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The Use of Left Ventricular Myocardial Stiffness Index as a Predictor of Myocardial Performance in Patients with Systemic Hypertension

Ehab Elsayed Elhfny, Mostafa Attia Alswasany, Mohamed Abdel Halim

Cardiology Department, Faculty of Medicine - Al-Azhar University, Cairo, Egypt

drmohamedhalim848@gmail.com

Abstract: Background: Patients suffering from systemic hypertension show morphological changes in the myocardial structure which in turn increase left ventricular stiffness. Introduction: Hypertension can lead to both systolic and diastolic abnormalities. There are several conventional indices for evaluating systolic function, such as ejection fraction, cardiac output, cardiac index and fractional shortening, while diastolic index can be assessed among others by transmitral Doppler wave pattern, isovolumic relaxation time, tissue Doppler and deceleration time. Aim of the work: To investigate the changes in the myocardium stiffness index for patients suffering from systemic hypertension, and to assess their left ventricular performance by TDI. Material and methods: a prospective study done over a period of one year that included established cases of hypertension diagnosed on the basis of history taking, and clinical examination, during the study period from (1/11/2014 to 30/12/2015). 150 subjects were divided into two groups, group A which included 100 hypertensive patients and group B which included 50 normal subjects. The two groups were evaluated by history taking, clinical examination and echocardiography. The data was analysed using Unpaired, Chi-square and Pearson correlation tests using GraphPad Instat & Med-Calc software, word processing data base and statistics programs. Results: The myocardial performance index has been shown to correlates directly with myocardial stiffness and also correlates significantly with other conventional indices. Conclusion: The diastolic stiffness was significantly higher in hypertensive patients compared to healthy subjects, also IMP appears to be a good measure of global left ventricular function (systolic and diastolic function), and is a sensitive and accurate evaluation of disease states. Recommendations: Another study is recommended to detect SI in patients with complicated hypertension particularly those with CHF.

[Ehab Elsayed Elhfny, Mostafa Attia Alswasany, Mohamed Abdel Halim. The Use of Left Ventricular Myocardial Stiffness Index as a Predictor of Myocardial Performance in Patients with Systemic Hypertension. N Y Sci J 2016;9(12):1-7]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 1. doi:10.7537/marsnys091216.01.

Keywords: Left Ventricular Stiffness – Systemic Hypertension

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Assessment of left and right ventricular systolic function in type I diabetic patients by two-dimensional speckle tracking Echocardiography

Sameh Allam, Mohey-EldinSamy, WaeelAttia, Ashraf Al-Amir and Mahmoud Zakaria

Cardiology Department, Faculty of Medicine, Al-Azhar University, Egypt.

drmahmod985@gmail.com

Abstract: Introduction: Diabetes mellitus (DM) may lead to diabetic cardiomyopathy which is defined as myocardial dysfunction independent of coronary artery disease (CAD) and hypertension. The pathogenesis of diabetic cardiomyopathy is multifactorial: hyperglycemia, increased free fatty acids, hyperinsulinemia, insulin resistance, and inflammatory cytokines change cellular metabolic pathways in cardiomyocytes and impair cardiac function. Speckle tracking Echocardiography is a new echocardiographic technique that allows a precise evaluation of myocardial function. This method is accurate, reproducible, and angle independent, and it enables a complete assessment of regional and global function in three directions. Aim of the work: is to assess left ventricular (LV) and right ventricular (RV) systolic function in type I diabetic patients using two-dimensional speckle tracking Echocardiography (2 D STE).  Material and methods: fourty patients with type I DM with mean age 28.55±5.37 years & mean duration of diabetes is 16.5±5.3 years & mean HbA1C 8.2±1.2. All cases were recruited from the Endocrinology Clinic and internal medicine department in Al-Hussein University Hospital from October 2015 to September 2016 and 10 control subjects with mean age 26.6±3.66 years were prospectively evaluated. The 2D STE assessment of LV longitudinal strain and RV free-wall longitudinal strain was performed. Results: In diabetic group, left ventricular global longitudinal strain (LVGLS), and right ventricular free-wall global longitudinal strain (RVGLS) were significantly lower compared with the controls: LVGLS (-20.75 ± 1.88 vs.-22.6 ± 1.71, P= 0.007) and RVGLS (-30.22 ± 3.48 vs. -32.70 ± 2.91, P = 0.044). Conclusion: Type I DM is associated with subclinical LV systolic dysfunction and RV systolic function is worse in type I DM compared with control subjects which can be detected with 2 D STE. Recommendations: The STE technique should be combined with conventional echocardiography for follow up of ventricular function in diabetic patients.

[Sameh Allam, Mohey-EldinSamy, WaeelAttia, Ashraf Al-Amir and Mahmoud Zakaria. Assessment of left and right ventricular systolic function in type I diabetic patients by two-dimensional speckle tracking Echocardiography. N Y Sci J 2016;9(12):8-12]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 2. doi:10.7537/marsnys091216.02.

Keywords: diabetic cardiomyopathy - type I diabetes mellitus - ventricular function - speckle tracking echocardiography.

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Evaluation of Cardiac Function in Patients with Liver Cirrhosis by Conventional and 2-Dimensional Speckle Tracking Echocardiography

Safwat Al hwary, Yaser El sayed, Mostafa Ismail, Mohammed Allam, Abdallah Hagag

Cardiology Department, Faculty of Medicine, Al-Azhar University, Egypt.

abdohagav90@gmail.com

Abstract: Background: In our country, there are many studies on cirrhosis, its associated conditions and their effect on cardiac function, but a few studies on evaluation of cardiac function in patients with liver cirrhosis by speckle tracking echocardiography have been done in our country, even outside. Cirrhosis is associated with certain abnormalities in left ventricular (LV) structure and function. Two-dimensional speckle-tracking echocardiography (2D-STE) enables a rapid and accurate analysis of regional LV systolic mechanics in the longitudinal directions. Objective: To investigate the systolic function of the left ventricle using 2 Dimentional Speckle-tracking echocardiography in stable, non-alcoholic liver cirrhosis patients with preserved LV ejection fraction. Material and methods: A prospective study done in Echocardiography Unit, Cardiology department, El-Hussein University Hospital over a period of one year that included a total of 60 subjects, including 40 cirrhotic patients and 20 healthy individuals, were enrolled. Using 2D-STE, the strain on longitudinal (L) functions of the LV were measured, during the study period from (1/10/2015 to 1/10/2016). All the patients were examined in the left lateral decubitus position. Standard 2D TTE examination were performed with a "Philips iE33 X Matrix "ultrasound machine using "S5-1 "& "X5-1 "matrix array transducers (Philips Medical Systems, Andover, USA) equipped with STE technology, using a multi frequency (1 - 5 MHz). Results: In the cirrhotic group, the LS (19.98 ± 7.65 vs. 29.50 ± 5.92, p<0.001) were found to be lower than in the healthy control group. Conclusion: LV myocardial contraction was impaired in the longitudinal direction. Using the 2D-STE method for the regional evaluation of the LV, the LV damage can be detected in the subclinical phase in cirrhotic patients.

[Safwat Al hwary, Yaser El sayed, Mostafa Ismail, Mohammed Allam, Abdallah Hagag. Evaluation of Cardiac Function in Patients with Liver Cirrhosis by Conventional and 2-Dimensional Speckle Tracking Echocardiography. N Y Sci J 2016;9(12):13-16]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 3. doi:10.7537/marsnys091216.03.

Keywords: Liver cirrhosis - Cirrhotic cardiomyopathy - Ventricular function - Speckle tracking, echocardiography

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Comparison of Relative Humidity and Temperature Based Models for Estimating Global Solar Radiation in Uyo, Nigeria

*John F Wansah¹, Prisca Innocent², Actor J. Ocheje³, Jacob B. Akeredolu³, Cookey Iyen³ and Amaitem J. Iseh³

¹Department of Physics, Modibbo Adama University of Technology Yola, Yola

²Department of Physics, University of Uyo, Uyo

³Department of Pure and Applied Physics, Federal University Wukari, Wukari

fomunyuydzesinyuy@gmail.com

Abstract: A comparative study has been carried out using four relative humidity-based models to estimate the global solar radiation in Uyo (Longitude 5' 02^o N, Latitude 7' 55^o E). The values of the measured and the estimated global solar radiation models were tested using the root mean square error (RMSE), the mean bias error (MBE) and the mean percentage error (MPE); and the coefficient of determination, R² and correlation coefficient, r were also calculated. From the results obtained, Augustine and Nabuchi; and Ituen et al Models are most suitable for estimating monthly average daily global solar radiation for Uyo and locations with similar geographic and climatic conditions. Since the study, design and utilization of solar energy conversion devices depend to a greater extend on the monthly average daily global solar radiation data so determined, then the global solar radiation intensity values obtained by this approach can be used in the design and estimation of performance of solar applications system in Uyo, Nigeria.

[John F Wansah, Prisca Innocent, Actor J. Ocheje, Jacob B. Akeredolu, Cookey Iyen and Amaitem J. Iseh. Comparison of Relative Humidity and Temperature Based Models for Estimating Global Solar Radiation in Uyo, Nigeria. N Y Sci J 2016;9(12):17-23]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 4. doi:10.7537/marsnys091216.04.

Keywords: Relative humidity, temperature, global solar radiation models, Uyo

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Left ventricular ejection fraction to left atrial volume index ratio as a new predictor of left atrial appendage thrombus formation in patients with atrial fibrillation

Mohey Alabaady, Mohammed Algammal, Mohammed Sarhan, Hamada Al sheikh, Tarek Bassoiuny, Mohammed Moanes, Ahmed Mohammed Hassan

Cardiology Department, Faculty of Medicine - Al-Azhar University, Cairo, Egypt

dr.hamada.sh@gmail.com

Abstract: Background: A recent study demonstrated that in patients with nonvalvular atrial fibrillation (AF), a ratio of left ventricular ejection fraction (LVEF) to the left atrial volume index (LAVI) of, 1.5 has 100% sensitivity fordetecting left atrialappendage (LAA) thrombus. We sought to apply this ratio in valvular and nonvalvular AF who attending Echocardiography Unit, Cardiology Department, Bab El She’ryia University Hospital. Introduction: Although. So small, it is so important! LAA is a separate structure from LA with unique developmental, anatomical, and physiological properties. LAA is one of the most important structures of heart during AF because it is the major site for thrombus formation. TEE is the method of choice for evaluating both anatomy and function of LAA and in particular for detection of the thrombus. However, TEE is uncomfortable for the patients and carries its own risks. So, many upgraded methods & efforts done in the past & still in recent era to present an alternative noninvasive method in steed of TEE in detection of LAA thrombus. Aim of the work: Detecting the presence or absence of LAA thrombus using 2D transthoracic echocardiographyby a simple, rapid and non-invasive method. In addition, to add a new point in prediction of those who are at high risk of thrombo-embolic complications of AF and subsequently need long-life anticoagulants. Material and methods: a prospective study done over a period of one year that included 66 AF patients indicatedfor TEE examination. Patients were subjected to informed verbal consent, full history taking with special emphasis on history of hypertension, diabetes mellitus, and history of thromboembolic complications &history of any contraindication for TEE examination. All patients were assessed clinically with full Cardiological examination & resting 12 leads ECG was done to all. As well as the CHADS2VAS2C score for every patient with nonvalvular AF was calculated. Conventional 2D TTE was done. LVEF to LAVI ratio through TTE has been measured. 2D TEE targeting the LAA was done. Data was collected & coded using Microsoft Office Excel Worksheet while statistical analysis was performed using statistical package for social sciences (SPSS) version 23.0 for windows. Results: Out of 66 AF patients, 38 females & 28 males ranged between 20 & 66 years with mean age ± SD was(49.06 ± 12.09) years. There was total agreement between this 2D TTE simple approach & TEE in detection of LAA thrombus. There was significant reduction in LA and LAA parameters measured by 2D TTE in relation to TEE. We noticed reasonable correlations between LAA thrombus formation & impaired LV systolic function, decrease LAA flow measurements & increase LA diameter. In addition, we observed the effect of AF on LAA dimensions, which made it larger than usual. Conclusion: Low LVEF to LAVI ratio has a comparable accuracy to trans esophageal approach. The addition of long-life anticoagulant is mandatory to whom suffering from AF, if LVEF to LAVI ratio is ≤1.4 regardless the CHA2DS2-VASc score. The safest type of AF is that due to thyrotoxicosis. Weight loss has a precious role in decreasing the formation of LAA thrombus. The shorter the patient, the more incident of LAA thrombus formation. CAD extended farther to be one of the significant risk factor. The atrial flutter has the same impact as well as the atrial fibrillation. The rate control is preferred to rhythm control. LAA thrombus as well as incidence of AF is directly proportionate to increased patient age. Recommendations: Therefore, the usage of LVEF to LAVI ratio, as a comfortable & safe method before cardioversion instead of semi invasive maneuver (TEE) which routinely used. Usage of this ratio as a bedside screening test in all AF patients, directing the management and helping decision-making. Finally, the LVEF to LAVI ratio adds more patients to those at high risk of stroke whom requiring long-life anticoagulant, regardless the CHA2DS2-VASc score to guard against thrombo-embolic complications of AF.

[MoheyAlabaady, Mohammed Algammal, Mohammed Sarhan, Hamada Al sheikh, Tarek Bassoiuny, Mohammed Moanes, Ahmed Mohammed Hassan. Left ventricular ejection fraction to left atrial volume index ratio as a new predictor of left atrial appendage thrombus formation in patients with atrial fibrillation. N Y Sci J 2016;9(12):24-31]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 5. doi:10.7537/marsnys091216.05.

Keywords: Left atrial appendage – Thrombus - Atrial fibrillation - Left atrial volume - Ejection fraction –Transoesophageal echocardiogram (TEE) – Transthoracic echocardiogram (TTE).

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Assesment of Left Ventricular Function in Preeclamptic Women with Preserved Left Ventricular Ejection Fraction Using Two Dimensional Speckle Tracking Imaging

Abdel Halim Abu Al Magd, Samy Nouh, Mohammad Al-Deftar, Hany Maged, Mohamed Al Sisi

Department of Cardiology - Faculty of Medicine - Al-Azhar University, Cairo, Egypt. dr_sisi11@yahoo.com

Abstract: Introduction: Preeclampsia is a common hypertensive disorder of pregnancy. It is associated with both immediate, as well as long-term postpartum morbidity and mortality due to cardiac-related issues. Even in clinically asymptomatic patients, subtle echocardiographic changes in left ventricular function have been observed in preeclampsia. Of the conventional echocardiographic indices, ejection fraction remains relatively preserved until later in the course of the disease process, making it less useful as a screening tool to follow patients over time. Speckle tracking echocardiography (STE) is a new echocardiographic technique that allows a precise evaluation of myocardial function. This method is accurate, reproducible, and angle independent, and it enables a complete assessment of regional and global function in three directions. Aim of the work: assessment of LV systolic function in preeclamptic women using two-dimensional (2 D) speckle tracking Echocardiography (STE). Material and methods: We evaluated the feasibility of strain imaging using speckle-tracking echocardiography in women with preeclampsia. Fifty-five women were enrolled in this study and 50 were analyzed: 30 with preeclampsia, 10 with nonproteinuric hypertension and 10 without a hypertensive disorder. Echocardiographic ejection fraction and global peak longitudinal and circumferential strain were measured. All cases were collected from the Gynecology and Obstetrics department in El-Hussein University Hospital from December 2015 to September 2016. Results: in preeclamptic pregnant women, longitudinal strain and circumferential strain are reduced compared to non-proteinuric hypertensive pregnant women and non-hypertensive pregnant women. Conclusion: Myocardial strain imaging using speckle tracking is more sensitive than left ventricular ejection fraction to detect differences in left ventricular systolic function in pregnant women with and without hypertensive disorders of pregnancy. Recommendations: The STE technique should be combined with conventional echocardiography for assessment and follow up of ventricular function in preeclamptic pregnant women.

[Abdel Halim Abu Al Magd, Samy Nouh, Mohammad Al-Deftar, Hany Maged, Mohamed Al Sisi. Assesment of Left Ventricular Function in Preeclamptic Women with Preserved Left Ventricular Ejection Fraction Using Two Dimensional Speckle Tracking Imaging. N Y Sci J 2016;9(12):32-39]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 6. doi:10.7537/marsnys091216.06.

Keywords: preeclampsia – echocardiography - ventricular function - speckle tracking echocardiography

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Assessment of Prosthetic Mitral Valve by Real-Time 3D Echocardiography

Mokhtar Gomaa, Mostafa Ismail, Mohammad Al-Deftar, Mohammed Abdelwahab

Department of Cardiology - Faculty of Medicine - Al-Azhar University

m.abushahba87@gmail.com

Abstract: Introduction: A reliable method for the assessment of the mitral valve (MV) area is essential for the management of patients with a prosthetic MV. In this study, we assess the feasibility of 3-dimensional (3D) echocardiography to directly measure the mechanical MV orifice area in a clinical imaging protocol. The 3D anatomic diastolic area (ADA) and 3D color Doppler diastolic area were compared with a manufacturer-defined geometric orifice area (GOA) and Doppler-derived effective orifice area (EOA) for normal mechanical MVs. Aim of the work: Assess the feasibility and reproducibility of 3DE to directly measure the orifice area of the prosthetic mechanical MV, to compare The 3D measured orifice area with a manufacturer-defined geometric orifice area (GOA) and Doppler-derived effective orifice area (EOA) for normal mechanical MVs. Material and methods: The study comprise thirty five patients (29females and 6 males) with mechanical prosthetic valve of different types in mitral position(7 patients of them have prosthetic valve in both mitral and aortic position), the mean age of them 38.37±8.2 years. All cases were recruited from the Cardiothoracic surgery Clinic and Cardiology department in Al-Hussein University Hospital from September 2015 to October 2016. Transthoracic and Transesophageal (2D&3D) echocardiography were done for all patient to measure EOA, 3D ADA and 3Dcolor Doppler diastolic area. Results: The EOA was 2.19±0.33 cm², 3D ADA was 2.76±0.42 cm², 3D color Doppler area was 2.47±0.39 cm² and all correlated well with the manufacturer defined GOA which was 4.13±0.53cm². Repeated measurements of 3D ADA and 3D color Doppler area showed no significant variability. Conclusion: Direct measurement of mechanical prosthetic mitral valve orifice area by 3D echocardiography is feasible, reproducible and correlated well with manufacturer defined area of different types of prosthetic mitral valves. Recommendations: Transesophageal 3D echocardiography should be considered for better evaluation and measurement of prosthetic mitral valve area and function.

[Mokhtar Gomaa, Mostafa Ismail, Mohammad Al-Deftar, Mohammed Abdelwahab. Assessment of Prosthetic Mitral Valve by Real-Time 3D Echocardiography. N Y Sci J 2016;9(12):40-45]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 7. doi:10.7537/marsnys091216.07.

Keywords: 3D echocardiography -3D Anatomic Diastolic Area - 3D color Doppler area - Effective Orifice Area - Transesophageal echocardiography.

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Business Apprenticeship Training (BAT) and Youth Empowerment: A Strategy for Poverty Alleviation and unemployment/self-Reliance in Nigeria

Idris Yakubu Haliru* ¹², Asnarulkhadi Abu Samah ¹, Ma’arof Bin Redzua¹, Nobaya Ahmad¹

¹Dept. of Social & Development Sciences, Faculty of Human Ecology, Universiti Putra Malaysia

²Dept. of Local Govt. Studies & Development Studies, College of Administrative and Social Science, Kaduna Polytechnic, Kaduna, Nigeria.

idrisyakubu175@yahoo.com

Abstract: Business Apprenticeship Training (BAT) is key to youth empowerment, poverty alleviation, unemployment and self-reliance. However, the paper intend to bring to the fore the need to engage the youths into business, income and profit oriented ventures of knowledge and skills via vocational training aimed at empowering the youths, improve their poverty status, create employment and make them self-reliant. Data reviewed shows that youths constitute quite above half of the productive capacity of the Nigerian population. Therefore, the high rate of poverty and unemployment percentage ratio is unacceptable and as a result, there is the need to put the nation onto the path of sustained development, growth and income generation for the youths to exploit by positively engaging the youths into vocational skills, knowledge and training. The main thrust of the paper is to describe the key essence of (BAT) as an intervention scheme aimed at empowering the youths by engaging them meaningfully, reduce poverty, unemployment and sustained wealth creation. The paper recommends among others, that the government should make concerted effort at all levels of governance by enhancing vocational training thereby creating entrepreneurs and arresting unemployment.

[Yakubu IH, Abu Samah A, Redzua M, Ahmad N. Business Apprenticeship Training (BAT) and Youth Empowerment: A Strategy for Poverty Alleviation and unemployment/self-Reliance in Nigeria. N Y Sci J 2016;9(12):46-55]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 8. doi:10.7537/marsnys091216.08.

Keywords: Business Apprenticeship Training (BAT), Youth Empowerment, Poverty and Self-reliance.

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Development of a Digester for producing Biogas from Domestic Wastes

Osunade. J. A.; Ogunjimi, L. A. O.; and *Olanrewaju, B. A.,

Department of Agricultural and Environmental Engineering, Faculty of Technology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. t_olanrewaju@yahoo.com

Abstract: Human activities generates waste both at subsistence, commercial and industrial level; some of these wastes poses threat to the air, land and water bodies necessary for normal life. The main objective of this study was to develop a floating drum biodigester for biogas generation from organic wastes. The biodigester was constructed using locally available materials like plastic Keg and drum, gas hose, Gas valve, Gas pressure gauge, Tee gas connector, Gas needle nut, PVC tube pipe, PVC elbow pipe, back nut, nipple and reducer, PVC gum, Flexi tape. Ruler, funnel, oven dryer, digital vernier caliper, digital K type thermometer, digital weighing balance, hygrometer and pan were used for evaluating the digester. Wastes used for evaluation include spinach sticks (S), plantain peel (P) and poultry manure (PM); they were also mixed in equal proportion; parameters evaluated for include moisture content, carbon and nitrogen content. Data collected was subjected to analysis of variance (ANOVA) test to determine the effects of the digester temperature, ambient temperature and pH on biogas generated of the various levels of treatments. Duncan’s multiple range tests was used to establish the differences among treatments using Statistical Analysis System software. The quantity of gas produced from S, P and PM vary tremendously in volume. The mix of S+ P + PM had the highest gas production of 613.2cm³ as against those from S + P and P + PM with 437.71cm³ and 292.14cm³ respectively at early digestion of 14 days; while P+PM had the highest gas production of 254.76cm³ as against those of S + P and S +P+PM with 58.33cm³ and 40.37cm³ respectively at 28 days. The gas production on the 56^th day stands at 150.39cm³ and 96.96cm³ for S +P+PM and S+P, respectively, with P+PM having the least production after the 28th day. The biodigester is safe to operate, versatile in operation and can operate as batch or continuos flow process. About 80-90% of the gas was produced within 30-35 days.

[Osunade. J. A.; Ogunjimi, L. A. O. and Olanrewaju, B. A. Development of a Digester for producing Biogas from Domestic Wastes. N Y Sci J 2016;9(12):56-61]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 9. doi:10.7537/marsnys091216.09.

Keywords: Biodigester, spinach sticks, plantain peel, poultry manure, biogas

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Evaluation of Dexamethasone as an adjuvant to Bupivacaine in ultrasound guided supraclavicular brachial plexus block in patients undergoing upper limb surgeries

Elsayed Elsayed Ahmed Elfeky, Ali Abdullah Alkumity and Mohamed Mahmoud Ali Dawoud

Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Egypt

mohamed.dawoud.581187@facebook.com

Abstract: Background: Supraclavicular brachial plexus block (SBPB) is an effective nerve block for use during upper limb surgery as an alternative to general anesthesia. In addition, this block has postoperative analgesic effect for these surgeries. Objective: Evaluating the efficacy of dexamethasone as an adjuvant to bupivacaine in an ultrasound-guided supraclavicular brachial plexus block (SBPB). Patients and Methods: We compared two groups of patients; each group included 20 patients scheduled for upper limb surgeries and anesthetized by SBPB. Group A(was anesthetized by an injection of 20 ml bupivacaine 0.5% mixed with2 ml normal saline), and group B( was anesthetized by an injection of 20 ml bupivacaine 0.5% mixed with 2 ml (8) mg dexamethasone). The two groups were assessed for efficacy of the block by assessment of the onset and duration of sensory and motor block and assessment of the quality and duration of postoperative analgesia. The two groups were assessed for the incidence of complications. Results: The addition of dexamethasone to bupivacaine in ultrasound guided SBPB significantly hastened the onset and prolonged the duration of sensory and motor block. Dexamethasone yielded better quality of postoperative analgesia and significantly longer duration of postoperative analgesia. Conclusion: The addition of dexamethasone to bupivacaine in ultrasound-guided SBPB significantly decreased the onset time and prolonged the duration of sensory and motor blockade. Also, it prolonged the duration and improved the quality of postoperative analgesia, with very few incidences of complications.

[Elsayed Elsayed Ahmed Elfeky, Ali Abdullah Alkumity and Mohamed Mahmoud Ali Dawoud. Evaluation of Dexamethasone as an adjuvant to Bupivacaine in ultrasound guided supraclavicular brachial plexus block in patients undergoing upper limb surgeries. N Y Sci J 2016;9(12):62-65]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 10. doi:10.7537/marsnys091216.10.

Keywords: Dexamethasone, bupivacaine, supraclavicular block.

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Determine the Frequency of Extra-Articular Manifestations among Rheumatoid Arthritis Patients

Kashif Ali Fazlani¹, Bedar-bakhat khan², Najma Khan Sahito³

¹Department of Medicine, Government Hospital Qasimabad Hyderabad

²Department of Medicine, Liaquat University Hospital Jamshoro

³Department of Operative Dentistry, Liaquat University of Medical & Health Sciences, Jamshoro

drkashfazlani@live.com

Abstract: Objective: To determine the frequency of extra-articular manifestations among rheumatoid arthritis patients. Subjects and Methods: A total of 110 clinically diagnosed cases of Rheumatoid arthritis (RA) were evaluated in this study. Extraarticular features included renal involvement, Respiratory involvement, pericardial involvement, Sjogren syndrome, rheumatoid nodules, Hematological changes, Felty syndrome, vasculitis were studied. Results: Mean age was 58.3 ±6.9 years. Gender distribution showed female preponderance (Male: Female = 1: 3.2). Results: Extra-articular manifestations of rheumatoid arthritis were diagnosed in 48 (43.6%) patients. Rheumatoid nodules was the most common extra-articular manifestation found in 14 (29.2%) cases followed by hematological manifestation in 12 (25%) cases, carpal tunnel syndrome in 9 (18.8%) cases, respiratory involvement was seen in 7 (14.6%) cases, serositis in 4 (8.3%) cases, eye disease in 3 (6.3%). Conclusion: The prevalence of ExRA during disease course was 43.6%, while rheumatoid nodules was the most common extra-articular manifestation and vasculitides, felty`s syndrome, amyloidosis was least common manifestation found in this study.

[K.A.Fazlani, B.B.khan, N.K.Sahito. Determine the Frequency of Extra-Articular Manifestations among Rheumatoid Arthritis Patients. N Y Sci J 2016;9(12):66-69]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 11. doi:10.7537/marsnys091216.11.

Keywords: Rheumatoid arthritis, ExRA, Rheumatoid nodules, Sjogren syndrome.

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Gestational sac size, yolk sac size and embryonic cardiac activity as prognostic factors of first trimester Pregnancy Outcome

Mohammed Salah, Osama Al-Saeed, Mostafashaban *, Halanabil**

Department of obestatric and gynacology, Al -Azhar University.

* Department of obestatric and gynacology, Eltebin central hospital.

**Department of obestatric and gynacology, Cairo University.

Abstract: Objective: To detect correlation between each of the ultrasound parameters that were assessed in the first trimester (the gestational sac size, yolk sac size and fetal cardiac activity) to early pregnancy loss. Methods: 380 pregnant women during the first trimester were entrolled in the study. Each patient was submitted to first ultrasound scan between 5 and 6 weeks of gestation (Gestational sac size, Yolk sac size and Fetal heart rate) and follow up scan of the same parameters every two weeks until 12 weeks of gestation. Results: In the pregnancies that resulted in normal 1^st trimester, there was a significant association between CRL and FHR (P <0.00012), mean gestational sac diameter (P <0.00012) and mean yolk sac diameter (P <0.00012). In the cases that subsequently resulted in pregnancy loss, FHR for CRL was significantly lower than normal (P <0.00012), the gestation sac diameter was smaller (P<0.00012), but the yolk sac diameter was not significantly different (P = 0.062) and no significant association between abnormal yolk sac size and fetal loss was found. Conclusion: First trimester ultrasound measurement of these parameters proved to be an important, helpful and noninvasive tool in the investigation, diagnosis as well as the follow up of pregnant females in their early pregnancy especially those who develop symptoms of threatened abortion.

[Mohammed Salah, Osama Al-Saeed, Mostafashaban, Halanabil. Gestational sac size, yolk sac size and embryonic cardiac activity as prognostic factors of first trimester Pregnancy Outcome. N Y Sci J 2016;9(12):70-74]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 12. doi:10.7537/marsnys091216.12.

Keywords: Gestational; sac size; yolk; embryonic cardiac activity; prognostic factor; trimester Pregnancy Outcome

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Cable-Tie Seton For Treatment of Complex Fistula in Ano: A Prospective Case Series

Mostafa Mahmoud Salama¹, Mohamed Ibrahim Mohamed Shalamesh², Hamada Rashad Mohammed³, Ahmed Abd elAl Sultan⁴, Ayman Hemi Ibrahim⁵

¹Department of General Surgery, Al-Azhar University Hospitals, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Tel: + 20 1110816308. Email: mostafa_slama_2015@yahoo.com

²Department of General Surgery, Al-Azhar University Hospitals, Faculty of Medicine, Al-Azhar University, Cairo Egypt. Email: Mohamedshalamsh@gmail.com. Tel: 01006742796

³Department of General Surgery, Al-Azhar University Hospitals, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Email: dr_7mada79@yahoo.com. Tel: 01003902869

⁴Department of General Surgery, Al-Azhar University Hospitals, Faculty of Medicine, Al-Azhar University, Cairo Egypt. Email: dr.ahmedsultan@hotmail.com. Tel: 01005056641

⁵Department of General Surgery, Al-Azhar University Hospitals, Faculty of Medicine, Al-Azhar University, Cairo Egypt. Emai: ldr.ayman_helmy10@yahoo.com. 0120493493

Abstract: Objective. To determine the fecal incontinence and recurrence rate in patients with complex fistula in ano managed with cable tie seton at a tertiary care teaching hospital. Methods. This is a prospective case series of patients with complex anal fistula i.e. recurrent fistula or encircling >30% of external anal sphincter, managed with cable tie seton from May 2015 to October 2016. Patients were seen in the clinic after one week of seton insertion under anesthesia and then every other week. Each time the cable-tie was tightened if found loose without anesthesia and incontinence was inquired according to wexner’s score. Results. Seventy nine patients were treated during the study period with the age (mean ± standard deviation) of 41 ± 10.6 years and. The seton was tightened with a median of six times (3–15 times range). Complete healing was achieved in 11.2 ± 5.7 weeks. All the patients were followed for a minimum period of one year and none of the patients had any incontinence. Recurrence was found in 4 (5%) patients. Conclusion. The cable tie seton is safe, cost effective and low morbidity option for the treatment of complex fistulae in-ano. It can, therefore, be recommended as the standard of treatment for complex fistulae-in-ano requiring the placement of a seton.

[Mostafa Mahmoud Salama, Mohamed Ibrahim Mohamed Shalamesh, Hamada Rashad Mohammed, Ahmed Abd elAl Sultan, Ayman Hemi Ibrahim. Cable-Tie Seton For Treatment of Complex Fistula in Ano: A Prospective Case Series. N Y Sci J 2016;9(12):75-80]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 13. doi:10.7537/marsnys091216.13.

Keywords: Cable-Tie Seton; Treatment; Complex; Fistula; Case Series

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Assessment of Consumption Rate, Packaging and Storage System of Cassava Products in Ibadan South-West Local Government, Oyo State, Nigeria

Makinde, O. O.¹, Adegbokan, O. B.¹, Fadele, N. T¹., Akinola, O. J.¹, and Aremu, D. O.¹

¹Department of Agricultural and Environmental Engineering, University of Ibadan, Nigeria

² Department of Agricultural Engineering, Federal college of Agriculture, Moor Plantation, Ibadan, Nigeria

Abstract: Cassava is the third largest source of food carbohydrate in the tropic after rice and maize; consumption rate of cassava products varies with tribe, locality and culture. The main objective of this study was to assess the consumption rate, packaging, storage system and duration of cassava products. Cassava products assessed include gari, fufu, lafun, starch, flour and chips. A case study of Ibadan south-west local government in Oyo state, Nigeria was selected for the study due to availability of people of the major tribes in Nigeria; the local government has 40 km² area and population of 282,585. Data was collected for this study with the aid of well-structured questionnaire and personal interviews were also granted. Simple random techniques were used to select seventy five respondents from the study area and descriptive statistical tool was used to analyze the data obtained. The result showed that the most consumed product in the area is fufu with the highest cumulative (33%) followed by gari with cumulative percentage of 24%. Cassava products are consumed daily in most households in this local government area most especially gari. The packaging material mostly used for these products is nylon and gari was found to have the highest shelf life of about six month in well drained store. The study shows that many dwellers in Ibadan south-west local government depends on cassava products for their survival.

[Makinde, O. O., Aegbokan, O. B., Fadele, N. T., Akinola, O. J., Aremu, D. O. Assessment of Consumption Rate, Packaging and Storage System of Cassava Products in Ibadan South-West Local Government, Oyo State, Nigeria. N Y Sci J 2016;9(12):81-84]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 14. doi:10.7537/marsnys091216.14.

Keywords: Cassava products; consumption rate; packaging; storage system and duration

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Effect of single low dose of magnesium sulphate on postoperative pain in lower abdominal surgeries for patients receiving general anesthesia

Abd Elnasser Ahmed Hussein, Ahmed Saied Abd Elrahman and Mohamed Gomaa Ali

Department of Anesthesia and Intensive care, Faculty of Medicine, Al-Azhar University, Egypt mohammedaladl66@gmail.com

Abstract: Background: Magnesium sulphate has been used for many years in cardiologicaland obstetric issues. There are another uses for magnesium sulphate such as analgesic effect. Objective: This randomized, double-blind, prospective study was done to evaluate the effects of magnesium sulphate on postoperative pain in patients undergoing lower abdominal surgeries after receiving general anesthesia. Patients and Methods: Block randomization method was used to generate a random list. The magnesium group (n=20) received 50 mg/kg of magnesium sulfate in 100 mL of normal saline solution “isotonic saline” given intravenously (single low-dose), just 15 minutes before the induction of balanced general anesthesia. Patients in control group (n=20) received 100 ml of 0.9% sodium chloride solution given intravenous at the same time. Pain was evaluated with Numeric Rating Scale (NRS) with 10 cm length (starting from 0, no pain, to 10, worst pain) was evaluated at 6, 12, and 24 hours after the surgeries and compared in both groups. Also, hemodynamic parameters (NIBP and HR) were recorded every 6 hours interval for 24 hours. Results: NRS (Numeric Rating Scale) with 10 cm length (starting from 0, no pain, to 10, worst pain) was evaluated at 6, 12, and 24 hours after the surgeries and compared in both groups and results was represented by column chart. Also, mean arterial pressure and heart rate were recorded preoperatively as baseline, after infusion of magnesium sulphate, after induction of anesthesia, 6 hours, 12 hours and 24 hours postoperatively. There were no significant differences in Heart rate (HR) between two groups at base line. HR increase after infusion of magnesium and started to decrease after induction of anesthesia in both groups, but still higher in magnesium group while after 24 hours HR decreased in magnesium group and still high in control group. Conclusion: The preoperative administration of single low dose of magnesium sulphate was a safe and effective method in the management of postoperative pain after lower abdominal surgery.

[Abd Elnasser Ahmed Hussein, Ahmed Saied Abd Elrahman and Mohamed Gomaa Ali. Effect of single low dose of magnesium sulphate on postoperative pain in lower abdominal surgeries for patients receiving general anesthesia. N Y Sci J 2016;9(12):85-88]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 15. doi:10.7537/marsnys091216.15.

Key words: Magnesium sulphate, pain; surgery

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Ultrasound guided thoracic Paravertebral block versus wound infiltration of bupivacaine for management of postoperative pain after modified radical mastectomy

Mona Hanem Abdelghafar¹, Mohamed Ali Aboud², Ali Abdallah Alkumity¹ and Barakat Abuelhassan Osman Yousef¹

¹Anesthesiology and Intensive care Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

²Diagnostic radiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Barakatosman31@gmail.com

Abstract: Background: Pain after breast surgery is usually severe, and continuous thoracic paravertebral block (cTPVB) has been considered to be an effective pain treatment. Recently, continuous local wound infiltration (cLWI) has become increasingly popular but the outcome of this method regarding the analgesic effect has not been fully evaluated. Objective: We sought to determine the effectiveness of ultrasound guided paravetebral block and wound infiltration of Bupivacaine for postoperative pain management after modified radical mastectomy. Patient and methods: This prospective randomized study was carried out on 40 ASA grade (I-II) adult female patients classified into two groups, group (A) after general anesthesia, a catheter was threaded in the paravertebral space guided by ultrasound, before disconnection of anesthesia by 30 minutes we gave a loading dose of bupivacaine 0.25%, after one hour we gave a maintenance dose through elastomric pump. Group (B) at the end of surgery we placed a catheter subcutaneously, after closure of the wound we gave a loading dose of bupivacaine 0.25 %, after one hour we gave a maintenance dose through elastomeric pump. Results: showed that no statistical difference between the two groups as regard pain visual analogscore (VAS), nausea and vomiting, morphine consumption, hemodynamically, alertness and satisfaction. Conclusion: The present study demonstrated that both cLWI and cTPVB techniques were effective in management of acute postoperative pain after modified radical mastectomy, decreased morphine and antiemetic consumption, reduced nausea and vomiting.

[Mona Hanem Abdelghafar, Mohamed Ali Aboud, Ali Abdallah Alkumity and Barakat Abuelhassan Osman Yousef. Ultrasound guided thoracic Paravertebral block versus wound infiltration of bupivacaine for management of postoperative pain after modified radical mastectomy. N Y Sci J 2016;9(12):89-94]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 16. doi:10.7537/marsnys091216.16.

Keywords: U-S, Infiltra Long^TM, cTPVB, cLWI, Bupivacane, MRM, Postoperative pain

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Excretion/secretion of Lucilia sericata and Chrysomya albiceps (Diptera: Calliphoridae) maggots as potential anticancer agent and kinases inhibitor

Ahmed Z.I. Shehata, Ahmed B.M. Mehany, Tarek M.Y. El-Sheikh

Department of Zoology, Faculty of Science, Al-Azhar University, Nasr City, Cairo, Egypt.

ahmedzeinhom00@gmail.com

Abstract: This study was performed to investigate the anticancer activity of sterile larval excretion/secretion (ES) of Lucilia sericata and Chrysomya albiceps on seven human parts tumor cell lines named: Human Liver Carcinoma cell line (HepG-2), Human Breast Carcinoma cell line (MCF-7), Human Colon Carcinoma cell line (HCT-116), Human Lung Carcinoma cell line (A-549), Human Intestinal Carcinoma cell line (CACO), Human Prostate Carcinoma cell line (PC-3) and Human Cervical Carcinoma cell line (HELA). The SulphoRhodamine-B (SRB) assay was applied to compare the antitumor activity of maggot's ES with the antitumor agent Fluorouracil (5-FU). In vitro anticancer evaluation of L. sericata and C. albiceps maggot's ES revealed that, both maggot's ES possess moderate to high anticancer activities against the different human tumor cell lines used, with IC₅₀ values 14.8±0.05, 31.3±0.09, 27.3±0.11, 16.4±0.07, 31.1±0.31, 30.4±0.12, 85.6±0.35µg/ml for L. sericata ES and 17.3±0.26, 33.4±0.17, 32.1±0.37, 20.2±0.14, 34.8±0.25, 77.6±0.19 and 89.5±0.34 µg/ml for C. albiceps ES against (HepG-2), (MCF-7), (HCT-116), (A-549), (CACO), (PC-3), and (HELA) cell lines, compared to 28.3±0.32, 40.7±0.34, 19.8±0.11, 20.14±0.43, 31.82±0.25, 60.7±0.45 and 53.5±0.51µg/ml for the anticancer agent Fluorouracil  (5-FU), respectively. In addition, L. sericata and C. albiceps ES affect the human epidermal growth factor receptor (EGFR), Human Insulin Receptor (IR), Human vascular endothelial cell growth factor receptor (VEGFR) and Fibroblast Growth Factor Receptor (FGFR) with IC₅₀ 6.57±0.09, 1.24±0.15, 5.41±0.18 and 3.22±0.22µg/ml for L. sericata ES and 9.62±0.11, 3.39±0.23, 8.01±0.17 and 6.72±0.16µg/ml for C. albiceps ES.

[Ahmed Z.I. Shehata, Ahmed B.M. Mehany, Tarek M.Y. El-Sheikh. Excretion/secretion of Lucilia sericata and Chrysomya albiceps (Diptera: Calliphoridae) maggots as potential anticancer agent and kinases inhibitor. N Y Sci J 2016;9(12):95-101]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 17. doi:10.7537/marsnys091216.17.

Keys words: Anticancer, ES, L. sericata, C. albiceps, kinases.

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Three dimensional and Doppler Characteristics of Subendometrium in Cases of Menorrhagia after Intrauterine Contraceptive Device Insertion

Mohammed A. Abd Elkhalek¹, Abd ELmonem M. Zakaria², and Abd Elmonsef A. Sedeek³

¹Department of Obstetrics and Gynecology, Faculty of Medicine Al-Azhar University, Cairo, Egypt

²Prof. of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Faculty of Medicine Al-Azhar University, Cairo, Egypt

³Assist. Prof. of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Faculty of Medicine Al-Azhar University, Cairo, Egypt

Drmohammed.afify@gmail.com

Abstract: The intrauterine contraceptive device is one of the most frequently used method of contraception allover the world. The most important adverse effects related to copper intrauterine contraceptive device use are excessive uterine bleeding and menstrual pain which are responsible for 5-15% removal rate of IUD during the first year of its insertion. Abnormal uterine bleeding may be excessive to the extent of causing iron deficiency anemia. There are several possible mechanism that explain the cause of menorrhagia in patient using IUCD. Several studies reported that IUD insertion increase the production of prostaglandins in the endometrium which cause an increase in vascularity, vascular permeability and inhibitplatelet activity and therefore increase menstrual bleeding. With recent advances in ultrasound. Three-dimensional power Doppler ultrasound can be used to evaluate endometrial and subendometrial perfusion in cases of menorrhagia. The aim of the present study is to evaluate subendomtrial blood flow in cases of menorrhagia after copper IUCD insertion in comparison to cases using IUCD and not complaining of abnormal uterine bleeding and cases not using IUCD. This study includes 315 women divided into three groups. Group I; included 105 women using copper intrauterine device (Tcu 380A) and complaining of menorrhagia, Group II; included 105 women using copper IUD and not complaining of abnormal uterine bleeding and group III; not using any contraceptive method and not complaining of abnormal uterine bleeding. The uterus and ovaries were first visualized using conventional B-mode ultrasound to check uterine size and presence of uterine masses and the accurate placement of the device inside the uterus in first and second groups. The color pulsed Doppler was activated in the 2D mode, the right and left uterine arteries pulsatility index (PI) and resistance index (RI) were calculated. Then the ultrasound machine was switched to the 3D mode with power Doppler, subendometrial blood flow pulsatility index (PI) and resistance index were calculated then three-dimensional power Doppler vascular indices; vascularization index (VI), flow index (FI) and vacular flow index (VFI) were calculated automatically using VOCAL (virtual-organ computer aided analysis) software. As regard to Doppler findings, it was noted that PI, RI of uterine arteries and subendometrial PI and RI were significantly lower in group I incomparison to group II and group III (p-value <0.001) while subendometrial power Doppler indices VI, FI, VFI were significantly higher in group I incomparison to group II and group III. The results of our study revealed that uterine artery and subendometrial blood flow were increased in women with IUCD induced menorrhagia in comparison to women with copper IUD and not complaining of abnormal bleeding and women without copper IUD. By using ROC curves, the optimum cutoff value of VI was >4.1 and FI was >34 and VFI >0.98 with sensitivity 87.6%, 89.5% and 85.7% and specificity 96%, 95.2% and 87.6% respectively.

[Mohammed A. Abd elkhalek, Abd ELmonem M. Zakaria, and Abd Elmonsef A. Sedeek. Three dimensional and Doppler Characteristics of Subendometrium in Cases of Menorrhagia after Intrauterine Contraceptive Device Insertion. N Y Sci J 2016;9(12):102-105]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 18. doi:10.7537/marsnys091216.18.

Keywords: Three dimensions; Doppler; Characteristics; Subendometrium; Menorrhagia; Intrauterine; Contraceptive; Device; Insertion

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Vasculogenic Erectile Dysfunction and Vitamin D level in Blood

Tarek Mohammed Tawfik¹, Mohammed Aref Ibrahim², Ahmed Saeed Mohammed Aladl¹ and Omar Yahya Zaki Nassar¹

¹Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Al-Azhar University, Egypt.

²Department of clinical pathology, Faculty of Medicine, Al-Azhar University, Egypt.

omaryahyanassar@gmail.com

Abstract: Background: Endothelial dysfunction has been demonstrated to play an important role in pathogenesis of vasculogenic erectile dysfunction and other vasculogenic pathology as cardiovascular diseases. Vitamin D deficiency is deemed to promote endothelial dysfunctions. Objective: 1-Compare changes in vitamin D levels in serum of normal individuals and erectile dysfunction patients.2-Coorelate vitamin D levels in serum with severity and type of erectile dysfunction. Patient and Methods: The study included 80 men out of 162 men presented to the Andrology & STDs Department, Faculty of Medicine, Al-Azhar University after application of inclusion and exclusion criteria and after ethical approval and informed consent. They were allocated into: Healthy potent men (n=40) and Men with erectile dysfunction (ED) (n=40). Diagnosis and severity of ED was based on the IIEF-5 and Penile Duplex. It’s aetiology was classified as arteriogenic, venogenic or mixed. Serum vitamin D level was measured by ELISA. Results: 40 patients were classified as 21 patients with arteriogenic erectile dysfunction and 19 patients with venogenic erectile dysfunction. Mean vitamin D level was 26.25  ng/mL; vitamin D deficiency (<20 ng/mL) was present in 57.5%, 15.0% had suboptimal vitamin D level (<30 ng/ml) and only 20.0 % had optimal vitamin D levels (30-50 ng/ml). 5% had upper normal vitamin D level (>70 ng/ml) and 2.5% had overdose non toxic vitamin D level (>150 ng/ml). p value <0.001. Vitamin D level in arteriogenic erectile dysfunction was lower than in venogenic erectile dysfunction patients. Penile Duplex revealed that arteriogenic erectile dysfunction was more frequent in those with vitamin D deficiency as compared to those with Venogenic erectile dysfunction. Conclusion: Vit. D serum levels with its VDR expression play a role of male sexual health being significantly decreased in men with erectile dysfunction. The research presented suggests that many common mechanisms underlie both cardiovascular disease and vasculogenic erectile dysfunction, and that vitamin D deficiency is closely associated with both disorders. We hypothesize that optimizing serum vitamin D levels through sunlight exposure or vitamin D supplementation helps delay the onset of erectile dysfunction. Coupled with positive changes in lifestyle, such optimization may restore normal sexual function to some men. Recommendations: 1-Including serum vitamin D assessment as a part of routine investigation for patient complaining with erectile dysfunction. 2-Additional experimental and clinical studies to determine appropriate dose of vitamin D supplementation for patients with ED.

[Tarek Mohammed Tawfik, Mohammed Aref Ibrahim, Ahmed Saeed Mohammed Aladl and Omar Yahya Zaki Nassar. Vasculogenic Erectile Dysfunction and Vitamin D level in Blood. N Y Sci J 2016;9(12):106-110]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 19. doi:10.7537/marsnys091216.19.

Keywords: Vasculogenic erectile dysfunction, Vitamin D level in blood.

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Predictors of Early Seizures in Patients with Acute Ischemic Stroke

Hussein M. Hussein Metwally, Emad F. Shahin, Mahrous I. Seddeek and Ahmed A. Nassar

Neurology Department of Al-Azhar University Hospitals (Al-Hussein and Bab –Alsharea Hospitals), Egypt.

dr_ahmedabdelfattah86@yahoo.com

Abstract: Background: early seizures (ES) may complicate the clinical course of patients with acute stroke. The aim of this study was to assess the predictive factors for early seizures in patients with first-ever stroke. Patient and methods: A total of 100 consecutive patients with first-ever stroke, admitted to our stroke and neurology department, were included in this study. Early seizures were defined as seizures occurring within 14 days from acute stroke. Patients with history of epilepsy were excluded. Results: About 13 patients (13%) had early seizure. We had 6 women and 7 men. The mean age was 60.3 ±10.5. They were significantly more common in patients with cortical involvement, severe and large stroke, and in patient with cortical associated hemorrhage. Conclusion: Early seizures occurred in about 13% of patients with acute stroke. In these patients cortical involvement, large infarction and hemorrhagic transformation are the predictive factor for ES.

[Hussein M. Hussein Metwally, Emad F. Shahin, Mahrous I. Seddeek and Ahmed A. Nassar. Predictors of Early Seizures in Patients with Acute Ischemic Stroke. N Y Sci J 2016;9(12):111-113]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 20. doi:10.7537/marsnys091216.20.

Keywords: Predictor; Early Seizure; Patient; Acute Ischemic Stroke

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Incidence of Vascular complications among Egyptian population during trans femoral Aortic Valve Implantation

Mansour Mohamed Moustafa, Islam Shawky Abdelaziz, Moustafa Ibrahim Mokarrab, Ahmad Elsayed Yousef and Mohammed Elsoudi Nasr

Cardiology Department, Faculty of Medicine, Al-Azhar University, Egypt.

nmohamedsoudy@yahoo.com

Abstract: Objectives: This study sought to evaluate the incidence, impact, and predictors of vascular complications in transcatheter aortic valve implantation (TAVI). Background: Vascular complications increase morbidity and mortality in transfemoral TAVI; however, there remains a paucity of data describing these serious events. Introduction: Vascular complications are among the most frequent and serious complications of trans femoral TAVI, and have been associated with significantly increased patient morbidity and mortality. De-spite improved patient selection and down-sizing of the delivery system, these complications remain the Achilles’ heel of this novel procedure. Aim of the work: To describe the incidence of vascular complications in trans femoral TAVI patients, based on the VARC criteria, and to identify predictors of these serious events among the Egyptian population. Material and methods: We performed a prospective cohort study of 30 consecutive transfemoral TAVI recipients. Vascular complications were defined by the Valve Academic Research Consortium (VARC) criteria. Results: In our cohort of elderly patients (83.3 5.9 years), the logistic Euro Score was 25.8%, 11.9%. The Edwards valve was used in 3 cases (18- to 24-F) and the Core Valve in 27 (18-F). The minimal femoral artery diameter was 8.17 1.14 mm, and the calcification (0 to 3) and tortuosity scores (0 to 3) were 0.58 0.72 and 0.28 0.53, respectively. The mean sheath diameter was 8.10 0.82 mm, (VARC major: 17.3%, minor: 10.2%), and major vascular complications predicted 30-day mortality (22.7% vs. 7.6%, p 0.049). The SFAR (hazard ratio [HR]: 186.20, 95% confidence interval [CI]: 4.41 to 7,855.11), center experience (HR: 3.66, 95% CI: 1.17 to 11.49), and femoral calcification (HR: 3.44, 95% CI: 1.16 to 10.17) predicted major complications by multivariate analysis. An SFAR threshold of 1.05 (area under the curve 0.727) predicted a higher rate of VARC major complications (30.9% vs. 6.9%, p 0.001) and 30-day mortality (18.2% vs. 4.2%, p 0.016). Conclusion: Vascular complications in transfemoral TAVI are relatively frequent. VARC major vascular complications increase 30-day mortality and are predicted by experience, femoral calcification good selection of patient and improvement in size of dilaviry system will improve patient selection for transfemoral TAVI and may improve outcome.

[Mansour Mohamed Moustafa, Islam Shawky Abdelaziz, Moustafa Ibrahim Mokarrab, Ahmad Elsayed Yousef and Mohammed Elsoudi Nasr. Incidence of Vascular complications among Egyptian population during trans femoral Aortic Valve Implantation. N Y Sci J 2016;9(12):114-121]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 21. doi:10.7537/marsnys091216.21.

Key Words: aortic stenosis balloon valvuloplasty risk factors transcatheter aortic valve implantation vascular complications.

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Study of profile of status Epilepticus in a sample of Egyptian patients treated in Al-Azhar university hospitals

Fathy Mahmoud Afifi, Emad Fawzy Shahin, Mohie El-Din Tharwat Mohamed and El-Noamany Nader Abd-Elhamid

Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

noamanyna@yahoo.com

Abstract: Background: Status epilepticus (SE) is a medical emergency that can lead to serious sequelae if left untreated, SE was defined as an ongoing seizure lasting more than 5 minutes, or by repeated seizure without complete recovery in between. Identification of clinical parameters and etiological factors for SE can be used for early diagnosis, management and improve outcome. Objective: evaluate the clinical parameters and etiological factors of status epilepticus in a sample of Egyptian patients admitted at Al- Azhar university hospitals. Methods: Data on all consecutive patients with status epilepticus of all etiologies admitted to Al Azhar university hospitals included detailed medical and neurological history, detailed history of epilepsy (type of seizure, frequency of seizure, anti-epileptic drugs use and etiology of epilepsy), history of status epilepticus (Type, etiology, trigger factors, duration of SE, recurrent SE or not, Anti-epileptic drugs for treatment of SE and outcome), after neurologic evaluation. Patients were subjected to relevant laboratory, neuroimaging and electroencephalographic studies and incase of nonconvulsive status epilepticus, EEG criteria were used. Etiological factors and detailed clinical data about SE and detailed clinical data about history of epilepsy in epileptic patients had been documented and all these data tabulated and statistically managed. Results: The most common cause of SE in epileptic patients was poor compliance to AED and the cause of SE in non-epileptic was vascular cause. Marital status and family support had an important role in compliance on AED, commonest cause of death was vascular causes and commonest cause of disability was CNS infection. Drug abuse precipitate recurrence of SE. Patients with history of recurrent SE develop SE needs longer time and more drugs to be controlled. Mortality rate due to SE was 12.5%. idiopathic etiology offered the best chance for good clinical outcome. Conclusion: Status epilepticus is a complex clinical syndrome that requires immediate and careful evaluation. SE caused by a variety of diseases of different outcomes, so cases of SE should be investigated thoroughly and need urgent evaluation. Social and family support plays an important role in drug compliance and development of SE.

[Fathy Mahmoud Afifi, Emad Fawzy Shahin, Mohie El-Din Tharwat Mohamed and El-Noamany Nader Abd-Elhamid. Study of profile of status Epilepticus in a sample of Egyptian patients treated in Al-Azhar university hospitals. N Y Sci J 2016;9(12):122-131]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 22. doi:10.7537/marsnys091216.22.

Key words: Status epilepticus; profile; Egyptian patients; drug compliance; family support.

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Evaluation of Different ECG Parameters to Predict the Culprit Artery and Site of occlusion in patient with Acute Inferior Wall Myocardial Infarction

Mamdouh Helmy Eltahan¹, Ali Ali Ramzy², Ashraf Mohamed Anwar³, Ashraf Al-Amir Abd Elfattah⁴ and Omar Samir Sedik ⁵

¹Professor of cardiology, Faculty of medicine (Cairo) Al-Azhar University, Egypt

²Assistant Professor of cardiology, Faculty of medicine (Cairo) Al-Azhar University, Egypt Assistant ³Professor of cardiology, Faculty of medicine (Cairo) Al-Azhar University

⁴Lecturer of cardiology, Faculty of medicine (Cairo) Al-Azhar University, Egypt

⁵Resident doctor at cardiology, Faculty of medicine (Cairo) Al-Azhar University, Egypt

elghannam88@gmail.com

Abstract: Background: Acute myocardial infarction is still a major public health problem despite the impressive stride in diagnosis and management. Furthermore, the early and accurate diagnosis with the proper management of this major event is an important challenge. The determination of infarct related artery in acute inferior myocardial infarction is extremely important for the prediction of potential complication and predicting the probable site of occlusion is worthwhile because proximal occlusions are likely to cause greater myocardial damage. Aim of Work: The aim of the present study is to evaluate the use of different ECG criteria to evaluate the culprit artery and site of occlusion in patients with acute inferior wall myocardial infarction. Methodology: The present history was conducted on 100 patients presenting to Al Azhar University Hospitals by acute inferior myocardial infarction. All patients were subjected to: thorough history taking, full clinical examination, surface ECG, serial cardiac enzymes, echocardiography and coronary angiography. Studied ECG criteria included ST segment depression in lead avr >.1mv, ST segment elevation in lead III more than lead II, ST segment depression in lead I>0.05 mv, ST segment elevation in lead V4R> 1mv, rhythm and heart rate. Results: This present study confirmed the utility of ST segment depression in lead aVR for predicting LCX occlusion and association with larger infarct size, A higher ST segment elevation in lead III than in lead II and ST segment depression in lead I> 0.05mm are markers for right coronary artery related acute inferior wall myocardial infarction, The amplitude of ST segment elevation and the proximity of culprit lesion along the infarct related right coronary artery was found to be significantly related, ST segment elevation in lead V4R ≥ 1mm as a criterion for RCA involvement has excellent specificity and PPV however low sensitivity and NPV were found and ST segment elevation in lead V4R ≥ 1mm was also assessed as a criterion for proximal RCA involvement vs. mid to distal RCA involvement in cases of inferior wall MI. Conclusion: It is possible to predict the culprit coronary artery in inferior wall acute myocardial infarction by using the readily obtainable measures on the admission electrocardiography. Recommendations: We recommend analysis of electrocardiography in patients with myocardial infarction to predict the culprit coronary artery and its proximity, for more proximal occlusions are likely to cause greater myocardial damage and early intervention is recommended.

[Mamdouh Helmy Eltahan, Ali Ali Ramzy, Ashraf Mohamed Anwar, Ashraf Al-Amir Abd Elfattah and Omar Samir Sedik. Evaluation of Different ECG Parameters to Predict the Culprit Artery and Site of occlusion in patient with Acute Inferior Wall Myocardial Infarction. N Y Sci J 2016;9(12):132-139]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 23. doi:10.7537/marsnys091216.23.

Keywords: Evaluation; Different ECG Parameter; Predict; Culprit Artery; occlusion; patient; Acute Inferior Wall Myocardial Infarction

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Comparative Study Between The Effect Of Sleeve Gastrectomy And Mini Gastric Bypass On Type II Diabetic Morbid Obese Patient

Mohammed Ibrahim El-Anany, Hamdy Abd El-Aleem Mohammed, Abed Mohammed Abd El-Badei Kendil

General Surgery Depatment - Faculty of Medicine, Al-Azhar University

Abedkendil88@gmail.com

Abstract: Aim: The aim of this study was to compare between the effect of sleeve gastrectomy and mini gastric bypass on type II diabetic morbid obese patient as regard, the mean operative time, conversion rate, hospital stay, rate of complications, Diabetic remission, and weight loss within 6 months. Patients and methods: In randomized prospective comparative study, 30 patients morbid obese with type II diabetis were enrolled in this study, 15 patients underwent GS (Group I) and 15 patients underwent MGB (Group II). For all patients, full history tacking, general and local examination, routine laboratory investigations. Cardiopulmonary evaluation, abdominal ultrasound Upper GIT endoscopy, DVT prophylaxis and Informed consent were done. During operations, Operative details were recorded: Mean operative time, Intraoperative mishap, Cause of conversion if occurred and any associated procedures. Postoperative: Clinical evaluation and Gastograffine X-ray (0n second day). If no leaks, Patients started fluids immediately. Patients discharged when the condition permitted and the drain was removed. Diet progression from soft to solid at weeks 7. Daily walking for 30 minutes. Patients received multivitamins and calcium supplements. Results: No statistical significant difference was detected between the two groups as regard( history and clinical characteristics); age and sex distribution, occupation, life style, onset of obesity, surgical history, dietary hapits, anthropometric measures (weight, height and BMI), excess weight, waist circumference, hip circumference and W/H. There is no statistical significant difference between the two groups, as regard, diabetic remission, conversion rate, mean overall cost, early and late complication. Significant difference of shorter operative time and hospital stay were detected with GS. Statistically difference between the two groups, as regard; postoperative patients’ weight reduction, BMI reduction, decreased W/H, increased (%EWL) and (%BMIL) in favor of MGB. Conclusion: There was a significant reduction of mean BMI in both LSG and LMGB, while %EWL and %BMIL more prominent in LMGB, but SG have significant shorter operative time and less postoperative hospital stay. There was obvious amelioration of obesity related DM in LSG and MGB but LMGB have higher rate of resolution.

[Mohammed Ibrahim El-Anany, Hamdy Abd El-Aleem Mohammed, Abed Mohammed Abd El-Badei Kendil. Comparative Study Between The Effect Of Sleeve Gastrectomy And Mini Gastric Bypass On Type II Diabetic Morbid Obese Patient. N Y Sci J 2016;9(12):140-149]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 24. doi:10.7537/marsnys091216.24.

Keywords: Laproscopic Sleeve Gastrectomy (LSG), Laproscopic Mini Gastric Bypass (LMGB)

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Clinical Outcome and Running Cost of Holmium Laser Lithotripsy for Ureteroscopic Treatment of Upper Ureteral Calculi

Hesham Abd Elmoneim, Sabri Mahmoud and Mourad Mahmoud Mourad

Urology Department, Faculty of Medicine, Al-Azhar University, Egypt

aboziedhesham@gmail.com

Abstract: Objective: To evaluate the efficacy, safety and running cost of upper ureteric stones treatment with holmium laser lithotripsy using semirigid ureteroscope. Patients and Method: 100 patients with upper ureteral calculi, who underwent ureteroscopic holmium laser lithotripsyusing semirigid ureteroscope, were analyzed prospectively. Ninety patients completed the study and ten patients lost to follow up. Patients were evaluated about the gender, age, stone size, ureteral stenting, stone migration, residual stone, operative time, complication, previous ESWL application, hospitalization period and running cost. Results: The mean age of our patients was 42.49+13.10 (range: 17-71) years. Procedural failure was observed In 21(23.3%) of 90 patients. Double J stents were fixed in 56 (62%) of the patients. The total success rate was 76.67% and the average cost of laser lithotripsy including disposable elements was 520.12± 135$. Three patients (3.33%) developed late post operative ureteral stricture. Conclusion: Ho: YAG laser lithotripsy using semirigid ureteroscope was effective in managing upper ureteralstones. It has satisfactory stone free rate, although major intraoperative complications may occur.

[Hesham Abd Elmoneim, Sabri Mahmoud and Mourad Mahmoud. Clinical Outcome and Running Cost of Holmium Laser Lithotripsy for Ureteroscopic Treatment of Upper Ureteral Calculi. N Y Sci J 2016;9(12):150-155]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 25. doi:10.7537/marsnys091216.25.

Keywords: Ureteroscopy, Holmium: YAG Laser, Lithotripsy.

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Ultrasound Guided Extracorporeal Shock Wave Lithotripsy for Renal Calculi in Children

Alkotp Shehata, Kotb Ayman, and Selmy Gamal

Urology department, Al-Azhar University Hospitals, Cairo, Egypt.

shehatamohamed086@gmail.com

Abstract: Objective: To evaluate the efficacy of Ultrasound guided extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones in children. Patients and Methods: This is a prospective interventional uncontrolled study conducted on a group of children who underwent ESWL under ultrasound guidance at Bab El-Sha’ariya university hospital. Fifty children with renal stone were included in the study after obtaining the local ethical committee approval. All parents of these children signed an informed consent. Our inclusion criteria were children aged from 1 to 18 years with both radiolucent and radio opaque renal stones up to 2cm. We excluded children with distal obstruction, stones > 2 cm, active UTI, children with uncorrected Coagulopathy, elevated serum creatinine and skeletal deformity or special/abnormal anatomy of the upper tract. All procedures were performed with the children in supine position and under general anesthesia using Dornier Lithotripter S II machine. Results: In all 50 patients the overall fragmentation rate was 94%. Stone free rate for pelvic, lower calyceal, middle calyceal and upper calyceal stone was 47.4%, 75%, 57.1% and 100% respectively. The most frequent complications were hematuria 4% and UTI 4%. The size and multiplicity of stones affected stone clearance after ESWL (p= 0.025 and p< 0.001), other factors as age, sex and stone site were not statistically significant, P values were above 0.05. Conclusion: Ultrasound guided ESWL is safe and curative for renal calculi in the majority of children (94%). Moreover, the results of the present study may recommend Ultrasound guided ESWL as the primary treatment of choice for renal stones in children up to 2 cm with minimal morbidity as well as in Solitary stones and radiolucent stones had better clearance rate.

[Alkotp Shehata, Kotb Ayman, and Selmy Gamal. Ultrasound Guided Extracorporeal Shock Wave Lithotripsy for Renal Calculi in Children. N Y Sci J 2016;9(12):156-161]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 26. doi:10.7537/marsnys091216.26.

Keywords: Ultrasound; Guide; Extracorporeal; Shock; Wave; Lithotripsy; Renal Calculi; Children

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Stentless versus stented laparoscopic pyeloplasty, A comparative study

Mahmoud Faisal Rashad, Abd Elbaset M. EL Emam, Shawkey A. EL Mikkawy and Mourad M. Mourad

Department of Urology, Al-Azhar University Hospitals, Cairo, Egypt

Drfaysl2012e@yahoo.com

Abstract: Objectives: To compare stented versus stentless laparoscopic pyeloplasty (LP) in treatment of uretero pelvic junction obstruction regarding success rate, operative time, blood loss, intra and post operative complications, analgesic requirement and hospital stay. Patients and Methods: A prospective randomized study was done on 45 patients underwent LP from May 2013 to March 2016 at Al-Azhar University Hospitals. The studied patients were classified into two groups, Group A (stented LP), Included 25 patients (12 males & 13 females) were treated with stented LP, their age ranged from (5 – 35 years) with mean age of 18.60. Group B (stentless LP), Included 20 patients (13 males & 7 females) were treated with stentless LP, their age ranged from (3.5 – 26 years) with mean age of 14. All procedures were performed transperitoneally. Anderson Hynes pyeloplasty was done for 41 Patients, while y-v flap was done for 4 patients. Patients were followed with clinical assessment, urine C&S after three months and IVU, DTPA scan after six± twelve months. Perioperative parameters including operative time, analgesic use, hospital stay, complications and success rates were compared. Results: The mean operative time was 180.27 minutes ±SD 29.41 (range 110-222.5 minutes) in group A, while the mean operative time was 124.66 minutes ±SD 28.75 (range 80-180 minutes) in group B No significant intraoperative complications or blood loss in both group. Success rate was 92% in group A and 90 % in group B. leakage was detected in 60% of group B and 8% in group A. No significant difference in hospital stay or analgesic requirement in both groups. Conclusion: Although stentless LP has an increased risk for persistent leakage in early post operative period, it is considered to be safe and effective as its stented counterpart with the advantage of avoidance of stent related symptoms and another cystoscopy for DJ stent removal.

[Mahmoud Faisal Rashad, Abd Elbaset M. EL Emam, Shawkey A. EL Mikkawy and Mourad M. Mourad. Stentless versus stented laparoscopic pyeloplasty, A comparative study. N Y Sci J 2016;9(12):162-165]. ISSN 1554-0200 (print); ISSN 2375-723X (online). http://www.sciencepub.net/newyork. 27. doi:10.7537/marsnys091216.27.

Keywords: Stentless; versus; stent; laparoscopic pyeloplasty; comparative; study

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