Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101The Beneficial Effects of Adding Magnesium Sulphate to General Anesthesia for Laparoscopic Sleeve Gastrectomy98990412132010.21608/ijma.2020.121320ENMahmoud Gaballah MontasserAliDepartment of Anesthesia and Intensive Care, Al-Ansar Private Hospital, Jeddah, KSA [Department of Anesthesia and Intensive Care, Damietta Faculty of Medicine, Al-Azhar University, EgyptAyman Saleh MohamedRagabDepartment of Anesthesia and Intensive Care, Damietta Faculty of Medicine, Al-Azhar University, EgyptAdel Al-Hady AhmedDiabDepartment of Anesthesia and Intensive Care, Damietta Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200818<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Obesity is a significant health issue. It was estimated that about 700 million were obese<strong>.</strong> Some call this trend the “New World Syndrome”.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The study aims to compare between intravenous injections of one to two grams of magnesium sulfate [MgSO<sub>4</sub>] in patients scheduled for elective laparoscopic sleeve gastrectomy.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> It is a multicenter study, which included 800 patients who were scheduled for elective laparoscopic sleeve gastrectomy under general anesthesia; all patients were randomly grouped into two equal groups [n = 400]. The first group for one gram and the second group for two grams of MgSO<sub>4</sub> over 10 minutes immediately after induction of anesthesia and before starting surgery. Then, all were assessed postoperatively for different variables.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The duration of full recovery was significantly shorter, intensive care unit admission and postoperative pain immediately after recovery till the end of the first 18 hours was lower in M2 when compared to the M1 group. Postoperative respiratory depression, nausea, and vomiting were significantly decreased. The number of early ambulation was significantly increased, while the length of stay was significantly reduced in the M2 group. Intraoperative bleeding and pain after 18 hours showed a non-significant difference between both groups. Postoperative bleeding was reported in two patients in the M2 group and returning to the operating room again within 6 hours and managed by blood transfusion and surgical laparoscopy. No patients suffered from deep vein thrombosis or any other complications.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Adding MgSO<sub>4</sub> to general anesthesia in laparoscopic sleeve gastrectomy had beneficial effects, which increased by increasing the dose from one to two grams.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Prevalence of Headache in Children with Epilepsy90591212042510.21608/ijma.2020.43838.1180ENSherief M.Al ShazlyDepartment of Neurology, Damietta Faculty of Medicine, Al-Azhar University, EgyptHanyEl-khaleegyDepartment of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt.Journal Article20200922<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Epilepsy is a common pediatric health problem that urges parents to seek medical advice. However, it could be associated with prodromal manifestation [e.g., headache] that the parents usually pass unnoticed. Previous literature is defective regarding the prevalence of headaches among children with epilepsy.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Estimating the prevalence and characteristics of headaches associated with epilepsy in pediatric populations.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> We included 130 children with epilepsy [study group] and 130 healthy children as a control group. All were selected from Al-Azhar University Hospitals [new Damietta]. An inquiry about headache and its characteristics, especially in relation to seizure attacks, had been performed.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Children with epilepsy had a higher rate of headache when compared to healthy children [48.5% versus 22.3%];migraine is the commonest type in the epileptic group and tension-type headache in the control group. In children with epilepsy, headaches were associated with a higher rate of generalized epileptiform activity, increased frequency of seizures, and monotherapy use.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Headache is highly prevalent among children with epilepsy and necessitates proper screening, further investigations, and proper treatment. Future studies to investigate the problem on a wide scale are warranted</span><span style="font-family: Arial Narrow; font-size: small;">.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Atracurium with or without Dexmedetomidine as an Adjuvant to Lignocaine for Intravenous Regional Anesthesia in Upper Limb Surgeries91392114222710.21608/ijma.2021.142227ENMohamedArafaDepartment of Anesthesia and Intensive Care, Damietta Faculty of Medicine, Al-Azhar University, EgyptNiazy AbdelmokhlesAbdelmotablebDepartment of Anesthesia and Intensive Care, Damietta Faculty of Medicine, Al-Azhar University, EgyptAyman SalehRagabDepartment of Anesthesia and Intensive Care, Damietta Faculty of Medicine, Al-Azhar University, EgyptJournal Article20201030<strong><span style="font-family: Arial Narrow; font-size: small;">Background: </span></strong><span style="font-family: Arial Narrow;">The use of adjuvants in intravenous regional anesthesia [IVRA] for upper limb surgeries seems to increase efficacy and reduce side effects. Trials are continued to reach the ideal combination.</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Aim of the work:</span></strong><span style="font-family: Arial Narrow;"> The study aimed to evaluate the efficacy and safety of IVRA for upper arm surgery using different adjuvants [atracurium and dexmedetomidine].</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Patients and methods:</span></strong><span style="font-family: Arial Narrow;"> 120 patients scheduled for elective upper limb surgeries were included. Patients were divided randomly into four equal groups. </span><span style="font-family: Arial Narrow;">Group I received 40 ml lignocaine 0.5% alone, group II: received 40 ml [lignocaine 0.25% plus dexmedetomidine 50 μg], group III received 40 ml [lignocaine 0.25% plus atracurium 2 mg], and group IV received 40 ml [[lignocaine 0.25% plus dexmedetomidine 50 μg and atracurium 2 mg]. surgery duration, quality of anesthesia, postoperative analgesia, and hemodynamics were monitored</span><span style="font-family: Arial Narrow;">.</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Results:</span></strong><span style="font-family: Arial Narrow;">The onset of sensory and motor block was significantly shorter in groups II and IV than in group I or III. Also, both sensory and motor block were significantly shorter in group IV when compared to group II [2.53±0.57, 3.60±0.62 vs. 3.33±0.54 and 5.20±0.84 respectively]. Besides, the pain was significantly lower in groups II and IV than groups I or III after deflation at 5, 15, 30, 60 minutes, and up to 8 hours. The need for postoperative analgesia was significantly higher among groups I and III when compared to groups II and IV [56.7%, 63.3% vs. 30.0% and 20.0%, respectively]. No major adverse events were reported</span><span style="font-family: Arial Narrow;">.</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: small;"> <span style="font-size: small;">The use of dexmedetomidine as an adjuvant had a significantly better postoperative analgesia, longer duration of sensory and motor block, and earlier onset of action. In addition, the use of atracurium besides dexmedetomidine improves the quality of IVRA</span><span style="font-size: xx-small;">.</span></span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Toxocariasis; A Neglected Tropical Disease, Association With Asthma, Chronic Urticaria and Unexplained Neurologic Manifestations Among Children92292912469710.21608/ijma.2020.46359.1192ENKhaled AlyTemsahDepartment of Parasitology, Damietta Faculty of Medicine, Al-Azhar University, EgyptMostafa ElshahatMostafaDepartment of Parasitology, Damietta Faculty of Medicine, Al-Azhar University, EgyptHany Abdul HadyEl-KhaleegyPediatrics Department, Damietta Faculty of Medicine, Al-Azhar University, EgyptAtef WahdanEl RifaiDepartment of Chest Disease, Damietta Faculty of Medicine, Al-Azhar University, EgyptMonaAbd RabooDepartment of Parasitology, Faculty of Medicine for Girls, Al-Azhar University, Egypt.Sherief M.Al ShazlyDepartment of Neurology, Damietta Faculty of Medicine, Al-Azhar University, Egypt.Journal Article20201015<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">The link between parasitic infestation and allergic diseases or unexplained neurologic manifestations was hypothesized, especially in children. However, the debate continues regarding this link</span><span style="color: black; font-family: Arial Narrow; font-size: medium;">.</span><br /><strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Aim of the work</span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">: To determine the seroprevalence of toxocariasis in children with different allergic diseases [bronchial asthma and skin allergy], besides the unexplained neurological manifestations [epilepsy and focal neurologic deficits] in children. </span><br /><strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Patients and methods:</span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;"> Children with bronchial asthma [40 children], skin allergy [40 children], and unexplained neurological manifestations [epilepsy and focal neurologic deficits], [40 children] were included. All underwent a full history taking, clinical examination, lab investigations, and seropositivity determination for <em>Toxocara</em> <em>canis</em>.</span><br /><strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Eosinophilia was reported in 22.5%, 30.0%, and 17.5% of asthma, skin, and unexplained neurological manifestations groups, respectively. In patients with asthma, the prevalence of toxocariasis was 15.0%; in skin disease, it was 7.5%, and in unexplained neurological manifestations, it was 12.5%. There was no significant difference between positive and negative toxocariasis regarding patient demographics. But there was a significant increase in contact with pets, chronic urticaria, lymph nodes involvement, and eosinophilia in positive when compared to negative groups</span><span style="color: black; font-family: Arial Narrow; font-size: medium;">.</span><br /><strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;"> The association between <em>Toxocara</em> <em>canis</em> infection and allergic diseases such as bronchial asthma, chronic urticaria, and unexplained neurological manifestations [epilepsy and focal neurologic deficits] was confirmed in the present work. The contact with dogs and cats [pets] was the major determinant risk factor explaining such association. Prospective cohort studies were warranted to examine the cause-effect relationship.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Effect of Oral Exposure to Bisphenol A on the Liver and Kidney of Adult Male Albino Rats93093711238310.21608/ijma.2020.37970.1152ENMohamed Ali MahmoudAbbasDepartment of Physiology, Damietta Faculty of Medicine, Al-Azhar University, EgyptSamir Atef FaridElmetwallyDepartment of Forensic Medicine and Clinical Toxicology, Damietta Faculty of Medicine, Al-Azhar University, EgyptMokhtar AhmedMokhtar Abo-ElfotohDepartment of Forensic Medicine and Clinical Toxicology, Damietta Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200804<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The organic composite of two phenolic neighbors [BPA] is Bisphenol A [BPA]. It is also commonly called propane 2,2 bis[4-hydroxyphenyl]. BPA is a voluminous industrial chemical used to manufacture epoxy resins and plastics.</span><br /><span style="font-family: Arial Narrow; font-size: medium;"> <strong>Aim of the work:</strong> Evaluation of the effect of oral Bisphenol A on the liver and kidney of adult male albino rats.</span><br /><span style="font-family: Arial Narrow; font-size: medium;"> <strong>Materials and Methods:</strong> Forty adult male albino rats [local strain] were divided into four groups [each 10 rats]. First is the control group, second is the low does BPA, third is moderate does BPA, and four is the high does BPA. The duration of exposure extended to 30 days. Then, blood samples have been collected for the measurement of serum aspartate aminotransferase [AST], serum alanine aminotransferase [ALT], blood urea, serum creatinine, superoxide dismutase [SOD], catalase, and glutathione. Also, hepatic and renal tissue samples were prepared for histopathological study.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Oral administration of BPA in a dose of 50, 100, and 150 Mg/kg/day for 30 days led to a significant increase in the blood levels of ALT, AST, urea, and creatinine associated with a significant reduction in the blood levels of superoxide dismutase, Glutathione peroxidase, and catalase. There were few vacuolations of hepatocytes and congested blood vessels of the liver that were associated with changes in the kidney [narrow cortex, dilated tubules, and hypercellular glomeruli]. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Bisphenol A oral exposure for 30 consecutive days is associated with several changes in biochemical parameters that indicate liver and kidney injury. </span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101A comparison between the Use of Chest X-ray and Lung Ultrasound in the Diagnosis of Pneumonia in Children in Damietta Governorate93894511859710.21608/ijma.2020.36693.1154ENAhmed MohamedKarkarDepartment of Pediatrics, Damietta General Hospital, Ministry of Health, EgyptMohamed AbdelsalamZannounDepartment of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, EgyptAhmed Mohamed FekryEldeekDepartment of Radiology, Damietta Faculty of Medicine, Al-Azhar University, EgyptMagdy Mohamed AshmawySakrDepartment of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200814<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Pneumonia is a life-threatening disease in children. Diagnosis of pneumonia is mainly clinical. However, some clinical features may be subtle or not specific. Lung ultrasound (LUS) might be used as a diagnostic tool in pneumonia as it is an easily accessible and safe imaging technique.</span><br /><strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Aim of the work</span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">: This study aimed to investigate the role of lung ultrasound in diagnosing pneumonia compared to chest x-ray in children. </span><br /><strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Subjects and methods:</span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;"> This cross-sectional study was carried out at the general pediatric wards and pediatric intensive care units [PICUs], Department of Pediatrics, Al-Azhar University Hospital [Damietta]. It included 120 patients who were clinically diagnosed to have pneumonia. Each legal guardian signed informed consent. Then, everyone was subjected to chest x-ray and lung ultrasound, and results were compared.</span><br /><strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;"> Sonographic findings in children with pneumonia as consolidation was detected in 114/120 (95.6%), air bronchogram in 104/120 (86.7%), fluid bronchogram 37(31.1%), multiple B-lines in 68/120 (56.7%), pleural effusion in 29/120 (24.4%). The lung ultrasound [LUS] showed higher diagnostic accuracy (94.45%), sensitivity (95.6%), and specificity (93.3%). There was a statistically significant good agreement between LUS and chest X-ray [CXR].</span><br /><strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;"> LUS is safe, accurate, and more sensitive for the diagnosis of suspected pneumonia in the pediatric age group and had the advantage of reducing radiation hazard when compared to chest X-ray</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Comparative Study of Color Doppler Imaging in Normal and Abnormal First Trimester Pregnancy94695211859810.21608/ijma.2020.39922.1160ENSileem AhmedSileemDepartment of Obstetrics and Gynaecology, Faculty of Medicine, Al-Azhar University, Assiut, EgyptTarek MohamedMansourDepartment of Radio-diagnosis, Faculty of Medicine, Al-Azhar University, Assiut, EgyptOsamaAabdelazemDepartment of Obstetrics and Gynaecology, Faculty of Medicine, Al-Azhar University, Assiut, EgyptJournal Article20200819<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Color Doppler ultrasonography enables the non-invasive study of physiologic and pathophysiologic changes in the uterine and ovarian circulation in pregnant and non-pregnant women.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">To evaluate the potential value of color Doppler of the uterine artery, corpus luteum blood flow, and subchorionic blood vessels in abnormal first-trimester pregnancy.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and methods: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">The study included 200 pregnant women in the first trimester in the antenatal care clinic of the Department of Obstetrics and Gynecology AL Azhar University [Assiut], divided into two groups; control group [100 cases] with normal pregnancy and study group [100 cases] which was further subdivided into threatened abortion [60 cases], blighted ovum [20 cases] and vesicular mole [20 cases].</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results</span></strong><span style="font-family: Arial Narrow; font-size: medium;">:</span><span style="font-family: Arial Narrow; font-size: medium;">The uterine artery resistance index [RI] of the study groups was lower than the control group. The decrease was highly significant in the uterine artery RI of both threatened abortion and blighted ovum groups and significant in the vesicular mole group. Uterine artery pulsatility index [PI] showed a significant decrease in the study group compared with the control cases. There was a highly significant negative correlation between gestational age and both RI and PI of the study group's uterine artery. There was a higher prevalence of abortion in a group of threatened abortion compared to the control group.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">The prevalence of pregnancy complications is increased in association with abnormal blood flow patterns of the early uteroplacental circulation. Doppler indices of the early gestation uteroplacental circulation have an important value in the threatened abortion follow up.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Unintentional Poisoning among Preschool Children in Jeddah, Saudi Arabia (2014-2016): A Retrospective Cohort Study95396111989810.21608/ijma.2020.42737.1168ENIman Mohamed WahbySalemCommunity Medicine Department, King Abdulaziz University [Rabigh], Kingdom of Saudi Arabia; Community Medicine Department, Faculty of Medicine, Al-Azhar University, Egypthttps://orcid.org/00AhlamNattoPublic Health Specialist, East Jeddah Hospital; Community Medicine Consultant, Joint Program of Family and Community Medicine, Jeddah, KSAMohmad MabroukSweifMedical student at Alexandria Faculty of Medicine, EgyptJournal Article20200913<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Acute unintentional home intoxication in preschool-age children is a major cause of preventable morbidity and mortality. In the United States, 2012, around half of the youngsters younger than 6 years were accounted for as a poison occasion. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> To estimate family and poison injury characters of preschool children who had unintentional home poisoning at poisoning department center under public health administration in Jeddah City, Saudi Arabia, during the duration between 2014-2016 and to recognize the relationship between unintentional poison' risk factors (personal, family character and injury factors) and poison types. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Methodology:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> This retrospective cohort study was proceeded in the Jeddah poison center. All preschool children (0-5) years involved were reported as unintentional household harm (poisoning) cases at the chosen center. The questionnaire had developed and validated "from three public health experts," which was filed from center files and completed by a researcher telephone call to child-parent. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> 41.5% of the affected children were occupied the (>12-24 months) age cluster. In addition, 62.6% of the participants were males, and most of the kids [44.4%] had a low social class. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Inadvertent poisoning was commonly associated with age cluster (1-2 years), male gender, families with greater than three children, mother higher education, medicine poisoning of powder form, oral route, and at the morning time.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Value of Intraoperative Ultrasound in Decreasing Incidence of Residual Radiolucent Stones Post- Percutaneous Nephrolithotomy96296611930310.21608/ijma.2020.29998.1125ENMohammedMohammedAl Hada Hospital, Urology Department, Taif University, Saudi Arabia.
Mater University Hospital, Urology Department, University Collage Dublin, Ireland.AndrewJonesMater University Hospital, Urology department, University college DublinNabeelKuwaijoThe Galway Clinic - Royal College of Surgeons in Ireland00353864559955JalalAl ShareefAl Hada Hospital, Taif region, Urology Department, Taif University. Saudi ArabiaIbrahimSalmanAl Hada Hospital, Urology Department, Taif University, Saudi Arabia.
Benha University, EgyptShadySolimanAl Hada Hospital, Urology Department, Taif university, Saudi Arabia.
Urology department, Mansoura University, EgyptJournal Article20200511Background: Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for large renal calculi. The primary goal of treatment is absolute clearance of stone. The incidence of residual stones after PCNL ranges from 10% to 60% and may be higher in radiolucent stones. <br />Aim of work: Our objective was to assess the effectiveness of the use of ultrasound during PCNL in patients with radiolucent stones in reducing the incidence of residual fragments postoperatively. <br />Patients and Methods: This was a single center prospective study over a 6 year period. We identified 86 patients undergoing PCNL with radiolucent stones. Ultrasound was used in conjunction with traditional fluoroscopy to identify residual fragments. Each patient had a first day post-operative computed tomography to assess for residual fragments. The sensitivity of ultrasound with fluoroscopy was compared to clinically or radiologically [CT] detected residual fragments. <br />Results: Our overall stone clearance rate was 82.6% [as evidenced by postoperative CT]. The sensitivity of intra-operative ultrasound when compared to postoperative CT was 95.8%, specificity 40.0%, the positive predictive value 88.3% and negative predictive value 66.7%<br />Conclusions: The use of intra-operative ultrasound during PCNL for radiolucent stones may help in reduction of postoperative imaging. However, future studies are recommend.Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Relationship between Vitamin-D Receptor Gene Polymorphism FokI and Fetuin- A as A marker of Vascular Calcification in Egyptian Hemodialysis Patients96797510940010.21608/ijma.2020.31335.1130ENFatma IbrahimMayahDepartment of Internal Medicine, Faculty of Medicine for Girls, Al Azhar University, EgyptHayam HamzaMansourDepartment of Internal Medicine, Faculty of Medicine for Girls, Al Azhar University, EgyptRagaa RamadanMohamedDepartment of Internal Medicine, Faculty of Medicine for Girls, Al Azhar University, EgyptNadia KamalMareyDepartment of Internal Medicine, Faculty of Medicine for Girls, Al Azhar University, EgyptKhaled Younis YounisMohammedDepartment of Internal Medicine National Research Center, EgyptAmr MohamedIbrahimDepartment of Clinical Pathology National Research Center, EgyptTarek Fakhr EldeenOsmanDepartment of Nephrology, National Institute of Urology and Nephrology, EgyptJournal Article20200530<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Vascular calcification is a common complication in end-stage renal disease patients and the leading cause of morbidity and mortality.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The current work aimed to evaluate the possible relationship between vitamin D receptor gene polymorphism FokI with fetuin-A and intact parathormone hormone in Egyptian hemodialysis patients.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patient and Methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> This study is a cross-sectional study including 50 hemodialysis patients attending the hemodialysis unit in Al-Zahra University Hospital and 30 apparently healthy persons as a control group. For all studied subjects, a detailed history was taken, physical examination, carotid intima-media thickness by carotid duplex, echocardiography, Laboratory investigations included serum levels of calcium, phosphorus, iPTH, fetuin, and genotype frequency by PCR</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> There was a highly significant increase in carotid intimal media thickness in the patient group Vs. control group & a highly significant decrease in serum Fetuin-A in the patient's group Vs. control group. There was a significant difference in the genotype distribution of FokI polymorphism among patients and control. There were significant negative relationships between FF genotype and iPTH and a highly significant negative correlation between serum fetuin-A and iPTH in the patient group.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Vitamin D receptor gene FokI polymorphism FF genotyping is more frequent in hemodialysis patients who have higher iPTH and lower fetuin-A levels, which could identify the high-risk group susceptible to vascular calcification in hemodialysis patients. Further studies are needed.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Off-Pump Versus On-Pump Coronary Artery Bypass Surgery in Ischemic Heart Disease Patients with Impaired Contractility and Renal Dysfunction: A Comparative Study97698312030310.21608/ijma.2020.43214.1173ENKhalidAbdelsamadDepartment of Cardiothoracic Surgery, Faculty of Medicine, Banysuef University, Banysuef, EgyptMohamed ShaffikHassanDepartment of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University, EgyptMohamed EldesoukySharaaDepartment of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University, EgyptIsmail NasrElsokkaryDepartment of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200917<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Coronary artery bypass surgery using cardiopulmonary bypass [CPB] carries the risk of renal impairment, which cannot be attributed to a single factor. This study compared the off-pump technique with the on-pump technique on kidney function in ischemic heart disease patients.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;"> Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The study aimed to compare off-pump with on-pump technique on kidney and heart functions in patients with renal impairment with no need for dialysis but with impaired Ejection fraction [EF]. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> This prospective non-randomized study included 60 patients who presented with symptoms of ischemic heart disease and subsequently underwent myocardial revascularization with preoperative serum creatinine levels between 1.6 to 2.5 mg/dl and EF below 45%. Patients were as following: Group A patients [on-pump]: included those who underwent surgery on cardiopulmonary bypass. Group B patients [off-pump]: included those who underwent off-pump surgery. Both groups were compared in terms of renal impairment markers and needed for dialysis and early postoperative outcome.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;"> Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Renal impairment needs management by dialysis was developed in nine patients [30%] in the pump group [group I] and two patients [7.67%] in the off-pump group, with a significant difference. Group [I] showed a significant increase of transfused blood, blood urea nitrogen, serum creatinine, acute kidney injury [13 patients], reopening for bleeding, postoperative renal impairment, need for renal dialysis, total intensive care unit stay, and the total duration of hospital admission. However, it had a significant reduction in hemoglobin and creatinine clearance. </span><br /><span style="font-family: Arial Narrow; font-size: medium;"> <strong>Conclusion:</strong> Off-pump coronary revascularization offers a better kidney function preservation and has a decreased risk for kidney dysfunction in patients with renal impairment without dialysis compared with coronary revascularization with cardiopulmonary bypass. </span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Immunohistochemical Expression of Cyclin D1 and PIN1 in Endometrial Carcinoma98499412030410.21608/ijma.2020.43269.1174ENShimaa ShafikAbu_SeadahDepartment of Pathology, Faculty of Medicine for Girls, Al-Azhar University, EgyptSamah MohamedAttiahDepartment of Pathology, Faculty of Medicine, Al-Azhar University, EgyptMohamed YousefAliDepartment of Pathology, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200917Background: Cyclin D1, a positive regular of the cell cycle, may lead to uncontrolled cell proliferation. Overexpression of Cyclin D1 has been associated with the diagnosis and prognosis of numerous tumors. PIN1 binds and isomerizes the phosphorylated serine/threonine–proline motif, which lead to alteration in the structure and function of proteins. The altered phosphorylated proteins by PIN1 are closely linked to development of cancer. PIN1 is strongly expressed in the majority of tumors, suggesting it promotes tumorigenesis, and negatively associated with the clinical prognosis. <br />Objectives: To assess Cyclin D1 & PIN1 expression and correlation in endometrial adenocarcinoma. Also to assess the relationship between Cyclin D1 & PIN1 expression and clinico-pathological variables of cases of endometrial carcinoma.<br />Materials and Methods: Study included 30 cases of endometrial adenocarcinoma specimens. Immunohistochemical staining was performed for both Cyclin D1 and PIN1. Blocks of tumor tissue and clinical data were gathered from the files of Pathology Department of Al-Zahraa University Hospital, between July 2017 and October 2019. <br />Results: Cyclin D1 positive expression and PIN1 high expression were increased significantly with age, high clinical stage, high pathological grade and more myometrium invasion depth. Cyclin D1 expression was positively associated with PIN1 expression (P-value = 0.004).<br />Conclusions: Cyclin D1 & PIN1 expression associated with age, stage, grade and depth of myometrial wall invasion in patients with endometrial carcinoma. The overexpression of Cyclin D1 & PIN1 seems to indicate a more malignant phenotype of endometrial carcinoma.Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Assessment of Anti-Streptolysin-O Titre in Healthy School-Age Children in Alexandria Governorate995100012030510.21608/ijma.2020.42462.1163ENAziza AbdelazizAbdouDepartment of Pediatrics, Damietta Faculty of medicine, Al-Azhar University, EgyptMohamed Abdel SalamZannounDepartment of Pediatrics, Damietta Faculty of medicine, Al-Azhar University, EgyptMagdy ZakiEl GhanamDepartment of Clinical Pathology, Damietta Faculty of medicine, Al-Azhar University, EgyptJournal Article20200910<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Serology of streptococcal [GAS] group-A is used for post-streptococcal disease diagnoses, such as acute rheumatic fever, and occasionally for streptococcal pharyngitis diagnoses. Streptococcal titers vary according to a number of factors, including age and population. In developing countries, where GAS-induced impetigo is rare, the titers in healthy people are low in early childhood, peak in children aged 6 to 15, decrease in late adolescence and early adulthood, and then flatten off afterwards.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> To assess Anti streptolysin-O titre in healthy school age children in Alexandria governorate. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and Methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> A prospective study had been performed in Alexandria Governorate and the collected sample were tested in clinical pathology Lab [Al-Azhar University Hospital, Damietta]. A total of 3000 [1540 Males, 1460 Females] serum samples had been collected from children aged 6-15 years, had been tested for Anti-streptolysin O titer [ASO] by latex. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> ASO from 100-200 was higher with 1281 [42.7%] followed by <br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusions:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> We concluded that upper limit of normal [ULN] ASOT is quite high in normal Egyptian children, reaching up to 850.0 IU / ml. Mapping of upper normal levels and associated factors with increased levels could provide a clue for future planning to prevent streptococcal infection and its associated complications. </span></span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101On-Pump versus Off-Pump Coronary Artery Bypass Grafting in Patients with Poor Left Ventricular Function1001100612035210.21608/ijma.2020.43316.1175ENAhmed MahmoudAsklanycardiothoracicsurgery,fuclty of medicine ,Beni suef university, Beni suef ,EgyptEl Husseiny El HusseinyGamilDepartment of cardiothoracic surgery,faculty of medicine, Al Azhar university,Cairo, EgyptMohamed HossinyMahmoudcardiothoracic surgery,faculty of medicine,Al Azhar university,Cairo, EgyptIsmail NasrElsokkaryDepartment of cardiothoracic surgery , faculty of medicine , Al Azhar university , egypt.Journal Article20200917<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> There is an increase in the number of patients with severely impaired left ventricle function who referred for CABG. Many studies showed that surgical intervention for those high-risk patients has high survival and wonderful outcome compared to medical treatment.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> This study aimed to evaluate our experience with coronary artery bypass surgery in patients with EF [ 25% up to 40%] either to perform surgery using off or on-pump technique and try to conclude which technique may be safer regarding cardiac function.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and Methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> This prospective observational patient cohort study from August 2017 to July 2019 enclosed forty consecutive patients divided into 2 teams every 20 patients either off or on pump technique according to surgeons' expertise. Pre-, intra- and post-operative data were collected for all patients. All survivors were subjected to a 6-months follow-up clinically and by Echocardiograghy assessment.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Improvement of ejection fraction [EF] was encountered in our study; the mean 6-months operative EF improved for each team by [36% versus 37%] for off-pump and on-pump interventions, respectively. There was no statistically important difference in the information collected for each technique [p-value>0.05] regarding most points of comparison.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Results of CABG in high-risk patients were acceptable with on-pump and off-pump techniques with nearly comparable results in our study, at least in the early 6-months after intervention. Intra-aortic balloon usage is valuable when indicated.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Use of Liquid Nitrogen as A local Adjuvant to Decrease Recurrence after Extended Curettage, and Reconstruction by Autogenous Bone Graft for Treatment of Aneurysmal bone Cyst: Our Updated Experience1007101512042410.21608/ijma.2020.43006.1171ENMohamed Abdel RahmanMostafaDepartment of Orthopedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptOsman AbdellahMohamedDepartment of Orthopedic Surgery, Damietta Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200915<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Aneurysmal bone cyst [ABC] can be managed by curettage and different bone grafts. However, the recurrence rate is high, and different adjuvants had been proposed to reduce recurrence. The use of liquid nitrogen could be used as an adjuvant.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> To present our experience with liquid nitrogen use as an adjuvant in ABC's management.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and Methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Twenty-five patients with ABC had been evaluated. All were treated by extended curettage followed by liquid nitrogen for two cycles and reconstruction of the cavity by a bone graft. Radiological and functional outcomes had been documented, and any complications had been registered.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Femur was the most common site for ABC. The graft was obtained from iliac crest for all patients, mainly corticocancellous [68.0%]. The ABC grade was grade 2 among [80.0%] and grade 3 among [20.0%]. Graft union achieved in all patients in an average of 6.52±2.27 months. The mean follow-up duration was [44.52±16.81 months; range 24- 72 months], and all patients were alive and completely free from the disease. The functional score ranged from 70% to 94%, [average of 85.12±7.32%]. Recurrence rate [8.0%] and wound infection had been recorded in another two patients [treated conservatively and completely resolved within days].</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Extended curettage of ABC with adjuvant cryotherapy had good results with a lower recurrence rate. The additional use of a bone graft allowed for consolidation in all cases with a short time for cyst healing.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101LASER Versus Mechanochemical Ablation in Treatment of Primary Varicose Vein of Lower Limb1016102412095010.21608/ijma.2020.21429.1060ENMohamed AbozeidAhmed AbozeidDepartment of Vascular Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt0000-0001-9560-893XMetwaly RagabIbrahimDepartment of Vascular Surgery, Damietta Faculty of Medicine, Al-Azhar University, EgyptGamal El-sayedAlmaadawyDepartment of General Surgery, Damietta Faculty of Medicine, Al-Azhar University, EgyptJournal Article20191224<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Endovenous thermal techniques, such as endovenous laser ablation [EVLA], are the recommended treatment for varicose veins. Non-thermal techniques such as Mechanochemical ablation [MOCA] have potential benefits.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> To compare EVLA with MOCA in the treatment of primary varicose vein of the lower limb.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and Methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> 40 patients who had primary great saphenous varicose veins [VV] admitted at the Vascular Surgery Department, Al-Azhar University Hospital, New Damietta, Egypt. They randomized into two equal groups each one included 20 patients group [1] treated by EVLA and group [2] treated by MOCA.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The time of operation of studied patients ranged from 22 to 44 minutes, and there a statistically significant decrease in time of group 2 compared to group 1. [25.36±1.80 vs. 37.30±2.47 respectively]. Postoperative pain in studied patients ranged from 0 [no pain] to 7 [severe pain], there statistically significant decrease in pain of group 2 compared to group 1. As regard to induration, it was reported in 4 patients, representing 20% of group 1 [4] patients, were significant differences between groups 1 and 2 [20% vs. 0% respectively]. At the end of the sixth month postoperatively, as regard complete occlusion of the great saphenous vein [GSV] vein, there was statistically no significant difference between group 2 when compared to group 1 [92.5% vs. 95% respectively].</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusions:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> MOCA was associated with better results on short-term follow-up.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Clipless Cholecystectomy in Adult and Pediatric Populations: Harmonic versus LigaSure Sealing1025103214432110.21608/ijma.2021.39729.1159ENSayed Ahmed ElhadyAbdelmonemDepartment of Surgery [Pediatric Surgery Unit], Dameitta Faculty of Medicine, Al-Azhar University, Egypt; Second Affiliation: Dallah Hospital, Ryadah, Kingdom of Saudi ArabiaMohammedEidDepartment of General Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt; Second Affiliation, Maternity and Children Hospital, Najran, Ministry of Health, KSAJournal Article20200818<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Laparoscopic cholecystectomy is the commonest surgical intervention in adults and pediatrics. The controversy still exists about the ideal sealing system. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The study aimed to evaluate the Harmonic scalpel and the LigaSure in laparoscopic clipless cholecystectomy in adults and pediatrics.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> 60 adults and 30 pediatric patients were selected from our institution and scheduled for total clipless laparoscopic cholecystectomy, either by Harmonic or LigaSure sealing system. Preoperatively, all patients were evaluated by history taking, clinical examination, Lab investigation, and ultrasound examination. Demographic, operative, and postoperative data were documented. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Both groups of sealing systems were comparable regarding demographics, operative time, blood loss, postoperative pain, and complications. In adult patients, 6.7% had complications [bile leak and common bile duct injury] in the harmonic group. In contrast, in the LigaSure group, 10.0% had complications [pneumonia in 3.3% and common bile duct injury with bile leak in 6.7%]. On the other hand, no bile leak or common bile duct injury was reported in the pediatric age group. The majority of pediatrics had chronic hemolytic anemia. Conversion to open in pediatrics was reported in 2 patients in harmonic and none in the LigaSure group. Surgical site infection was reported in 1 patient in LigaSure, while pneumonia was reported in 2 patients in the harmonic group. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> LigaSure and Harmonic sealing systems are effective and safe in total clipless cholecystectomy in adult and pediatric populations. </span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Prevalence and Clinical Significance of Factor V Leiden Mutation in Egyptian Preeclamptic Women1033103812124710.21608/ijma.2020.39091.1155ENAhmed MohamedAlsheikhDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, EgyptAhmed MohammedElsadekDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, EgyptSamy AminGebreelDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200816<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Factor V [Leiden] mutation, also known as activated protein-C resistance, is the most common of the inherited thrombophilias. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The present study aimed to ass the prevalence of factor V Leiden mutation in a group of Egyptian pregnant women and its relation to maternal and neonatal outcomes.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The present prospective study included 130 preeclamptic women with a singleton pregnancy in the 3rd trimester. Blood samples were obtained for DNA analysis to assay factor V Leiden mutation. Transabdominal obstetric ultrasound examination was performed to confirm the fetal number, viability, presentation, estimated fetal weight, position & grade of the placenta, amount of liquor, biophysical profile, and gestational age. This was achieved through the measurements of the biparietal diameter, head circumference, abdominal circumference, and femur length. Flow velocity waveforms were obtained from each uterine artery.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Factor V Leiden [FVL] mutation was identified in 20 patients [15.4 %]. Comparison between women with FVL and women without revealed a significantly higher frequency of intrauterine growth restriction [IUGR], intrauterine fetal death [IUFD], small for gestational age [SGA], preterm labor, and intensive care unit [ICU] admission among women with FVL mutation. They also have a significantly higher frequency of abnormal Doppler findings, abruptio placenta, and placental infarction.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The present study suggested that maternal and neonatal complications in PE patients may be related to FVL, abnormal uterine artery Doppler findings, and placental infarction.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Incidence of Dysphagia in Patients with Unilateral Vocal Cord Paralysis1039104512230910.21608/ijma.2020.45632.1190ENIbrahimEldsokyDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, EgyptWael FawzyIsmaielDepartment of Otorhinolaryngology, Damietta Faculty of Medicine, Al-Azhar University, DamiettaJournal Article20201009<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">It is essential and evaluates dysphagia among patients with UVCP to help the management, improves the quality of life, and prevents secondary complications.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">This research aims to find the incidence of dysphagia in patients with unilateral vocal cord paralysis [UVCP].</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and Methods: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">This study was performed in 245 patients with UVCP; 98 males and 147 females. There were two groups of patients: the non-dysphagia group [130 patients] and the dysphagia group [115 patients]. Assessment of patients was performed by the verified 10-item Eating Assessment Tool [EAT-10] and Dysphagia Handicap Index [DHI].</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Performing EAT-10 questionnaire revealed average values of 18.5 ± 9.56 and 34.3 ± 11.3 in the non-dysphagia group and dysphagia groups, respectively. DHI showed mean values of 45.7 ± 18.12 and 85.42 ± 21.7 in the non-dysphagia group and dysphagia groups, respectively. All of them demonstrated a highly significant variation [P = 0.001]. Regarding the etiology of UVCP, iatrogenic was the first cause of UVCP; it was the cause of 36.9% and 36.52%, followed by idiopathic; 23.1% and 24.34 %, intubation injury; 12.6% and 11.3%, tumor; 10% and 9.56%, trauma; 8.46% and 8.69%, thyroid surgery; 4.62% and 5.22%, and neurodegenerative disease; 4.62% and 4.35% of non-dysphagia and dysphagia groups, respectively.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">The incidence of dysphagia in unilateral vocal cord paralysis depends mainly on the cause; however, vocal cord paralysis itself increases the incidence of dysphagia whatever the cause.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Relation Between Fetal Doppler Pulmonary Artery Indices and Neonatal Respiratory Distress Syndrome In Term Neonates1046105212124810.21608/ijma.2020.43097.1172ENAhmed MohamedAlsheikhDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, EgyptAhmed MohammedElsadekDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, EgyptSamy AminGebreelDepartment of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200916<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Neonatal respiratory distress syndrome (RDS) is a common and challenging neonatal morbidity. Reliable prediction of the condition can improve management. Fetal pulmonary artery (PA) Doppler indices were suggested for prediction. However, the findings of different studies are conflicting.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The present study aimed to assess the value of PA indices in the prediction of neonatal RDS in term babies.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Subjects and methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> This prospective study included 120 women with singleton term pregnancy. Assessed Doppler indices for the main pulmonary artery included pulsatility index (PI), resistive index (RI), peak systolic velocity (PSV), and the At/Et ratio. Upon delivery, the newborn babies were examined for RDS signs (tachypnea, retractions, and/or nasal flaring).</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Among the 120 delivered babies, there were 16 (13.3 %) with RDS. Comparison between neonates with RDS and neonates without showed significantly lower neonatal weight, higher pulmonary artery RI and PI, higher pulmonary artery PSV in neonates with RSD. Also, they had a significantly lower pulmonary artery at/et ratio when compared with normal babies. The pulmonary artery at/et ratio showed the best performance compared to other indices (sensitivity: 100.0 %, specificity: 50.0 %) at a cut-off (0.32).</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusions:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The present study documented reliable predictive value of PA hemodynamic parameters including RI, PI, PSV, and at/et ratio in predicting neonatal RDS in term babies.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Safety and Efficacy of Sofosbuvir and Daclatasvir in The Treatment of Chronic HCV Infection in Elderly Egyptian Patients1053105912231010.21608/ijma.2020.46788.1195ENMohamed G.MohamedDepartment of Hepatogastroenetrology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, EgyptMohamed B.BastawyDepartment of Hepatogastroenetrology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, EgyptMostafa A.ElhawaryDepartment of Hepatogastroenetrology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, EgyptMohamed R.RashedDepartment of Hepatogastroenetrology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20201018<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Chronic Hepatitis-C virus [HCV] infection is endemic in Egypt, with the highest prevalence worldwide. There are few studies on the effectiveness and safety of direct acting antivirals in treating geriatric patients with chronic HCV. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> This study aimed to determine the efficacy and safety of sofosbuvir and daclatasvir with or without ribavirin in treating chronic HCV infection in geriatric Egyptian patients. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and Methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> In this study, we analyzed the medical files of 100 patients with chronic HCV, ≥ 65 years old, naïve, and eligible for HCV treatment. Patients were classified into: Group I; 50 patients without cirrhosis and Group II; 50 patients with Cirrhosis. All patients were subjected to history taking, clinical and laboratory evaluation. Electrocardiogram [ECG] and echocardiography were also conducted. Polymerase chain reaction [PCR] for HCV- ribonucleic acid [RNA] was performed and compared between groups at baseline, at the end of treatment, and at 12 weeks later. All patients underwent an abdominal ultrasound and fibrosis-4 [FIB-4] score. Group I was treated with sofosbuvir 400 mg and daclatasvir 60 mg once daily for 12 weeks, while weight-based ribavirin was added in group II. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Overall, 95 patients achieved sustained virological response[SVR]-12, three had failed treatment, and two had relapse. There were no significant differences in treatment success between the groups after treatment completion [HCV RNA was below the detection limit in 49 patients in group I and 48 patients in group II] and 12 weeks later [HCV RNA was below the detection limit in 48 patients in group I and 47 patients in group II], with one patient in group I and two patients in group II had failed treatment. There was also a significant decrease in alanine transaminase [ALT] and aspartate transaminase [AST] in both groups after treatment completion. Some patient symptoms like easy fatigability and dyspepsia have been improved with no significant cardiac changes after therapy.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusions:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Sofosbuvir and daclatasvir with or without ribavirin are safe and effective in treating elderly Egyptian patients with chronic HCV infection.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Percutaneous Nephrolithotomy in the Modified Flank Free Supine Position: An Observational Prospective Study to Identify the Surgeon’s Learning Curve1060106812242810.21608/ijma.2020.39468.1156ENAhmed M.Abdel GawadDepartment of Urology, Al-Azhar Faculty of Medicine (Males), District II, New Damietta City, Damietta Governate, Egypt.0000-0001-7051-6019Ahmed YousefAboelsaadUrology Department, Faculty of Medicine (Damietta), Al-Azhar University0000-0001-9851-8120Journal Article20200816<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Percutaneous nephrolithotomy was usually practiced in prone position. However, there is a recent shift towards supine position. This shift needs a continuous practice to increase the surgeon’s learning curve.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aims:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> To give an insight into the learning curve of a single surgeon, capable of doing percutaneous nephrolithotomy in the conventional prone position, during his transition to the supine one using different indicators.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Materials and Methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> This study included 80 procedures, equally divided into 4 groups and the following endpoints were recorded and compared among groups: operation and fluoroscopic screening times, volume of the irrigant fluid consumed, postoperative length of hospital stay, stone clearance rate and procedure related morbidity.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The mean operation and fluoroscope screening durations showed a statistically significant decline with time. The operative time drop from 117 minutes at the beginning to about the half [60 minutes] after sixth months and working with 80 patients. The fluoroscopy time declined from 3.5 minutes at the beginning to 1.5 minute at the end. Our stone clearance rate continued to improve among groups [with advancement of learning curve] [P = 0.034] without approaching the plateau. Also for other indicators [volume of the irrigant fluid consumed, postoperative length of hospital stay and complications], all showed statistical significant reduction with increased learning curve [P < 0.0001].</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusions:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Operative time and stone clearance rate continued improvement with increasing learning curve. However, the volume of irrigation fluid, rate and grade of complications and length of postoperative stay reached its plateau after 40 procedures.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101The Value of Endoscopic Dacryocystorhinostomy in Management of Acquired Nasolacrimal Duct Obstruction1069107412270910.21608/ijma.2020.42826.1169ENAhmed SobhiAbdelaalDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, EgyptAhmed IbrahimZaghloulDepartment of Otorhinolaryngology, Damietta Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200914<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">The epiphora is the most common manifestation of obstruction of the nasolacrimal duct, which is treated by dacryocystorhinostomy either by external or internal endoscopic endonasal approach. With the advance of the nasal endoscope, the endoscopic dacryocystorhinostomy became well established.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">To evaluate the efficacy and safety of intranasal endoscopic dacryocystorhinostomy [DCR] in the management of patients with acquired nasolacrimal duct obstruction.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and Methods: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">This is a retrospective study of patients with acquired obstruction of the nasolacrimal duct who underwent intra-nasal endoscopic dacryocystorhinostomy [EDCR] at Al-Azhar University Hospitals from September 2012 to October 2015. Forty-five procedures were done where primary endoscopic DCR was done on forty patients and revision endoscopic DCR was done on failed five patients. The outcome is measured by subjective improvement of epiphora<strong>.</strong></span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">The patients were followed up for three years, improvement of 35 patients with epiphora from 40 patients [the rate of success was 86.7%] and the remaining five failed cases undergoing revision EDCR with the improvement of four from them. The success was confirmed with the subjective improvement of epiphora. The rate of minor complications reported was 28.8% and managed conservative, and only one major complication occurred in one patient.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">The endoscopic intranasal DCR is an effective and safe procedure in the management of acquired obstruction of the nasolacrimal duct and gives a high success rate.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Relation between Iron Status and Hemoglobin A1c in Children with Type-1 Diabetes Mellitus1075108212422610.21608/ijma.2020.46734.1193ENFatma MustafaEl NezelyDepartment of pediatrics and Neonatology Al-Azhar University-Faculty of medicine, Damietta, EgyptHussien MetwallyAbd ElmaksoudDepartment of pediatrics and Neonatology Al-Azhar University-Faculty of medicine, Damietta, Egypt.Magdy ZakiEl GhanamDepartment of Clinical Pathology, Al-Azhar University-Faculty of medicine, Damietta, EgyptJournal Article20201017<strong><span style="font-family: Arial Narrow; font-size: small;">Background: </span></strong><span style="font-family: Arial Narrow;">Hemoglobin A1c [HbA1c] is the best standard for measurements of glycemic control level in type 1 diabetes mellitus, especially in children. As iron deficiency anemia is a prevalent finding in children with diabetes, it may affect HbA1c levels in those children. </span><br /><strong><span style="font-family: Arial Narrow; font-size: small;"> Aim of the work:</span></strong><span style="font-family: Arial Narrow;"> To determine the effects of iron deficiency anemia on hemoglobin A1c in type 1 diabetes mellitus</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Patients and methods:</span></strong><span style="font-family: Arial Narrow;">This was cross-sectional analytic study was done on 80 children with diabetes with type 1DM receiving insulin therapy; the patients divided into two groups, 21 diabetic children with iron deficiency anemia and 59 diabetic children with iron sufficient state, attending to the pediatric department of Al-Azher University Hospital in Damietta from February 2019 to September 2019. All children included were subjected to complete medical history, general examination, systemic examination, and laboratory investigations; [</span><span style="font-family: Arial Narrow;">Complete blood count [CBC]</span><span style="font-family: Arial Narrow;">, HbA1c, Serum Iron, Serum Ferritin, Total Iron Binding Capacity, Fasting blood glucose, Post Prandial blood glucose, and ESR]</span><span style="font-family: Arial Narrow;">.</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Results:</span></strong><span style="font-family: Arial Narrow;">In our study, we divided all patients [80 diabetic children] regarding glycemic control according to HbA1c value into three levels, the first level was optimal glycemic control level [HbA1c< 7.6%], the second level was suboptimal glycemic control [HbA1c 7.6 – 9.0%] and the third level was poor glycemic control level [HbA1c> 9.0%], there was a statically highly significant increase in HbA1c value of the iron-deficient diabetic group in compared to iron sufficient diabetic group at all levels of glycemic control.</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: small;"> <span style="font-size: small;">Iron deficiency anemia seems to increase HbA1c value in diabetic children Type 1, at the same degree of glycemia</span><span style="font-size: xx-small;">.</span></span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Intrathecal Fentanyl versus Dexmedetomedine as Adjuvants to Bupivacaine for Cesarean Section1083108712515910.21608/ijma.2020.23709.1097ENTawfikNoor El-DinDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, EgyptMostafaHussienDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University [Assiut Branch], EgyptAhmedAbd El-GalilDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, EgyptAhmed EmadAbd EllatifDepartment of Anesthesia and Intensive Care, Damietta Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200208<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Intrathecal α2 agonists prolong the duration of action of local anesthetics and reduce the required dose. Dexmedetomidine is an α2 receptor agonist, and its α2/α1 selectivity is eight times higher than that of clonidine</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> This study aimed to determine the effect of adding dexmedetomidine or fentanyl to intrathecal bupivacaine on the onset time, duration, and intensity of motor and sensory blocks as the primary outcome and postoperative analgesia, sedation, and incidence of side effects as a secondary outcome in cesarean section. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The study was carried out on 40 adults full-term pregnant female submitted for elective cesarean section were randomly classified into two equal groups, twenty patients each: Group [D]: Patients received intrathecally bupivacaine and dexmedetomidine. Group [F]: Patients received intrathecally bupivacaine and fentanyl.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Sensory and motor block onset times were shorter in Group D than in Group F. The regression of the sensory block to S1 dermatome and Bromage 0 were longer in Group D than in Group F. The two-dermatome regression time was longer in Group D than in Group F. There was a statistically significant decrease in group F regarding systolic, diastolic, mean arterial blood pressure, and heart rate than in group D. The postoperative analgesic effect time was longer in group D than in group F. Neonatal outcome was normal in all groups</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> We concluded that adding intrathecal dexmedetomidine to bupivacaine for spinal anesthesia synergistically increase block duration and shortens sensory and motor block onset time with better postoperative analgesia without any significant adverse effects.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Evaluation of Serum Insulin, Glucose and Liver Function in β-Thalassemia Major and Their Correlation with Iron Overload1088109612576710.21608/ijma.2020.43776.1179ENBasma MohammedMatarDepartment of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, EgyptMagdy Mohamed AshmawySakrDepartment of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, EgyptLotfy AbdElfattahAlsehaimyDepartment of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, EgyptHesham SamirAbd Al-sameeDepartment of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar University, Egypt27608151100155Journal Article20200922<strong><span style="font-family: Arial Narrow; font-size: large;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: large;">Beta-thalassemia syndromes are a set of hereditary blood disorders marked by a deficiency of beta-globin chain synthesis, resultant in decrease hemoglobin in red blood cells [RBC], anemia, and a reduced RBC production</span><br /><strong><span style="font-family: Arial Narrow; font-size: large;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: large;"> To evaluate glycometabolic and liver function in cases with β-thalassemia major and their correlation with serum iron and ferritin</span><br /><strong><span style="font-family: Arial Narrow; font-size: large;">Patients and methods:</span></strong><span style="font-family: Arial Narrow; font-size: large;"> This was a case-control study that was performed in the pediatric department of Al-Azher University Hospital in Damietta from June 2018 to June 2019. Fasting serum glucose, insulin, and liver enzymes were assessed for 48 cases and 40 ordinary controls. Serum iron and ferritin were recorded as an indicator of iron overload</span><br /><strong><span style="font-family: Arial Narrow; font-size: large;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: large;"> Fasting serum insulin, alanine transaminase [ALT] levels, aspartate transaminase [AST] levels were significantly high in thalassemia major [TM] cases than in the control group [p <br /><strong><span style="font-family: Arial Narrow; font-size: large;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: large;"> The kids with β-TM have a high glycemic disorders incidence rate, may be because of the insulin resistance due to the amplified iron burden.</span></span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Block versus Ultrasound Guided Transversus Abdominis Plane Block for Lower Abdominal Surgeries: A comparative Clinical Study1097110312768110.21608/ijma.2020.48487.1198ENMostafa YehiaRoshbeikDepartment of Anesthesia, Intensive Care and Pain Medicine, Damietta Faculty of Medicine, Al-Azhar University, EgyptEzzat MAl-SaudiDepartment of Anesthesia and Intensive Care, Assiut Faculty of Medicine, Al-Azhar University, EgyptAdel AlhadyDiabDepartment of Anesthesia, Intensive Care and Pain Medicine, Damietta Faculty of Medicine, Al-Azhar University, EgyptHanySaiedDepartment of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, EgyptTarik SaberSarhanDepartment of Anesthesia, Intensive Care and Pain Medicine, Damietta Faculty of Medicine, Al-Azhar University, Egypt0000-0003-0084-4310Journal Article20201102<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Effective pain relief is of utmost importance to anyone undergoing surgery. Postoperative pain relief increases patient comfort and satisfaction. This is best accomplished with a multi-modal approach. Recent trends in minimally invasive surgery and improved recovery protocols have addressed pain treatment in light of these goals</span><span style="color: black; font-family: Arial Narrow; font-size: medium;">.</span><br /><strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Aim of the work</span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">: Comparison between ultrasound-guided Ilioinguinal and Iliohypogastric nerve block with ultrasound-guided transversus abdominis plane block regarding postoperative analgesia in patients scheduled for lower abdominal surgeries. </span><br /><strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Patients and methods:</span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;"> Seventy patients of ASA I or II, aged 21-50 years, who planned for elective open lower abdominal surgeries were included. They signed an informed consent and were randomly classified into two groups: [Group I] scheduled for Ilioinguinal and Iliohypogastric nerve block, and [Group II] scheduled for transversus abdominis plane block guided by ultrasound. Postoperative pain assessment was conducted by numerical rating score.</span><br /><strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">In inguinal hernia repair, pain score at rest was significantly reduced in the TAP group when compared to Group-I at 30 minutes till the seventh hour postoperatively and at 12 up to 15 hours postoperatively. Also, in the CS group, the pain score was significantly decreased in TAP block when compared to nerve block at 90, 105 minutes, and from 4 up to seventh postoperative hours. With movement, pain scores were significantly lower at the 4, 5, 6, 7, 8, 9, 10, and 11 -hours in group II in inguinal hernia. It was significantly decreased at the 90 minutes to 2 -hours in group II in the CS subgroup. The total analgesic requirements were significantly lower in group II</span><span style="color: black; font-family: Arial Narrow; font-size: medium;">.</span><br /><strong><span style="color: black; font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="color: black; font-family: Arial Narrow; font-size: medium;"> Ultrasound-guided TAP block tended to be more effective than Ultrasound-guided II/IH nerve block in lowering postoperative pain scores and decreasing the need for rescue analgesia in lower abdominal surgeries.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Value of Ultrasound in the Management of Acute Respiratory Distress Syndrome by Optimal PEEP1104111211607510.21608/ijma.2020.116075ENAli Mohamed AliAbdelhameedDepartment of Chest Diseases, Damietta Faculty of Medicine, Al-Azhar University, EgyptAtef Wahdan SalehAlrifaiDepartment of Chest Diseases, Damietta Faculty of Medicine, Al-Azhar University, EgyptAbdelhay IbraheemAbdelhayDepartment of Chest Diseases, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200825<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Acute respiratory distress syndrome [ARDS] is usually associated with significant morbidities and may need admission to the intensive care unit [ICU]. Mechanical ventilation, when indicated, needs continuous monitoring. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> To assess the clinical value of ultrasonic monitoring in pulmonary recruitment and optimal positive end-expiratory pressure [PEEP] in ARD cases.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> It included thirty patients with ARDS. All were subjected to clinical evaluation, X-ray chest, lung ultrasound, and laboratory investigations. All patients underwent mechanical ventilation by increasing PEEP, starting at 5 mmHg then [6, 9, 12, and 15 mmHg] according to patient response with documentation of good response. At each PEEP, a chest ultrasound was completed, and results were correlated with respiratory functions. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Hypertension, diabetes, COPD and hypothyroidism were reported in 63.3%, 66.7%, 16.7% and 40.0% respectively. The rate of primary weaning success was 36.7%, and 30.0% achieved weaning success in the third trail; tracheostomy indicated for 13.3%, pneumothorax 10.0%, pleural effusion 6.7%, and the mortality rate was 33.3%. Increased PEEP was concomitant by the progressive improvement of respiratory functions. In addition, there was a progressive significant decrease of B-lines at different areas from right and left lungs. All effects were significant at PEEP 9. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusions:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Gradual increments of PEEP helps to tailor the patient response on an individual basis. The use of readily available, portable ultrasound permits the daily monitoring and could guide the treatment protocol</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Effect of Tissue Plasminogen Activator on Treatment Outcome and Neuronal Degeneration in Acute Ischemic Stroke1113111812860810.21608/ijma.2020.47340.1196ENMuhammadMasoudLecturer of Neurologyو Faculty of Medicineو Beni-Suef UniversityShimaaAbd ElkareemLecturer of Clinical Pathology
Faculty of Medicine – Beni-Suef UniversitySomiaSayedDepartment of Neurology
Faculty of Medicine – Beni-Suef UniversityHatemElmasryProfessor of Neurology
Faculty of Medicine – Beni-Suef UniversityJournal Article20201022<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Acute ischemic stroke [AIS] is a leading worldwide neurological morbidity with significant disability. Recombinant tissue plasminogen activator [r-TPA] is approved for the treatment of AIS.</span><span style="font-family: Arial Narrow; font-size: medium;">Neuron-specific enolase [NSE] is a marker of brain damage in patients with traumatic brain injury, stroke, and hypoxic encephalopathy.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The present study assessed the prognostic value of serum NSE in r-TPA treatment of patients with AIS.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> The present prospective study included 53 patients with AIS. They comprised 25 patients who didn’t receive r-TPA and 28 patients who received r-TPA. The clinical severity of the stroke was assessed using National Institute of Health Stroke Scale [NIHSS]. A modified Rankin score was used to evaluate the degree of disability in the affected patients. Radiological imaging included echocardiography, brain computed tomography, and carotid and vertebrobasilar duplex. NSE was assessed at 24 h after r-TPA infusion.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Patients subjected to r-TPA treatment had significantly lower NSE one day of stroke when compared with another group [23.7 ±14.3 versus 11.9 ± 8.9; p=0.001]. Also, patients with r-TPA treatment had a significantly higher frequency of favorable outcome at day 90 [67.8 % versus 44.0 %; p=0.001]. Interestingly, NSE levels one day after stroke were significantly lower in patients with favorable outcome [14.39 ±9.6 versus 19.83 ±14.9; p=0.048] and showed significant correlation with infarct size [r=0.63;p=0.001] and NIHSS after 24h [r=0.67;p=0.001].</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> r-TPA treatment resulted in a significant decrease in NSE levels. These levels were significantly correlated with infarct size, NIHSS at 24 hours, and MRS at 90 days.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101The role of Trans-abdominal Ultrasound in Assessing Disease Activity and Severity in Ulcerative Colitis1119112412876410.21608/ijma.2020.45279.1188ENRagab MahmoudRagabDepartment of Hepatology, Gastroenterology and Infectious Diseases, Damietta Faculty of Medicine, Al-Azhar University, EgyptMohamedHeizaDepartment of Hepatology, Gastroenterology and Infectious Diseases, Damietta Faculty of Medicine, Al-Azhar University, EgyptKhaledElmolaDepartment of Hepatology, Gastroenterology and Infectious Diseases, Damietta Faculty of Medicine, Al-Azhar University, EgyptMostafa M.ShakweerDepartment of Radiology, Damietta Faculty of Medicine, Al-Azhar University, Egypt2974077209316470Journal Article20201005<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Ulcerative colitis [UC] is an inflammatory disease of the colon with a relapsing-remitting course. Early diagnosis is crucial, and the presence of a screening test is of utmost importance.Bowel ultrasound could be used as a screening tool for UC.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> To assess the diagnostic accuracy of bowel ultrasound in detecting disease activity and severity in adult patients with UC, compared with Ileocolonoscopy as the reference standard.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> This prospective study included 42 adult patients with an established UC diagnosis for at least six months. All patients were subjected to full inquiry about their disease history, complete clinical examination, laboratory investigations, colonoscopy, and bowel ultrasound of the abdomen with Doppler mapping.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Colonoscopy revealed that 41% in remission and 59% in an activity. Thirty patients had left-sided, and 12 had an extensive UC. White blood cells, platelet count, erythrocyte sedimentation rate, and C- reactive protein significantly increased in patients with activity versus remission. But, hemoglobin concentrations significantly decreased. Colonic wall thickness significantly increased in patients with activity versus remission [5.17±0.74 vs. 2.57±0.24, respectively]. Hypoechogenic or lost colonic wall pattern, enlarged mesenteric lymph nodes and Doppler colonic wall-flow significantly increased in cases with disease activity versus remission [32.0%, 24.0% and 72.0% vs 0.0%, 0.0% and 0.0% respectively].</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Transabdominal bowel ultrasound had a beneficial role in diagnosing ulcerative colitis. It could be used as a screening tool for rapid diagnosis or follow up of treatment.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Combined Endoscopic Sinus Surgery and Eustachian Tube Balloon dilatation improves Eustachian Tube Functions in patients had Chronic rhinosinusitis with nasal polyposis and Eustachian tube dysfunction1125113512916610.21608/ijma.2020.42697.1167ENMohamed HamedAlahmerDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Egypt; ENT consultant at Algafel International Hospital, KSAAshraf AbdallaWahbaDepartment of Otorhinolaryngology, Damietta Faculty of Medicine, Al-Azhar University, Egypt; ENT Consultant at Yanbu National Hospital, KSAJournal Article20200912<strong><span style="font-family: Arial Narrow; font-size: medium;">Background:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Chronic rhinosinusitis [CRS] is a distressing disease that affects patients' mental and physical health. Eustachian tube dysfunction [ETD] affects approximately 1% of the adult population, especially patients with rhinosinus diseases. Transnasal Balloon Eustachian tuboplasty [BET] is a safe intervention for adult patients with chronic ETD. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> To evaluate the impact of combined Function endoscopic sinus surgery [FESS] for CRS and BET on ETD manifestations compared to FESS only.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and Methods:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> 45 patients were randomly allocated into Group C underwent FESS, and Group-I underwent FESS and BET. ETD was evaluated using the 7-item Eustachian Tube Dysfunction Questionnaire [ETDQ-7] score, Otoscopy, Valsalva maneuver, and tympanometry. BET was performed using the XprESS ENT Dilation System with balloon inflation to 12 atmospheres for 2-min. Study outcomes were determined after 6-wk.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> At 6-wk, the frequency of normal TM position and positive Valsalva's maneuver was significantly higher, and ETDQ-7 scores were significantly improved in all patients, while the frequency of tympanogram type-A was significantly and non-significantly higher in groups I and C, respectively. ROC curve and Regression analyses defined the application of FESS with BET as the significant predictor for normalization of tympanogram to type-A.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion:</span></strong><span style="font-family: Arial Narrow; font-size: medium;"> Coupling Balloon Eustachian tuboplasty with Function endoscopic sinus surgery provided outcome more superior to Function endoscopic sinus surgery alone. Balloon Eustachian tuboplasty in experienced hands can be performed with a 100% technical success rate </span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Protective Effect of Cinnamon and Ginger on Acrylamide Induced Hepatotoxicity in Adult Male Albino Rats1136114413087310.21608/ijma.2020.43688.1177ENEl-sayed HamdeyEl-sayed GaweshDepartment of Forensic Medicine and Clinical Toxicology, Damietta Faculty of Medicine, Al-Azhar University, EgyptAhmed IbrahimAbdelreheem ElshouraDepartment of Forensic Medicine and Clinical Toxicology, Damietta Faculty of Medicine, Al-Azhar University, EgyptMohamed AliAbbasDepartment of Medical Physiology, Damietta Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200921<strong><span style="font-family: Arial Narrow; font-size: small;">Background:</span></strong><strong><span style="font-family: Arial Narrow; font-size: small;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: small;">Acrylamide [ACR] is an essential chemical that is extensively used in many industries and also in laboratories such as treatment of drinking water, wastewater, and soil, production of paper, petroleum, mine, asphalt, dyes, adhesives, and polishes; it is known as a possible carcinogenic compound. Ginger oleoresin's hepatoprotective role can be attributed to its free radical scavenging, anti-inflammatory, and hypolipidemic activities and is partially mediated by the 6-gingerol, shogaol, and zingerone of its active component. Cinnamomum zeylanicum is used to treat many diseases and to prevent such diseases. </span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Aim of the work:</span></strong><span style="font-family: Arial Narrow; font-size: small;">Evaluation of the effects of cinnamon and ginger extracts administration on Hepatotoxicity adult male albino rats. </span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Materials and Methods:</span></strong><span style="font-family: Arial Narrow; font-size: small;"> The groups were divided into five adult male albino rats of a local strain: Group I: acted as a control group with regular salines, group II: hepatotoxicity caused by acrylamid, groups III: hepatotoxicity plus cinnamon, group IV: hepatotoxicity plus ginger, group V: hepatotoxicity plus cinnamon and ginger. Samples for alanine aminotransferase [ALT], aspartate transfers of amino [AST], urea, creatinine, blood urea nitrogen (BUN), total cholesterol, triglyceride [TG], malondialdehyde, </span><span style="font-family: Arial Narrow; font-size: small;">tumor</span><span style="font-family: Arial Narrow; font-size: small;"> necrosis factor α [TNF], superoxide dismutase [SOD], glutathione peroxidase [GPX], as well as total antioxidant [TAC] levels were obtained at the end of the experimental period. </span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Results: </span></strong><span style="font-family: Arial Narrow; font-size: small;">Administration of cinnamon and ginger to hepatotoxic rats led to a significant decrease in the mean value of ALT, AST, urea, creatinine, BUN, MDA, and TNF. In addition, it is associated with a significant increase of SOD, GPX, and TAC.</span><br /><span style="font-family: Arial Narrow; font-size: small;"> <strong>Conclusion:</strong><span style="font-size: small;"> Cinnamon<span style="font-size: small;"> and ginger have a protective effect against abnormalities in hepatotoxic rats due to its several protective properties.</span></span></span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Comparison Study between Intralesional Injection of MMC with Bare Sclera Excision of Pterygium and Conjunctiva Auto Grafting Technique1145115113087410.21608/ijma.2020.45799.1191ENSayed MostafaEl-SayedDepartment of Ophthalmology, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20201010<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Pterygium is a fibrovascular tissue that abnormally invades the cornea from the conjunctiva.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Comparison Bare sclera technique of pterygium excision immediately after injecting it with MMC and conjunctival autografting without using MMC regarding recurrence rate and other complications. </span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Methods: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">This prospective interventional study included 40 cases of pterygia from September 2017 to March 2019. cases were divided into two groups: Group 1 included 20 eyes received 0.1 ml [0.01%] of intrapterygial mitomycin-C [MMC] injection, then excision with bare scleral Group 2 included 20 eyes with simple excision then covering the bare sclera with a conjunctival autograft from superior bulbar conjunctiva.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">The mean age was 45.175 and 45.4 years in Group 1 and 2, respectively, [P = .527]. There were 7 [35%] males and 13 [65%] females in Group 1 and 8 [40%] males and 12 [60%] females in Group 2 [P = .744]. The regression rate was 5% in each Groups [P = 1]. Postoperatively, scleral hypo vascularity occurred in 5 eyes [25%] in Group 1 while never in Group 2 [P = .009]. Graft necrosis noticed in 2 cases [10%] in group 2.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Both techniques resulted in a negligible [5%] recurrence rate. Although conjunctival graft with a significant reduction of complications as scleral hypo vascularity but with more surgical time. </span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Self-gripping Mesh in Inguinal Hernia Repair1152116213650610.21608/ijma.2021.50241.1214ENIbrahim Goda IbrahimAtiaDekirnis Central Hospital, Ministry of Health, Mansoura, Dakahlia, EgyptAmr Abd-AlghanySarhanDepartment of General Surgery, Damietta Faculty of Medicine, Al-Azhar University, EgyptMohamed MustafaBalbolaDepartment of General Surgery, Damietta Faculty of Medicine, Al-Azhar University, EgyptJournal Article20201130<strong><span style="font-family: Arial Narrow; font-size: medium;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Inguinal hernia repair is a common procedure that general surgeons undertake with different techniques aiming for a better outcome.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Aim of the work: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Comparison between self-gripping mesh and sutures for mesh fixation in open [Lichtenstein] inguinal repair</span><span style="font-family: Arial Narrow; font-size: medium;">.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Patients and Methods: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">This study is a prospective trial. Fifty adult males scheduled for inguinal hernia repair were classified into two groups: group A [n=25] underwent inguinal repair with self-gripping mesh; group B [n=25] underwent inguinal repair with mesh fixation using proline sutures.</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Results: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">The mean operative time was 37.4 ±13.5 and 48.81±14.7 minutes in groups A and B, respectively. The incidence of seroma, scrotal edema, and wound infection was 4%, 8%, and 8% in the group [A] compared to 12%, 24%, 12% in the group [B], respectively. No recurrence was reported in either group. However, 12% and 80% in groups A and B had mild postoperative pain [p <0.001]. After three months of surgery, no cases of chronic groin pain reported in the group [A] compared to three in the group [B] [p>0.05]. The mean time to return to normal activities in a group [A] was 2.51days and 5.97 days in the group [B] [p <0.001]. Mean pain visual analogue scale [VAS] scores at 6 months were 0.5 [0.4 to 1.5] in the self-gripping mesh group and 8.6 [3.3 to 12.5] in sutured mesh group [p <0.01]. The mean cost of ProGrip mesh was higher than the mean cost of polypropylene mesh [4508 VS 555 LE] [p <0.001].</span><br /><strong><span style="font-family: Arial Narrow; font-size: medium;">Conclusion: </span></strong><span style="font-family: Arial Narrow; font-size: medium;">Lichtenstein open inguinal hernia repair with ProGrip low-density polyester mesh is a safe, with short operative time, simple and effective method for inguinal hernia repair and may improve patient general health, reduce postoperative pain and improve quality of life. However, its high price makes its use questionable in low economic settings.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Psychological Effects of Acne Vulgaris Among Secondary School Adolescents in Damietta Governorate1163117113650710.21608/ijma.2021.44447.1184ENSarah MohammedElsadekDepartment of Dermatology, El-Senbellawein General Hospital, Ministry of Health, El-Mansoura, EgyptZakaria MahranObaidDepartment of Dermatology, Damietta Faculty of Medicine, Al-Azhar University, EgyptOsamaHashemDepartment of Dermatology, Damietta Faculty of Medicine, Al-Azhar University, Egypt0000000337730990Ayman AlhosseinyAbdelmaksoudDepartment of Psychiatry, Damietta Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200929<strong><span style="font-family: Arial Narrow; font-size: small;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: small;">Acne is reported to have a negative effect on mental health in adolescents.</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Aim of the work: </span></strong><span style="font-family: Arial Narrow; font-size: small;">Evaluation of the psychological effects of acne vulgaris amongst secondary school adolescents in Damietta Governorate</span><span style="font-family: Arial Narrow; font-size: small;">.</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Patients and Methods: </span></strong><span style="font-family: Arial Narrow; font-size: small;">A cross-sectional study was completed on 172 students with acne vulgaris aged between 15- and 19-years during the period extended from September 2019 to March 2020 in Damietta governorate schools from both sexes. Patients with disorders present before acne or other chronic diseases were excluded from the study. All patients were evaluated by the Arabic version of the Dermatology Life Quality Index [DLQI] to determine the dermatological quality of life [QOL] among acne cases.</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Results: </span></strong><span style="font-family: Arial Narrow; font-size: small;">46.8% of cases had body dysmorphic disorders. 82.7% of cases complained of anxiety, with a mean value of 15.47</span><span style="font-family: Arial; font-size: small;">±</span><span style="font-family: Arial Narrow; font-size: small;"> 11.08. From them, 39.9% had a mild degree, 23.8, 20.3, and 16.1% had moderate, severe, and very severe. 76.9% of cases complained of depression, with a mean value of 13.68 </span><span style="font-family: Arial; font-size: small;">±</span><span style="font-family: Arial Narrow; font-size: small;"> 8.55. From them, 45.9%, 28.6, 12.0&13.5% had a mild degree, moderate, severe, and very severe acne. Regarding resilience, only 6.9% had a mild degree, 43.4&49.7 had moderate and high degrees with a mean value of 124.25 </span><span style="font-family: Arial; font-size: small;">±</span><span style="font-family: Arial Narrow; font-size: small;"> 18.35. According to our knowledge, this was an early study to assess resilience in acne cases.</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Conclusion: </span></strong><span style="font-family: Arial Narrow; font-size: small;">The occurrence of anxiety, depression, and body dysmorphic disorders is higher among acne patients in comparison to that of the general population. We found no relation between resilience and acne severity.</span>Al-Azhar University (Damietta), Faculty of MedicineInternational Journal of Medical Arts2636-41743120210101Microscopic and Endoscopic Transoral Approaches for the Management of Craniocervical Chordomas1172117813689510.21608/ijma.2021.42543.1165ENMohammad Fathy MohammadEissaDepartment of Neurosurgery, Faculty of Medicine for Girls, Al-Azhar University, Egypt0000-0002-9107-5352Mohamed SoleimanMohamed SoleimanDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, EgyptGasser HasanAl-ShayalDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, EgyptTawfik AbdelaatyElkholDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, EgyptIbrahimEldsokyDepartment of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, EgyptMohamed Ahmed AbdelwahidEllabbadDepartment of Neurosurgery, Faculty of Medicine, Al-Azhar University, EgyptJournal Article20200911<strong><span style="font-family: Arial Narrow; font-size: small;">Background: </span></strong><span style="font-family: Arial Narrow; font-size: small;">Craniocervical chordoma representing a challenge for surgeons. The endoscopic transoral approach is used for treatment. Additional exposure is required. However, its benefits are not sufficiently addressed. <strong> </strong></span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Aim</span></strong><span style="font-family: Arial Narrow; font-size: small;">: To evaluate the use of endoscopy in the transoral approach and the benefits of additional exposure in cases of craniocervical chordomas.</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Patients and Methods</span></strong><span style="font-family: Arial Narrow; font-size: small;">: in this study, 12 patients had a confirmed diagnosis of chordoma after histopathological examination due to the presence of craniocervical destructive lesions. The author performed all surgical cases using a microscopic transoral approach in 6 patients, an endoscopic-assisted microscopic transoral approach in 3 patients, and a purely endoscopic transoral approach in 3 patients. Eight patients required posterior cervical fusion according to the extent of instability. Preoperative and postoperative data were collected, including radiological examination and clinical status data.</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Results: </span></strong><span style="font-family: Arial Narrow; font-size: small;">in this study, 12 patients were evaluated clinically and radiologically. It was found that the use of endoscopic assistance in the microscopic transoral approach, or the use of the purely endoscopic transoral approach,added greater angles of exposure of the tumors that could not be reached when using a microscope alone. This led to greater tumor removal and excision with the same precautions and safety for the patient using these approaches compared with the use of the microscopic approach alone. The use of endoscopy alone minimized the incision of the posterior pharyngeal wall and led to good healing, which is an important goal in this field and additional angles of view.</span><br /><strong><span style="font-family: Arial Narrow; font-size: small;">Conclusion</span></strong><span style="font-family: Arial Narrow; font-size: small;">: The use of endoscopy either for assistance in the microscopic transoral approach or alone led to the safe implementation and greater extent of tumor removal and excision. We recommend the use of endoscopy in such cases.</span>