Publisher: Al-Azhar University   (Total: 6 journals)   [Sort by number of followers]

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Al-Azhar Intl. Medical J.     Open Access   (Followers: 8)
AL-Azhar J. of Pediatrics     Open Access   (Followers: 17)
Al-Azhar J. of Pharmaceutical Sciences     Open Access   (Followers: 6)
Al-Azhar Medical J.     Open Access   (Followers: 8)
J. of Recent Advances in Medicine     Open Access   (Followers: 16)
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Al-Azhar International Medical Journal
Number of Followers: 8  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2682-3381 - ISSN (Online) 2682-339X
Published by Al-Azhar University Homepage  [6 journals]
  • Spheno-Orbital Enplaque Meningioma; Surgical strategy and Proptosis result

    • Abstract: Background: Spheno-orbital enplaque meningioma (SOEMs) are complex lesions that primarily originate in the sphenoid wing with extensive hyperostosis and may involve the orbit and cavernous sinus, making a gross total resection difficult and posing a high risk of postsurgical morbidity and recurrence. Method: a series of 13 consecutive patients with SOEM presented by proptosis and hyperostosis who underwent surgical excision by frontotemporal craniotomy, clinical, radiological, surgical technique and follow up was reviewed and analyzed. Result: In this series of 13 consecutive patients, 11 were women and 2 were men. The age range was from 35-63 years with a mean of 46.3 years. Tumors were located on the right side in 9 patients (69%) and the left side in 4 patients (31%). Cavernous sinus (CS) and superior orbital fissure (SOF) invasion in 4 cases (31%). Gross total excision grades I and II were obtained in 6 cases (46%), near total excision grades III in 3 cases (23%), and partial excision grade IV in 4 cases (31%). 11 cases (85%) show improvement of proptosis (7 patients, 54% have a complete resolution of proptosis and 4 cases, 31% have partial resolution of proptosis) and 2 cases show no improvement of proptosis after a long follow-up period. Conclusion: The decision for each case of Spheno-orbital enplaque meningioma should be individualized depending on the extension of the lesion to the surrounding structures. Extension to the CS and SOF should be considered the surgical limit for excision.
  • The Role of Repetitive Transcranial Magnetic Stimulation in Spastic
           Hemiplegic Cerebral Palsy in a Sample of Egyptian Children

    • Abstract: ABSTRACT Background; One of the most common neurologic disorders is cerebral palsy. To improve quality of life, many tools have been employed. rTMS is a new established technique to treat spasticity and improve the outcome of rehabilitation program in various neurologic conditions. Aim and objectives; To assess the effect of high frequency rTMS on improving spasticity and motor performance in spastic hemiplegic CP in a sample of Egyptian children. Patients and methods; 65 children aged between 4-18 years attending the Neuro-Pediatric Unit of Al-Azhar University hospitals were recruited in the period from beginning of Jan, 2022 to the end of June, 2022. They were randomly allocated into two groups: Study Group: 40 patients received 8 sessions of high frequency rTMS (2 sessions per week for 4 weeks) followed by physical therapy (PT) of 30 minutes duration. 1500 pulses (50 pulses per train with total 30 trains) per session with an intensity of 90% of the motor threshold at a frequency of 10 Hz were received. Contralateral primary motor cortex (M1) was the site of stimulation. Each train had duration of 30 sec with inter- train delay of 25 seconds. Control Group: 25 patients received only physical therapy (PT) of 30 minutes (2 sessions per week for 4 weeks). Results: The study group has been improved statistically significantly as compared with the control group. Conclusion: r-TMS essentially contributes to reducing spasticity and enhancing motor performance in hemiparetic CP children.
  • A cross-sectional analysis of the relationship between tinnitus functional
           index and anxiety and depression disorders in tinnitus patients with
           normal hearing

    • Abstract: Background: There is a substantial prevalence of psychopathology of anxiety or depression, and several mental problems in many tinnitus groups. Aim of The Work: To use the Tinnitus Functional Index (TFI) as a valid scale for assessing the overall severity of tinnitus and detailed analysis of multiple severity domains, and correlating it to The Hospital Anxiety and Depression Scale (HADS) scores , This to establish a potential correlation between tinnitus and anxiety and depressive disorders to improve tinnitus clinical implications and rehabilitation. Subjects and Methods: A cross-sectional study design was designed to explore the prevalence of psychological disorders among patients with tinnitus and to analyse its multiple severity domains thresholds using both TFI & HADS questionnaires. Results: There was a positive correlation between both anxiety & depression subscales of (HADS) and total TFI scores with its subscales.  Conclusion: Despite the limited understanding of psychological concerns in tinnitus patients, the prevalence of anxiety disorders in these populations has increased. The reported co-occurrence might impact the clinical course of tinnitus and its management.
  • Histopathological Study about the Effects of Chronic Concomitant
           Administration of both Pregabalin and Ibuprofen on the Skeletal, Cardiac
           and Smooth Muscles of Male Albino Rats

    • Abstract: Background: there is not enough information available to assess the relationship between Pregabalin use and muscular damage. Also, the effect of pregabalin ibuprofen combination on musculature not well assessed till now. Objectives: The study aimed to evaluate the possible chronic concomitant effect of both pregabalin and ibuprofen on skeletal, cardiac and smooth muscles in male albino rats. Subjects and methods: One hundred adult healthy male albino rats weighting 200 – 250 gm were obtained from the animal house, Faculty of Medicine, Assiut University, Egypt. The animals were classified into five groups: Group one (Negative control):10 male albino rats, received normal feeding, group two (Positive control): 15 male albino rats given 1 ml of distilled water, group three: 25 male albino rats were given pregabalin at dose 250 mg/kg/day orally (1/20 LD50), group four: 25 male albino rats were given ibuprofen at dose of 80 mg/kg/day orally (1/20 LD50), group five: 25 male albino rats were given ibuprofen at dose of 80 mg/kg/day and pregabalin at of dose 250 mg/kg/day. All animals were treated for three months. Results: as regard weight of animals, there were statistically significant difference between positive control group versus Pregabalin, and pregabalin+ ibuprofen groups. Also histopathological examination showed that chronic use of pregabalin was associated with atrophy, inflammatory cells and cell degeneration of skeletal muscle. Conclusion: The current study demonstrated that the chronic use of pregabalin was associated with atrophy, inflammatory cells and cell degeneration of skeletal muscle of male albino rats.
  • Effectiveness of Surgery for Degenerative Lumbar Spinal Stenosis: A
           Systematic Review

    • Abstract: Background: Lumbar spinal stenosis is common condition. Many similar treatment procedures have been described. In managing spinal stenosis surgery has expanded dramatically in the last two decades. Aim of the study: Assess the safety and efficacy of operative and invasive therapies for people experiencing degenerative LSS. Patient and methods: PubMed, Embase, Web of Science, and the Cochrane library were used to find relevant clinical research. Participants in such studies were 60 years old or older and had degenerative lumbar spinal stenosis. Results: All studies were randomized controlled trials. There were 974 patients. As regard Outcomes measures after surgical treatment, significant improvement in functional outcome and scores. Outcome of patients were measured pre and post operation by oswestry disability index (ODI) score in 8 studies with mean pre operation score 43.7 and post operations score decreased to 26.06. Visual analog scales (VAS) were used in 3 studies with preoperation mean score 5.49 and decreased post operation to 22.5. EQ-5 D was used by 1 study and mean preoperation score was 0.29 which increased to 0.58 postoperation.SF-36 scores were used to assess patient’s outcome after surgery and showed that mean SF-36 physical pre was 34.7 decreased to33.1, mean SF-36 mental pre was 58.6 increased to 66.4 and mean SF-36 pain pre was 31.2 and changed to34.6. Conclusion: Surgery showed higher effectiveness and functional outcome improvement and scores among included studies. As regard Patient’s satisfaction reported in three studies in 114 patients was satisfied. Keywords: Clinical studies; Effectiveness; Lumbar spinal stenosis; Treatment strategy.
  • Prevalence of Child Sexual Abuse in Sohag Governorate in Egypt during One
           Year from January to December, 2020.

    • Abstract: Background: Child sexual abuse is a major threatening problem to child health which predispose to different distressing short-term and long-term complications including psychic, cognitive, physical and social hazards. Objective: To evaluate all alleged child sexual abuse cases that presented to Forensic Medicine Authority in Sohag Governorate of Egypt during 2020. Patients and Methods: There were (69) alleged cases of child sexual abuse presented to the Forensic Medicine Authority in Sohag Governorate during 2020. A history were taken from children to analysis and identify the situation of the assault then general and local examinations were done for detection of any positive findings. Results: In our study male cases were higher than female cases (70.7 % to 29.3% respectively) and male children in school group (6-12 y), represent the highest percentage of sexually abused children (47.7%). Anal abuse was the most common local injury findings among male cases (73.4 %). Conclusion: Male cases were higher than female cases and anal assault was the most common site of injury among study cases.
  • Effect of manufactured fat emulsion Infusion on Protein Loss in Burn
           Patients (Randomized controlled study)

    • Abstract: Background: Burn injury management requires a lot of time and resources. Most patients need lengthy hospital stays. Aim of the study: To determine the impact of manufactured fat emulsion on protein loss in burn patients. Patients and Methods: This Randomized controlled study included 20 patients of 20% up to 40% of TBSA that were hospitalized to department of plastic and reconstructive surgery, Al-Azhar University hospital, which was prospectively be simple into two groups. Group (A) were subjected manufactured fat emulsion IV infusion. Group (B) controlled. The study duration ranged from 6-12 months. The patient administrates 1-1.5g /per kg of intralipid (20%) from post burn day 4. venous blood samples were taken for testing total protein, albumin, total cholesterol and triglyceride and 24 hours’ urinary creatinine on post burn days 1st, 7th ,14th, 21st, 30th respectively. Result: There is a substantial reduction in total protein, plasma albumin and urinary creatinine from 1st day to 21days among group A and group B. However, there is a slight change in cholesterol and triglycerides without statistically significant difference. at 1st day and 7th day, total protein, plasma albumin, cholesterol and triglycerides were comparable in both groups without statistically significant difference. At 14th day total protein was substantially greater in group A compared to group B. At 21st and 30th day total protein, plasma albumin was significant higher in group A compared to group B. Conclusion: The intralipid 20 percent IV infusion is a useful energy source to reduce albumin loss in severely burnt individuals.
           ALBINO RATS (Light and Electron Microscopic Study)

    • Abstract: Background: Sildenafil citrate is effective in men with erectile dysfunction. Sildenafil induces degenerative changes in seminiferous tubules and interstitial histological alterations. Diabetes mellitus may cause an end-organ damage in many systems as the genitourinary system. The testis is the primary sex organ and is formed mainly of stroma and parenchyma. It is a mixed gland that performs both endocrine and exocrine activities. Objective: To reveal the effect of sildenafil citrate in high and toxic doses on the histological structure of the healthy and diabetic rat testes. Material and methods: The research was carried out at the animal house at Faculty of Pharmacy, Al-Azhar University between July, and September 2021. Fifty adult rats were used divided into the following groups: Group I: 10 rats received distilled water daily; group IIA: 10 rats received intraperitoneal injection of sildenafil 9mg/kg/d; group IIB: 10 rats received sildenafil 13.5mg/kg/d, group IIIA: received a single dose of an intraperitoneal injection of 150 mg/kg body weight of alloxan to induce diabetes then sildenafil citrate 9 mg/kg/d, group IIIB: received a single dose of an intraperitoneal injection of 150mg/kg of alloxan to induce diabetes then intraperitoneal injection of sildenafil citrate 13.5mg/kg/d. Animals from all groups were examined 2 months after the start of the experiment. Results: Sildenafil had a toxic effect on the testes of adult albino rats that was more severe with the toxic dose and in diabetic rats. Conclusion: Sildenafil had toxic effects on the testes in high doses and also in diabetics.
  • Study of Laparoscopic Nissen versus Anterior Partial fundoplication in
           management of gastro esophageal reflux disease in children

    • Abstract: Background: GERD is the most common upper gastroesophageal disorder in the Western population. A number of strategies have been recommended to prevent this problem. Aim of the Work: to compare the Nissen fundoplication with partial anterior fundoplication. Patients and Methods: The present comparative study included thirty patients who had symptomatic GERD admitted in pediatric surgery department ,Al-Azhar University hospitals and all patients submitted to preoperative clinical evaluation and investigations. Patients were randomly allocated to undergo either laparoscopic Nissen fundoplication (group I) or laparoscopic partial anterior fundoplication (group II). All patients in our study signed a consent form. Results: there was no significant difference between both groups as regard intraoperative complications, the hospital stay. But there was a significant difference between both groups in regarding operative time in favor of partial anterior procedure. After 1, 3, 6 months there is no significant difference between both groups as regarding to heartburn and regurgitation . As regarding to post operative dysphagia After 3 months there was a highly significant difference between both groups as regards dysphagia in favor of partial anterior fundoplication as dysphagia was significantly less with partial anterior fundoplication. After 1, 3 and 6 months gas bloating less common with partial anterior fundoplication but without significant differences between both groups. Conclusion: Partial anterior fundoplication seems safe and effective in treating the symptoms of GERD as Nissen fundoplication including patients with severe forms of the disease. Its technique is simpler and takes shorter time to perform.
  • Evaluation of the Medial Sural Artery Perforator Flap for Validity Around
           Knee Reconstruction

    • Abstract: Background: Soft tissue defects overlying the knee are often the result of trauma, post-burn contracted scars, and malignancy requiring a wide excision. These defects signify a great challenge to surgeons when faced with reconstructive surgery. Aim of the Work: Evaluation of the versatility of pedicle medial sural artery perforator flap as a regional flap in reconstruction of knee and around knee soft tissue defects. Patients and Methods: Twenty patients were recruited in this study who suffered soft tissue defects of knee and peri-knee with exposed vital structures. Fourteen patients were male and six were female and their ages ranged from 8 to 43 years (mean 10 years). all patients underwent reconstruction by medial sural artery perforator flap. Doppler ultrasound and CT angiography were performed to evaluate the location, number, and size of MSAPF perforators. Results: Flap survival was uneventful, as 2 (10.0%) patients with Tip necrosis healed with dressing, 3 (15.0%) patients with partial graft loss at the donor site healed by secondary intention, and 3 (15.0%). The follow-up ranged from 3 to 13 months with a mean of 7.75 ± 2.95. The Pedicle Length (cm) ranged from 5.5 to 12 with a mean of 9.15 ± 1.76, and The mean Post-Operative Hospital Stay (day) was 13.30 ± 7.04. Perforator numbers ranged from 1 to 3 with a mean of 1.25 + 0.44. Conclusion: Pedicle MSAP Flap is a versatile pliable flap and has along reliable pedicle with little donor site problems.
  • Functional Outcome of Double and Four Strand Techniques in Hand Flexor
           Tendon Repair

    • Abstract: Background: 14% to 30% of all treated patients examined in emergency rooms have hand injuries. Tendon injuries rank 2nd (29%) of all patients treated for hand injuries. Objective: To demonstrate the functional outcomes of double-strand and four-strand procedures for the repair of hand flexor tendons and the benefits of early rehabilitation. Patients and methods: We carried out this prospective study on 40 patients who had completely cut flexor tendons of the hand at the plastic and burn surgery department of Al-Hussein & Bab Elsheria University Hospital, Al-Azhar University (Cairo). Results data suggest that, when it comes to hand flexor tendon restoration, there is no statistically significant difference between modified Kessler and 4 strand procedures. Also, no significant difference statistically between 2 groups of the early rehabilitation (active and passive). Except when the surgeon employs the 4-strand approach, utilizing an early active rehabilitation strategy is more crucial. Conclusion: There were no statistically significant differences in the two strands' or the four strands' groups in terms of total active range of motion. However, we found that cruciate (4-strand) suture techniques are simple to carry out and sufficiently strong for post-operative rehabilitation that begins early. Early active mobilization was associated with improved edema and soft tissue alterations. Compared to the inactive group, active motion significantly reduces adhesion development. Also, no variation was detected in the rupture rate between the two groups.
  • The Surgical Outcome of Chronic Rhinosinusitis with Emphasis on Rhinogenic

    • Abstract: Background: Chronic rhinosinusitis (CRS) is a persistent inflammatory disease. The pathogenesis of CRS involves many factors including genetics, status of the sinonasal microbiome, infections, and environmental influences. Aim of the study :To monitor the outcome of sinus surgery and to evaluate headache severity, duration, and frequency. Patients and methods: A prospective study was conducted at Al-Azhar University Hospital. We targeted 60 patients belonging to both sexes aged between 18 and 65 years. Divided into 3 groups: Group (1): Chronic Rhinosinusitis with or without concha bullosa, Group (2): Chronic Rhinosinusitis with or without hypertrophy turbinate, and Group (3): Chronic Rhinosinusitis with or without deviated septum. Result:A total of 60 patients, significant difference found regarding nasal obstruction between the groups.Based on Visual Analogue Scale (VAS), the intensity of pain in the group1revealed a highreduction from 6.25 ± 1.87 (Preoperative) to 2.88 ± 1.01 (3 months aftertreatment) and 1.54 ± 1.21 (6 months after treatment). In group 2 the intensity of pain revealed a high reduction from 5.87 ± 0.911 (Preoperative) to 3.01 ± 1.39 (3 months after treatment) and 1.33 ± 0.935 (6 months after treatment). In group 3 the intensity of pain revealed a high reduction from 6.48 ± 1.72 (Preoperative) to 2.51 ± 0.993 (3 months after treatment) and 1.59 ± 1.13 (6 months after treatment) Conclusion: Surgical removal of contact points in the nasal cavity can be effective in treating the headache. Contact point headache has the highest severity, duration, and frequency.
  • Total Arterial Revascularization versus Conventional Coronary Artery
           Bypass Grafting; A Comparative study

    • Abstract: Background: The superiority of total arterial revascularization over the conventional method is a matter of continuous debate. Therefore, we aimed to compare early surgical and hospital outcomes of the total artery and conventional revascularization strategies in patients undergoing coronary artery bypass grafting (CABG). Methods: The study included 60 patients who underwent primary elective CABG from 2018 to 2020. Patients were grouped according to the revascularization strategy into two groups. Group 1 included patients who had conventional revascularization using left internal mammary artery (LIMA) and vein grafts (n= 30), and group 2 included patients who had total arterial coronary revascularization (TACR) (n= 30). Results: Patient who had TACR were significantly younger (48.43 ± 11.72 vs. 55.63 ± 3.97 years; P= 0.003). TACR patients had shorter cardiopulmonary bypass (53.70 ± 9.91 vs 61.83 ± 9.60 min; P= 0.002) and ischemia times (38.20 ± 7.78 vs 44.03 ± 7.23 min; P= 0.004). Blood loss and transfusion were significantly higher in patients in the conventional group (P= 0.01 and ˂0.001, respectively). TACR was associated with shorter mechanical ventilation (3.83 ± 0.95 vs. 4.80 ± 1.40 hours; P= 0.003), ICU (1.13 ± 0.35 vs. 1.47 ± 0.51 days; P= 0.004) and hospital stay (4.47 ± 0.63 vs. 6.04 ± 0.71 days; P= 0.001). After six months, angina and dyspnea classes were significantly better in the TACR group. Conclusions: The debate about the optimal CABG conduit is ongoing. Total arterial revascularization could be associated with favorable short and mid-term results.
  • Comparative Study between Clinical Outcomes of All Inside Technique and
           Standard Antero-Medial Technique in Anterior Cruciate Ligament

    • Abstract: Background: Although theoretically superior to traditional technique, anatomical single bundle ACLR via all-inside technique does not appear to demonstrate statistically significant advantages over conventional technique, as with the Lysholm scoring system. Aim of the work: This study compared the post-operative clinical outcomes of arthroscopic ACL restoration using the "all-inside approach" versus the "traditional procedure". Patients and Methods: Between March 2020 and December 2021, fifty patients were admitted to the department of Orthopedic surgery and Traumatology in Sayed Galal University Hospital with torn ACL exhibiting high grade pivot shift (II or III) under anesthesia. Results: The mean age of the patients was (28.55 ± 8.57) years in group I and (28.75 ± 7.71) in group II. The mean duration of symptoms was (8.95 ± 6.09) months in group I and (10.28 ± 10.42) months in group II. The overall results at the sixth months were considered as excellent in Group I had five cases (33.33%) with excellent results and four cases (26.67 %) with good results. In group II, nine cases were excellent (60%) and three cases (20%) were good. In the 6th months, Group I mean was (85.50 ± 11.10) and group II was (91.90 ± 8.94) which was statiscally insignificant.
  • Prevalence and severity of mineral bone disorders in chronic kidney
           disease patients

    • Abstract: Background Bone abnormalities are frequently developed in hemodialysis patients and people with chronic kidney disease (CKD). It results from aberrant bone turnover and a decline in bone mineral density (BMD). Aim and objectives: With the help of dual energy X-ray absorptiometry in this study, poor bone mineral density in CKD patients at Al-Hussein University Hospital will be analysed for prevalence and severity. Subjects and methods: This Cross-Sectional research included 120 Patients (2 groups) 60 CKD Patients and 60 Hemodialysis Patients. The study has been conducted in Nephrology Unit Al-Hussien University Hospital. Results: In ESRD group there was Significant statistically (p-value = 0.008) T score femur and eGFR had a positive connection (r = 0.34). Significant statistically (p-value = 0.008) There is an r-value of 0.34 between the T score of the spine and the eGFR. While in CKD group significantly significant (p-value = 0.001) differences. T score femur and Creat have a negative connection (r = -0.41) with each other. Significant statistically (p-value = 0.001) T score femur and eGFR had a positive connection (r = 0.43). Significant statistically (p-value = 0.02) The T score forearm and the eGFR have a positive connection (r = 0.3). Conclusion: MBD are common features among CKD patients especially in late stages leading to Osteoporosis and fractures. Dual Energy X- Ray (DXA) could be utilized as efficient method for detection of the level of bone affliction in CKD patients and is essential for bone loss monitoring Keywords: mineral bone disorders, chronic kidney diseases.
  • Prevalence and Impact of External Genitourinary Anomalies among Children
           undergoing routine Circumcision

    • Abstract: Background: The knowledge of the incidence of congenital anomalies is important for planning health services in our country. It helps in planning the budget as well as measures for the management and the prevention of the disorders. It also helps to establish a program raising awareness of urogenital anomalies and their management. Objective: The aim of this study is to evaluate the normal anthropometric value of the normal penis and to detect the prevalence and impact of external genitourinary anomalies among 3000 Egyptian children attending for nonmedical circumcision. Patients and Methods: The prospective multi centric study was done on 3000 male babies coming for routine circumcision in an outpatient clinic in Al Azhar university hospitals in the period from 2018 to 2021. All babies were examined and evaluated for the genitourinary parameters. Results: the study suggests normal anthropometric values of SPL , AGD, preputial length, meatal diameter according to age. The incidence of urogenital anomalies among studied children is about 18.4%. Conclusion: This study gives value reference and percentile curves for stretched penile length (SPL) , AGD, Preputial length, meatal diameter and glans closure length in healthy Egyptian males from the age of one day to 10 years
  • Early versus delayed umbilical cord clamping during cesarean section of
           pregnant women with preeclampsia: Maternal and neonatal outcome

    • Abstract: Background: umbilical cord serves like a conduit for fetus's gas exchange, nourishment, & endocrinal homeostasis.  Clamping of umbilical cord marks watershed moment in development of foetus into independent entity. Aim of the work: To compare effects of  early versus delayed cord clamping on intraoperative blood loss during caesarean delivery in cases with severe preeclampsia. As well as to compare neonatal benefit of delayed cord clamping versus early cord clamping. Patients and methods: This randomized prospective control study was conducted, including 60 near term pregnant women with severe preeclampsia candidate for termination by cesarean delivery and the surgery was performed by qualified staff member at the Obstetrics and Gynecology Department, Al-Azhar University Hospitals. The study duration ranged from 6-12 months. Results: Postpartum hemorrhage was slightly more frequent in delayed group compared to early group. However, blood transfusion, and Uterotonic administration were slightly less frequent in delayed group compared to early group but without difference between 2 groups. Conclusion: There was no difference between delayed and early cord clamping as regard maternal or fetal outcomes. Only neonatal crying/breathing established before cord clamping was significantly more frequent in delayed group compared to early group.
  • Mid-Secretory Uterine Artery Doppler Indices and Endometrial Thickness in
           Patients with Unexplained Recurrent Pregnancy Loss

    • Abstract: Back ground : Recurrent pregnancy loss (RPL) occurs in up to 3% reproductive age couples. Potential uterine predictors for implantation measurable by ultrasound include endometrial thickness and volume, endometrial pattern, as well as blood flow in the uterine and sub-endometrial arteries. Aim: to evaluate endometrial thickness and uterine artery blood flow using Transvaginal color Doppler ultrasound during the midluteal phase of the menstrual cycle for women with unexplained recurrent pregnancy loss (RPL). Patients and methods: A prospective controlled clinical trial was conducted on 90 non pregnant women :45 Patient group and 45 Control group. All participants underwent comprehensive examinations and were scanned by transvaginal Doppler ultrasonography during the midluteal phase to measure endometrial thickness, the pulsatility index (PI), resistance index (RI) and systolic/diastolic ratio (S/D) values of the left and right main uterine arteries. P value less than 0.05 was considered statistically significant. Results: No statistically significant difference between the studied groups as regard to endometrial thickness. While highly statistically significant increased right and left uterine arteries S/D ratio ,RI and PI in the cases group when compared with the control group (p-value < 0.001) . Conclusion: Normal blood flow to uterus plays an important role in pregnancy outcome while endometrial thickness has less important role. Color Doppler ultrasound can be used to detect abnormal uterine Doppler indices that can predict pregnancy outcome.
  • The correlation of The Placental Thickness, Umbilical Artery Doppler and
           Fetal growth

    • Abstract: Background: A healthy foetus requires the normal growth of the placenta during the pregnancy. On the other hand,, any disturbance related to its maturation may have a major effect on the fetal growth and the pregnancy outcome.. Aim and objectives: to detect the relation between the umbilical artery Doppler, placental thickness, and foetal growing. Subjects and methods: This cross-sectional study conducted at the outpatient clinic of the obstetrics and gynecology department, Al-Azhar University hospitals (assuit) and AL_Eman General Hospital Results: At the first visit, there was a strong positive connection between placental thickness and AC, BPD, and HC (r=1.00, p < 0.001). At the second visit, There were a notable positivity correlation between placental thickening and estimated foetal weight and umbilical flow by the Doppler (r=1.00, p < 0.001). Conclusion: Estimating the fetal weight is essential in our daily obstetric practice, especially at the third trimester. It helps the obstetricians in making decisions about delivery time and mode of delivery, to protect against the complications of low birth weight and macrosomic babies during labor and puerperium. From the findings of this study we can conclude that, there is measurably critical positive relationship between placental thickness and EFW, BPD, FL, AC and umbilical flow by the Doppler. Estimation of the placental thickness by Ultrasound is a good predictor for foetal growth and birth weight.
  • Cervical Cytologic and Colposcopic Changes in Cases Using Intrauterine
           Devices for Along Time

    • Abstract: Background: Intrauterine Contraceptive Device (IUD) is a safe, convenient and inexpensive method of contraception involving neither repetition nor interference with sexual activity. Aim of the work: To to examine cytologic and colposcopic changes in individuals utilising IUCDs in the cervical region.for long periods of time and to create awareness among the IUCD users for regular follow up. Patients and methods: The Obstetrics and Gynecology Department of Al-Hussein University Hospital conducted this cross-sectional study. 200 monogamous individuals with IUCD who have been free of STIs for three to five years made up the study group (Group 1). On the other hand, and Control Group (Group 2) included 200 patients without a previous anamnesis of any contraception method. Results: Between the subjects in groups (1) and (2), the quantity of aberrant cervical cytology differed in a statistically significant way (p=0.02). When compared to group 1, group 2 was shown to have a higher incidence of inflammatory and infectious disorders, but group 1 had a higher incidence of abnormal ectopic changes (2). Regarding the degree of ectopy, there was a statistically significant difference between group (1) and group (2). (2). The findings of the colposcopy revealed a significant statistical distinction between members of group (1) and group (2). Conclusion: It is crucial to make sure that cervical cancer screening and contraception function closely together in order to give women the best treatment possible.
  • Intravenous Iron Sucrose versus Intramuscular Iron Sorbitol in management
           of iron deficiency anemia during pregnancy

    • Abstract: Background: The greatest prevalent nutrient shortage in pregnant women across the globe is iron deficiency anemia (IDA). Maternal anemia continues to significantly increase neonatal morbidity and death, and there is worry over the elevated incidence of iron and other micronutrient deficiencies among pregnant women in poor nations. Aim of the work: To examine the effectiveness and safety of intramuscular iron sorbitol citric acid complex and intravenous iron sucrose in the treating of iron deficiency anemia (IDA) in gestation. Patients and methods: At the Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, 100 pregnant women were separated into two groups for this randomized controlled trial. Between July 2021 and December 2021, 50 pregnant women were separated into two groups: group A got intravenous iron sucrose treatment, while group B got intramuscular iron sorbitol medication. Results: Regarding the negative effects of the therapy, there was a statistically substantial variation between the two trial groups. Conclusion: We concluded that for treating mild anemia in pregnancy, intravenous iron sucrose treatment was shown to be both substantially more efficient and safer than intramuscular iron sorbitol citrate therapy.

    • Abstract: Background: The prevalence of placenta previa has been recently estimated to be approximately 0.5% of all pregnancies, and this increase correlates to the elevated cesarean section rate. Placenta previa is a major cause of maternal morbidity and mortality because of the associated massive antepartum and intrapartum hemorrhage. Placenta previa is associated with preterm delivery, with the neonatal mortality increasing threefold. Aim of the study: The aim of this study was to determine the relationship between placenta accreta and its complications in cases of previous cesarean section with placenta previa anterior. Patients and Methods : This study conducted in Department of obstetrics and Gynecology, Al husseiun Hosp. A total of 50 patients with the diagnosis of placenta previa in current pregnancy and having previous history of Cesarean section enrolled. Statistical analyses to determine the relationship between previous cesarean section and subsequent development of placenta previa accreta Results: The incidence of maternal complication was higher in acreta group more than non acreqta including intensive care unit admission, while there was statistical significant difference regarding injury to the urinary bladder, bowel injury complication and intra partum hemorrhage there was no mortality in our study. Incidence of fetal complication was significantly higher in acreta. Conclusion: The increased incidence of placenta accreta is partly correlated with the rising overall caesarean section rate, it would seem that this is not the only recent influence on its increasing frequency. Even amongst women with previous caesarean sections the incidence of placenta accreta has increased nearly three times.
  • Helicobacter Pylori and the Severity of Preeclampsia

    • Abstract: Background: The main cause of maternal morbidity and mortality, intrauterine growth retardation, as well as fetal prematurity, is pre-eclampsia. Helicobacter pylori was found to infect several parts of the stomach and duodenum and has consequently been linked to a higher risk of gastric cancer. Pre-eclampsia is more frequent in women infected with H. pylori than in women who are not. Aim of the work: To assess the relation between severity of pre-eclampsia and of Helicobacter pylori infection. Patients and methods: This case-control research involved 100 pregnant women at the Obstetrics and Gynecology Departments of Al-Azhar Hospital and Mansoura International Hospital, with 50 healthy, normal pregnant women in group A (the control group) and 50 cases diagnosed with pre-eclampsia in group B (the case group). All participants underwent the taking of history, a complete general examination, an obstetric examination, and laboratory investigations. A serological diagnosis of H. pylori infection has been made utilizing anti-H. Pylori IgG detection. Results: In the preeclampsia group, H. pylori was statistically significantly higher. The frequency of IUGR, maternal ICU admission, and neonatal ICU admission among the preeclampsia group has increased statistically significantly. There have been statistically significant positive connections across HP positivity and elevation in SBP/DBP as well as the degree of proteinuria among the pre-eclampsia group. There has been a statistically significant increase in IUGR incidence and maternal ICU admission among pre-eclampsia cases who tested positive for HP infection. Conclusion: Study suggess that HP infection impairs the process of placentation and thus is a risk factor for PE incidence.
  • Intravenous versus Intramuscular Oxytocin in the Prevention of Atonic
           Post-Partum Hemorrhage after Vaginal Delivery

    • Abstract: Background: Primary postpartum hemorrhage (PPH) is among of the most main sources of mother deaths throughout the world. The changed profile of laboring women, who are now more probable to be aged, overweighted, or have substantial clinical co-morbidities, is leading to an increase in obstetric difficulties, Aim and objectives: in a double-blind controlled experiment, to examine the impact of an intramuscular (IM) single dose of oxytocin (10 IU per 1 mL) and placebo IV administration (1 mL 0.9 % saline gradually administered ) with an IV single dose of oxytocin (10 IU per 1 mL administered gradually over 1 min) and placebo IM administration (1 mL 0.9 % saline) during natural birth, Subjects and methods: The randomized controlled experiment was carried out at Al Azhar University's EL Hosain Hospital. It featured 200 ladies who wanted to give birth vaginally, Result: severe postpartum hemorrhage and blood transfusion were significantly more frequent in intramuscular group compared to intravenous group, Conclusion: In comparison to intramuscular oxytocin, intravenous oxytocin causes less severe PPH, blood transfusions, and induction to a critical care unit at the third phase of labor, and has fewer adverse effects.
  • The diagnostic function of office hysteroscopy and three-dimensional (3D)
           endometrial volume measurement in the evaluation of women with
           perimenopausal bleeding

    • Abstract: Background: In the peri- and postmenopausal years, abnormal uterine bleeding (AUB) is the most prevalent reason for gynecological appointments. Aim of the work: To detect the role of office hysteroscopy and three-dimensional (3D)  endometrial volume measurement in the evaluation of women with perimenopausal bleeding. Patients and methods: This study was conducted at Al-Azhar University in Al Hussein university hospital from March 2017 to October 2019 Obstetrics and Gynecology department. The research included 100 studied cases complaining of perimenopausal bleeding at the outpatient clinic. Results: hyperplasia followed by complex endometrial hyperplasia and only 1 case of endometrial carcinoma was discovered. In group 2 most common endometrial histopathology was discovered proliferative endometrium then secretory endometrium and 6 cases of atrophic endometrium. Conclusion: In cases of perimenopausal bleeding, this study demonstrated the diagnostic value of office hysteroscopy and three-dimensional (3D) ultrasonographic endometrial volume measurement, and showed that combining those 2 modalities of diagnosis had led to increase the ability & sensitivity of diagnosis and With perimenopausal women with irregular uterine bleeding, the capacity to rule out significant intrauterine disease to minimize further operative interventions, especially for surgically high-risk patients.
  • Prediction of fetal hypoxia by ductus venosus Doppler pattern in high-risk

    • Abstract: Background: Ductus venosus doppler has effective role in treatment of disorders that put the fetus at risk of cardiovascular diseases. In antenatal assessment, Doppler ultrasonography is increasingly being used to evaluate the blood flow volume rate in vessels during the cardiac cycle in the fetoplacental, uteroplacental circulation. Aim of the work: To discover if ductus venosus Doppler velocimetry may give earlier prediction of fetal hypoxemia than umbilical and middle cerebral artery blood doppler velocity in high-risk pregnancy or not. Patients and methods: According to the inclusion criteria, 60 pregnant women after the age of fetal viability (28 weeks of pregnancy) were included in the study. In order to facilitate statistical description, we divided the cases into 2 groups (Hypoxic and Non-Hypoxic groups), according to Apgar score, if less than 7 at 5 minutes or Cord PH less than 7.35. Results: The best cut-off value for the ductus venosus RI was >0.45 with a sensitivity of 98.7%, specificity of 56.7%, positive predictive value (PPV) of 80%, and negative predictive value (NPV) of 100%. When comparing the diagnostic ability of ductus venosus RI and middle cerebral artery systolic/diastolic ratio, the ductus venosus resistance index showed the highest diagnostic ability 91% against 71% for the middle cerebral artery systolic/diastolic ratio. Conclusion: Ductus venosus Doppler US is a useful way to assess fetoplacental circulation and has a good ability to predict fetal low oxygen. The most reliable index to predict low oxygen is the resistance index.
  • Efficacy of Immediate Insertion of an Intrauterine Contraceptive Device
           during Cesarean Section in Comparison with Late Insertion after the

    • Abstract: Background: Postpartum period is one of the critical times when a woman needs special optimal health services as complication rates are quite high during this period and also the women are vulnerable to unintended pregnancy. Aim of the work: To evaluate and compare between intrauterine device (IUD) (pregna T Cu 380A) insertion at the cesarean section and after puerperium in terms of expulsion rate, pain, and amount of bleeding. Patients and methods: This was prospective study, conducted at the Department of Obstetrics and Gynecology of El Hussein University hospital and El Sayed Galal hospital, on 200 women who were scheduled for elective cesarean section, divided into 2 groups: (Group A): included 100 women who agreed to insert immediate post placental IUD during the C/S delivery, (Group B): included 100 women who chose to insert IUD after puerperium as a control group. Results: Regarding IUDs in group I, 85% patients were retained, 15% were expulsed. Regarding IUDs in group II, 92% patients were retained, 8% were expulsed. There was no significant difference between the groups. The only significant difference between two groups is difficulty during IUD insertion, otherwise there are no significant difference regarding expulsion, abnormal bleeding, pain and other adverse events. Conclusion: Based on our finding we conclude that, Post placental intra caesarean Copper T 380A insertion during the C/S delivery is safe and effective, bypass causes of difficult IUD insertion after puerperium with low expulsion rate; so it can be considered a standard procedure.
  • Effect of Repetitive Transcranial Magnetic Stimulation on Essential

    • Abstract: Background: The effects of cerebellar low-frequency repetitive transcranial magnetic stimulation (rTMS) in individuals suffering from essential tremor (ET) are controversial. Aim of The Work: To evaluate repetitive transcranial magnetic stimulation (rTMS) can help people with essential tremors. Patients and Methods: This case study involved 30 subjects divided into an active group of 15 ET patients and a sham group of another 15 ET patients who were treated in tertiary care at Al-Hussein and Sayed Galal Hospitals, Al-Azhar University. The Fahn, Tolosa, Marin (FTM) Tremor Rating Scale has been used to evaluate and scale tremors at baseline, as well as a day, one month, two months, and three months following the (sham and active) repetitive transcranial magnetic stimulation sessions. Results: The results of this study showed that repeated active rTMS over the cerebellum enhanced total and specific subcores (tremor, drawing, and functional disability).The influence lasted for 3 months following the final session. The sham group's total and specific FTM subcores (tremor, drawing, functional disability) showed no significant differences.  Conclusion: For patients suffering from severe essential tremor, cerebellar rTMS can be an effective therapy choice.
  • Evaluation of water tolerance after laparoscopic sleeve gastrectomy

    • Abstract: Background: Obesity is a leading cause of death, luckily it is preventable. Surgical Intervention e.g. laparoscopic sleeve gastrectomy (LSG) is a successful method of obesity management. Patients underwent LSG experience post-operative difficulty of water and fluids intake. Aim of the work: To determine  water and juice tolerance following LSG with incidence calculation and comparing this with short-term outcome of LSG regarding excess weight loss and complications. Patients and methods: This Study includes 20 patients with ages ranges from 18 to 45 years and their Pre-operative BMI ranges from 38 to 65. Patients underwent LSG and were followed up for 3 months. Early and delayed (3 months later) assessment and contrast study (CS) were done. Of those patients 6 underwent upper GI endoscopy to exclude complications. Results: In early follow up showed 10 patients (50%) became water intolerant while 3 patients (15%) became juice intolerant. After 3 months 6 patients (30%) became water intolerant while 1 patient (5%) became juice intolerant. Comparing early and delayed CS, the esophageal transit results, unlike gastric transit time showed improvement coinciding with the improvement of tolerability among patients. The difference between water and juices CS results was insignificant. Conclusion: Fair water tolerance is crucial for early safe hospital discharge after LSG.  But after LSG, patients' water tolerance, unlike other fluids is significantly affected. This water intolerance improves over time. More studies with larger samples and longer follow up are needed to determine the long-term outcome of fluid tolerance following LSG and its effect on patient's weight loss and quality of life.
  • Role of Rouviere's sulcus in identification and dissection of Calot's
           triangle during Laparoscopic Cholecystectomy

    • Abstract: Background - One of most common surgical technique applied overall the world is laparoscopic cholecystectomy due to the high features instead of another surgical techniques. Furthermore; it is represents as the main technique for gallstones treatment; however the incidence of bile-duct injury still higher than that of open cholecystectomy. Various surgical procedures and principles have been proposed to reduces bile duct injury. Aim - to determine the frequency and the type of Rouviere’s sulcus and its importance as landmark during laparoscopic cholecystectomy. Patients and Methods - This prospective study included hundred-patients who had symptomatic gallstone disease and underwent laparoscopic cholecystectomy in Al Azhar Universty Hospitals and Ahmed Maher Hospital. Results - Our results revealed that, regarding the indications for cholecystectomy, the most common indication in the study participants were symptomatic gall stones in 36 (36%) of participants followed by acute cholecystitis in 29 (29%) participants and biliary pancreatitis in 16 (16%) participants. Conclusion - Rouviere‘s sulcus was re-present in (76%) of total cases. It is an easily identifiable anatomic feature for secure laparoscopic cholecystectomy.
  • Factors Influencing Outcome of Treatment of Posterior Communicating
           Arteries Aneurysm

    • Abstract: Background: The study of posterior communicating artery (PComA) aneurysms, and the different modalities as well as the factors influencing the treatment represent a great challenge Aim of the Work: We aimed to explore out whether factors are associated to a better or worse prognosis in aneurysms of the posterior communicating artery. We also sought to see how different treatment techniques for posterior communicating arteries aneurysm performed, as well as the problems and side effects of each. Patients and Methods: This study was conducted on 39 (20 males and 19 female) patients who were diagnosed with posterior communicating artery aneurysm at Neurosurgery department, Al-Azhar University Hospitals and Damanhur Medical National Institute. Results: The surgical technique (clipping) for the treatment of aneurysms represented 20.5%, while the endovascular techniques accounted for 79.5% (coiling represented 56.4%, stent-assisted coiling represented 12.8% stenting was provided only 10.3%), and 83.9% of the endovascular techniques had a good outcome with a significant difference (P = 0.016), and 16.1% results were bad, while the results of surgical clipping were 37.5% good and 62.5% bad. Conclusion: During the current study and according to our selection criteria, all the factors that we analyzed were not statistically significant. But the endovascular techniques have a better advantage in the treatment of (PComA) artery aneurysms.
  • Study of Sacroiliac fixation in patients with sacroiliitis associated with
           L5 Lythesis

    • Abstract: Background: Chronic low back discomfort is frequently brought on by the sacroiliac joint. The SIJ may be involved in 15–30% of patients who attend for examination of low back pain. Aim of the work: This study evaluates sacroiliac fixation in patients with sacroiliitis associated with L5 lythesis. Patients and methods: In this prospective and retrospective study, 10 individuals with spinal disorders were examined. Ten patients with mechanical sacroiliac joint discomfort underwent sacroiliac joint fixation. Results: Overall, this series' results showed that 7 patients (or 70%) had fully resolved their problems, 2 patients (or 20%), partially improved, and 1 patient (or 10%), had not. Conclusions: Sacroiliac fixation was safe and efficient in the treatment of patients with sacroiliitis associated with L5 lythesis. Currently, one of the most widely used methods for spinopelvic fusion is S2AI screw fixation. Significantly fewer clinical and radiographic problems are linked to the S2AI method. We need further comparison research with larger sample sizes and longer follow-ups to corroborate our findings and pinpoint the risk factors for unfavourable outcomes.
  • Zinc and Abdominal Aortic Calcification in Patients under Regular

    • Abstract: Background: Vascular calcification is known to be significantly influenced by zinc deficiency. Low serum zinc inhibited the osteochondrogenic phenotypic flip of phosphate-induced vasculature smooth muscle cells (VSMCs), which led to the formation of vascular calcification. Abnormal mineral metabolism, like hyperphosphatemia, which leads to the phenotypic conversion of VSMCs into osteoblasts that secrete collagen, is a contributing factor for the development of arterial calcification in CKD. Aim and objectives: The goal of this research was to evaluate the link between zinc and abdominal aortic calcification in individuals receiving regular hemodialysis. Subjects and methods: This Cross-Sectional research included 40 Hemodialysis Patients The study Will Be Conducted In Nephrology Unit Al Hussien Hospital. All patients receive 3 Hemodialysis sessions weekly. Results: AAC score and age have a strong positive link (r = 0.56) that is statistically substantial (p-value< 0.001). AAC score and BMI have a statistically substantial (p-value = 0.014) negative connection (r = -0.39). AAC score and albumin have a strong negative connection (r = -0.55) that is statistically substantial (p-value < 0.001). AAC score and PTH have a statistically substantial (p-value = 0.036) positive connection (r = 0.33). AAC score and serum zinc have a statistically substantial (p-value = 0.005) negative connection (r = - 0.43). Conclusion: Low serum zinc is connected with high odds of having AAC.
  • Efficacy and Safety of YAG Laser Vitreolysis for Symptomatic Vitreous

    • Abstract: Background: The symptoms of patients with vitreous floaters are frequently underestimated, leading to no intervention. The majority of patients who have floaters receive conservative therapy that includes patient education and reassurance. On the other hand, more severe instances can necessitate pars plana vitrectomy or YAG laser vitreolysis. The potential for conducting vitreolysis using an Nd: YAG laser has arisen as an alternate therapy to avoid the complications of vitrectomy. Aim of the study: the study aimed to evaluate the safety and effectiveness profile of YAG laser vitreolysis as a modality of therapy for symptomatic vitreous floaters. Patients and methods: A prospective study has been done on 50 eyes of 50 patients who had full posterior vitreous detachment and persistent vitreous floaters. The Ultra Q ReflexTM (Ellex Medical Lasers, Adelaide, Australia) was used to perform laser vitreolysis on patients. Follow‑up was done for 6 months. Patient satisfaction and complications were recorded. Results: 6% of patients experienced treatment failure, compared to 14% of patients who reported complete success, 46% who reported significant success, and 34% who reported partial success. No complications were recorded in postoperative 6 months follow up period. Conclusion: When used on carefully selected patients, YAG laser vitreolysis represents a safe and efficient therapy for symptomatic vitreous floaters.
  • Role of Pigtail Catheter in Patients with Encysted Empyema and in
           Pleurodesis of Patients with Malignant Pleural Effusion

    • Abstract: Background: The use of pigtail catheter has developed as a viable choice for thoracostomy tube being less invasive, less painful and fewer procedure-associated complications. Aim of the work: to assess the role of pigtail catheter in encysted empyema and compare the use of it versus the chest tube in pleurodesis in candidates with malignant pleural effusion. Patients and Methods: There were 60 patients in this study, divided into two groups: Group I included 20 patients with encysted empyema and a pigtail catheter was placed using chest ultrasonography guidance. Group II included 40 patients with malignant pleural effusion who were subdivided into two groups: Group IIA included 20 patients who had a pigtail catheter inserted under the guidance of chest ultrasonography until the pleural effusion was completely drained, after which the pleurodesis with povidone-iodine was performed. Group IIB included 20 patients who had a chest tube implanted until the pleural effusion was completely drained, after which the pleurodesis with povidone-iodine was performed. Results: As regards the role of pigtail catheter in encysted empyema showed successful drainage in 85% of the studied patients with fewer complications. And as regard role of it in pleurodesis in patients with malignant pleural effusion showed the same efficacy, more safety and fewer complications than a chest tube. Conclusion: The use of a pigtail catheter to drain encysted empyema and malignant pleural fluid might be regarded a safe, simple, and successful approach. And we recommend it in draining that fluid
  • Role of Diffusion Weighted Imaging and Apparent Diffusion Coefficient
           Value in Diagnosis of Asymptomatic / Inactive Multiple Sclerosis Plaques

    • Abstract: Background: Although in most cases, the diagnosis of MS remains a clinical, magnetic resonance imaging became a fundamental imaging technique for the investigation and monitoring patients with MS, as it allows the visualization of lesions in the brain and spinal cord and help in understanding and follow of the disease and it is widely used to confirm the clinical diagnosis. Aim of the study: To evaluation of asymptomatic or inactive multiple sclerosis plaques by using diffusion weighted imaging and ADC value. Patients and methods: We evaluated prospectively 50 patients with known multiple sclerosis and fulfilled McDonald Criteria 2017. Patients of interest were recruited from the Neurology department in Al-Azhar University Hospitals during two years (May 2020 to May 2022). Clinical diagnosis was performed by an expert neurologist with 10 years of experience in treating MS. Results: Receiver operator characteristics (ROC) curves for ADC value x (10−3 mm2/s) as a predictor of activity of the M.S disease in enrolled patients. ADC value x (10−3 mm2/s) indices were significant predictors as denoted by the significantly large area under the curves (AUCs), there was used to define the best cut off value of ADC value x (10−3 mm2/s) which was ≥1.292, with sensitivity of 82.1% specificity of 82.6% positive predictive value of 85.2%, negative predictive value of 79.2%, diagnostic area under the curve of 0.828 with p-value <0.001. Conclusion: Measurement of ADC value should be done as a routine study with conventional MRI in MS patients.
  • Relation between Endothelial Protein C Receptor Gene Polymorphism 6936A/G
           and the Risk of Vascular Access Thrombosis in Patients with End Stage
           Renal Disease on Hemodialysis

    • Abstract: Background: The most significant complication of chronic kidney disease (CKD) is end-stage renal disease (ESRD). Hemodialysis (HD) necessitates a well-functioning vascular access with enough blood flow for clearance and blood dialysis. Thrombosis of the veins can be caused by both acquired and inherited factors. Aim of the study: We aim to assess EPCR levels in patients with ESRD on hemodialysis & study relationship between the presence of EPCR gene polymorphisms (6936A/G) and incidence of vascular access thrombosis. Patients and methods: This research was carried out on 50 studied cases admitted to the Theodor Bilharz Research Institute (TBRI), Imbaba, Giza, Hemodialysis Unit, Nephrology Department from November 2018 to May 2019. In addition, 25 age and sex-matched normal people (control cases) were included. Results: The mutant EPCR (6936A/G) genotypes were found to be substantially more prevalent in our investigation and the polymorphic type allele (G allele) in (p < 0.05) in ESRD patients on long-term hemodialysis with thrombosis compared to healthy subjects and ESRD patients without thrombosis. the flow cytometric expression of CD 201 was statistically reduced in ESRD patients on long-term hemodialysis with thrombosis (p < 00.01) & without thrombosis (p < 00.05) when compared to healthy subjects. CD201 Expression levels showed negative correlation with EPCR 6936 A/G heteromutant genotype. Conclusion: The result obtained via the recurrent study provide evidence that EPCR 6936A/G (rs867186) genetic polymorphisms in ESRD patients on long-term hemodialysis could be a potential reason for Venous thrombosis.
  • Prospective study of outcomes of Laparoscopic versus open splenectomy in
           hematological and benign splenic diseases

    • Abstract: : In the last 20 years, laparoscopic surgery has advanced at a remarkable pace. The standard for the management of hematologic diseases of the spleen is laparoscopic splenectomy (LS). Aim and objectives: The goal of the research was to evaluate laparoscopic and open splenectomy patients in terms of operating time, intraoperative complications, hospitalization length, and duration to return to normal activities. Subjects and methods: Twenty patients with hematological and benign splenic disorders were included in prospective research at Al-Azhar University Hospitals (Al-Hussein and Sayed Galal). They were divided into groups at random by picking every two patients and assigning one to group (A) and the other to group (B), with each group consisting of ten patients. Group (A) undergo laparoscopic splenectomy. Group (B) undergo open splenectomy. Results: There is significant reduction in the hospital stay between both group (P=0.00). Patients in lap group were dismissed from the hospital on the 2nd postoperative day (8cases), but (2cases) were discharged on the 3rd day as they were converted to open surgery with median stay in hospital 1.3 days. Conclusion: LS are efficient in producing the desired therapeutic response in patients with suitable indication for splenectomy. The operative times for Laparoscopic splenectomy are longer than those for OS but they tend to decrease with experience. The intraoperative blood loss and complications of LS are generally better than those reported for OS.
  • Evaluation of role of ultrasound in assessment of successful weaning from
           mechanical ventilation in critically ill patients

    • Abstract: Background: Mechanical ventilation waning failure is a common problem, and bedside ultrasonography could be helpful in prediction of the weaning process and its results. Aim of The Work: To ssess by means of ultrasound how diaphragmatic parameters are important in predicting weaning outcome by assessing diaphragmatic thickness, diaphragmatic mobility and variation. Patients and Methods: This study included 62 mechanically ventilated patients who were subjected to transthoracic ultrasonography of the diaphragm throughout a spontaneous breathing experiment and had been divided into two groups: successful extubation and unsuccessful extubation. Results: With a p-value of <0.001, a high DE after extubation was linked to extubation success. Extubation failure was linked to lower DTF before and after extubation, with a p-value of 15 had 100% sensitivity, 85.06% specificity, 70.5 PPV and 100% NPV with p-value 20.4 had 93.55% sensitivity, 93.55% specificity, 93.5% PPV, and 93.5% NPV with p-value Conclusion: Diaphragm ultrasound evaluation of DTF and DE is a simple new weaning index which can be used as a bedside technique in clinical practice and has promising predictors of weaning success or failure before and after extubation.
  • Role of Transient Elastography (Fibroscan) in Early prediction of
           Hepatitis C Virus Related Hepatocellular Carcinoma

    • Abstract: Background: Hepatocellular carcinoma (HCC) is the fifth-leading cause of cancer-related deaths globally. Liver biopsy is the gold standard for diagnosing liver fibrosis and cirrhosis. Instead of a liver biopsy, a number of noninvasive diagnostic tools for assessing hepatic fibrosis as a risk factor for HCC, such as fibroscan. Aim of work: Assess the role of Transient Elastography (Fibroscan) in prediction of (HCC) in chronic hepatitis C virus patients. Subjects and methods: A case-control study included 133 patients with cirrhosis and HCC and 133 patients with HCV-Liver cirrhosis without HCC was carried out. Each patient had their medical history taken, and thorough clinical examination, they were assessed for liver stiffness using fibroscan, all patients underwent Triphasic CT scan, routine laboratory investigations were taken from each patient as liver function test, CBC and tumor markers. Results: Males resembled the majority and patients with HCC were significantly older than those without HCC (p-value < 0.001). Our data showed that sensitivity analysis of liver stiffness measured by transient elastography (FibroScan) can be used to discriminate between cirrhotic group without HCC and HCC group at a cutoff level of > 24.3, with 90.5% sensitivity, 85.7% specificity, 86.4% PPV and 90% NPV (AUC = 0.941 & p-value less than 0.001). Conclusion: Fibroscan can significantly predict HCC among patients post-HCV treatment using cutoff point of liver stiffness > 24.3 kPa.
  • Fibroscan and Low-Density Lipoprotein Versus Non-invasive Markers (APRI
           test and FIB-4) As Determinants of Severe Liver Fibrosis in Egyptian
           Diabetic Patients With Non-Alcoholic Fatty Liver Disease.

    • Abstract: Background: Type 2 Diabetes Mellitus (T2DM) cases commonly have non-alcoholic fatty liver disease (NAFLD) that can develop into severe liver fibrosis. Clinical implications might arise from the early detection of hepatic fibrosis. Aim of the study: to evaluate the role of non-invasive scores (APRI score and FIB-4), fibroscan and low-density lipoprotein in predicting Egyptian patients with NAFLD who have severe liver fibrosis. Patients and methods: : A prospective cohort study was carried out. in the heptogastroentrology and infectious disease Al-Hussien University Hospital and The National Hepatology and Tropical Research Institute (NHTMRI) over a 3-years period. Ninty patients attended the outpatient clinic who had NAFLD were enrolled in the study on aprospective basis, aged18 to 70 years old. Result: the cases was separated into two groups diabetic and non diabetic Concerning the correlation between APRI test and (fib-4, fibrosis LSM, steatosis CAP, and lab tests show significant positive correlation as regard Fib-4, fibrosis Lsm, AST, and ALT, and significant negative correlation as regard platelet and FBS, and the relationship between Fib-4 and fibrosis LSM and steatosis CAP and lab tests show significant positive correlation as regard fibrosis LSM, Age, and AST, and significant negative correlation as regard platelets and urea. Conclusion: The combination of Fibroscan, APRI score,LDL-c and FIB-4 techniques gives a useful approach for evaluating liver fibrosis in NAFLD cases. Keywords: Fibroscan;Liver Fibrosis; Diabetic Patients ; Non Alcoholic Fatty Liver Disease
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762

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School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762

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