> The mean age of the studied cases was 34.27 ± 11.74 years and male predominance with all of the studied patients noted no complications wither early or late and returned to their previous level of activity. All the cases achieved bony union (100%) in a mean of 12.5 weeks. There was improvement in mean radiolunate and scapholunate angles. Average range of motion and modified Mayo score. There were no early complications of surgical site infection or sensory disturbances in the area of the radial nerve. There were also none late septic complications. No radiographic progression of arthritis was noted in any patient within the available follow-up time. All patients returned to their previous level of activity and satisfied with the late clinical and functional results.
<strong>Conclusion:</strong> Volar vascularized bone grafts is an easy method and provides excellent results while needing no special equipment. Bone grafting is the mainstay treatment for non-union scaphoid. Vascularized bone grafts using pronator quadratus osteomuscular flaps have proved to be more biological and more successful treatment option.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701SYSTEMIC REVIEW OF MANAGEMENT OF KNEE OSTEOCHONDRITIS DISSECANS BY MOSAICPLASTY (REVIEW ARTICLE)1683169217825910.21608/amj.2021.178259ENHassanMohamed HassanDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, EgyptMohamedM. BesarDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, EgyptEmadM. ZayedDepartment of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20210617<strong>Background:</strong> Osteochondritis dissecans (OCD) is a pathological process affecting the subchondral bone of the knee in children and adolescents with open growth plates (juvenile OCD) and young adults with closed growth plates (adult OCD). It may lead to secondary effects on joint cartilage, such as pain, edema, possible formation of free bodies and mechanical symptoms, including joint locking.
<strong>Objective:</strong> To detect the osteochondral auto graft Transplantation in Management of OCD Knee as regards clinical outcomes and complications.
<strong>Subjects and methods:</strong> This systematic review include 14 original articles published from January 2014 to June 2019 which was that 14 studies were included prospective studies were the commonest type appeared in 6 studies followed by Case series in 4 studies , retrospective in 3 studies and Randomized controlled trial in one study.
<strong>Results:</strong> Results of the study revealed that the commonest score used to assess outcome was: Knee Injury and Osteoarthritis Outcome Score (KOOS) which used in 5 studies and shows improvement after treatment, International Knee Documentation Committee (IKDC) scores appeared in 4 studies preoperative and postoperative values shows significant increase postoperative, Hospital for Special Surgery (HSS) appeared in one study, and results revealed that 54 cases showed complications, graft failure founded among 16 cases and 34 needs reoperations.
<strong>Conclusion:</strong> On the basis of the good clinical and MRA results obtained at long-term follow-up, mosaicplasty can be considered a safe and reliable option for the treatment of unstable OCD in adult patients.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701THE EFFECT OF BIPOLAR RADIOFREQUENCY ABLATION (NOVASURE ENDOMETRIAL ABLATION SYSTEM) ON ENDOMETRIAL THICKNESS AND BLEEDING IN PATIENTS WITH PREMENOPAUSAL BLEEDING1693170617826110.21608/amj.2021.178261ENSherifM. El-AgamyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityIsmaelT. El-GarhyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityAshrafHamdyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Ablation of the endometrial lining of the uterus as an alternative to hysterectomy was found to be a less invasive and aggressive method. A large number of clinical trials, as well as retrospective analysis of clinical and financial data, has shown that endometrial ablation allows for a lower morbidity and mortality rate and significantly lower procedure costs. Worldwide, endometrial ablation is increasingly being adopted by the gynecological community.
<strong>Objective:</strong> To study the effect of bipolar radiofrequency ablation system on endometrial thickness and bleeding in patients with premenopausal bleeding.
<strong>Patients and Methods:</strong> This was a prospective comparative randomized study including 30 women with premenopausal bleeding not responding to medical treatment performed at Al-Azhar University hospitals and Gamal Abdel Nasser Hospital during the period from April 2016 to October 2018.
<strong>Results:</strong> The majority of the patients improved (83.3%), 19 of them have complete recovery (63.3%), while 6 cases (20.0%) have minor bleeding, 4 cases (13.3%) have bleeding less before treatment, while only one case has no change.
<strong>Conclusion:</strong> Bipolar radiofrequency ablation performed under local anaesthetic in the postmenstrual phase is an effective and efficient method of treating the majority of women who wish conservative surgical treatment for heavy menstrual loss.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701FETAL OUTCOME AND VAGINAL DELIVERY RATES AMONG PRIMIGRAVIDAE WITH UNENGAGED HEAD AT ONSET OF LABOR1707172217826210.21608/amj.2021.178262ENEl-Sayed AhmedEl-DesoukyDepartments of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University, CairoEl-SayedFaragDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, EgyptAttiaMohamedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20210617<strong>Background:</strong> The criteria for diagnosing delivery disorders in the first and second stages of labor remain controversial. It is generally accepted that an elevated position of the fetus in primigravidas during short-term labor may indicate a threat to normal progression of labor due to fetal-pelvic disproportion or obstruction of the fetal passage by tumor or placenta.
<strong>Objective:</strong> To determine fetal outcome and vaginal delivery rates among primigravida with unengaged head at onset of labor.
<strong>Patients and Methods:</strong> This study was conducted on 250 primigravidae with unengaged fetal head presented at term in active labor during the period from January 2019 to December 2019. Any solid indication for cesarean section whether in the mother or the fetus was excluded.
These cases were given a full trial of labor and the progress of each was recorded on a partogram, The mode of delivery, the duration of labor (first and second stage), the weight of the new born and the Apgar score, were all recorded.
Also maternal morbidity and mortality were recorded. Epidural anesthesia was given to the patients on demand, and the effect of it on the mode of delivery, the duration of the first and second stage and the Apgar score were reported.
<strong>Results:</strong> Most of the patients included in the study delivered vaginally (82%) while only 18% delivered by cesarean section. The primigravida with unengaged fetal head at onset of labor, although at risk for C.S, most of them delivered vaginally when were given a full trial of labor and watched carefully. The length of the first and second stage of labor prolonged slightly in these patients. The need for oxytocin augmentation also increased in those patients.
The Apgar score at 1 minute and 5 minutes also decreased in the new-born of these primigravidae. There were no differences in maternal morbidity among the primigravidas presented with unengaged fetal head and those presented with engaged fetal heads. The use of epidural anesthesia did not affect the rate of C.S. although it may lengthen the duration of the first and second stage of labor. In addition, Apgar score was not affected by the use of epidural.
<strong>Conclusion:</strong> The primigravida with unengaged fetal head at onset of labor, although at risk for C.S., most of them delivered vaginally with a full trial of labor and watching carefully.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701EFFECT OF HYOSCINE-N-BUTYL BROMIDE ON CERVICAL EFFACEMENT AND DILATION DURING NORMAL LABOR1723173417826410.21608/amj.2021.178264ENHossamAbd El-Hady Ismail AbdullahDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut)YousryOmar Salim Al-MaraghiDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut)AhmedHashim MohammedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut)OsamaAbd El-AzemDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut)Journal Article20210617<strong>Background:</strong> Labor is a multifactorial and dynamic process which involves myometrial contraction, cervical ripening and dilation and the expulsion of the fetus and placenta in an orderly manner.
<strong>Objective:</strong> To study the efficacy and safety of Hyoscine-N-butyl bromide (HNBB) on enhancement of cervical effacement and dilation during normal labor, duration of labor and mode of delivery compared to the control group.
<strong>Patients and methods:</strong> This was a randomized un blinded controlled trial was conducted on pregnant women in active phase of first stage of labor from those attendant labor ward of Obstetrics and Gynecology Department at Sohag General Hospital. 200 pregnant women were recruited to this study and divided into 2 equal groups. Study group received Buscopan 20 mg diluted in 9 ml saline slowly intravenously and control group received 10 mL normal saline.
<strong>Results:</strong> The mean duration of active phase of labor in the study group and control group was found to be 186 and 338 minutes respectively (p value = 0.0001). No significant difference was observed in the duration of second and third stage of labor, mode of delivery, birth weight, Apgar score and color of the liquor in both the groups.
<strong>Conclusion:</strong> Administration of HNBB i.v. significantly reduced the duration time of cervical dilation in the active phase of first stage of labor, thereby reducing the total duration of labor. Hyoscine –N- butyl bromide is a new aid in the management of uncomplicated labor for a convenient shorter and safer physiological delivery making it more tolerable for the mother.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701PREDICTIVE VALUE OF SERUM TUMOR NECROSIS FACTOR-Α LEVEL AND UTERINE ARTERY DOPPLER INDICES AT 11-13 WEEKS' GESTATION IN CASES OF PREECLAMPSIA1735174817826510.21608/amj.2021.178265ENAbdallahArafa TaemyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityIsmaelMohamed Talaat El-GarhyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityOsamaEl-Saeed AliDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityNagahMohammed Abo-MohammedDepartment Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Cytokines are involved in fetoplacental development, and have been suggested to be the placental factor capable of damaging endothelial cells and contributing to many of the pathophysiological changes associated with preeclampsia. Uterine artery Doppler measurements show that impedance to flow in the uterine arteries decreases with gestational age in normal pregnancies. That impedance to flow is increased in established pre-eclampsia and fetal growth restriction (FGR), and this increased impedance predates the onset of the clinical syndrome of pre-eclampsia or FGR.
<strong>Objective:</strong> To determine the validity of using combined biophysical (uterine artery Doppler) and biochemical (TNf- α) markers at 11-13 weeks for early screening for pre-eclampsia.
<strong>Patients and methods:</strong> This study was conducted at the outpatient clinic at Sayed Galal Hospital, Al-Azhar University. This was a prospective cohort study that carried out on three hundred pregnant women who attended to outpatient clinic for antenatal care at 11-13 weeks of pregnancy with 48 missed cases (in the form of 2 IUFDs, 3 preterm labors, 30 miscarriages, and inability to follow 13 cases up).
<strong>Results:</strong> There were no statistically significant differences between women who developed pre-eclampsia and who did not develop pre-eclampsia as regard maternal age and BMI. The mean concentration of sTNF- α, was higher in women who developed pre-eclampsia than in women who did not develop pre-eclampsia, and the differences were statistically significant. The best cut off value of the serum TNF- α is ≥14 pg/ml and at this value, we have sensitivity 67.8%; specificity 98%; PPV 79.4%; NPV 96.4%. The mean PI of the right and the left uterine arteries was higher in women who developed pre-eclampsia than in women who did not develop pre-eclampsia, and the differences were statistically significant. The best cutoff value of the mean uterine arteries was 1.7 and at this value we have 100% sensitivity, 84.4% specificity, 41.7% PPV, 100% NPV.
<strong>Conclusion:</strong> The combination of TNF-α and UA Doppler waveforms almost invariably predicts PET and other adverse pregnancy outcomes; therefore, when used together, biochemistry and ultrasound screening have the ability to improve the sensitivity of screening for PET.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701EFFECT OF MATERNAL BODY MASS INDEX ON PROGRESS AND OUTCOME OF LABOR IN NULLIPAROUS PREGNANT WOMEN1749176017826610.21608/amj.2021.178266ENMohamedAhmed Ragheb MansourObstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar UniversityHossamAl-Din Hussien Kamel SalemObstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar UniversityMohamedMahmoud MohamedObstetrics & Gynecology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Obesity is a widely spread health problem the complications of which are too many whether general or obstetric complications.
<strong>Objective:</strong> The aim of this observational study is to evaluate the impact of increased BMI of nulliparous women on progress of labor, incidence of peri-partum complications (1ry outcome) and neonatal outcome of these women (secondary outcome).
<strong>Patients and Methods:</strong> In this prospective observational study, 150 primigravidas in labor were recruited in Mit Ghamr General Hospital between November 1st, 2019 and April 30th, 2020 and categorized into 5 groups according to WHO BMI classification; Group A contained 50 patients with BMI 18.9-24.9, group B 50 patients with BMI 25-29.9, group C1 20 patients with BMI 30-34.9, group C2 20 patients with BMI 35-39.9 and group C3 10 patients with BMI at least 40. Recruited patients were monitored for their progress of labor (in terms of time of cervical dilation from 4 cm to 10 cm, the accordingly calculated rate of cervical dilation and duration of head descent) and their development of peri-partum complications (cervical dystocia, shoulder dystocia, arrest of head descent, the subsequent potential need for CS, 3rd and 4th degree perineal tears, 1ry post-partum hemorrhage, retained placenta). Neonatal outcome was observed by measuring fetal birth weight, APGAR score at 1 minute and 5 minutes, subsequent potential need for NICU admission and occurance of neonatal jaundice.
<strong>Results:</strong> A statistically significant difference was found regarding progress of labor and neonatal outcome with women in obese groups (C1, C2, C3) having slower progress and worse neonatal outcome, while no statistically significant difference was found regarding mode of delivery and peri-partum complications.
<strong>Conclusion:</strong> Obese women in labor considered high-risk cases that required special measures whether on short-term or long-term basis.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701Effects of Exogenous Progesterone on Fetal Nuchal Translucency Measured By 2d Ultrasonography1761177017826710.21608/amj.2021.178267ENMohammadGomaa Ali Abd Al-JawadDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityFawziAhmed Abd El-AzizDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityWaelSoliman TahaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Progesterone is an essential hormone for the continuation of pregnancy and is prescribed in 13–40% of women with threatened miscarriage, according to the literature. Progesterone shows these effects by releasing certain anti-abortive cytokines, modulation of the maternal immune system (immunological tolerance of the fetus), and with relaxation of uterine muscles.
<strong>Objective:</strong> To evaluate the thickness of fetal nuchal translucency between 11-14 weeks’ gestation among women receiving exogenous progesterone and to compare these findings with controls to determine the effect of progesterone on NT.
<strong>Patients and Methods:</strong> This is a prospective case control study upon pregnant women presented to the obstetric outpatient clinic and fetal medicine unit at Al-Hussien hospital in their first trimester during the period from March 2019 till the end of March 2020. One handred women were included in this study, and they were divided into two equal groups: group A and group B control group. To evaluate the thickness of fetal nuchal translucency between 11-14 weeks’ gestation among women receiving exogenous progesterone and to compare these findings with controls to determine the effect of progesterone on NT.
<strong>Results:</strong> There was a statistical significant correlation between nuchal translucency (NT) among cases and control group as mean thickness in cases was 1.5 cm ranging from 1 cm to 2 cm with ± 0.4 standard deviation, while in control group the mean thickness was 1.2 cm ranging from 0.9 cm to 1.8 cm and ± 0.2 standard deviation and p value 0.001 which correlate statistical significance. Thus exogenous progesterone significantly increases NT thickness when compared with controls. However, none of cases nor control had babies with pathological thickness in the nuchal translucency. Thus none of the studied groups underwent further assessment using biochemical markers in the form of β HCG and PAPP-A nor amniocentesis. The mean NT was s significantly higher in the studied cases taking progesterone. However, this increase was still within the normal range of NT and did not affect the risk of aneuploidy.
<strong>Conclusion:</strong> The mean nuchal translucency significantly increased in cases taking progesterone therapy in the first trimester. However, this increase is still within the normal range of nuchal translucency. Although nuchal translucency was found to be associated to progesterone intake, the dose of which, duration and indication of intake didn’t statistically relate to the thickness of nuchal translucency.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701INFRAPUBIC VERSUS SUBCORONAL SEMI-RIGID PENILE PROSTHESIS IMPLANTATION: A PROSPECTIVE STUDY1771178217826810.21608/amj.2021.178268ENAbd El-RahmanAwadeenDepartment of Plastic & Reconstructive Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptSaadeddinAliDepartments of Andrology & Dermatology Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210617<strong>Background:</strong> Medical treatment accomplished good results in the treatment of erectile dysfunction (ED). However, these results were temporary, whereby approximately 80% of the patients experienced drop out. Penile prosthesis insertion is an outstanding treatment for patients with ED who are refectory to medical treatment or those who desired to leave off pharmacotherapy to gain lasting treatment.
<strong>Objectives:</strong> To assess the safety, efficacy, and sexual and psychological satisfaction among patients with ED who were subjected to subcoronal or infrapubic penile prosthesis implantation.
<strong>Patients and Methods:</strong> The present study was a prospective case-control study that was carried out at Al-Azhar University Hospitals through the entire period of 2016 to 2020. Men with ED that did not respond to medical treatment and had vasculogenic impotence based on penile duplex were included in the study. All patients were submitted to clinical evaluation comprised of detailed sexual and urological history, and physical evaluation. All patients were subjected to frequent follow-up assessment visits for six months after the surgery.
<strong>Results:</strong> This study included a total of 18 patients with ED. Out of them, 9 (50%) patients were subjected to the infrapubic approach, while 9 (50%) patients were treated with the subcoronal approach. Three months postoperatively, all men revealed an average penile length at maximum inflation of 13.4 cm (9.3-17.5 cm). This status was continued for six months in which no patient lost his penile length. Among patients treated with the subcoronal approach, one patient developed penile extrusion one and half months post-operatively due to wound dehiscence secondary to uncontrolled DM. As for the infrapubic group, a patient developed superficial infection and wound dehiscence and responded to antibiotic use and secondary suturing. Another case developed a hypertrophic scar.
<strong>Conclusion:</strong> Erectile dysfunction can be safely and effectively treated by implantation of the penile prosthesis by the subcoronal approach. This approach achieved high satisfactory functional, aesthetic, and psychological outcomes relative to the infrapubic approach.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701THE IMPACT OF LARGE VOLUME LIPOSUCTIOM WITH ADRENALINE ONLY ON THE PREGNANCY AND AESTHETIC OUTCOMES OF INFERTILE OBESE WOMEN1783179817827010.21608/amj.2021.178270ENAbd El-RahmanAwadeenDepartment of Plastic & Reconstructive Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHanyMagedDepartment of Obstetrics & Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210617<strong>Background:</strong> Obesity dysregulates the hypothalamic-pituitary-ovarian axis resulting in ovulatory dysfunction and subsequent infertility. Tumescent liposuction comprised injection of a large volume of lactated Ringer's solution or normal saline, containing super-diluted epinephrine and lignocaine, in the subcutaneous fat. Even though this procedure accomplished accepted results as a body contouring surgery, the association between large-volume liposuction and infertility outcomes was not examined yet.
<strong>Objectives:</strong> To reveal the aesthetic and reproductive outcomes of obese infertile female patients with established underlying hormonal irregularities and submitted to large-volume tumescent liposuction with the use of adrenaline only.
<strong>Patients and Methods:</strong> The present prospective cohort study was conducted at Al-Azhar University Hospitals throughout September 2015 and August 2020. Obese or overweight infertile women within the reproductive age with menstrual irregularities, for at least one year were eligible for inclusion in the present study. These abnormalities were confirmed based on laboratory, and radiological evaluation. The procedure was done under general anesthesia and sterilization with betadine with small stabs in targeted areas. Post-operative pain was assessed using Visual analogue scale (VAS).
<strong>Results:</strong> A total of 18 female patients with established infertility of more than one-year duration were included in this study. Patients were furtherly assorted based on fulfilling Rotterdam criteria into two groups: Group (A) including 10 patients with polycystic ovarian syndrome (PCOS), and group (B) encompassing eight patients without. Clinically, three cases of secondary infertility get pregnant after the procedure, one case get pregnant after eight months and two of them after one year. Furthermore, two cases of primary infertility with PCOS get pregnant after six months and the other after one year. Seven cases of secondary infertility developed dramatic improvement in hormonal profile preparing them for conception without pregnancy. Patients experienced a statistically significant decline in the body mass index (P<0.001, t=61.3). As for patients’ satisfaction, 15 (83.33%) gave a 4 or 5 score to their general appearance. This was reflected in the quality of life in which 13 (72.22%) patients were highly satisfied. No patient complained of uncomfortable postoperative pain.
<strong>Conclusion:</strong> Large-volume tumescent liposuction with use of adrenaline only was a safe, effective, and promising procedure in amending the negative reproductive and aesthetic repercussions of obesity among infertile obese women. These findings were associated with satisfactory pregnancy and cosmetic outcomes, which reflected on patients’ satisfaction. No patient in our cohort experienced discomfort pain despite xylocaine non-use.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701COMPARATIVE STUDY OF CROSS LINKING VERSUS STROMAL PUNCTURE IN KERATOCONUS1799181017827210.21608/amj.2021.178272ENAhmedN. IshakDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityAbd El-GhanyI. Abd El-GhanyDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityAttiatM. MostafaDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Keratoconus is a non-inflammatory condition where the cornea assumes a conical shape because of thinning and protrusion of the corneal stroma. The corneal thinning induces irregular astigmatism, myopia, and corneal protrusion, leading to mild to marked impairment in the quality of vision. Symptoms are highly variable and, in part, depend on the stage of progression of the disorder.
<strong>Objective:</strong> To compare refractive and topographic outcomes between cross-linking (CXL) and corneal stromal puncture in stiffening the cornea and halt the progression of Keratoconus.
<strong>Patients and Methods:</strong> This randomized controlled study included 19 patients (30 eyes) with keratoconus. They were not presenting with any eye disease and had never undergone eye surgery. The total number of subjects meeting the inclusion and exclusion criteria. They were divided into 2 groups, group (A) 9 patient: 15 eyes received cross-linking and group (B) 10 patient: 15 eyes received corneal puncture. All examination, investigation and the procedure were done at El Sayed Galal Hospital and Nour al Hyaa eye Hospital, Cairo.
<strong>Results:</strong> The results showed significant improvement in postoperative value of UCVA, BCVA, than its preoperative value. In addition, a statistically significant decrease of postoperative K1 in both group than its preoperative value while there was a statistically significant increase of K2 postoperative value compared to preoperative value in puncture group, K2 showed significant decease postoperative in CXL group. There was significant increase in corneal thickness postoperatively compared to preoperative values in puncture group, corneal thickness showed significant decrease postoperatively in CXL group. Comparing both groups, there was significant improvement in postoperative UCVA, postoperative BCVA in puncture group than in CXL group. On the other hand, there was a significant decrease in mean of postoperative corneal thickness in CXL group than puncture group.
<strong>Conclusion:</strong> Overall, the results of this study continue to support the efficacy of CXL in progressive keratoconus and explored new modality of its treatment by anterior stromal puncture (ASP), with an improvement in UCVA, and BCVA 3 months after operation.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701EARLY VERSUS DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH MILD ACUTE BILIARY PANCREATITIS1811182417827310.21608/amj.2021.178273ENAhmedEid Saad El-FayoumiDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityMohammadAhmad Abd El-GawadDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityWalidRaafat Abd El-AteyDepartment of General Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Acute biliary pancreatitis and timing of cholecystectomy has always been a challenge for surgeons dealing with biliary pathology. Both the diagnosis and treatment have evolved over the last years with the introduction, and universal application of advanced imaging modalities, as well as endoscopic and laparoscopic procedures.
<strong>Objective:</strong> To compare between index and interval laparoscopic cholecystectomy in the management of acute mild biliary pancreatitis.
<strong>Patients and methods:</strong> This study was carried out on 50 patients with mild acute biliary pancreatitis, period from April 2020 to December 2020. The study had been carried out at Al-Hussein Hospital, Al-Azhar University, and Damanhour National Medical Institute. They were divided into two equal groups: Group A underwent early cholecystectomy within a week of admission, and group B underwent delayed (interval) cholecystectomy 4-6 weeks after discharge.
<strong>Results:</strong> Early group included 3 males (12%) and 22 females (88%), while interval group included 5 males (20%) and 20 females. (80%) ,Regarding age (p=0.209) , mean age ±SD for the index group was 39.40 ± 10.46 years, and range 23 – 59 years , while in the interval group mean age ±SD was 43.40 ± 11.69 years ,and range 22 – 59 years. All cases were subjected to through history taking and complete clinical examination. Abdominal pain was the presenting symptom in all patients (100%), jaundice was present in 10cases (40%) in group A and in 8 cases (32%) in group B. Laparoscopic cholecystectomy (LC) was completed to all patients in group A and group B without conversion to open cholecystectomy. Peristalsis was audible and patients started oral fluid intake in the same day of surgery in all cases. No intraoperative complications took place, and no postoperative complications were recorded. Patients were followed for 3 months post-operatively, no mortality, and no complications were recorded.
<strong>Conclusion:</strong> Laparoscopic cholecystectomy in mild acute biliary pancreatitis was safe and feasible during index admission with no added risks. Postponing cholecystectomy did not alter intra-operative complications.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701THE EFFECT OF ADDITION OF METFORMIN TO CLOMIPHENE CITRATE IN INDUCTION OF OVULATION FOR FEMALES WITH POLYCYSTIC OVARY SYNDROME1825183217827510.21608/amj.2021.178275ENMohamedA. Abd El-AlDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMohamedK. MostafaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMohamedI. FarahatDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Clomiphene citrate is considered first line therapy for ovulation induction for women with polycystic ovary syndrome (PCOS) and infertility the benefits of metformin on insulin sensitivity have been demonstrated in non-diabetic women with PCOS.
<strong>Objective:</strong> Comparing the efficacy of Clomiphene citrate + Metformin, and Clomiphene citrate alone in treatment of anovulation.
<strong>Patients and Methods:</strong> Sixty patients were included in this study and were divided into two equal groups: The first group received (Clomiphene citrate for induction of ovulation starting from day 2 of the cycle for 5 days in a dose of 100 mg/day and Metformin 500mg tablets twice daily; while the second group received only Clomiphene citrate for induction of ovulation starting from day 2 of the cycle for 5 days with a dose of 100mg/day.
<strong>Results:</strong> Both lines of treatment were effective in treatment of PCOS patients without statistically significant difference between Clomiphene citrate +Metformin group, and Clomiphene citrate group as regard ovulation rate. There was a statistically significant decrease in oligomenorrhea after treatment in comparison to their values before treatment in both groups.
<strong>Conclusion:</strong> Both CC+Metformin, and CC alone were effective in treatment of infertility in PCOS patients.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701ASSESMENT OF CORONARY ARTERY BYPASS GRAFTS BY MULTIDETECTOR CT1833184017827810.21608/amj.2021.178278ENEl-SayedAhmed Saeed AhmedDepartment of Radiology, Faculty of Medicine, Al-Azhar UniversityAhmedAbd El-Fattah Abu-RashedDepartment of Radiology, Faculty of Medicine, Al-Azhar UniversityMahmoudIbrahim El-ShamyDepartment of Radiology, Faculty of Medicine, Al-Azhar UniversityIsmailNasr El-SokkaryDepartment of Cardiothorathic Surgery, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Multidetector computed tomography (MDCT) had made a revolution in coronary artery bypass grafts (CABG) evaluation due to high temporal and spatial resolution beside it is beingnon invasive and highly effective in assessment of extra coronary manifestations.
<strong>Objective:</strong> To evaluate the feasibility of high-quality multi-detector computed tomography ((MDCT) in assessment of CABG patients in comparison with conventional coronary angiography.
<strong>Patients and methods:</strong> Fifty patients were enrolled for ECG gated CT of coronary arteries bypass grafts between MAY 2020 and September 2020. Patients subjected to conventional coronary angiography within 10days after MDCT exam. at Al-Hussein University Hospital. Administration of beta blocker and nitroglycerin was done prior to CT exam. Breath hold training was mandatory.
<strong>Results:</strong> Forty six grafts were arterial and 74 were venous. Thirty six of the arterial grafts (78.2 %) were patent, 6 (13 %) were significantly narrowed and 4 (8.8 %) were completely occluded. Regarding venous grafts, 52 (70.2 %) of them were patent, 14 (19 %) were significantly narrowed, 8 (10.8 %) were completely occluded. CT angiography compared to the conventional angiography as a gold standard technique gave us a sensitivity of 100%, a specificity of about 98% and an accuracy of about 93.6% in the assessment of any type of coronary artery grafts.
<strong>Conclusion:</strong> Multi Detector CT is considered the imaging modality of choice at the current days to evaluate the patency and stenosis of coronary artery bypass grafts than the conventional coronary angiography due to its multiple drawbacks.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701THE EFFECT OF CORNEAL ASTIGMATISM ON RETINAL NERVE FIBER LAYER THICKNESS AND OPTIC NERVE HEAD MEASUREMENTS BY OPTICAL COHERENCE TOMOGRAPHY1841184817828310.21608/amj.2021.178283ENMohammadSaad AhmadDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAbu BakrFarid Abu Al-NagaDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptHossamEl-Din Abd El-Monem ZiadaDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210617<strong>ABSTRACT</strong>
<strong>Background:</strong> Optical Coherence Tomography (OCT) is a non-invasive investigative technique that functions as a type of optical biopsy. It has been an important diagnostic tool in evaluation of optic nerve head (ONH) and macula. Evaluation of OCT ONH is essential, since the thickness of the RNFL and ONH parameters can be affected in various optic neuropathies like glaucoma, optic atrophy and optic disc edema.
<strong>Objective:</strong> To evaluate the effect of corneal astigmatism on retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) parameters measured with spectral-domain optical coherence tomography (OCT).
<strong>Methods:</strong> Forty eyes of 32 patients were included in this study.Group I; 20 non/low astigmatic eyes to be compared with Group II; 20 astigmatic eyes (10 eyes have with the rule corneal astigmatism WTR and 10 eyes have against the rule corneal astigmatism ATR). The average corneal astigmatism in group I was -0.33±0.17 D (range -0.5-0 D), in group II it was -3.18±0.87 D (range -4.5- -2 D) in eyes of with the rule corneal astigmatism, and -3.13±0.84 D (range -4.5- -2.25 D) in eyes of against the rule corneal astigmatism. All forty eyes underwent full ophthalmic examination and performed OCT ONH imaging by SD-OCT Angio Vuein Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Cairo, from January to November 2019.
<strong>Results:</strong> No significant difference was noted in the disc area, rim area, vertical C/D ratio and cup volume (all P values > 0.05). There were no significant differences between the two groups in global average RNFL thickness, as well as superior, inferior, nasal and temporal quadrant RNFL thickness (P values > 0.05).
<strong>Conclusions:</strong> corneal astigmatism had statistically insignificant effect on optic nerve head parameters and retinal nerve fiber layer thickness measured with spectral domain optical coherence tomography.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701PREDICTION OF PROLONGED PREGNANCY IN NULLIPAROUS WOMEN BY TRANSVAGINAL ULTRASOUND MEASUREMENT OF CERVICAL LENGTH AT 37 WEEKS OF PREGNANCY1849185817828510.21608/amj.2021.178285ENMahmoudAbd El-Allah MohammedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University Cairo, EgyptAl-SayedMohammad TahaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University Cairo, EgyptAttiaMohammad AttiaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University Cairo, EgyptJournal Article20210617<strong>Background:</strong> Prolonged pregnancy occurs in approximately 10% of all singletone pregnancy and is associated with an increased risk of foetal macrosomia, intrapartum fetal cardiac abnormalities, meconium staining, perinatal death, and cesarean delivery.
<strong>Objective:</strong> To detect the relationship between transvaginal ultrasound measurement of cervical length at 37 weeks of pregnancy and prolonged pregnancy in nullipara.
<strong>Patients and Methods:</strong> This was a prospective study of women attending Mataria teaching hospital was conducted from January 2019 to December 2019. The study included 120 women at 37 weeks of gestation observed till time of delivery. Gestational age was determined from the menstrual history and confirmed by an ultrasound scan and measurement of the crown–rump length in the first trimester, or the head circumference in the second trimester.
<strong>Results:</strong> This study showed that cervical length at weeks can predict the likelihood of prolonged pregnancy and is associated with the gestation at spontaneous onset of labor in low-risk nulliparous women and the best cut-off value for prediction of prolonged pregnancy was 3.3cm with a sensitivity of 80% and specificity of 83.1.
<strong>Conclusions:</strong> Transvaginal ultrasound measurement of cervical length at 37 weeks of pregnancy is important for prediction of the duration of pregnancy in primigravidae.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701ROLE OF DIAGNOSTIC HYSTEROSCOPY IN INFERTILE WOMEN WITH NORMAL HYSTEROSALPINGOGRAM1859187017828810.21608/amj.2021.178288ENAmrM. SleemDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityEL-SayedM. TahaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityAhmedS. MohamedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> The indication for routine hysteroscopy (HSC) in patients undergoing diagnostic hysteroscopy as part of an infertility work up is still a matter of controversy. Although most clinics continue to use hysterosalpingography (HSG) as their routine test to assess the uterine cavity, there is a growing body of literature dealing with the use of HSC as an important instrument to use in the evaluation and treatment of infertile couples.
<strong>Objective:</strong> To evaluate the role of the diagnostic hysteroscopy in infertile women with normal HSG.
<strong>Patients and Methods:</strong> This cohort observational study was carried out at Ahmed Maher Teaching Hospital, Egypt, from November 2019 till May 2020, on one hundred women Patients having primary infertility.
<strong>Results:</strong> The mean age of the studied cases was 29.58 ± 6.75 with range (20-40). The mean period of infertility was 4.89 ± 1.07 with range (3-7), the mean BMI was 28.27 ± 2.13 with range (25-32). There were 10% illiterate, 45% with moderate education and 45% with high education, there were 92% Primigravida and 8% multigravida, and there were 92% with primary type of infertility, and 8% with secondary type of infertility. There were 17% with diabetes, 28% with hypertension and 13% with previous pelvic surgery. Among the studied cases, there were 38 with detected abnormality, i.e. (5%) endometrial polyp, (2%) Cervical Polyp, (6%) cervical stenosis, (3%) chronic endometritis, (3%) hypertrophic endometrium, (2%) atrophic endometrium, (5%) Intrauterine adhesions, (4%) Cornual fibrosis, (2%) cornual inflammation, (4%) Sub mucous myoma and (2%) septum. There was no significant difference between the cases who detected abnormality and who didn’t as regard age, period of infertility, BMI, education, parity and type of infertility. There was no significant difference between the cases who detected abnormality and who didn’t as regard menstrual history. There was no significant difference between the cases who detected abnormality and who didn’t as regard diabetes, hypertension and previous pelvic surgery.
<strong>Conclusion:</strong> The incidence of uterine pathologies (congenital and acquired) in women with primary or secondary infertility approximated 30%, thus, justifying, the use of diagnostic hysteroscopy in the primary routine investigation of infertile women.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701ROLE OF PROPHYLACTIC TRANEXAMIC ACID IN REDUCING BLOOD LOSS DURING ELECTIVE CESAREAN SECTION1871188017829010.21608/amj.2021.178290ENAhmedMohamed El-Seadawy GhanemObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityMofeedFawzy MohamedObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversitySamirKhamis GalalObstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Post-partum hemorrhage (PPH) is a major cause of maternal mortality globally. Tranexamic acid, an anti-fibrinolytic agent is an attempt to prevent this complication.<br /> <strong>Objective:</strong> To identify the efficacy of intravenous (IV) tranexamic acid in reducing blood loss during elective cesarean section (CS).<br /> <strong>Patients and Methods:</strong> A Randomized Controlled Study was conducted on 200 women undergoing cesarean section. They were allocated to either Study or Control group by computer generated random number tables. Tranexamic acid (TXA) was given prior to surgery in study group in addition to the routine care (10 units of oxytocin added to the intravenous drip soon after baby delivery), whereas the control group had routine care alone. Blood loss was measured in both groups. Hemoglobin before and after surgery was estimated, and the percentage of difference was compared.<br /> <strong>Results:</strong> There was a significant reduction in blood loss calculated from placental delivery till end of surgery: 391.95 ml in study group versus 633 ml in control group (p < 0.000). Another parameter studied was the percentage of fall in hemoglobin before and after surgery. Postoperative hemoglobin was significantly higher in study group than control group (p < 0.000); Reduction in hemoglobin was significantly less in study group than control group by (0.76 ± 0.29 gm/dl) (p < 0.000). There were no immediate post-operative complications to the mother and neonate.<br /> <strong>Conclusion:</strong> Tranexamic acid (TXA) significantly reduced the amount of blood loss during Elective Cesarean Section (CS). Use of TXA was not associated with adverse effects. Thus, TXA can be used safely and effectively in subjects undergoing CS.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701CORRELATION BETWEEN LEPTIN, INSULIN AND POLYCYSTIC OVARY SYNDROME1881189217829310.21608/amj.2021.178293ENAshrafFathy MohamedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityAbd El-MoneimMohamed ZakariaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMakkiAbd El-Moneim AliDepartment of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityAhmedOsama Abd El-MotaalDepartments of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Polycystic ovary syndrome (PCOS), a heterogeneous, complex genetic trait of unclear etiology, is an important cause of ovulatory and menstrual irregularity, subfertility and infertility, clinically evident hyperandrogenism, and metabolic dysfunction in women. It is recognized as one of the most common endocrine/metabolic disorders of women.
<strong>Objective:</strong> To investigate the serum levels of insulin and leptin in and their correlation with the endocrine and metabolic peculiarities of PCOS.
<strong>Patients and methods:</strong> This study was carried out on 100 females attending the outpatient clinic of Al Azhar University Hospital seeking conception assistance during the period between April 2019 and august 2020. All women were in the reproductive age group, had primary infertility and diagnosed as having PCOS according to Rotterdam criteria. All patients included within this study were classified under two equal groups: Patient group included women having PCOS, and control group include normal fertile healthy women received no hormonal medication during the last 3 months preceding the study.
<strong>Results:</strong> The biochemical laboratory investigation, including follicle stimulating hormone (FSH) and luteinizing hormone (LH) showed no statistically significant difference between control and patient groups. In contrast, the serum levels of LH/ FSH, free testosterone, fasting insulin and leptin in the patient group showed a significant increase as compared with the control group. Serum leptin level was found to be significantly elevated in overweight and obese patients. No significant differences in serum leptin were noted in normal weight patients. Similarly, serum insulin level was significantly higher in overweight and obese patients compared to overweight and obese control group. The serum leptin levels were plotted against Body mass index (BMI) in both control and patient group, significant correlations were observed. Also, there was a significant positive correlation between serum leptin and serum insulin levels.
<strong>Conclusion:</strong> Women with PCOS have altered leptin and insulin levels which were distinct differences between ovulating and non-ovulating women with PCOS. Also, there were significant differences in the levels of serum leptin levels and insulin levels between normal and overweight/obese women with PCOS.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701COMPARATIVE STUDY BETWEEN OXYTOCIN VERSUS TRANEXAMIC ACID AND ETHAMSYLATE COMBINATION IN REDUCING INTRAOPERATIVE BLOOD LOSS IN MYOMECTOMY1893190817829610.21608/amj.2021.178296ENAmmarM. Al-MorsiDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityKamelN. Abdul-GaleelDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityEl-SayedA. El-DesoukyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210617<strong>Background:</strong> Fibroids are the most common benign pelvic tumors affecting about 20% of women above 35 years of age. The diverse symptomatology of fibroids can be attributed to size, number and location of the tumors. The common symptoms include menorrhagia, infertility, abdominal mass and pressure effects.
<strong>Objective:</strong> To compare the efficacy of tranexamic acid and ethamsylate versus IV oxytocin infusion in reducing blood loss during abdominal myomectomy.
<strong>Patients and Methods:</strong> This study involved ninety women undergoing abdominal myomectomy for symptomatic uterine myoma divided randomly into three equal groups: Group A (Tranexamic acid and ethamsylate group) received 1 g tranexamic acid (2 ampoules of kapron 500 mg) and (1 ampoule of dicynone) IV just before skin incision, Group B (Oxytocin group) received 30 IU of oxytocin in 500 ml normal saline will be administered during myomectomy, and Group C (Saline group) received 110 ml normal saline IV just before skin incision. This study was conducted in Sayed Galal Al-Azhar University Hospital and El-Galaa Teaching Hospital during period time from December 2018 to December 2019.
<strong>Results:</strong> Using 1 g tranexamic acid and 1 ampoule of dicynone in abdominal myomectomy resulted in a significant reduction of blood loss than using 30 IU oxytocin in 500 ml normal saline immediately before the start of the surgery (509.24±57.28 ml in Tranexamic acid and ethamsylate group vs. 720.13±112.62 ml in oxytocin group).
<strong>Conclusion:</strong> Tranexamic acid and ethamsylate are more effective in reducing the transfusion requirement than oxytocin with more stable hematological and hemodynamic profile.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701COMPARATIVE STUDY OF TRANSVAGINAL SONOGRAPHY AND HYSTEROSCOPY FOR THE DETECTION OF PATHOLOGICAL ENDOMETRIAL LESIONS IN WOMEN WITH PERIMENOPAUSAL BLEEDING1909192017849710.21608/amj.2021.178497ENAmrAbd-Allah Roshdy HassanDepartment of Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityEsmailMohamed El-GarhyDepartment of Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityAshrafHamdy MohamedDepartment of Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20210618<strong>Background:</strong> Abnormal uterine bleeding is a common gynecological presentation in outpatient clinic, but is often complex and difficult to diagnose. Abnormal uterine bleeding (AUB) is the main reason in women to refer to gynecologists and accounts for two thirds of all hysterectomies.
<strong>Objectives:</strong> The aim of this study was to compare the diagnostic accuracy of two dimensional transvaginal ultrasound and hysteroscopy referring to histopathology in evaluation of uterine cavity lesions in perimenopausal women with abnormal uterine bleeding.
<strong>Subjects and methods:</strong> This was a prospective cohort study. The study was carriedout at Al Agouza Police Hospital, on fifty women in peri-menopausal period, The study was conducted the period from April 2019 till December 2019. All participants received comprehensive information regarding objective and the expected benefit of the study. All ethical considerations were taken throughout the whole work.
<strong>Results:</strong> The results of the study revealed that sensitivity 2D TVS in detection of endometrial hyperplasia was 100%, specificity was 88.7%, PPV was 73.30%, NPV was 100%, and accuracy was 94% with area under ROC curve 0.99, and sensitivity of hystroscope in detection of endometrial polyp was 36.3%, specificity was 100%, PPV was 100%, NPV was 84.7%, accuracy was 86% with area under ROC curve 0.45.
<strong>Conclusion:</strong> Transvaginal sonography has a moderate diagnostic accuracy in detecting endometrial hyperplasia and other intrauterine pathology. It is safe, acceptable and easily available in most secondary and tertiary care setting and is noninvasive. It should be continued as 1st line diagnostic tool in patients with abnormal uterine bleeding in perimenopausal women.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701DIRECT TROCAR INSERTION IN GYNECOLOGICAL LAPAROSCOPY; A CASE SERIES OF 300 CASES1921193217850110.21608/amj.2021.178501ENMostafaAbd El-Fattah Ahmed DwedarDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMohamedTaher IsmailDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversitySaidMohamed TahaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityMahmoudNashaat Khalaf Abd El-SalamConsultant of Laparoscopic Surgery, Faculty of Medicine, EL-Galaa Teaching HospitalJournal Article20210618<strong>Background:</strong> Laparoscopy is a diagnostic and surgical procedure used in all surgical disciplines.
The rationale for DTI, without prior pneumoperitoneum, is based on the difficulty of grasping and lifting the abdomen after it is distended with gas and the fact that the VN accounts for many complications. It was noted that complications of laparoscopic surgery are mostly entry-related and independent of the complexity of surgery. DTI without pneumoperitoneum was reported to be associated with minimal complications and preferred by some laparoscopic surgeons.
<strong>Objective:</strong> The study aimed to evaluate the patients who will undergo a DTI for laparoscopy, focusing attention on feasibility, safety, benefits and risks of DTI. We also want to discuss some technical aspects, such as the site of the trocar insertion.
<strong>Patients and Methods:</strong> A prospective cohort study had been carried out in El-Galaa Teaching Hospital during the period between August 2015 and December 2019.Three hundred gynecological patients admitted for either scheduled or emergency laparoscopy. The following methods were done: Direct trocar insertion during laparoscopy had been the standard entry for all selected cases without prior pneumoperitoneum. The entry had been performed at the umbilical level.
<strong>Results:</strong> successful pneumoperitoneum was established in 100% patients irrespective of previous surgery, BMI, parity. Mean time to induce pneumoperitoneum was 100.6±19.27 seconds in all patients. 10 patients had a minor omental injury as there was 10 (3.3%) omental adhesions to anterior abdominal wall due to previous surgery. These injuries were very small and managed by laparoscopy.
<strong>Conclusion:</strong> DTI is a very safe and reliable technique for creation of pneumoperitoneum, and should be used routinely instead of closed Veress needle technique.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701ULTRASOUND MEASUREMENT OF TRANSCEREBELLAR DIAMETER (TCD)/ABDOMINAL CIRCUMFERENCE (AC) RATIO IN NORMAL AND GROWTH RESTRICTED FETUSES ABOVE TWENTY WEEKS OF GESTATION1933194417850310.21608/amj.2021.178503ENWaleedHassan Ahmed Mohamed IbrahimDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityIsmaelMohamed MeraDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityAbd El-MonsefAbd El-Hamed SedekDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210618<strong>Background:</strong> Intrauterine growth retardation (IUGR) is an obstetrical syndrome that is generally associated with increased mortality and morbidity. In IUGR, maternal placental blood flow is extremely compromised and that worsen the inter-villous circulation leading to an end-stage fetal distress.
<strong>Objective:</strong> To compare TCD/AC ratio in both normal and growth restricted fetuses in second and third trimesters and to find if there is any correlation between TCD/AC ratio and EFW.
<strong>Patients and methods:</strong> The study was conducted on 100 singleton pregnant women at EL-Sayed Galal University Hospital and Damanhour Teaching Hospital in the period between March 2019 till May 2020 and the patients were divided into two main equal groups. Group I included pregnant females with normally growing fetuses and Group II included pregnant females with growth restricted fetuses above 20 weeks of gestation.
<strong>Results:</strong> This study demonstrated the usefulness of the single cut-off value (13.75%) of the TCD/AC ratio which may contribute to the early identification of SGA infants. The problem lied in identifying the process at the onset or before the IUGR has become severe. Usually the first parameter to decrease is the fetal AC due to depletion of hepatic glycogen and subcutaneous fat stores. The TCD/AC ratio, which utilized a single cut-off value (13.75%) independent of GA, improved diagnostic sensitivity and specificity in these cases. The possible contribution of the TCD/AC ratio in identifying the fetal growth failure itself, which was more important than predicting weight at birth to be further evaluated. There was no correlation between TCD/AC ratio and EFW and no statistical significant correlation between TCD/AC ratio and UA Doppler.
<strong>Conclusion:</strong> In IUGR fetuses, the fetal TCD was less affected than fetal head circumference (HC) suggesting preferential preservation of cerebellar growth relative to other cranial structures. The TCD/AC ratio was helpful in recognizing abnormal fetal growth even when the GA was uncertain since this ratio was gestational age-independent.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701VALUE OF 3-D USS OF PLACENTAL VOLUME, UTERINE AND UMBILICAL ARTERY DOPPLER IN PREDICTION OF PRE-ECLAMPSIA1945195817850610.21608/amj.2021.178506ENSohaFarid Fahim HassanDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityAbd El-MoneimZakariaDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversitySamehSaeed FarajDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210618<strong>Background:</strong> Preeclampsia is a multisystem disorder of pregnancy defined by the combination of new-onset hypertension and proteinuria that contribute substantially to perinatal morbidity and mortality worldwide. Ultrasound can currently be used in the detection of adverse pregnancy outcome for example in Pre-eclampsia where Doppler indices and spectral wave forms are used.
<strong>Objective:</strong> To use Doppler ultrasound for evaluation on of placental volume changes using 3-D USS, as well as abnormalities in uterine and umbilical artery Doppler indices in prediction of pre-eclampsia.
<strong>Patients and Methods:</strong> This study was conducted in Department of Obstetrics and Gynecology of Al-Hussein Hospital, Al-Azhar University during the periods May 2016 till April 2017. This was a prospective observational study that carried on two hundred pregnant women enrolled into two equal groups. Group "A" consisted of 50 primipara and 50 multipara women with known risk factor to develop pre-eclampsia like previous history or medical disorder such as chronic hypertension and Group "B" consisted of 50 primipara and 50 multipara women without any risk factor to develop pre-eclampsia.
<strong>Results:</strong> There was no statistically significant difference between both groups as regard to umbilical artery pulsatility index (PI), while umbilical artery resistance index (RI) and abnormality have higher statistically significant values in group A. There was a statistically significant difference between both groups as regards uterine artery PI, RI, abnormality and persistent notch (p value= 0.025, 0.037, 0.001 and 0.001 respectively). There was statistically significant difference between PC and MG as regards to uterine artery abnormality and persistent notch. There was no statistically significant difference between both groups as regards to placental volume. ROC results revealed that umbilical artery RI, uterine RI, and placental volume cutoff values were higher than 0.67, 0.56, and 43 and the area under the ROC curve was equal to 0.672, 0.851 and 0.527. The sensitivity values of umbilical artery RI, uterine RI, and placental volume were 83.0, 86.5 and 79.2 respectively and the specificity values were 73.3, 60.0 and 62.5 respectively.
<strong>Conclusion:</strong> Three-dimensional Doppler ultrasound results, as well as resistance index from umbilical artery and uterine artery pulsatility index, resistance index, abnormality and persistent notch, could be considered as tools to determine hemodynamic repercussion caused by preeclampsia.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701COMPARATIVE STUDY BETWEEN CARBETOCIN VERSUS OXYTOCIN FOR THE PREVENTION OF ATONIC POSTPARTUM HEMORRHAGE AFTER REPEATED ELECTIVE CESAREAN SECTIONS1959197017850710.21608/amj.2021.178507ENMohamedE. AhmedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptIsmailM. El-GarhyDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptAshrafH. MohamedDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210618<strong>Background:</strong> Postpartum hemorrhage (PPH) is a serious condition remaining the single main cause of maternal morbidity and mortality.
<strong>Objective:</strong> To compare the prophylactic effects of carbetocin with those of oxytocin in the prevention of atonic PPH in patients undergoing repeated elective cesarean section (CS) under spinal anesthesia.
<strong>Patients and Methods:</strong> This comparative study was conducted on 100 pregnant women after 38 weeks underwent elective cesarean section under spinal anesthesia at Al- Azhar University Hospitals (Al- Hussein and Bab Al- Shaaria Hospitals) from April 2019 to October 2020, 50 patients received a single dose of 100 microgram intravenous carbetocin, the other 50 patients received 5 IU of oxytocin IV followed by 20-40 IU of oxytocin infusion on 1000 ml saline with a rate of 150 ml per hour.
<strong>Results:</strong> Patients who received carbetocin developed less major obstetric hemorrhage, required less intervention in the form of uterine massage and less additional uterotonic agents than those received oxytocin. The estimated blood loss was significantly lower in the carbetocin group than the oxytocin group. Also, the carbetocin group showed less incidence of severe anemia and the need for blood transfusion than oxytocin but that was statistically insignificant.
<strong>Conclusion:</strong> Carbetocin appeared to be effective or more as oxytocin for prevention of atonic postpartum hemorrhage in patients undergoing elective cesarean section. Carbetocin reduced the use of additional oxytocics following cesarean section when compared with the licensed dose of oxytocin (5 IU). Also, carbetocin improved the hemodynamic states of the patients, decreased the need for blood transfusion and incidence of severe anemia.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701Corneal Topographic Changes in Patients with Vernal Keratoconjunctivitis Before and After Supratarsal Triamcinolone Injection1971198017850810.21608/amj.2021.178508ENMohamedAl-Moghawery Mohamed Al-TorenyDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityAhmedSalah Abd El-RehimDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityEzzatNabil AbassDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210618<strong>Background:</strong> Vernal keratoconjunctivitis is a very common bilateral inflammation of the cornea and conjunctiva that can lead to vision threatening problems such as shield ulcer and corneal opacity. Variable treatment modalities were tried such as topical and systemic anti-histaminics, topical steroids and mast cell stabilizers. Supratarsal injection of triamcinolone acetonide was proved to be a safe and effective method for treatment of vernal keratoconjunctivitis.
<strong>Objective:</strong> To evaluate changes in corneal topography indices before and after supratarsal injection of triamcinolone acetonide in patients with vernal keratoconjunctivitis.
<strong>Patients and methods:</strong> This study included 30 eyes of 15 patients with vernal keratoconjunctivitis who visited Al-Azhar University Hospitals and Alexandria Ophthalmology Hospital during in the period from June 2020 to December 2020. The patients were treated with supratarsal triamcinolone injection and corneal topography was done for them before and after injection.
Patients were evaluated pre and postoperatively. This included history taking and full clinical examination. Follow up visits 1 day, 1 month and 4 months after injection to assess signs of recovery. Corneal topography with Sirius pentacam was done before injection, 2 months and 4 months after injection to assess corneal topographic changes.
<strong>Results:</strong> There were statistically significant changes in the degree of astigmatism, corneal asphericity and surface asymmetry in some cases after injection. No statistically significant differences were recorded in K readings, corneal thickness or visual acuity.
<strong>Conclusion:</strong> Vernal keratoconjunctivitis was proved to cause changes in corneal topography and lead to changes in visual acuity and patient's refraction. Supratarsal injection of triamcinolone acetonide was an effective way to treat cases of Vernal Keratoconjunctivitis (VKC), and decrease the topographic changes related to this disease.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701COMPARISON OF ADVANCED BIPOLAR TISSUE FUSION TECHNOLOGY (LIGASURE™) HEMORRHOIDECTOMY VERSUS CONVENTIONAL MILLIGAN MORGAN HEMORRHOIDECTOMY1981198817866310.21608/amj.2021.178663ENAhmedAbdulrahman Mohammed AbdullatifDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohammedHassan El-ShafeyDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptYasserAhmed AmerDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210620<strong>Background:</strong> Conventional hemorrhoidectomy is a common surgical procedure which associated with postoperative morbidities such as pain, urine retention, postoperative bleeding and anal stenosis. The use of the Ligasure™ could result in decreased incidence of postoperative pain and complications as it has minimal thermal spread and limited tissue burn.
<strong>Objective:</strong> To evaluate hemorrhoidectomy using advanced bipolar electrocautery tissue fusion technology (LigaSure™) versus conventional Milligan-Morgan technique by monopolar diathermy.
<strong>Patients and methods:</strong> This prospective study included sixty patients scheduled for elective hemorrhoidectomy at Al-Azhar University Hospitals (El-Hussen and Bab Al-sha'reia University Hospitals), Department of Surgery. All sixty patients were divided in two equal comparative groups: Group A underwent conventional Milligan-Morgan hemorrhoidectomy and group B underwent Ligasure™ hemorrhoidectomy. Data of the sixty patients of the study was collected by the mean investigator himself from January 2020 to September 2020, then the analysis of the data was followed by different statistical methods. Such as the chronological presentation, the percentages, the arithmetic averages, and the t test. The data of the study were analyzed by statistical program SPSS, then Microsoft Excel sheets used to graph the results and integrated into Microsoft Word.
<strong>Results:</strong> Ligasure™ hemorrhoidectomy has a major improvement over the conventional technique. Technically, the Ligasure™ method was much simpler and can be safely carried out by relatively inexperienced junior surgeons. In comparison with conventional hemorrhoidectomy, Ligasure™ hemorrhoidectomy had less operating time (17.28 vs 9.85 minutes, p value <0.001) and had less intraoperative blood loss (65 vs. 17 ml, p value: <0.001). The post-operative pain was lesser in Ligasure™ than conventional hemorrhoidectomy. Post procedure complications such as bleeding (3.5% vs 10%), urinary retention (10% vs 20%) and wound infection (14% vs 20%) were all lower in the Ligasure™ group, and shorter postoperative hospital-stay (1.4 vs 3.2 days).
<strong>Conclusion:</strong> Ligasure™ hemorrhoidectomy was a suture less hemorrhoidectomy technique to achieve tissue and vessel sealing. It was safe, simple and effective, with less intraoperative bleeding, postoperative discomfort and other complications in comparison to conventional hemorrhoidectomy.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701EVALUATION OF THYROID FUNCTION TESTS BEFORE AND AFTER SYSTEMIC ISOTRETINOIN TREATMENT OF ACNE VULGARIS PATIENTS1989199617866410.21608/amj.2021.178664ENFayrouzAdel AhmedDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityAmrMohamed ZakyDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversitySamehMohamed Abd El-QodosDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> Acne, also known as acne vulgaris, is a long-term skin disease that occurs when hair follicles are clogged with dead skin cells and oil from the skin. It is characterized by blackheads or whiteheads, pimples, oily skin, and possible scarring.<br /> <strong>Objective:</strong> To evaluate TSH, free T3 and free T4 in patients with acne treated with systemic isotretinoin at baseline and after three months of treatment to find any alteration in TFTs.<br /> <strong>Patients and methods:</strong> This study was conducted on thirty patients with treatment for acne vulgaris. The study was done in Al-Azhar university hospitals from June 2018-February 2019.<br /> <strong>Results:</strong> The mean and standard deviation of age was 30.62 ± (7.6) years. There was no statistical difference in age distribution, i.e. normally distributed. As regard sex, there was 38 (76%) females and 12 (24%) males. The ratio of female to male was 3:1.Serum levels of thyroid function tests were compared by using Wilcoxon comparison test for non-parametric tests. There was a statistically significant difference between both variables. TSH levels markedly elevated in comparison to before treatment. In contrast to TSH levels, T3 and T4 reduced significantly when compared to before treatment levels.<br /> <strong>Conclusion:</strong> Dermatologists need to be aware about possible TFTs abnormalities during systemic isotretinoin therapy. Clinical symptoms regarding thyroid disease for both hypothyroidism and hyperthyroidism should be evaluated regularly at visits, and patients with concomitant thyroid function disease should be monitored for TFTs.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701FOLLOW-UP OF PATIENTS WITH SEVERE PULMONARY HYPERTENSION AFTER MITRAL VALVE REPLACEMENT1997201217866510.21608/amj.2021.178665ENKhaledMohamed Mohamed AliCardiothoracic Surgery Department, Faculty of Medicine, Al-Azhar UniversityMohamedShaffik Hassan AbdallahCardiothoracic Surgery Department, Faculty of Medicine, Al-Azhar UniversityMedhatAhmed Refaie MohamedCardiothoracic Surgery Department, Faculty of Medicine, Al-Azhar UniversityHaythamMohamed Abd El-Moaty HusseinCardiothoracic Surgery Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> Pulmonary hypertension (PH) occurs with an overall prevalence estimated at 15 per one million individuals. PH is only defined in the resting state and is present when the catheter derived mean pulmonary artery pressure (mPAP) exceeds 25 mmHg.<br /> <strong>Objective:</strong> To assess the clinical, echocardiographic, and hemodynamic changes occurring to patients with severe pulmonary hypertension after mitral valve replacement in early and mid-term period.<br /> <strong>Patients and methods:</strong> This study included 40 patients, who underwent mitral valve replacement for mitral valve disease with severe PH > 50 mmHg) were studied prospectively for immediate and midterm (after 2 years) postoperative hemodynamics and outcomes. This study was conducted in Shebeen El-Koom Teaching Hospital during the period August 2016 to December 2019.<br /> <strong>Results:</strong> The early and mid-term results of mitral valve replacement in patients with pulmonary hypertension were good with functional improvement and reduction of pulmonary hypertension. By the end of the study, some complications, which were successfully managed, were reported and survival at two years was 92.5%.<br /> <strong>Conclusion:</strong> Mitral valve replacement (MVR) was safe and effective operation even in patients with severe pulmonary hypertension (PH) with acceptable operative mortality, and a significant improvement in echocardiographic parameters, pulmonary pressure, and NYHA classification.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701FAILED BACK SURGERY SYNDROME2013202217866610.21608/amj.2021.178666ENMohamedRamadan El-SawyDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, EgyptAliKhodairDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, EgyptIslamMohamed Al-AghoryDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20210620<strong>Background:</strong> Chronic low back pain is a serious health problem. Chronic pain affects negatively quality of life and should be treated as interest as personal handicapping issues.
<strong>Objective:</strong> To discuss etiologies and risk factors of failed back surgery syndrome (FBSS) with evaluation of different management modalities to help lowering its incidence and upgrading patient’s outcome.
<strong>Patients and methods:</strong> This was a cross sectional retrospective study on randomized group of patients (50 patients) performed between May 2014 and May 2018 at El Sheikh Zayed specialized hospital. They complained from lower back pain with or without legs pain and had done one or more lumbar surgeries. All patients were subjected to history taking and neurological examination (motor power, stretch signs - strait leg raising, femoral stretch- and bladder control). Radiographic documentation was for all patients including magnetic resonance imaging (MRI) lumbar spinal stenosis (LSS).
<strong>Results:</strong> Forty-four patients (88%) were managed by surgical re-intervention after clinical evaluation including complain analysis and neurological assessment and correlating it with pre-operative radiological findings. Six patients (12%) were found to have no radiological findings correlated to their complaints.
<strong>Conclusion:</strong> Failed back surgery syndrome acts like a malignant disease that we are unable to completely treat it, but we can control it. In our study, we can catch many factors which will help. Patient selection to be fit candidate for lumbar surgery is a main matter.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701SCREENING OF EPIPHORA PATIENTS THROUGH ENDOSCOPIC EXAMINATION OF INFERIOR MEATUS2023203017866710.21608/amj.2021.178667ENMohamedH. MostafaDepartment of Otorhinolaryngology Faculty of Medicine, Al-Azhar University, EgyptAtefA. El-MaraghyDepartment of Otorhinolaryngology Faculty of Medicine, Al-Azhar University, EgyptAhmedM. Abd El-FattahDepartment of Otorhinolaryngology Faculty of Medicine, Al-Azhar University, EgyptJournal Article20210620<strong>Background:</strong> Epiphora is a common disease and has many causes which may be due to obstruction along the nasolacrimal system. Inferior meatus pathology is common but inferior meatus is not routinely evaluated. So, any patient with epiphora, nasal examination is mandatory and inferior meatus must be evaluated.<br /> <strong>Objective:</strong> Examination of the inferior meatus and nasolacrimal duct orifice in patients with epiphora, and estimation of the percentage degree of nasal causes in cases of epiphora,<br /> <strong>Patients and Methods:</strong> This retrospective study was carried out on fifty consecutive patients who attended to outpatient clinic, Al-Azhar University Hospitals (Al-Hussein and Sayed Galal University Hospitals) between September 2019 and June 2020. They were complaining of persistent bilateral or unilateral epiphora. All of them underwent trans-nasal endoscopic examination of inferior meatus for any lesion obstructing the opening of nasolacrimal ducts. This occurred by use of 2.8 mm 30 degree endoscope.<br /> <strong>Results:</strong> There were 15males (30%) and 35 females (70%).The mean age of included cases were 53.16 years. Thirty two patients appeared normal (64%),10 patients with hypertrophied mucosa at the orifice (20%).2 patients with dacryolith (4%), 2 patients with synechia obstructing the orifice (4%), 3 patients with cystic obstruction (6%), and one patient with mucosal plug at the orifice (2%). Females were mostly affected. Most of patients were unilaterally affected and most of them had hypertrophied mucosa at the nasolacrimal orifice.<br /> <strong>Conclusion:</strong> Inferior meatus endoscopy should be routinely performed in patients with epiphora to identify any pathology which may be easily corrected.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701COMPARATIVE STUDY BETWEEN RADIAL AND ULNAR ARTERY ACCESS FOR CORONARY ANGIOGRAPHY AND FOR PERCUTANEOUS CORONARY INTERVENTION2031204417866810.21608/amj.2021.178668ENMahmoudAbbas Abu-SereaCardiology Department, Faculty of Medicine, Al-Azhar UniversitySaadIbrahim Daif Allah Al-ZogheebyCardiology Department, Faculty of Medicine, Al-Azhar UniversityMansourMohamed SallamCardiology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> Transulnar approach had been suggested for elective procedures in patients not suitable for transradial approach. It is as safe and effective as the transradial approach for coronary angiography and intervention.
<strong>Objective:</strong> To evaluate the safety and feasibility of percutaneous transulnar approach for coronary angiography and intervention.
<strong>Patient and Methods:</strong> This study is a prospective study which was done in Cardiology department of Alazhar University Hospitals and National Heart Institute from the period of July 2019 to July 2020.
One hundred patients requiring coronary angiography plus or minus intervention were enrolled and randomly assigned for 2 equal groups: Group I with radial access and Group II with ulnar access. Demographic and comparative analyses of both access sites were obtained.
<strong>Results:</strong> Group II was notably older than Group I (60.9 ± 7.9 versus 57.7 ± 6.7, p= 0.029). There was no difference between the two groups concerning puncture time, number of attempts to fix the artery, procedure and fluoroscopy times. Procedural success rate in both groups was (96% versus 90% in group I and II respectively, p= 0.240) with similar frequency of acute complications as spasm, hematoma or hand ischemia. Vascular anomalies as high takeoff and tortuosities encountered more common in the radial as compared to ulnar group, however, did not reach statistical significance.
<strong>Conclusion:</strong> Transulnar approach was as safe and feasible as transradial access for coronary procedures with similar technical tactic, success and complication rates. However, because of radial artery was more superficial, transulnar access was a realistic alternative to radial route whenever not attainable.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701THE EFFECT OF ADMINISTRATION OF ASCORBIC ACID IN PREVENTION OF CONTRAST INDUCED NEPHROPATHY IN PATIENTS WITH RENAL IMPAIRMENT UNDERGOING CORONARY INTERVENTION2045205617866910.21608/amj.2021.178669ENAmrMohamed Imam Mohamed AmrDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityWaleedHassan Abd El-Hamied AsarDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityMohamedOsama Fathy KayedDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversitySaadIbrahim Dief AllahDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityAliAli RamzyDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>ABSTRACT</strong><br /> <strong>Background:</strong> Contrast-induced nephropathy is a potentially avoidable complication caused during procedures involving the use of radiographic contrast media. All subjects, especially the high-risk ones, should be subjected to available preventive protocols prior to and after such procedures.<br /> <strong>Objective:</strong> To evaluate the role of a hydration protocol involving the use of ascorbic acid plus the conventional sodium chloride hydration protocol N acetyl cysteine.<br /> <strong>Patients and methods:</strong> The current study was conducted on 86 patients presenting to the Cardiology Department at National Heart Institute to undergo elective percutaneous coronary intervention (PCI) during the period from April 2011 to November 2011. The study population was divided into two equal groups: Group 1 received ascorbic acid prior and after the procedure and group 2 received the conventional hydration measures without ascorbic acid. Both groups received normal saline and NAC (N Acetyl Cysteine).<br /> <strong>Results:</strong> There were no significant group differences regarding sex, incidence of diabetes mellitus, pre-existing renal impairment, age, hypertension, dyslipidemia, and the type and amount of contrast. Addition of ascorbic acid by hydration with normal saline and N- acetyle cysteine decreased significantly the rise in serum creatinine 48 hours (P=0.023) and 7 days (P=0.001) following coronary intervention. CIN occurred in one patient in ascorbic acid group versus 4 patients in the control group (P=0.36). Ascorbic acid did not show a significant effect regarding the protection against the contrast induced nephropathy versus the conventional hydration therapy.<br /> <strong>Conclusion:</strong> Ascorbic acid did not show a significant effect regarding the protection against the contrast induced nephropathy versus the conventional hydration therapy.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701THREE-DIMENSIONAL SPECKLE TRACKING ECHOCARDIOGRAPHY FOR EVALUATION OF LEFT ATRIAL FUNCTION IN CORONARY ARTERY DISEASE PATIENTS WITH PRESERVED LEFT VENTRICLE EJECTION FRACTION2057206817867010.21608/amj.2021.178670ENTaherMohammed Abd El-Halem El-MeghwaryDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityKamalAhmad Merghny MahgoubDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityAhmadAli Mohammed FahimDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityAhmedMohamed Abd El-RahmanDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> The left atrium (LA) is much more than simply a conduit for left ventricular (LV) filling, and its size and remodeling are recognized as a predictor of poor outcomes in multiple disease states. LA function is a surrogate marker of LV diastolic dysfunction.
<strong>Objective:</strong> To assess left atrial function in coronary artery disease patients with preserved left ventricle ejection fraction, with and without left atrial expansion by three dimensional speckle tracking echocardiograghy.
<strong>Patient and methods:</strong> Fifty patients with chronic coronary syndrome were divided according to left atrial dilation into two groups high risk group where left atrial dilation was more than 4cm (8 males and 8 females) and low risk group where left atrial dilation was less than 4 cm (18 males and 16 females) in addition to 20 healthy individual as control group (7 males and 13 females) who presented to the Cardiology Department at Al-Hussain University Hospital and Al-Azhar Islamic Center for elective coronary angiography from May 2019 to June 2020.
<strong>Results:</strong> There was a statistically significant increase in control group in comparison to low risk and high risk. The LA peak ventricular systolic area strain (ASs %) in patients group was significantly lower than in the control group, whereas in the low risk group was significantly higher than in the high risk group. The LA peak pre-atrial contraction area strain (ASa %) in patients group was significantly lower than in the control group, whereas in the low risk group was significantly higher than in the high risk group.
<strong>Conclusion:</strong> Three-dimensional speckle tracking echocardiography represented a non-invasive, relatively simple and reproducible technique to assess left atrial myocardial function in patients with chronic coronary syndrome.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701AORTIC FLOW PROPAGATION VELOCITY AND ITS RELATION TO MAGNITUDE OF SHUNT IN PATIENTS WITH ISOLATED PATENT DUCTUS ARTERIOSUS2068208017867110.21608/amj.2021.178671ENEbrahimMahmoud ZackzockDepartment of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohammadIsmail Al-DeftarDepartment of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMansourM MustafaDepartment of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210620<strong>Background:</strong> Patent ductus arteriosus (PDA) is normally associated with hyperdynamic status. Given the presence of a vascular shunt between the aorta and pulmonary artery, intrinsic aortic changes occur (aortic stiffness). Arterial stiffness is currently regarded as an independent predictor of cardiovascular morbidity and mortality. There is a close relationship between arterial stiffness and aortic flow propagation velocity (AFPV).
<strong>Objective:</strong> To assess aortic stiffness in patients with isolated PDA using Doppler-derived AFPV, assess shunt magnitude i.e. pulmonary to systemic blood flow ratio (QP/QS) in patients with isolated PDA by echocardiography, compare AFPV values in patients with isolated PDA and apparently healthy individuals, and to correlate AFPV with PDA size and shunt magnitude.
<strong>Patients and Methods:</strong> Our study was performed at Bab EL-Sha'riya Hospital, Al-Azhar University during the period from September 2019 and August 2020, and consisted of twenty-five patients with isolated PDA, and twenty healthy controls. Detailed history, physical examination was performed and conventional two-dimensional echocardiography was done to all cases then echocardiographic assessment of PDA including magnitude of the shunt by measuring QP/QS ratio. Aortic flow propagation velocity (AFPV) was measured in all cases.
<strong>Results:</strong> Patients with PDA exhibited significantly lower AFPV than the control (p < 0.001). AFPV was significantly correlated with systolic blood pressure (r= -0.29 &p= 0.01). Also, there was significant correlation (r=-0.426) between AFPV and PDA size, mainly pulmonary end (p=0.03), and magnitude of the shunt QP/QS (r= 0.723 & p < 0.001).
<strong>Conclusion:</strong> Transthoracic echocardiographic determination of the color M-mode propagation velocity of the descending aorta is a simple, non-invasive practical surrogate method in identifying arterial stiffness in patients with PDA and is related to effective orifice of PDA and magnitude of the shunt.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701PREDICTION OF SUBCLINICAL LEFT VENTRICULAR SYSTOLIC DYSFUNCTION BY MITRAL ANNULAR PLANE SYSTOLIC EXCURSION IN M-MODE ECHOCARDIOGRAPHY IN CORRELATION TO SPECKLE TRACKING BY 2-DIMENSIONAL ECHOCARDIOGRAPHY AND TISSUE DOPPLER IMAGING IN PATIENTS WITH TYPE 2 DIABETES MELLITUS2081209417867210.21608/amj.2021.178672ENMahmoudSalah Tawfik HamzaDepartment of Cardiology, Faculty of Medicine, Al-Azhar University (Boys-Cairo)Abd El-HalimMohammed Abu El-MagdDepartment of Cardiology, Faculty of Medicine, Al-Azhar University (Boys-Cairo)SamehEmil SadekDepartment of Cardiology, Faculty of Medicine, Al-Azhar University (Boys-Cairo)WaelMohamed AttiaDepartment of Cardiology, Faculty of Medicine, Al-Azhar University (Boys-Cairo)Journal Article20210620<strong>Background:</strong> Diabetes mellitus (DM) is considered as a major risk factor for heart failure with preserved Ejection fraction (EF). Using M-Mode echocardiographic method may be useful in prediction of early LV systolic dysfunction in patient with type II diabetes mellitus by measurement of mitral annular plane systolic excursion (MAPSE) in correlation to global longitudinal strain (GLS) and to tissue Doppler imaging (TDI).
<strong>Objective:</strong> To emphasize on the usefulness of M-mode echocardiographic methods like the mitral annular plane systolic excursion (MAPSE) correlated to speckle tracking by 2 dimensional (STE) and tissue Doppler imaging in prediction of subclinical LV systolic dysfunction in patients with type 2 diabetes.
<strong>Patients and methods:</strong> The study included 100 asymptomatic patients with type II DM and 50 healthy subjects as a control group. Echocardiography was performed to all of them All cases were recruited from the outpatient clinic in Maadi military Hospital in Cairo.
<strong>Results:</strong> The study included 100 asymptomatic patients with type II DM, 65 of them were females, and 50 healthy subjects as a control group, 27 of them were females. MAPSE were significantly lower in DM group [1.2 (1.1 – 1.25) cm] compared to control group [1.4 (1.3 – 1.5) cm] (p < 0.001). MAPSE linearly had a significant positive correlation with EF, GLS and Sa wave [r= 0.565, 0.723, 0.595 respectively], (p < 0.01). MAPSE linearly had a significant negative correlation with DM duration and HbA1C Level [r= -0.495, -0.776 respectively], (p < 0.01). Average MAPSE at a cut-off point (≤1.2cm) with good (82%) accuracy, sensitivity= 68% and specificity= 82% (p < 0.01).
<strong>Conclusions:</strong> MAPSE is a useful M-mode method in prediction of subclinical LV systolic dysfunction in asymptomatic type II diabetic patients, and it has a positive correlation to GLS and Sa wave of TDI. It has a negative correlation with duration of DM and HbA1C level.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701RECIPROCAL ST SEGMENT CHANGES IN MYOCARDIAL INFARCTION: ISCHEMIA AT DISTANCE VS. MIRROR REFLECTION OF ST-ELEVATION2095210617867310.21608/amj.2021.178673ENAlaaEl-Den Mohamed AliDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityAhmedMohammed Salah El-DinDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityMamdouhHelmy El-TahanDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> ST-elevation myocardial infarction (STEMI) is considered one of the commonest causes of morbidity and mortality all over the world. Nevertheless, survival following acute STEMI showed a considerable improvement as a result of increased symptom recognition, precise diagnosis in addition to effective timely reperfusion.
<strong>Objective:</strong> To detect the significance of the reciprocal ST segment alterations in the early stage of acute myocardial infarction (AMI) and whether it is truly reciprocal or represents a distant ischemia that might be revealed by coronary angiography.
<strong>Patients and methods:</strong> This study was conducted on 133 patients admitted to Al-Mokattam Health Insurance Hospital, with the diagnosis of acute STEMI treated with primary percutaneous coronary intervention (PPCI) during the period between November 2018 and December 2019.
<strong>Results:</strong> Distant ischemia in patients with STEMI undergoing PPCI level was significantly higher in reciprocal ST segment depression (RSTD) group (p-value < 0.001). Besides, multivessel disease (MVD) was more prevalent in RSTD group (36.8% vs. 17.5%) in comparison with NRSTD group. The degree of mitral regurge (MR) was more severe among patients with RSTD (P value = 0.029). Mortality rate was more in patients with RSTD, six patients has passed away all of them had RSTD.
<strong>Conclusion:</strong> The reciprocal changes (RC) caused by interaction of distant ischemia of non-infarcted coronaries and benign mirror electrical alterations, and it has a mortality effect. So, RSTD that was a simple ECG finding used as an indicator of patients at high risk who require a more aggressive approach.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701VALUE OF DIFFERENT ECHOCARDIOGRAPHIC MODALITIES IN THE ASSESSMENT OF LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSIVE PATIENTS WITH TYPE II DIABETES MELLITUS2107212617867410.21608/amj.2021.178674ENHossamFarid HamadaDepartment of Cardiology, Faculty of Medicine, Al-Azhar University, (Cairo)AhmadKamal MotaweaDepartment of Cardiology, Faculty of Medicine, Al-Azhar University, (Cairo)MohammadSaad El-GammalDepartment of Cardiology, Faculty of Medicine, Al-Azhar University, (Cairo)MohammadIsmail Al-DeftarDepartment of Cardiology, Faculty of Medicine, Al-Azhar University, (Cairo)Journal Article20210620<strong>Background:</strong> Left ventricular hypertrophy (LVH) is the response of myocytes to various stimuli leading to myocytes’ hypertrophy, which occurs as a compensatory response to increased after-load. It is defined as an increase in LV mass assessed by postmortem measurements, electrocardiographic (ECG), echocardiographic and cardiovascular magnetic resonance (CMR) criteria.<br /> <strong>Objective:</strong> To investigate the reproducibility of different echocardiographic modalities in the assessment of LVH in hypertensive patients and patients with type II DM in comparison to the golden standard CMR measurements.<br /> <strong>Patients and Methods:</strong> We prospectively investigated 40 patients with LVH, 20 patients being hypertensive and diabetic, 20 patients being diabetic only and 20 healthy control subjects (normal ventricular function and ECG and no cardiac risk factors). In addition to clinical and conventional echocardiographic parameters, LV mass and volumes were analyzed.<br /> <strong>Results:</strong> The comparison between new echocardiographic techniques and CMR showed that the assessments of LV volumes/LVEF by echocardiography and CMR have good correlations. However, the inter-technique agreement of absolute LV volumes revealed considerable differences, with significant underestimation of volumes and LVEF with respect to CMR. The LV mass was less in patients assessed by different algorithms of 2D echo rather than 3D echo and CMR, correlated positively with EDV and ESV.<br /> <strong>Conclusion:</strong> 3D echocardiography attains more solid results in patients diagnosed having LVH by 2D echocardiography. CMR would be preferable for research and specific clinical conditions requiring higher accuracy and reproducibility.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701VALUE OF SERUM MIDKINE LEVEL IN PATIENTS WITH LIVER CIRRHOSIS AND HEPATOCELLULAR CARCINOMA2127214017867510.21608/amj.2021.178675ENAhmedIbrahim El-Said MandourDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityMagdyAbd El-Karem Al-DahshanDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityOmarMohamed Khalil HeikalDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityMohamedSaad El-Din RadwanDepartment of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityMohamedShahat Hasib El-FayoumieDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide. Risk factors for HCC include chronic hepatitis B and hepatitis C, alcohol addiction, metabolic liver disease and exposure to dietary toxins such as aflatoxins and aristolochic acid.
<strong>Objective:</strong> To determine the value of serum Medkine level as a potential biomarker for patients with hepatocellular carcinoma.
<strong>Patients and methods:</strong> This study was conducted at the Gastroenterology and Hepatology Unit, Department of Internal Medicine Al-Azhar and Misr University for Science and Technology. 90 Egyptian patients were recruited and were divided into 3 Group I included 30 patients with liver cirrhosis, HCC was excluded in these patients at time of recruitment in the study, exclusion of HCC was based on the absence of any hepatic focal lesion in abdominal ultrasonography scanning. Group II included 40 patients with HCC. Diagnosis of HCC was based on the appearance of typical vascular pattern of enhancement in triphasic spiral CT scan of the abdomen. Control Group included 20 age and sex-matched apparently healthy subjects.
<strong>Results:</strong> Different liver function tests showed no statistically difference between two groups except for ALK. Ph and gamma glutamyltransferase (GGT) which were significant higher in group II than group I. There was a highly statistically significance difference regarding alpha-fetoprotein (AFP) which was higher in group II than group I and control group. Serum AFP levels were found to be significantly correlated with larger tumor size in this study. In addition, patients with advanced-stage hepatocellular carcinomas had significantly higher median AFP serum levels (BCLC B/C) than that of early-stage tumors (BCLC 0/A) (237ng/mL versus 23ng/mL). However, no significant correlation was found between serum midkine (MDK) levels with tumor size, number or serum levels of AFP, and no significant association was found between serum MDK levels and BCLC stages. The best cutoff values for MDK and AFP to discriminate HCC cases from those with liver cirrhosis were 0.39 and 10ng/mL, respectively, with sensitivities (90% versus 77.5%), specificities (60% versus 80%). The overall diagnostic performance of MDK for HCC diagnosis was much better than that of AFP. On comparing the sensitivities and specificities of MDK at the cutoff 0.39ng/mL to those of AFP at different cutoff values (10 and 400), the overall diagnostic performance of MDK for HCC diagnosis was much better than that of AFP.
<strong>Conclusion:</strong> Alpha-fetoprotein and midkine may have a complementary role in hepatocellular carcinoma surveillance and screening. Midkine increased the diagnostic yield in alpha-fetoprotein -negative hepatocellular carcinoma and the presence of either elevated alpha-fetoprotein or midkine increased the sensitivity of hepatocellular carcinoma detection. Midkine was also superior to alpha-fetoprotein in the diagnosis of NASH-related hepatocellular carcinoma and this finding postulated an exciting novel role for midkine in NASH-related carcinogenesis.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701MASIMO AS NONINVASIVE CONTINUOUS MONITORING FOR GUIDING FLUID IN INTENSIVE CARE UNIT2141215217867610.21608/amj.2021.178676ENAymanSaleh Mohammed RagabDepartment of Anesthesia and Intensive Care Department, Faculty of Medicine (Damietta), Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> It is necessary to keep tracks of blood and fluid treatment during admission patient in intensive care unit Patient may have signs of hypovolemic but fluid administration is not always beneficial, we are in need of bedside devices and techniques which can predict fluid responsiveness effectively and safely.
The pleth variability indices (PVI) allow noninvasive assessment of fluid management.
It is based on respiratory changes in arterial pulse pressure. PVI reflect vascular tone, circulating blood volume and intra thoracic pressure.
<strong>Objective:</strong> To compare between PVI and CVP (central venous pressure) as effective measures to manage of fluid loading in monitorization in I.C.U.
Patients and Methods: This study was carried out at King Khaled Hospital between June 2017 and October 2018 on 200 randomized patients dividing into two equal groups: Group (I) measuring fluid by CVP, and Group (II) measuring fluid by Masimo to assess fluid management therapy.
<strong>Results:</strong> In comparison of fluid management in I.C.U, the amount of fluid replacement was 3500 ± 1980.2 in group (I), and 1913 ± 540 in group (II). There was no significant difference between the two groups in red blood cells transfusion or hemoglobin level.
<strong>Conclusion:</strong> Masimo can be used as bedside non-invasive technique to measure fluid responsiveness in operating room and intensive care unit without complication, and more reliable than some invasive technique in guiding fluid therapy.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701MULTI-DETECTOR COMPUTED TOMOGRAPHY ROLE IN LOCAL STAGING OF COLONIC CARCINOMA2153216417867710.21608/amj.2021.178677ENKamalA. OunDepartment of Diagnostic and Interventional Radiology, Faculty of Medicine, Al-Azhar UniversityAmrM. ZayedDepartment of Diagnostic and Interventional Radiology, Faculty of Medicine, Al-Azhar UniversityAhmedM. El-DeebDepartment of Diagnostic and Interventional Radiology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> Pre-operative staging is critical for the treatment and surgical planning of colonic carcinomas.<br /> <strong>Objectives:</strong> To evaluate the role of the contrast enhanced multi-detector computed tomography (CEMDCT) in locoregional staging of the colonic carcinoma in correlation with pathological data as standard.<br /> <strong>Patients and Methods:</strong> The study included 30 consecutive patients diagnosed with colonic carcinoma by biopsy and colonoscopy and referred from the clinic at the National Cancer Institute. MDCT was performed for all patients after being submitted to intravenous non ionic contrast and oral and rectal positive or negative colon opacification. All patients underwent surgery. Tumors were classified with the TNM staging system. The MDCT findings for each patient were recorded and correlated with operative and pathological findings as reference standard. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated.<br /> <strong>Results:</strong> In the detection of extramural invasion, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of CEMDCT were 90%, 70%, 85.7%, 77.8% and 83.3% respectively. Regarding the accuracy of the T staging, the study accurately staged 20 patients (66.6%).<br /> In the detection of lymph node status, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 84.6%, 70.6%, 68.8%, 85.7% and 76.7% respectively.<br /> <strong>Conclusions:</strong> Contrast enhanced multi-detector computed tomography (CEMDCT) is a sensitive tool in the evaluation of extra-mural invasion, and promising technique in the evaluation of preoperative staging and prognostic factors of colon cancer.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701COLOR DUPLEX VERSUS CT ANGIOGRAPHY IN ASSESSMENT OF INFRA POPLITEAL ARTERIAL CIRCULATION IN DIABETIC PATIENTS: A COMPARATIVE STUDY2165217617867810.21608/amj.2021.178678ENYahyaAhmed Hassan MohammedDepartment of Radiodiagnosis, Faculty of Medicine, Al-Azhar UniversityAhmedAboul FotouhDepartment of Radiodiagnosis, Faculty of Medicine, Al-Azhar UniversityMohamedEl-FeshawyDepartment of Radiodiagnosis, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> Peripheral vascular disease is narrowing or occlusion of arteries mostly due to atherosclerosis which is very common in patients with diabetes mellitus (DM).
<strong>Objective:</strong> To compare lower limb arterial diseases using Color duplex and multi-detector CT angiography (MDCTA) and to find the better non-invasive modality of choice.
<strong>Patients and Methods:</strong> Thirty diabetic patients of lower limb peripheral arterial disease underwent Color duplex and multi-detector CT angiography (MDCTA). Infra popliteal arterial system, divided into anatomic segments and luminal narrowing, were compared using color duplex and axial images of arterial phase of CT angiography. Using statistical methods, sensitivity, specificity and accuracy of color duplex and CT angiography were determined.
<strong>Results:</strong> One hundred and fifty six arterial segments were studied with CT angiography and color duplex. Out of the total 156 vessel segments, color duplex was able to detect 140 (89.7 %) diseased segments, while MDCTA which was able to detect 114 (73 %) diseased segments. Color duplex was able to pick up grade 1 lesions better than MDCT angiography with sensitivity 91.6%. Grade 2 and grade 3 were better picked up by MDCT angiography with color duplex sensitivity of 80% and 76 % for grade 2 and grade 3 respectively. The two modalities showed comparable results for grade 4 lesions with sensitivity of 85.7 %. Significant statistical agreement existed between color duplex and CT angiography with moderate total agreement (Weighted kappa estimation (Kw) = 0.64) for grade 1 lesions, fair total agreement (Kw= 0.39) for grade 2 lesions, good total agreement (Kw = 0.75) for grade 3 and very good agreement (Kw= 0.88) for grade 4 lesions.
<strong>Conclusion:</strong> Color duplex is a safe, inexpensive, non-invasive, easily available diagnostic tool with high diagnostic accuracy in the investigation of peripheral arterial disease PAD among patients with diabetes mellitus DM. Color duplex is better than CT angiography in the diagnosis of Grade 1 and 2 lesions. CT angiography is more accurate in assessing grade 3 and grade 4 stenosis. Color duplex remains the only available diagnostic tool in diabetic patients with contraindications for contrast media administration.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701RELATION BETWEEN SERUM FERRITIN AND LEFT VENTRICULAR FUNCTIONS IN HEMODIALYSIS PATIENTS2177218417867910.21608/amj.2021.178679ENAhmedLotfy AhmedDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityFawzyHamed HassanDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityEl-SayedMohamed RashedDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityMohamedAhmed MosaadDepartment of Cardiology, Faculty of Medicine, Al-Azhar UniversityNabilFathy EsmaeelDepartment of Clinical pathology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> Cardiovascular disease is still the most common cause of morbidity and mortality in hemodialysis patients. High serum ferritin is correlated with mortality and cardiovascular outcome in maintenance hemodialysis patients.
<strong>Objective:</strong> To evaluate relationship between serum ferritin level and left ventricular functions and cardiovascular outcomes in hemodialysis patients.
<strong>Patients and methods:</strong> Sixty hemodialysis (HD) patients from Clinic of Internal Medicine Department, Al-Sayed Galal University Hospital, Cairo, Egypt between December 2019 and June 2020. Were enrolled Left ventricular mass (LVM), Left ventricular mass index (LVMi) and Left ventricular mass/height 2.7 (LVM/Ht2.7) were evaluated with transthoracic echocardiography. Patients were classified into two groups according to serum ferritin into 30 patients with serum Ferritin < 800 ng/ml (Group A), and 30 patients with serum Ferritin ≥ 800 ng/ml (Group B).
<strong>Results:</strong> We found statistically significant difference (p-value < 0.05) between studied groups as regard LVESD and LVM/Ht2.7, and statistical significant difference (p-value < 0.001) between studied groups as regard LVEDD and LVMI. The LVEDD, LVMI, LVESD and LVM/Ht2.7 values were significantly higher in group B (High Ferritin) compared with group A (Low ferritin).
<strong>Conclusion:</strong> High serum ferritin level (≥ 800 μg/L) was positively associated with left ventricular hypertrophy in hemodialysis patients.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701MICROPARTICLES AS A PREDICTIVE BIOMARKER IN ACUTE MYOCARDIAL INFARCTION2185220017868010.21608/amj.2021.178680ENAhmedAwad Ibrahim AhmedDepartment of Clinical Pathology, Al-Azhar Faculty of MedicineMajidAbdul-Fattah Ismael ShalabyDepartment of Clinical Pathology, Al-Azhar Faculty of MedicineMohamedAbd El-Hameed KhederDepartment of Clinical Pathology, Al-Azhar Faculty of MedicineMohamedSeleem MohamedNational Heart InstituteJournal Article20210620<strong>Background:</strong> Microparticles are small vesicles, between 0.1 and 1 μm in diameter. There are found in low concentrations in the plasma under physiological conditions and increased in pathological conditions.
<strong>Objective:</strong> To find the correlation between circulating microparticles levels and thrombotic burden in acute myocardial infarction.
<strong>Patients and methods:</strong> The study was conducted on 86 patients presented with acute myocardial infarction with ST-elevation, to the emergency Department at Ahmed Maher Teaching Hospital from September 1st 2019 till February 28th 2020. They were compared with 14 healthy individuals with identical demographic characteristics not suffering from any disease. Serum microparticles (CD41a) & (CD62E) and serum CKMB, troponin I, AST, and creatinine levels were measured in both groups.
<strong>Results:</strong> There were significant elevation of all parameters cardiac marker, CD41, and CD62E levels were observed in all patients of STEMI patients compared to the control group (p=<0.001).
<strong>Conclusion:</strong> In STEMI patients, the serum CD41a and CD62E levels rise due to their property as proinflammatory and thrombtic CD41 & CD62E can be used as a predictor of STEMI.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701ASSESSMENT THE ROLE OF URINE OSTEOPROTEGERIN AS A BIOMARKER IN LUPUS NEPHRITIS2201221217868110.21608/amj.2021.178681ENMahmoudIsmail ZoairDepartment of Clinical Pathology (Damietta) Faculty of Medicine, Al-Azhar University, EgyptMagdyZaki El-GhannamDepartment of Clinical Pathology (Damietta) Faculty of Medicine, Al-Azhar University, EgyptHassanAbd El-Aziz GaberDepartment of Clinical Pathology, Faculty of Medicine, Al-Azhar University, EgyptAhmedMohammed SolimanDepartment of Internal Medicine and Nephrology, Faculty of Medicine, Cairo University, EgyptJournal Article20210620<strong>Background:</strong> Urinary biomarkers may help in identification and assessment of the activity of lupus nephritis (LN).Urinary osteoprotegerin may reflect renal disease activity better.
<strong>Objective:</strong> To investigate urinary osteoprotegerin level as a potential marker of lupus nephritis activity.
<strong>Patients and Methods:</strong> The study included 90 individuals classified into three equal groups: Group (I): clinically and laboratory free, Group (II): patients without renal involvement (non active renal group) and Group (III): patients with active lupus nephritis. Measurement of the level of urinary osteoprotegerin has been done by ELISA from January 2018 till June 2019.
<strong>Results:</strong> All patients with systemic lupus erythromatosus SLE in group II and III had significant higher levels in urinary Osteoprotegerin compared to the control group (I). Moreover, SLE patients with lupus nephritis activity (Group III) had marked increase in urinary osteoprotegerin more than SLE patients without renal involvement (Group II).
The study showed also that, with advance of renal histopathological class in lupus nephritis patients, the urine OPG level showed more increase.
<strong>Conclusion:</strong> Urinary level of osteoprotegerin may be used as a biomarker for early prediction of lupus nephritis. Also, it may be used for monitoring the progression and follow up of lupus nephritis as well as with shifting from one class to another.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701EVALUATION OF DES-GAMMA CARBOXY PROTHROMBIN AS A BIOMARKER FOR EARLY DETECTION OF HEPATOCELLULAR CARCINOMA ON TOP OF CHRONIC ACTIVE HEPATITIS POST VIRUS C INFECTION2213222217868210.21608/amj.2021.178682ENAhmedAl-Sayed Saied AttiaDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar University,MagdyZaki El-GhannamDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityMagedAbd El-Fattah ShalabyDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityKhaledAhmed MohammedDepartments of Radiology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> Experience with Des-gamma Carboxy Prothrombin (DCP) is limited. Most studies on HCC biomarkers have focused on the accuracy of markers for diagnosis.
<strong>Objective:</strong> To assess serum level of Des-gamma carboxy prothrombin as a biomarker for early detection of hepatocellular carcinoma post chronic active hepatitis on top of hepatitis C virus infection (HCV).
<strong>Patients and Methods:</strong> This study was conducted on 60 individuals diagnosed as chronic HCV patients, and 30 healthy individuals were selected as a control group. Fifteen patients were suffering from chronic active hepatitis without complications, Fifteen patients were suffering from chronic active hepatitis with complications, Fifteen patients were of early cases of HCC on top of HCV, and Fifteen were patients of late cases of HCC on top of HCV. Des-gamma Carboxy Prothrombin were measured by ELISA.
<strong>Results:</strong> There was significant increase in Des-gamma Carboxy Prothrombin (DCP) in group (II) and group (III) when compared to control group (I). However, Patients in group (III) showed higher levels of DCP when compared to group (II).
<strong>Conclusion:</strong> DCP was promising in overcome AFP insufficiency in identity AFP negative HCC as DCP has a superior performance than AFP in identification of HCC from HCV-related in surveillance studies.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701ASSESSMENT OF PLATELET COUNT AND DOPPLER ULTRASOUND ON HEPATIC AND SPLENIC VENOUSSYSTEM AS NON-INVASIVE PREDICTORS OF GASTRIC VARICES IN PATIENTS WITH LIVER CIRRHOSIS2223223817868310.21608/amj.2021.178683ENOsamaSayed Ahmed Ahmed GhalwashDepartments of Hepatogastroenterology& infectious diseases, Faculty of Medicine, Al-Azhar University, Cairo, EgyptGamalMohammad Mohammad SolimanDepartments of Hepatogastroenterology& infectious diseases, Faculty of Medicine, Al-Azhar University, Cairo, EgyptGalalAbd El-Hameed Abou-FarragDepartments of Hepatogastroenterology& infectious diseases, Faculty of Medicine, Al-Azhar University, Cairo, EgyptMohammadAbolnaga MohammadDepartment of Radio diagnosis*, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210620<strong>Background:</strong> Gastric varices are probably associated with thrombocytopenia. However, the prevalence and severity of thrombocytopenia are unknown in this clinical setting.<br /> <strong>Objective:</strong> To assess platelet count and doppler ultrasound on hepatic and splenic venous system as non-invasive predictors of gastric varices in patients with liver cirrhosis with no history of previous endoscopic or surgical intervention for portal hypertension.<br /> <strong>Patients and Methods:</strong> An observational case control study was accomplished at Al-Azhar University Hospitals, Hepatogastroenterology and infectious diseases Departments, at Cairo from September 2018 to December 2019. One hundred and twenty patients with liver cirrhosis without past history of previous endoscopic or surgical intervention for portal hypertension were selected, and divided into three equal main groups:Group A: Cirrhotic patients without varices, Group B: Cirrhotic patients with esophageal varices only, and Group C: Cirrhotic patients with gastric varices, which divided into two subgroups: Group Ca:Six patients with isolated gastric varices and Group Cb:Thirty four patients with gastroesophageal varices. All patients were subjected to upper gastrointestinal endoscopy,complete blood picture (CBC) and abdominal Doppler ultrasonography study on hepatic and splenic venous systems.<br /> <strong>Results:</strong> Group Cb recorded the highest values of splenic size (P<0.001), ascites (p=0.006), portal vein diameter (P<0.001) and collaterals (P<0.001) compared to other groups. Group Ca recorded the lowest values of the mean portal vein flow velocity (MPVV)(p < 0.001), the mean splenic vein flow velocity(M.SVV) (P=0.026), and recorded the highest values of portal vein congestion index (P.CI) (P<0.001), portal vein thrombosis (PVT)(P<0.001), the mean values of the splenic vein diameter (P<0.001), cross sectional area of splenic vein (p < 0.001), splenic vein congestion index(S.CI) (p < 0.001), as well as abnormal blood direction in splenic vein(P=0.019) compared to other groups. Also, portal vein cross sectional area and the Child-Turcotte-Pugh score class “C” showed statistically significant difference (p < 0.001) between group A which recorded the lowest value compared to group B which recorded the highest value. Also, platelet count recorded no statistically significant difference between the four groups.<br /> <strong>Conclusion:</strong> Doppler ultrasound can be an easy, cheap and safe predictor of gastric varices, while platelet count has no any significance in predicting of gastric varices.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701IMMUNOHISTOCHEMICAL EXPRESSION OF P16 IN CERVICAL AND URINARY BLADDER SQUAMOUS CELL CARCINOMA2239225017868410.21608/amj.2021.178684ENEsmailT. M. A. El-BayoumyPathology Department, Faculty of Medicine, Al-Azhar UniversityEmadEl-Din R. MatarPathology Department, Faculty of Medicine, Al-Azhar UniversityYasserM. El-DweekPathology Department, Faculty of Medicine, Al-Azhar UniversityAhmadM. KandilPathology Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> p16 is a tumor suppressor protein important in regulating cell cycle. In bladder cancer, p16 mutations are widespread and tend to be more prevalent in low-grade superficial tumors than in higher-grade invasive tumors.
<strong>Objective:</strong> To evaluate expression of p16 in 25 cases of cervical squamous cell carcinoma and 25 cases of urinary bladder squamous cell carcinoma.
<strong>Patients and methods:</strong> This study was carried out in the Histopathology Department of Al-Azhar University Hospitals and from some private laboratories during the period from August 2019 up to January 2020. H & E stained sections were prepared from paraffin blocks for revision of diagnosis. Immunohistochemical analysis was done on 4 micron sections of formalin-fixed paraffin-embedded tissue using the labeled streptavidin-biotin method after antigen retrieval. Antibodies against P16 were utilized on sections from paraffin blocks. CINtec Histology kit includes a two-step antibody method for detection of human p16 antibody.
<strong>Results:</strong> Expression of P16 was positive in 92% of cases of squamous cell carcinoma of the uterine cervix and 60% of cases squamous cell carcinoma of the urinary bladder. In patients with cervical squamous cell carcinoma, there was statistically significant relation between intensity of P16 staining and tumor grading. In patients with squamous cell carcinoma of the urinary bladder, there was a statistically significant relation between intensity of P16 staining and tumor grading and staging. Moderate/strong staining intensity can predict staging 2B among patients with squamous cell carcinoma of the uterine cervix, and negative/weak staining intensity can predict staging 1A, 1B, 2A with sensitivity 52.9% and specificity 37.5% among patients with squamous cell carcinoma of the urinary bladder.
<strong>Conclusion:</strong> p16 immunohistochemical expression alone should not be used as a marker for differentiation between cervical and urinary squamous cell carcinoma.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701CLINICOPATHOLOGIC STUDY OF BASAL CELL CARCINOMA: A SINGLE-CENTRE RETROSPECTIVE STUDY2251226017868510.21608/amj.2021.178685ENAhmedMustafa Abd El-Wahab Al-BayomiDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityHusseinMohamed Hassab El-NabyDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityMohammedAbd El-Mawgoud AmerDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> Basal cell carcinoma (BCC) is the most common malignant neoplasm in fair-skinned individuals and accounts for about two-thirds of all skin cancers in Caucasians. BCC rarely metastasizes or causes death, but it can result in extensive morbidity through local invasion and tissue destruction.
<strong>Objective:</strong> To evaluate the clinicopathologic features of basal cell carcinoma in Egyptian population.
<strong>Patients and methods:</strong> Our study included 80 patients with BCCs from January 2015 to December 2019. A retrospective analysis of baseline clinical and histopathological data was for all subjects incorporated in the study. Data needed for the study were obtained from the case files. Patients were histologically diagnosed at Dermatopathology unit of Department of Dermatology and Venereology, Al-Hussein University Hospital, Cairo, Egypt.
<strong>Results:</strong> The present study showed that the clinical types of BCC of the involved patients were 41 lesions (39%) of ulcerative type, 39 lesions (37.1%) of nodular non pigmented type, 13 lesions (12.4%) of nodular pigmented type, 9 lesions (8.6%) of superficial type, and 3 lesions (2.9%) of advanced type. As regards the histological subtypes, 52 lesions (49.5%) were nodular, 11 lesions (15.9%) were pigmented, 9 lesions (8.6%) were adenoid, 9 lesions (8.6%) were superficial, 8 lesions (7.67%) were infiltrative, 7 lesions (6.7%) were micro-nodular, 6 lesions (5.7%) were nodulo-cystic and 3 lesions (4.3%) were baso-squamous.
<strong>Conclusion:</strong> Based on our findings, BCC was strongly associated with exposure to ultraviolet (UV) radiations. Tumors developed mainly on the sun-exposed skin of elderly individuals. Nodular BCC was the most common clinical and histological subtype.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701COMPARTIVE STUDY BETWEEN EPIDURAL ANALGESIA AND BILATERAL TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE PAIN RELIEF IN PATIENTS UNDERGOING CESAREAN DELIVERIES2261227017868610.21608/amj.2021.178686ENAbd AllahIbrahim Ahmed Hassan El-MallaAnesthesiology and Intensive Care Department, Faculty of Medicine, Al-Azhar UniversityGamalLotfy Abd El-Rahman GadAnesthesiology and Intensive Care Department, Faculty of Medicine, Al-Azhar UniversityBadrIsmail Fadl-Allah El-farAnesthesiology and Intensive Care Department, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> Caesarean section (CS) is one of the most common surgical procedures in the world. Post-operative pain affects both mother and the newborn, particularly the first 48 h after birth. The pain can be terrifying, disturbing the bonding between the mother and the child.
<strong>Objectives:</strong> The aim of this study was to compare the efficacy and safety of continuous bilateral transversus abdominis plane block versus epidural analgesia for post-operative pain relief after cesarean deliveries.
<strong>Patients and Methods:</strong> Sixty Patients of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for cesarean deliveries, were enrolled in this randomized, prospective, double-blind, clinical trial study after approval of the medical ethical committee at Al-Azhar university hospitals, Department of Anesthesia and after patients giving written consents, in the period from January 2020 till August 2020, Our study patients were randomly divided into two equal groups (epidural group and tap group).
<strong>Results:</strong> Epidural block provided significantly prolonged postoperative analgesia and reduced postoperative analgesic requirements as compared to ultrasound guided TAP block in patients undergoing CS. Both analgesic techniques were safe.
<strong>Conclusion:</strong> Epidural analgesia was better than TAP block regarding postoperative analgesia, total analgesic consumption and first time to rescue analgesia TAP block can be alternative to epidural when neuraxial anesthesia was contraindicated.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701CIRCULATING LEVEL OF INTERLEUKIN 6 IN PATIENTS WITH PRIMARY ANTIPHOSPHOLIPID SYNDROME2271228017868710.21608/amj.2021.178687ENAhmedMohammed KhalifaInternal Medicine, Departments, Al-Azhar Faculty of Medicine (Damietta)MohamedNabil RafatInternal Medicine, Departments, Al-Azhar Faculty of Medicine (Damietta)El-SayedEl-Meghawry El-SayedInternal Medicine, Departments, Al-Azhar Faculty of Medicine (Damietta)TarekMustafa OmranClinical Pathology *Departments, Al-Azhar Faculty of Medicine (Damietta)HendawyAbd El-Moety ZedanInternal Medicine
Departments, Al-Azhar Faculty of Medicine (Damietta)Journal Article20210620<strong>Background:</strong> The antiphospholipid syndrome (APS) is an autoimmune systemic disorder that carries many mortality and morbidity. Many cytokines come up in APS; IL6 is one of this cytokines.
<strong>Objective:</strong> Assessing Circulating Level of Interleukin 6 (IL 6) and its relations to thrombotic risk in patients with primary APS.
<strong>Patients and Methods:</strong> This study was carried out on sixty patients suffering antiphospholipid syndrome, and thirty healthy volunteers as a control. They were selected from inpatient and outpatient clinic of Internal Medicine and Unit of Immunology Departments from Al-Azhar University Hospitals (Al-Hussein, New Damietta and Al-Azhar University Hospitals), during the period from November 2017 to December 2019. They were divided into three equal groups: Group A; suffering from primary APS, Group B; suffering from secondary APS, Group C; healthy normal volunteers as a control group. All patients and controls were subjected to complete history, clinical assessment and laboratory investigations. Serum level of interleukin-6 was assessed.
<strong>Results:</strong> There was a statistical significant increase in IL6 among patients with 1ry APS as well as patients with 2ry APS. The commonest presentation among our studied patients with 1ry APS was venous thrombosis (17%) arterial thrombosis (9%) and unexplained abortion (10%). The significant signs that were detected on general examination of those patients were livedo reticularis (10%), Raynoud phenomen (15%) and purpuric eruption (13%). As regard 2ry APS, the commonest presentation among studied patients was venous thrombosis (23%) arterial thrombosis (24%) and unexplained abortion (12%). The significant signs detected on general examination of those patients were livedo reticularis (6%), Raynoud phenomen (10%), and purpuric eruption (13%). As regard the mean IL-6, there was a high significant difference between 1ry APS, 2ry APS and control groups (P<0.001). This study showed a positive correlation of IL-6 with arterial thrombosis among patients with 1ry APS. No correlation was detected between IL-6 and arterial thrombosis among patients with 2y APS. Regarding the correlation between venous thrombosis and IL-6 in patients with 1ry APS and 2ry APS, there were no statistically significant positive correlations as regard IL6.
<strong>Conclusion:</strong> IL-6 was found in patients to be elevated with primary APS. Serum IL-6 was showed to be positively correlated with arterial thrombosis.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701RELATION BETWEEN DEGREE OF LIVER STIFFNESS AND DEVELOPMENT OF HEPATOCELLULAR CARCINOMA IN CHRONIC HEPATITIS C VIRUS PATIENTS2283229617868810.21608/amj.2021.178688ENMohamedMahmoud El-TwabDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityAdelAbd El-Fattah El-RakeebDepartments of Internal Medicine, Faculty of Medicine, Al-Azhar UniversityMohamadKamal Al-SharqawiDepartments of Diagnostic Radiology, Faculty of Medicine, Al-Azhar UniversityAhmedMohamed Abo-HassanDepartments of Internal Medicine , Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> Hepatocellular carcinoma is the fifth most common tumor worldwide and the second most common cause of cancer-related death. Hepatitis C virus (HCV) infection is a leading cause of liver cirrhosis and hence the development of hepatocellular carcinoma (HCC). Egypt has the highest HCV prevalence worldwide. The introduction of new direct acting antiviral agents in the past 5 years has dramatically improved the outcomes of HCV treatment response with > 90% of patients achieving a sustained virological response (SVR) after 12 weeks of end treatment. However, the effect of direct-acting antivirals (DAAs) induced HCV clearance on HCC recurrence after HCC treatment has emerged as a topic of controversy.
<strong>Objective:</strong> To evaluate the relation between liver stiffness as measured by fibro scan and development of HCC in chronic HCV patients.
<strong>Patients and methods:</strong> A prospective study was done at Kafar Alshaykh National Hepatology Institute conducted in collaboration with the Gastroenterology Unit Department of Internal Medicine, Al-Hussein University Hospital, and Cairo Egypt. The study included 150 patients with proven liver cirrhosis secondary to chronic hepatitis C (CHC) they were further sub classified into three equal groups: Group I with chronic hepatitis C, liver cirrhosis and HCC, Group II with CHC and HCC that appeared after treatment with DAA, and Group III (control group) with cirrhotic chronic hepatitis C (CHC) without HCC.
<strong>Results:</strong> In this study, there was a statistically significant difference between group I (30.38 ± 11.32 kPa) and controlled group (25.0 ± 13.34 kPa), regarding fibro scan results (P = 0.004). On other hand there was no significant difference between group II (23.24 ± 7.69 kPa) and controlled group regarding LS.
<strong>Conclusion:</strong> Fibro scan can be a good technique for detection of HCC high-risk cirrhotic patients not treated by DAA and can be of great added value if incorporated in the current HCC screening protocols in hepatitis C cirrhotic patients. On the other hand, LS tended to decrease dramatically after the treatment with DAA. Using TE in these patients would therefore be misleading liver stiffness measurement (LSM), the risk of HCC remains because advanced fibrosis or cirrhosis, which is the most important risk factor for liver cancer, not completely resolved by antiviral treatment. As a matter of fact, the degree of liver fibrosis seems to be a strong predictor of the risk of HCC development.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701RELATION BETWEEN BETA 2 MICROGLOBULIN LEVELS AND CARDIAC PERFORMANCE IN PATIENTS ON REGULAR HAEMODIALYSIS2297230817868910.21608/amj.2021.178689ENMohamedFathy Al-MshalyDepartments of Internal Medicine & Nephrology, Faculty of Medicine, Al-Azhar UniversitySafwatFarrag AhmedDepartments of Internal Medicine & Nephrology, Faculty of Medicine, Al-Azhar UniversityMohamedSaeed Al-ShorbagyDepartments of Clinical Pathology, Faculty of Medicine, Al-Azhar UniversityEl-SayedMohamed RashedDepartments of Internal Medicine & Nephrology, Faculty of Medicine, Al-Azhar UniversityMohamedAhmed MosaadDepartments of Cardiology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> B2-microglobulin (B2M) is recognized as a surrogate marker of middle-molecule uraemic toxins and is a key component in the genesis of dialysis-associated amyloidosis.<br /> <strong>Objectives:</strong> To investigate the relation between hidden cardiac dysfunction in one side and B2M levels, conventional risk factors low hemoglobin levels, and aging on the other side.<br /> <strong>Subjects and methods:</strong> This was a case control study conducted on 50 patients aged 20-60 years with ESRD on regular HD and 50 apparently healthy individuals at El- Mokattam Insurance Hospital from September 2019 till March 2020.<br /> <strong>Results:</strong> There were statistically significant differences between groups regarding B2M, EF, LVMI, intraventricular septal thickness and LVEDD.<br /> There were no statistically significant differences between groups. Patient’s B2- microglobulin in Group (A) ranged between 76.00-109.70 with mean±S.D. 94.162±9.735, while in Group (B) ranged between 0.78-3.29 with mean±S.D. 1.956±0.704. There were statistically significant differences between groups. Patient’s LVMI in Group (A) ranged between 111.87-131.59 with mean±S.D. 123.41±5.675, while in Group (B) ranged between 82.02-104.84 with mean±S.D. 91.63±7.236. There were statistically significant differences between groups. Patient’s LVEDD in Group (A) ranged between 5.94-7.56 with mean±S.D. 6.79±0.505, while in Group (B) ranged between 3.27-5.25 with mean±S.D. 4.25±0.571. There were statistically significant differences between groups. Patient’s LVESD in Group (A) ranged between 4.80-5.73 with mean±S.D. 5.34±0.250, while in Group (B) ranged between 2.87-3.65 with mean±S.D. 3.27±0.243. There were no statistically significant differences between groups.<br /> <strong>Conclusion:</strong> Plasma B2M level was significantly and directly correlated with some cardiac performance factors such as LVMI, LVEDD, and LVESD. It was also significantly and inversely associated with GFR, albumin and Hb.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701COMPARISON OF INTRALESIONAL METHOTREXATE WITH TRIAMCINOLONE ACETONIDE IN TREATMENT OF HYPERTROPHIC SCARS2309231617869010.21608/amj.2021.178690ENSalehReda Saleh Al-KhateebDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityAmrMohamed ZakiDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityEmadMahmoud El-RewinyDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> Keloid and hypertrophic scars are common dermatological complaints produced by disruption of the normal wound-healing process. Since their earliest description, keloids have beleaguered patients and clinicians alike. These scars can be aesthetically disfiguring, functionally debilitating, and emotionally distressing.
<strong>Objective:</strong> Our study was carried out on 40 patients complaining of keloids divided into two equal groups A and B from November 2019 to June 2020: Group A: treated by triamcinolone acetinoid (TAC) every three weeks, and Group B treated by methotrexate (MTX) every three weeks for maximum eight sessions, We used multiple intralesional injections until the lesion was blanched. Patients were selected from out-patient clinic of Dermatology, Venereology and Andrology Department of Al-Azhar University Hospitals.
<strong>Results:</strong> The present study showed that the vascularity became normal (score 0) in 14 patients (70%), pink (score 1) in 6 patients (30%) in group A. Twelve patients (60%) became with normal vascularity (score 0), pink (score 1) in 8 patients (40%) in group B. Flatting of lesions (score 0) occurred in 14 patients (70%), while reduction to 2mm (score 1) documented in 6 patients (30%) in group A, and flattening (score 0) occurred in 10 patients (50%), reduction of the lesions to 2mm (score 1) occurred in 8 patient (40%) and 2 patient (10%) had score (2) height 2-5 mm in group B. Normal pigmentation (score 0) occurred in 16 patients (80%), mixed pigmentation (score 2) in 2 patients (10%) and hyperpigmentation (score 3) in 2 patients (10%) in group A and 6 patients (30%) showed normal pigmentation (score 0), 2 patients (10%) showed mixed pigmentation (score 2), 4 patients (10%) showed hypopigmentation(score 1) and 8 patients (40%) showed hyperpigmentation (score 3) in group B. Normal pliability in 16 patients (80%) (Score 0), 4 patients (20%) showed supple pliability (score 1) in group A. Normal pliability (score 0) was in 10 patients (50%), 2 patients (10%) showed yielding pliability (score 2), and 8 patients (40%) supple pliability (score 1) in group B. Assessment of the scar was based on Vancouver scar scale.
<strong>Conclusion:</strong> Triamcinolone acetinoid (TAC) was effective in treatment of hypertrophic scars than methotrexate with statistically significant difference at end of treatment period and follow up.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701ROLE OF CARDIAC MAGNETIC RESONANCE IMAGING IN ASSESSMENT OF RIGHT VENTRICULAR DYSFUNCTION IN PATIENTS WITH PULMONARY HYPERTENSION2317233017869110.21608/amj.2021.178691ENEmadMahmoud Abd El-Maksoud ArafaDepartments of Radio diagnosis, Faculty of Medicine, Al-Azhar UniversityMohamedAly AbboudDepartments of Radio diagnosis, Faculty of Medicine, Al-Azhar UniversityWafikIbrahim MohamedDepartments of Radio diagnosis, Faculty of Medicine, Al-Azhar UniversityMohamedAbu Mandour MousaDepartments of Cardiology, Faculty of Medicine, Al-Azhar UniversityJournal Article20210620<strong>Background:</strong> Patients with pulmonary hypertension (PH) can develop cor pulmonale later which is the leading cause of death in those patients. Although echocardiography is the mainstay in the assessment of hemodynamic and ventricular function in PH, magnetic resonance imaging (MRI) has emerged as the gold standard for quantifying volume, function, and flow in the right side of the heart.
<strong>Objective:</strong> To evaluate the role of cardiac magnetic resonance image in assessment of right ventricular functions in patients with pulmonary hypertension and to explore the relation between pulmonary artery pressures obtained from echocardiography and MRI -derived ventricular functions parameters.
<strong>Patients and methods:</strong> A total number of 27 patients scheduled for elective conventional echocardiography with known or suspected pulmonary hypertension were enrolled for MRI examination of the heart between October 2018 and March 2020, in Radiology Department, Al-Hussein University Hospital. All patients underwent cardiac MRI and echo within one week.
<strong>Results:</strong> We found that the mean value of left ventricular end systolic volume (LVESV) and left ventricular end systolic volume index (LVESVI) increased in pulmonary hypertensive patients. On assessment of the right ventricular mass index, the mean value was increased in our study compared to normal value. Right ventricular (RV) ventricular mass index (VMI) increased due to increased RV mass and decrease left ventricular (LV) mass. We visually assessed the position of the interventricular septum (IVS) during systole and diastole and had an abnormal position in some patients (nearly 38% of our cases either flattening or bowing toward the left ventricle). All of patients with abnormal septal position had systolic pulmonary pressure above 60 mmHg. We found that 79% of our patients had pulmonary regurge and the average velocity in the main pulmonary was 9.024±6 cm/sec which was less than normal average velocity (13.6±7cm/sec).
There was a significant positive correlation between the mean pulmonary arterial pressure (mPAP), and the RV mass(r=0.4), and a significant positive correlation between mPAP and VMI (r=0.52).
<strong>Conclusion:</strong> Cardiac MRI is a valuable tool to assess the effect of pulmonary hypertension on the ventricular functions and also valuable for assessment of treatment response, follow up and prognosis of such patients.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701Evaluation of Serum Cholinesterase Level as A diagnostic Marker in Chronic Liver Disease2331233617869210.21608/amj.2021.178692ENZayedSaid Youssef HassanDepartment of Clinical Pathology, Al-Azhar Faculty of MedicineAhmedMohammed Abdel Rahman TahounDepartment of Clinical Pathology, Al-Azhar Faculty of MedicineMagdyAbdel Kareim EldahshanDepartment of Internal Medicine, Al-Azhar Faculty of MedicineAhmedAbdul-Hameid Abo-ZiedDepartment of Clinical Pathology, Al-Azhar Faculty of MedicineJournal Article20210620<strong>Background:</strong> Liver is the main source of Butyrylcholinesterase (serum cholinesterase). It is a non-specific cholinesterase that is reduced in patients with advanced liver diseases. Measurement of serum Butyrylcholinesterase activity serves as a sensitive indicator of synthetic capacity of the liver.<br /> <strong>Objective: </strong>To evaluate serum cholinesterase levels in chronic liver disease patients.<br /> <strong>Patients and methods:</strong> In this study serum cholinesterase level was evaluated in chronic liver disease patients by a colorimetric kinetic assay method. Thirty cirrhotic subjects and thirty non-cirrhotic hepatic disease subjects were compared to 20 normal individuals. This study was done at Al-Azhar University Hospitals in the period between June 2018 and August 2020.<br /> <strong>Results:</strong> A significant decrease in serum Cholinestrease level was observed in all patients of chronic liver disease as compared to control group.<br /> <strong>Conclusion:</strong> Serum cholinesterase is a better diagnostic and prognostic marker than the conventional liver function test that are raised in other liver disease also.<br /> Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701Effect of serum adropin level and cinnamon water extract on normal and alloxan-induced diabetic adult male albino rats2337235017869310.21608/amj.2021.178693ENAhmadMohammad Farag Al-KotDepartment of Medical Physiology, Faculty of Medicine, Al-Azhar University, Cairo, EgyptJournal Article20210620<strong>Background:</strong> Adropin is a peptide first identified in 2008 in liver and brain tissues. It serves to modulate lipid and glucose metabolism and to maintain insulin sensitivity. It was found to be decreased in many disorders including diabetes mellitus (DM), atherosclerosis, diabetic nephropathy and many other diseases. Cinnamon tends to improve the serum glucose and lipid levels in diabetic subjects which may help in controlling DM and its disabling complications.
<strong>Objective:</strong> To study the effect of serum adropin levels and cinnamon water extract on normal and alloxan-induced diabetic adult male albino rats.
<strong>Materials and methods:</strong> Twenty-eight adult male albino rats of a local strain were used as an animal model for this study. They were divided into 4 equal groups; group 1 (control), group 2 (non-diabetic cinnamon-treated), group 3 (diabetic non treated), and group 4 (diabetic cinnamon-treated). After 4 weeks, blood samples were collected and serum was separated for the measurement of adropin level (by ELISA). Fasting blood sugar (FBS), HbA1C, cholesterol, LDL, HDL and TAGs were also measured. Collected Data were analyzed using SPSS version 25 and the difference between studied groups was considered significant when P ≤ 0.05.
<strong>Results:</strong> This study showed that there was a significant increase in serum adropin level in alloxan induced diabetic rats when compared with the normal rats. Also, the increase in serum adropin level showed a significant positive correlation with HbA1C, cholesterol, LDL and TAGs and a significant negative correlation with HDL. On the other hand, treatment with cinnamon showed a significant improvement of FBS, HbA1C and lipid profile and this was associated with reduction in serum adropin level.
<strong>Conclusion:</strong> The increase in serum adropin level in alloxan-induced diabetes is compensatory as it increases insulin sensitivity and ameliorates diabetic associated metabolic derangements and, in the future, it may be one of the members of diabetic medications.Al-Azhar Scientific Medical SocietyAl-Azhar Medical Journal1110-040050320210701Role of Ultrasound in the Evaluation of Painful Knee. A Comparative Study to MRI2351236217948310.21608/amj.2021.179483ENMuhammadReda Abdullah AliDepartment of Radio diagnosis, Faculty of Medicine, Al-Azhar UniversityAhmedAbdul Fatah Mahmoud Abo-RashedDepartment of Radio diagnosis, Faculty of Medicine, Al-Azhar UniversityAhmedMuhammad MoustafaDepartment of Radio diagnosis, Faculty of Medicine, Al-Azhar UniversityJournal Article20210623<strong>Background:</strong> One of the frequent musculoskeletal problems is knee pain. The trend of increasing of knee pain among the populations is noted. Therefore, choosing a reliable screening tool with reasonable cost is mandatory. Although magnetic resonance imaging (MRI) is the gold standard imaging modality for knee soft tissue structures, it has been widely abused with its high cost. Ultrasound is an established modality to image the soft tissue structures of the knee.
<strong>Objective:</strong> To show the role of ultrasound (US) in evaluating of knee pain and comparing the results with magnetic resonance imaging (MRI).
<strong>Patients and methods:</strong> This study included 40 patients (18 males and 22 females) with an age ranging from 15-69 years. This study was carried out at the Radiology Department of Al-Azhar University Hospitals for ultrasonography and MRI examination during the period from October 2019 to November 2020.
<strong>Results:</strong> Regarding meniscal horn tear, ultrasound detected tear in 2 cases, while MRI detected tear in 5 cases. Regarding meniscal horn degeneration, Ultrasound detected degeneration in 1 case, while magnetic resonance imaging detected degeneration in 6 cases. These results indicated that sonography was not accurate enough to be used as the only modality for diagnosing lesions of the knee menisci. Regarding medial collateral ligament (MCL) injury, ultrasound detected medial collateral ligament injury in 3 cases, while magnetic resonance imaging detected medial collateral ligament injury in 4 cases. The majority of the knees with osteoarthritis (OA) had effusion using ultrasound (100%) and magnetic resonance imaging (100%). Synovial thickening observed on ultrasound and magnetic resonance imaging. This study confirmed that there was a significant correlation between the magnetic resonance imaging and ultrasound techniques for evaluating the cartilage and soft tissue changes in the patients with knee osteoarthritis.
<strong>Conclusion:</strong> Ultrasound is an effective imaging modality that can be suitable as a screening tool for patients having knee pain. Knee US has reasonable accuracy in detecting collateral ligament and meniscal pathology. US with the advantages of being widely available lower in cost and with no contraindications should be the first modality of choice in evaluating knee pain. MRI can be reserved for equivocal US results.