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Al-Azhar Assiut Medical Journal
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This is an Open Access Journal

Open Access journal
ISSN (Print) 1687-1693
Published by Medknow Publishers

[448 journals]

Evaluation of serum sodium levels and mean platelet volume in children
with community-acquired pneumonia
- Authors: Amira Mohamed Hamed, Mohamed Fahmey Ibrahim, Hamada Kawshty Fayed, Mona Mohamed Abd EL-Meguid, Shimaa Esmail Hassen
  Pages: 1 - 7
  Abstract: Amira Mohamed Hamed, Mohamed Fahmey Ibrahim, Hamada Kawshty Fayed, Mona Mohamed Abd EL-Meguid, Shimaa Esmail Hassen
  Al-Azhar Assiut Medical Journal 2022 20(1):1-7
  Background and aim Community-acquired pneumonia (CAP) is one of the frequent causes of hospital admission, whereas hyponatremia (HN) is a common electrolyte abnormality in hospitalized patients and is associated with considerable morbidity and mortality. Mean platelet volume (MPV) may be a useful predictor for the diagnosis of CAP but not in disease severity. The purpose of this study was to evaluate serum levels of sodium and MPV in a child with CAP.Patients and methods This is a case–control study that has been carried out in a Malawi General Hospital. The total (100) participants included in the study were classified into two groups as follows: group I which is the case group included 50 children with clinical and laboratory evidence of pneumonia ranging from 1 month to 3 years. Group II which is the control group included 50 children (apparently healthy control) who attended for nonchest problem or serious medical condition. Serum sodium levels, hemoglobin levels, MPV, platelet count, total leukocyte count, and C-reactive protein were done to all children.Results HN was present in 82% of patients with CAP (41 out of 50). Patients with CAP had lower MPV than their healthy counterparts (7.11±0.42 vs. 9.14±1.04 fl; P<0.001). There was a statistically significant negative correlation between the grade of respiratory distress and the level of serum sodium and a positive correlation between the grade of respiratory distress and MPV (P<0.001).Conclusion HN is common among hospitalized children with CAP and MPV may be a useful predictor for the diagnosis of CAP.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):1-7
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/AZMJ.AZMJ_40_19
  Issue No: Vol. 20, No. 1 (2022)
Association between iron-deficiency anemia and febrile convulsion in
children
- Authors: Sarah M.H Rashwan, Yasser Abd El-Rahman Ahmed, Ahmed K Ibrahim, Ismail Abd El-Razek Kasem
  Pages: 8 - 14
  Abstract: Sarah M.H Rashwan, Yasser Abd El-Rahman Ahmed, Ahmed K Ibrahim, Ismail Abd El-Razek Kasem
  Al-Azhar Assiut Medical Journal 2022 20(1):8-14
  Background and aim Previous studies reported that iron-deficiency could be a risk factor for febrile seizure (FS), as the latter is more common in children younger than 2 years, and iron-deficiency anemia is also common in children of the same age. Yet, the relationship between iron deficiency and FS is not yet determined, and that is why this study was suggested. The aim of this study was to assess the association between iron-deficiency anemia and febrile convulsion (FC).Patients and methods This study included 60 children aged 6 months to 5 years. These children were divided into three groups: a group of 20 patients with FC, a group of 20 patients with fever but without FC, and a group of 20 healthy children.Results The main findings of this study were that there was a higher incidence of FSs found among children who received formula feeding. Furthermore, children with FSs had the lowest level of hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, and transferrin saturation values. However, iron-deficiency anemia was not associated with increased incidence of FCs.Conclusion It can be concluded that formula feeding, low hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, and transferrin saturation are reinforcing factors for FSs.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):8-14
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_207_20
  Issue No: Vol. 20, No. 1 (2022)
Role of the lung function test in asthmatic children admitted to Al-Azhar
University (Assiut)
- Authors: Amira M.M Hamed, Mohammed F Mohammed, Khaled H Awad, Yousry A.A.H Abdel-Rahman
  Pages: 15 - 25
  Abstract: Amira M.M Hamed, Mohammed F Mohammed, Khaled H Awad, Yousry A.A.H Abdel-Rahman
  Al-Azhar Assiut Medical Journal 2022 20(1):15-25
  Background and aim Lung function, especially spirometry, is an important investigatory tool in the evaluation of asthma in children. This study aimed to compare the clinical condition of asthmatic children using the lung function test before and after treatment and after 3 months as a follow-up of asthmatic patients admitted to Al-Azhar Assiut University Hospital.Patients and methods This clinical study was a prospective study that included 60 asthmatic children aged 6–16 years with bronchial asthma plus 30 children matched for age, sex and nutritional status as a control group over a period of 13 months from December 1, 2019 to December 31, 2020.Results The age of the children included in this study was found to be mean±SD 9.033±2.843, with a male predominance (male : female ratio 58% : 42%) and a positive family history of asthma (61%) and other allergic disorders (65%). There was a statistically significant change in forced expiratory volume at first second (FEV1), forced vital capacity (FVC), and the FEV1/FVC ratio that showed considerable improvement in both age groups at admission, after receiving the suitable treatment and at follow-up 3 months after discharge.Conclusion Pediatric asthma is a major clinical concern and represents a huge burden on the family and society, hence the importance of prompt and early diagnosis that includes lung function testing, especially FEV1, FVC, and FEV1/FVC ratio, in not only diagnosis but also for monitoring the efficacy of treatment and follow-up.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):15-25
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_42_21
  Issue No: Vol. 20, No. 1 (2022)
Spleen stiffness measurement based on shear-wave elastography for
noninvasive assessment of esophageal varices in liver cirrhosis cases
- Authors: Walid K Soliman, Khaled A Eid, Ahmed Q Mohammad
  Pages: 26 - 32
  Abstract: Walid K Soliman, Khaled A Eid, Ahmed Q Mohammad
  Al-Azhar Assiut Medical Journal 2022 20(1):26-32
  Background and aim Several laboratory tests and procedures have been considered as noninvasive prediction of esophageal varices (OV). This study assessed the usefulness of shear-wave elastography in splenic stiffness measurement (SSM) as a noninvasive assessment for OV prediction.Patients and methods This study was performed on 100 cases in Sohag Cardiology and Gastroenterology 1Center who were categorized into three groups: group A: (n=40) included liver cirrhosis of any cause proved clinically, laboratory, and by ultrasound; group B: (n=30) included chronic hepatitis of any cause; and group C: (n=30) included nonhepatic cases attending the hospital with gastrointestinal tract complaints. All cases have been subjected to full history taking and clinical examination before classification, complete blood count, alanine aminotransferase, aspartate transaminase, serum albumin, coagulation profile and serum bilirubin, hepatitis C virus antibody (HCV Ab) and hepatitis B surface antigen (HB Ag), abdominal ultrasonography, SSM by shear-wave elastography, and upper endoscopy for diagnosing of OV.Results As regards to abdominal ultrasound and upper endoscopy, significant differences were noted between three groups regarding spleen, spleen diameter, SSM, ascites, and OV (as 27.5 and 65% cases in group I had ascites and OV versus no cases in groups II and III as P<0.001). As regards to spleen diameter and SSM, significant increase was noted in group A than B and C, but insignificant differences were noted among groups B and C. As regards to OV grades in group A, there were five cases with grade I, nine cases with grade II, five cases with grade III, and seven cases with grade IV. Considerable positive correlations were noted among OV grades and acoustic radiation force impulse elastography (r=0.904, P <0.001).Conclusion SSM by shear-wave elastography is a useful noninvasive parameter for detection of OV presence and grading in cases of liver cirrhosis.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):26-32
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_16_21
  Issue No: Vol. 20, No. 1 (2022)
Treatment of corneal astigmatism by limbal relaxing incisions during
phacoemulsification surgery
- Authors: Maged A Naguib, Hussam E.O Elrashidy, Ghada Samir
  Pages: 33 - 38
  Abstract: Maged A Naguib, Hussam E.O Elrashidy, Ghada Samir
  Al-Azhar Assiut Medical Journal 2022 20(1):33-38
  Background and aim The aim was to assess the effectiveness of limbal relaxing incisions (LRIs) in treatment of astigmatism in patients undergoing phacoemulsification surgeries.Patients and methods Forty-eight eyes of 48 patients suffering from senile cataracts of mean age 64.7±7.9 (range: 50–77) years, and mean corneal astigmatism 1.8±0.73 diopters (D) (range: 1.5–3.5 D) were included in this study. All LRIs were performed at the end of phacoemulsification. Corneal topography results were compared before surgeries and 2 and 6 months after surgeries.Results A statistically significant reduction in the mean corneal astigmatism was seen from 1.8±0.73 D (range: 1.50–3.50) preoperatively to 1.1±0.24 D (range: 0.5–1.7) and 1.4±0.52 D (range: 0.60–1.9) in the second and sixth postoperative months, respectively (P<0.001). Surgical-induced astigmatism (the amount and axis of astigmatism change induced by surgery) was 0.90±0.48 at 2 months and 0.96±0.59 at 6 months. Correction index (calculated by determining the ratio of surgical-induced astigmatism/target-induced astigmatism) was 0.56±0.42 and 0.57±0.33 at 2 and 6 months, respectively. Index of success (ratio of topographic residual astigmatism and target-induced astigmatism) was measured to be 0.45±0.42 and 0.48±0.33 at months 2 and 6 correspondingly.Conclusion Combined LRI and phacoemulsification appears to be safe and fairly effective to correct mild-to-moderate corneal astigmatism. However, undercorrection is a common limitation that may be further managed by modified nomograms in future studies.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):33-38
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_22_21
  Issue No: Vol. 20, No. 1 (2022)
Blood monocyte subtypes in patients with pulmonary tuberculosis infection
- Authors: Tamer G El-Rab Attia, Mona M Abdelmeguid, Ali S Mohammed, Hamada K.S Fayed
  Pages: 39 - 45
  Abstract: Tamer G El-Rab Attia, Mona M Abdelmeguid, Ali S Mohammed, Hamada K.S Fayed
  Al-Azhar Assiut Medical Journal 2022 20(1):39-45
  Background and aim Monocytes are the primary target for Mycobacterium tuberculosis infection. Important alterations in the proportions of circulating monocyte subpopulations were found in patients with active tuberculosis (aTB). Our aim was to investigate the peripheral blood monocyte subsets in patients with active pulmonary tuberculosis (aPTB) and to evaluate their role in treatment response.Patients and methods A case–control study included 30 patients with aPTB and 30 healthy controls. Laboratory investigations include sputum examination, tuberculin test, and nucleic acid amplification test using GeneXpert MTB/RIF assay on sputum sample for patients only to confirm the diagnosis of aPTB. For all participants; complete blood count, erythrocyte-sedimentation rate, HIV antibodies, and flow cytometry analysis of peripheral blood monocyte subsets were done using surface markers CD14 phycoerythrin cyanin 7 and CD16 fluoroisothiocyanate for identification of monocyte subsets. Flow cytometry analysis was repeated 2 months after the start of treatment in aTB patients only.Results Classical monocytes were decreased while intermediate, and nonclassical monocytes were increased in aTB patients before treatment more than after 2 months of treatment and control group (P≤0.0001 for each). There was no significant difference in the three monocyte subsets between PTB patients after treatment and healthy controls. Also, the classical monocytes decreased while intermediate, and nonclassical monocytes increased in aTB patients with positive tuberculin test more than healthy controls with positive tuberculin test (P<0.0001 for each).Conclusion The expansion of CD16+ monocytes was reversed after treatment with anti-TB drugs and could be used to follow up tuberculous patients for treatment effectiveness.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):39-45
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/AZMJ.AZMJ_142_20
  Issue No: Vol. 20, No. 1 (2022)
Value of multislice computed tomography-coronary angiography in predicting
coronary artery diseases in type-2 diabetic patients in the chest pain
unit
- Authors: Ragab Ali Mohamed Habour, Islam Shawki, Ibrahim Faragallah, Hossam Al-Adl
  Pages: 46 - 53
  Abstract: Ragab Ali Mohamed Habour, Islam Shawki, Ibrahim Faragallah, Hossam Al-Adl
  Al-Azhar Assiut Medical Journal 2022 20(1):46-53
  Background and aim Diabetes mellitus is a metabolic disorder affecting a wide range of the population all over the world. Microvascular and macrovascular complications are very common in diabetic patients with high incidence of affection of the coronary arteries. Rapid and efficient management in cases (especially diabetics) complaining of chest pain at the emergency department is a matter of great importance to decrease the incidence of subsequent complications. Our aim was to predict coronary artery diseases in type-2 diabetic patients with typical chest pain with normal initial cardiac investigations at the emergency room by using computed tomography (CT) coronary angiography.Patients and methods A total number of 100 patients were included in this study and classified into two groups: 80 patients with diabetes mellitus (group A) and 20 nondiabetic patients (group B) presented with chest pain. Complete history was taken from the cases with performing of complete physical examination, and routine laboratory and radiological investigations. Additionally, echocardiography and multislice CT-coronary angiography (coronary computed tomography angiography) were done for all cases. Also, calcium score was calculated.Results CT angiography revealed affection in 19 (23.8%) cases of the cases in group A with no affected cases in group B with a statistically significant difference between the two groups. There was a high statistically significant agreement between the findings of the CT angiography and coronary angiography results (P<0.001). CT angiography had sensitivity of 70.37%, specificity of 100%, positive predictive value 100%, negative predictive value 86.89%, and accuracy of 90%.Conclusion An early coronary computed tomography angiography strategy has revealed high sensitivity in prediction of coronary artery disease affection as compared with ordinary coronary angiography in cases presented with chest pain to emergency department.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):46-53
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_47_21
  Issue No: Vol. 20, No. 1 (2022)
T-helper and natural killer cells’ disturbance in active
alopecia areata
- Authors: Abdel-Khalek H Younes, Refaat R Hammad, Ali Sobhy
  Pages: 54 - 59
  Abstract: Abdel-Khalek H Younes, Refaat R Hammad, Ali Sobhy
  Al-Azhar Assiut Medical Journal 2022 20(1):54-59
  Background and aim Alopecia areata (AA) is a common nonscarring hair disease targeting the hair follicles during the anagen phase, leading to hair loss. The etiology of AA is still unclear; however, evidence revealed the association of this disease with immune disturbance. Therefore, we aimed in this study to evaluate the level of natural killer (NK) and T-helper 1 (Th1) cells in the peripheral circulation of patients with different subtypes of AA during the active stage in comparison with the controls.Patients and methods Venous blood samples from 50 female patients and 50 healthy-controls were collected to evaluate the level of Th1 and NK cells using flow cytometry.Results Patients with active patchy AA, alopecia totalis, and alopecia universalis were associated with a lower level of circulating Th1 and NK cells when compared with the controls.Conclusion The observed reduction in the circulating Th1 and NK cells indicates the autoimmune nature of the disease. Also, we highlight the cellular shift from the peripheral circulation to the lesion site during the active stage; however, more research is required to reveal the exact mechanism for this phenomenon.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):54-59
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_76_21
  Issue No: Vol. 20, No. 1 (2022)
Postoperative pulmonary embolism, risk factors, and medical
thromboprophylaxis: a 2-year retrospective study
- Authors: Eman Sobh, Maisa A Abdel Wahab, Zeinab R Adawy, Heba M Abdelgalil, Ola I Saleh, Doaa M Zakaria, Randa S Elshahat
  Pages: 60 - 66
  Abstract: Eman Sobh, Maisa A Abdel Wahab, Zeinab R Adawy, Heba M Abdelgalil, Ola I Saleh, Doaa M Zakaria, Randa S Elshahat
  Al-Azhar Assiut Medical Journal 2022 20(1):60-66
  Background and aim The major surgical procedures have a significant risk of venous thromboembolism (VTE), especially pulmonary embolism (PE), leading to poor prognosis and life-threatening conditions. The major surgical procedure has 20-fold risk increase in VTE and the risk is increased by 30% in the absence of optimal prophylaxis. This study aimed to estimate the incidence of PE among surgical patients undergoing preoperative thromboprophylaxis according to Caprini score, these considerations can improve the clinical outcome and allow optimal use of thromboprophylactic strategies against VTE.Patients and methods We performed retrospective analysis of records of patients admitted to surgical wards at our hospital and identified those who developed postoperative PE. We calculated Caprini score to assess the risk for VTE.Results Among patients admitted to surgical wards, we identified 107 cases of postoperative PE. Most of them had major surgeries, most of them were females, and a considerable proportion of those who developed PE did not receive thromboprophylaxis although being at moderate or high risk for VTE according to Caprini score. Few patients had poor outcome.Conclusion Perioperative thromboprophylaxis is crucial to avoid complication with VTE. Caprini score may be a good clinical score to decide which patients to receive perioperative thromboprophylaxis.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):60-66
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_67_21
  Issue No: Vol. 20, No. 1 (2022)
Two nitazoxanide-based quadruple regimens for eradication of Helicobacter
pylori infection: a single-center randomized controlled trial
- Authors: Amro M Hassan, Khaled Eid, Khaled A.M Eliwa, Muhammad Abdel-Gawad
  Pages: 67 - 71
  Abstract: Amro M Hassan, Khaled Eid, Khaled A.M Eliwa, Muhammad Abdel-Gawad
  Al-Azhar Assiut Medical Journal 2022 20(1):67-71
  Background and aim Eradication of Helicobacter pylori becomes an ongoing challenge worldwide because eradication rates of H. pylori are declining to less than 60% in some countries. As there is no acceptable definite long-standing used therapeutic regimen for H. pylori, clinicians are doing their best to find new regimens to improve eradication rates of H. pylori. Nitazoxanid and fluoroquinolones, including moxifloxacin and levofloxacin, have been used in treatment of H. pylori. The study aimed to assess and compare the efficacy of two nitazoxanide-based quadruple regimens in treatment of patients infected with H. pylori.Patients and methods This prospective randomized controlled trial was conducted on 100 patients diagnosed to be infected by H. pylori by stool antigen test (one-step H. pylori Antigen test Device). They were randomized into two groups: group 1: 50 patients were treated for 14 days with quadruple therapy, including nitazoxanide, moxifloxacin, omeprazole, and doxycycline; and group 2: 50 patients were treated for 14 days with quadruple therapy, including nitazoxanide, levofloxacin, omeprazole, and doxycycline. Eradication of H. pylori was assessed 4 weeks after the end of treatment by stool antigen test (one-step H. pylori Antigen test Device).Results Eradication rate of H. pylori infection was higher in patients treated with nitazoxanide–moxifloxacin-based quadruple therapy 37 (74%) than in patients treated with nitazoxanide–levofloxacin-based quadruple therapy 32 (64%), but there were no significant differences between the studied groups with P value (P<0.28). By subgroup analysis of eradication rate among anemic and nonanemic patients treated by nitazoxanide–moxifloxacin and nitazoxanide–levofloxacin-based quadruple therapy, we found that eradication rate was higher in anemic patients 88% and 80% than nonanemic patients 60% and 45%, with significant P values 0.02 and 0.01, respectively.Conclusions Use of moxifloxacin instead of levofloxacin in the nitazoxanide-based quadruple regimen improves eradication therapy of H. pylori.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):67-71
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_74_21
  Issue No: Vol. 20, No. 1 (2022)
A comparative study between magnesium sulfate and dexmedetomidine as
adjuvants to bupivacaine using ultrasound-guided lumbar-plexus block in
lower abdominal surgeries
- Authors: Mahmoud A AbdAlsalam, Nayera A.H Mohamed
  Pages: 72 - 84
  Abstract: Mahmoud A AbdAlsalam, Nayera A.H Mohamed
  Al-Azhar Assiut Medical Journal 2022 20(1):72-84
  Background and aim Pain international association of described pain as an unpleasant sensory and emotional practice accompanied with actual or potential tissue injuries. Opioid administrations remain the cornerstone of postoperative pain relief, but it may cause significant side effects, including sedations, nausea, vomiting, and urinary retention. We aimed to compare the efficacy of ultrasound-guided lumbar-plexus block through adding magnesium sulfate and dexmedetomidine (DEX) to bupivacaine on postoperative analgesia and thereafter surgical operation.Patients and methods This prospective, randomized, double-blinded, controlled research was performed on Al-Azhar University Hospitals. A total of 75 cases of both sexes, age between 21 and 65 years, American Society of Anesthesiologists class I– II, were listed for elective lower-abdomen surgical operation underneath general anesthesia.Results Pain scores were decreased significantly in the study groups for 12 and 18 h in BM and BD, respectively, also, there was a significant decrease at 2, 4, 6, 8, and 12 h in the BD group lesser than the BM group postoperatively. The time to the initial analgesic appeal was significantly extended in the BD group (11.9±1 h) than the BM group (10.6±0.7 h).Conclusion Posterior lumbar-plexus block utilizing 22 ml of bupivacaine 0.5% with DEX 1 μg/kg decreases pain score, opioid consumption, prolongs duration of analgesia, better hemodynamics stability, and perfect outcome of cases’ satisfaction postoperatively compared with posterior lumbar-plexus block using 22 ml of bupivacaine 0.5% with magnesium sulfate 150 mg. DEX provides faster onset time and longer periods of MB and extended period of analgesia with smaller consumptions of postoperative rescue analgesia.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):72-84
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_100_21
  Issue No: Vol. 20, No. 1 (2022)
Endovascular evaluation of intracranial atherosclerotic stenosis in a
sample of Egyptian patients presented with ischemic stroke
- Authors: Mahmoud M Hassan, Khalid M Sobh, Mahmoud Galal, Salah I Ahmed, Sherief M Al Shazly, Abd Elaziz Shokry
  Pages: 85 - 92
  Abstract: Mahmoud M Hassan, Khalid M Sobh, Mahmoud Galal, Salah I Ahmed, Sherief M Al Shazly, Abd Elaziz Shokry
  Al-Azhar Assiut Medical Journal 2022 20(1):85-92
  Background and aim Intracranial atherosclerosis is an important etiology of ischemic stroke and is associated with multiple vascular risk factors. Endovascular evaluation is used for assessing patterns and distributions of intracranial atherosclerotic stenosis in a sample of Egyptian patients presented with ischemic stroke.Patients and methods A total of 50 patients with ischemic stroke or transient ischemic attack were included. Assessment of the state of cerebral vessels before the procedure was done by duplex ultrasound, magnetic resonance angiography, and/or computed tomography angiography to confirm any stenosis in intracranial vessels. Neurological assessment was done before and after the procedure using the National Institutes of Health Stroke Scale score. Digital subtraction angiography was done to evaluate the degrees and patterns of stenosis.Results A total of 50 participants (29 males and 21 females) were included. Their ages ranged from 30 to 78 years. The major risk factors were dyslipidemia (62.0%), hypertension (60.0%), diabetes mellitus (54.0%), smoking (48.0%), and atrial fibrillation (22.0%). The procedure was performed on 50 patients. A total of 39 (78.0%) patients had angiographic findings of vessel stenosis in either extracranial or intracranial vessels or both. In those 39 patients, 32 (64.0%) patients had arterial stenosis, and seven (14.0%) patients were found to have total occlusion. A total of 18 (36.0%) patients had angiographic findings of intracranial atherosclerotic stenosis. Of these 18 patients, 14 (28.0%) patients had arterial stenosis, and four (8.0%) patients were found to have total occlusion. The most common site of intracranial stenosis was middle cerebral artery (33.3%).Conclusion Endovascular evaluation of patients with ischemic stroke is yielding, informative, safe, and easy to be done.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):85-92
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_75_21
  Issue No: Vol. 20, No. 1 (2022)
Comparing the effect of gonadotropin versus letrozole for induction of
ovulation in patients with polycystic ovary syndrome with clomiphene
citrate failure
- Authors: Ahmed I.A Ali, Abd El-Azeem M Ahmed, Adel A Elboghdady
  Pages: 93 - 99
  Abstract: Ahmed I.A Ali, Abd El-Azeem M Ahmed, Adel A Elboghdady
  Al-Azhar Assiut Medical Journal 2022 20(1):93-99
  Background and aim Polycystic ovary syndrome (PCOS) is an endocrinopathy affecting women during the childbearing period, with incidences of between 8 and 13%. PCOS is the main cause of anovulatory infertility with a prevalence of 20% in infertile women. We aimed to compare the ovulation induction effect of letrozole versus gonadotropins in patients with PCOS after clomiphene citrate (CC) failure.Patients and methods This is a prospective comparative study held in the El Hussien University Hospital, Al-Azhar University; throughout the duration of 12 months from January 2020 to January 2021. In all, 100 women were enrolled in the study diagnosed with PCOS with an ovulatory infertility and after CC failure, patients were allocated into two groups in a ratio of 1 : 1. The first group included 50 patients and received (letrozole 2.5 mg tablet) twice daily.Results There was higher incidence of confirmed ovulation in the gonadotropin group (62%) compared with the letrozole group (58%) with no significance. It also showed a higher incidence of confirmed pregnancy in the gonadotropin group (34%) compared with the letrozole group (30%), but that difference was statistically nonsignificant. The results showed a shorter duration till the day of trigger in the letrozole group (13.48) compared with the gonadotropin group (14.55), the difference was significant. Endometrial thickness on day of trigger was higher in the gonadotropin group (11.3) compared with the letrozole group (10.9) with no significance.Conclusion In patients who failed to conceive with CC, gonadotropins have higher pregnancy rates for ovulation induction than letrozole with an insignificant statistical difference.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):93-99
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_78_21
  Issue No: Vol. 20, No. 1 (2022)
Ketoconazole 2% cream versus a combination of ketoconazole 2% cream and
adapalene 0.1% gel in the treatment of pityriasis versicolor
- Authors: Khaled M Tawfik, Waleed A Mahmmoud, Amira G.E. Ali
  Pages: 100 - 103
  Abstract: Khaled M Tawfik, Waleed A Mahmmoud, Amira G.E. Ali
  Al-Azhar Assiut Medical Journal 2022 20(1):100-103
  Background and aim Pityriasis versicolor is a common chronic superficial fungal infection that manifests during or after puberty in hot humid temperatures. Topical treatments, which are the first line of treatment, are divided into nonspecific and specific antifungal agents; however, the therapeutic approaches for pityriasis versicolor depend mainly on synthetic antifungal drugs, in particular ketoconazole. However, due to the frequent recurrence of this disease, and the widespread application of azole drugs, resistant strains have emerged leading to increasingly failed treatment rates. Retinoic acid creams are also effective against pityriasis versicolor. Especially adapalene gel that has less irritation compared with other topical retinoid products and also has rapid onset of action. Therefore, we aimed to evaluate the efficacy and safety of a combination treatment of ketoconazole cream 2% and adapalene gel 0.01% in the treatment of pityriasis versicolor.Patients and methods In all, 100 patients were divided equally into two groups: group 1 patients were treated with topical application ketoconazole 2% cream and adapalene 0.1% gel once daily for a total duration of 2 weeks. Group 2 patients were treated with a topical application ketoconazole 2% cream for a total duration of 2 weeks.Results There was significant improvement rates in the combined group than ketoconazole-only group with P value=0.023. Adepalene+ketoconacole group had more irritation as a side effect than the ketoconazole group with significant P value=0.001.Conclusion The combination of adapalene 0.1% gel and ketoconazole 2% cream is safe, rapid, and effective in the treatment of pityriasis versicolor.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):100-103
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_97_21
  Issue No: Vol. 20, No. 1 (2022)
Assessment of post-LASIK flap thickness created by mechanical
microkeratomes by anterior segment optical coherence tomography
- Authors: Islam A.M Amr, Hassan S.E Yousef, Asaad N Ahmed
  Pages: 104 - 112
  Abstract: Islam A.M Amr, Hassan S.E Yousef, Asaad N Ahmed
  Al-Azhar Assiut Medical Journal 2022 20(1):104-112
  Background and aim Laser-assisted in situ keratomileusis (LASIK) is the most popular refractive surgical operation for the correction of myopia, hyperopia, and astigmatism. Corneal flap creation is an essential step for the success of LASIK. The aim of the work is to evaluate the accuracy of the post-LASIK flap thickness created by mechanical microkeratomes using Anterior segment optical coherence tomography (ASOCT).Patients and methods This study included 60 eyes (of 30 patients), who underwent LASIK for refractive error correction. The patients were divided into two groups: (a) group A involved 30 eyes of 15 patients; in this group, the mechanical microkeratome Moria M2 (Moria M2, 110) was used. (b) Group B involved 30 eyes of 15 patients; in this group, the microkeratome Moria M2 (Moria M2, 100 with medlogic plano head) was used.Results As regards postoperative changes in flap thickness, the results of the current study showed that there were no considerable changes in thickness of the flap between 1 week, 1 month, 3 months, and 6 months postoperatively in either group.Conclusion Moria M2 100 with medlogic plano head created LASIK flaps with thinner thickness, and more predictability and more preservation of bed thickness than those created with the Moria M2 110.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):104-112
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_116_21
  Issue No: Vol. 20, No. 1 (2022)
Role of food allergy in otitis media with effusion
- Authors: Wessam A Fouad, Sayed M Makhemaer, Hala Abd El-Hassib Mohamed, Ayat A Awwad
  Pages: 113 - 120
  Abstract: Wessam A Fouad, Sayed M Makhemaer, Hala Abd El-Hassib Mohamed, Ayat A Awwad
  Al-Azhar Assiut Medical Journal 2022 20(1):113-120
  Background and aim The role of food allergy (FA) in chronic otitis media with effusion (OME) is argumentative. New proof from cellular biology and immunology clarifies the essentials of allergic responses and permits exact diagnosis more than before for allergies and inflammatory disease. We aimed to detect the occurrence of FA in patients with chronic OME.Patients and methods This a prospective, cohort randomized controlled study that was conducted at Al Azhar University Hospital, Otorhinolaryngology Department, on 40 patients divided into two groups: patient group included 20 patients with OME, and control group included 20 patients without any medical problems about FA or OME. The prevalence of FA was detected by skin prick test and assessment of serum immunoglobulin E and eosinophil count.Results There were highly statistically significant correlations between increase in the total serum immunoglobulin E and eosinophil count and developing OME (P<0.00); however, there were no statistically significant correlations between age and developing OME (P<0.396).Conclusion The possibility of association and the contribution of FA should be kept in mind in OME cases.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):113-120
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_99_21
  Issue No: Vol. 20, No. 1 (2022)
Audiovestibular performance in patients with low bone mineral density: a
case–control study
- Authors: Mohamed Elwan, Mohamed M Elmoursy, Ahmed M Ibrahim Metwaly, Mohamed M Ryan
  Pages: 121 - 126
  Abstract: Mohamed Elwan, Mohamed M Elmoursy, Ahmed M Ibrahim Metwaly, Mohamed M Ryan
  Al-Azhar Assiut Medical Journal 2022 20(1):121-126
  Background and aim Audiovestibular dysfunctions have been previously linked to osteoporosis (OP) with controversies about the mutual relationship. In this study, we aimed to assess the audiovestibular functions in patients with OP and osteopenia and to study their association with vitamin D deficiency.Patients and methods Of 60 patients enrolled in this study, 30 had low bone mineral density (BMD) (group I) and 30 had normal BMD (group II). After clinical examination and evaluation of serum vitamin D and calcium levels, the participants then were referred for audiovestibular assessments, which included basic audiological evaluation by pure tone audiometry and speech audiometry, tympanometry, acoustic reflex, video-nystagmoscopy tests, and vestibular-evoked myogenic potential (VEMP) to assess saccular function. Both participants and audiologist were blinded regarding the BMD results.Results There was a significant difference between patients and controls regarding the level of calcium (P=0.002) and vitamin D (P=0.001). There was a significant difference in the normal hearing threshold between both groups (P=0.005). There was no significant difference in VEMP testing (VEMP P1; P=0.489, amplitude; P=0.898). Benign paroxysmal positional vertigo was the most common finding in group I, among the females, where they had vitamin D deficiency (16.67±4.16) and OP (mean T score=−2.73±0.06).Conclusions Patients with low BMD showed a greater degree of audiovestibular dysfunction, which should be considered among the associating risk factors and comorbidities. Assessment of the audiovestibular functions should be recommended for patients with low BMD in the management guidelines.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):121-126
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_119_21
  Issue No: Vol. 20, No. 1 (2022)
Role of dialysate sodium and serum sodium gradient in intradialytic
hypertension of regular hemodialysis patients
- Authors: Mohamed M Fayed, Emad A Mohamed, Hindawy A Zidan, Ahmed A Assem, Moahmed A El-Sayed
  Pages: 127 - 133
  Abstract: Mohamed M Fayed, Emad A Mohamed, Hindawy A Zidan, Ahmed A Assem, Moahmed A El-Sayed
  Al-Azhar Assiut Medical Journal 2022 20(1):127-133
  Background and aim Sodium (Na+) balance largely depends on interdialytic dietary salt intake and intradialytic Na+ removal during hemodialysis (HD) for chronic renal failure cases. To preserve a normal Na+ equilibrium, interdialytic Na+ increase should be filtered during HD. Sodium gradient (Na+ G) is obtained by subtraction of the dialysate Na+ concentration and the patient’s own pre-HD plasma sodium concentration. The aim was to evaluate the role of dialysate and serum Na+ G in patients with intradialytic hypertension (IDH).Patients and methods A cross-sectional observational study was done to evaluate the role of Na+ G in IDH in a cohort of HD patients followed in the dialysis center of Damanhur Fever Hospital. Among 119 prevalent patients on MHD in our center during period from March 2021 to July 2021, we found 26 patients with IDH, so we selected a control group of 26 patients with intradialytic normotension (age and sex matched). So, the study included 52 patients (age and sex matched) who were divided into two groups: group A included 26 patients who were intradialytic normotensive, and group B included 26 patients with IDH.Results A total of 52 patients were included in our final analysis. The sample included patients who are diagnosed with ESRD and under regular HD schedule, with a mean±SD age of 54.4±12.3 years. Comparison of different sodium concentrations revealed that there was no significant difference between pre-dialytic, and postdialytic Na serum levels, along with no difference in sodium gradients, with P values greater than 0.05.Conclusion IDH was not significantly associated with sodium gradient, age, sex, hemoglobin level, and predialytic and postdialytic serum sodium concentrations.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):127-133
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_84_21
  Issue No: Vol. 20, No. 1 (2022)
Comparison of corneal changes after phacoemulsification in diabetic and
nondiabetic eyes
- Authors: Asmaa Ibrahim Elminshawy, Hanan Saied Hegazy, Mona Mohamad Aly
  Pages: 134 - 141
  Abstract: Asmaa Ibrahim Elminshawy, Hanan Saied Hegazy, Mona Mohamad Aly
  Al-Azhar Assiut Medical Journal 2022 20(1):134-141
  Background and aim Endothelium of the cornea is susceptible to surgical trauma during phacoemulsification from ultrasound energy. Several studies have reported various results of corneal changes after phacoemulsification in diabetic and healthy patients. The aim was to evaluate and compare changes in precorneal tear film, anterior and posterior corneal surfaces, endothelial cell changes, and central corneal thickness (CCT) between diabetic and healthy patients before and after uneventful phacoemulsification.Patients and methods A total of 40 eyes of 40 patients who were scheduled for cataract surgery were divided into group 1 (20 eyes in nondiabetic patients) and group 2 (20 eyes in diabetic patients). Ophthalmological examinations, including uncorrected and best-corrected visual acuity (BCVA), slit lamp to examine anterior and posterior corneal surfaces, tear film breakup time test (TBUT), anterior chamber depth by IOL Master (Topcon ALADDIN HW2.0), and specular microscopy (Topcon SP-1P, made In Japan), were done preoperatively and at 1 week, 1 month, and 3 months postoperatively.Results Significant differences were found between preoperative and postoperative periods in both groups regarding BCVA, TBUT, CCT, endothelial cell density (ECD), coefficient of variation, and hexagonal cells, except that changes became insignificant with respect to CCT at 3 months in nondiabetic and at 1 week and 3 months in diabetic and in CD at 1 month in healthy patients.Conclusion There were significant changes in BCVA, TBUT, CCT, and ECD after phacoemulsification in the diabetic and healthy groups. There was a significant delay in the recovery of CCT 1 month after phacoemulsification in the diabetic compared with healthy individuals.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):134-141
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_130_21
  Issue No: Vol. 20, No. 1 (2022)
Role of computed tomography and MRI in children with sensorineural hearing
loss
- Authors: Ahmad Mohamed Saeed Alkady, Saad Rezk Abd Al-Wahed El-Gebaly, Tarek Mohamed Mohamed Mansour, Mohamed M Elmoursy Kasem
  Pages: 142 - 147
  Abstract: Ahmad Mohamed Saeed Alkady, Saad Rezk Abd Al-Wahed El-Gebaly, Tarek Mohamed Mohamed Mansour, Mohamed M Elmoursy Kasem
  Al-Azhar Assiut Medical Journal 2022 20(1):142-147
  Background and aim Given the tremendous developments in visualization science, there are many congenital and acquired internal ear anomalies that have no radiological signs. However, visualization is an important instrument for the assessment of congenital and acquired sensory neural hearing loss (SNHL) triggers. The aim is to assess the value of multidetector computed tomography (MDCT) and MRI in internal ear abnormality detection in children with SNHL.Patients and methods This study included 100 children of 10 years or younger with SNHL. The cochlea, the vestibule, the three semicircular canals, the endolymphatic duct, and the internal acoustic canal. In addition, three-dimensional DRIVE MRI gives good demonstration of all four nerves within the internal acoustic canal.Results A total of 46 malformations were detected in only 25 patients with 42 malformations that were detected in MDCT examination presenting 91% of all abnormalities, while in MRI examination, 44 malformations are detected presenting 96% of all abnormalities. MDCT showed accuracy, sensitivity, and specificity 96.7, 91.3, and 100%, respectively, while for MRI, it showed accuracy, sensitivity, and specificity 98.3, 95.7, and 100%, respectively.Conclusion Imaging plays an important role in the workup of children with SNHL. Therefore, it is imperative to define the etiology of hearing loss. High-resolution CT and MRI modalities are the two principal radiological investigations to detect various pathologies in the inner ear. ‘Dual-modality imaging’ using both MRI and CT, made sense for many patients because the dual-scan approaches detect abnormalities related to hearing loss that would not otherwise be found using either modality alone.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):142-147
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_191_20
  Issue No: Vol. 20, No. 1 (2022)
Relationship between central corneal thickness and axial eye length using
partial coherence interferometry
- Authors: Wafaa A.E Abdelkhalek, Hanan S Hegazy, Mohamed I El-Kasaby
  Pages: 148 - 153
  Abstract: Wafaa A.E Abdelkhalek, Hanan S Hegazy, Mohamed I El-Kasaby
  Al-Azhar Assiut Medical Journal 2022 20(1):148-153
  Background and aim Several studies have shown the relationship between axial length (AL) of the eye and central corneal thickness (CCT). Since genetics, ethnicity, and race can affect these factors, their differences between different societies can probably explain refractive error variance. We present the ocular parameter values in 154 eyes of different refractive error groups to investigate the correlation between AL of the eye and CCT in Egyptians with refractive errors.Patients and methods In all, 154 patients were classified into emmetropic, hypermetropic, simple myopic, congenital myopic, and malignant myopic groups. Most ocular parameters were achieved using IOLMaster 700 and stratified according to AL and CCT.Results The CCT means in the studied groups was 537±34, 523±31, 541±40, 524±40, and 524±27 μm in emmetropic, hypermetropic, simple myopic, congenital myopic, and malignant myopic groups, respectively. The AL was 23±0.76, 22±1.1, 25±1.3, 26±1.4, and 29±1.6 mm, respectively. Regarding the correlation between AL of the eye and CCT (r=−0.01, P=0.92, confidence interval=−0.17 to 0.15).Conclusion This study provided valued measurements of ocular parameters of the Egyptians with refractive errors. Besides, there is no significant correlation between AL of the eye and its CCT in Egyptians with errors of refraction.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):148-153
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_139_21
  Issue No: Vol. 20, No. 1 (2022)
Comparison between video head impulse and videonystagmography in patients
with vertiginous migraine
- Authors: Waleed M.N Mohamed, Gehan A Elzaree, Mahmoud M Hassan, Ahmed M Mohamed
  Pages: 154 - 157
  Abstract: Waleed M.N Mohamed, Gehan A Elzaree, Mahmoud M Hassan, Ahmed M Mohamed
  Al-Azhar Assiut Medical Journal 2022 20(1):154-157
  Background and aim In addition to the classic migraine symptoms of vertigo, dizziness, and imbalance, vestibular migraine causes vertigo, dizziness, and imbalance. The video head impulse test (VHIT) is a novel approach for determining the function of each semicircular canal. Although videonystagmography (VNG) is an effective tool for identifying peripheral vertigo, not all patients with central vertigo can be easily detected. The goal of this research is to confirm the findings of the functional outcome of VHIT versus VNG in patients with vertiginous migraine.Patients and methods We selected 40 patients (both sexes) with vestibular migraine and 25 normal individuals as control. Both groups were subjected to complete clinical examination after thorough history taking, laboratory investigations, VHIT, and VNG.Results VNG had excellent predictive value in the patients’ group (95% confidence interval=0.891–0.998, P=0.0001) with a 96.6% sensitivity and 86.2% specificity, while VHIT had poor predictive value with a sensitivity of 100% and specificity of 48.1% (95% confidence interval=0.523–0.779, P=0.099).Conclusion VNG has a specificity and sensitivity for the prognosis of vestibular migraine that is virtually identical to VHIT.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):154-157
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_147_21
  Issue No: Vol. 20, No. 1 (2022)
Prevalence of pathological myopia in Upper Egypt
- Authors: Mohamed E Ahmed
  Pages: 158 - 161
  Abstract: Mohamed E Ahmed
  Al-Azhar Assiut Medical Journal 2022 20(1):158-161
  Background and aim Pathological myopia (PM) is one of the main causes of blindness globally, and its prevalence continues to increase rapidly over time. The aim of this study was to investigate the prevalence of PM in the clinical population in Assiut City, Upper Egypt, during a period of 1 year.Patients and methods This cross-sectional study was carried out on a clinical population attending a large ophthalmology center in Assiut City, Upper Egypt, during the period from January to December 2018. All patients were subjected to full ophthalmologic examination. The noncycloplegic refraction was measured using an autorefractometer. The examined eyes were diagnosed as PM if they had refraction of more than or equal to −6 D spherical equivalent or an axial length of more than or equal to 25.5 mm.Results The study included 1548 eyes of 812 patients. Pathologically myopic eyes represented 152 eyes, with a prevalence of 9.82%. Of the total included patients, 102 (12.6%) patients had at least one pathologically myopic eye. Patients with bilateral PM represented 73 (71.6%) cases. Their refractive error ranged from −6.0 to −26.0 D, with a mean of −13.24±4.13 D, and their mean axial length was 28.2±2.14 mm and ranged from 26.1 to 35.2 mm.Conclusion The prevalence of PM in the studied sample was 9.82%, which was obviously higher compared with studies on other populations. Further large community-based studies are warranted to determine its prevalence as a step to overcome this true burden.
  Citation: Al-Azhar Assiut Medical Journal 2022 20(1):158-161
  PubDate: Fri,4 Mar 2022
  DOI: 10.4103/azmj.azmj_143_21
  Issue No: Vol. 20, No. 1 (2022)