Ain Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301POTENTIAL ROLE OF GLP-1 RECEPTOR AGONIST IN A RAT MODEL OF CARDIO-RENAL SYNDROME TYPE-3: EFFECTS ON OXIDATIVE, INFLAMMATORY AND INOS EXPRESSION AXIS12816731310.21608/asmj.2021.167313ENAtef M.AboodPhysiology Department, Faculty of Medicine, King abdulaziz University, Jeddah, Saudi Arabia.+Faculty of Medicine, Ain Shams University, Cairo, Egypt.Hosam AhmedAwadPhysiology Department, Faculty of Medicine, King abdulaziz University, Jeddah, Saudi Arabia.+Faculty of Medicine, Ain Shams University, Cairo, Egypt.Sherif MHassanAnatomy and histology department, Faculty of medicine, King abdulaziz University, Jeddah, Saudi 3 Arabia.+Anatomy department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.Journal Article20210428Background: Acute renal and cardiac diseases are common encounters in hospitalized and non-hospitalized patients. Kidney and heart pathology are continuously interrelated. The impact of acute kidney injury (AKI) on the cardiac function is demonstrated in both preclinical and clinical studies and is termed cardio-renal syndrome type 3.<br />Aim of the work: The aim of this work is to establish an animal model of cardio-renal syndrome type 3, and to study the effect of glucagon-like peptide-1 receptor (GLP-1R) agonist “liraglutide” on this condition.<br />Materials and methods: Sixty male Wistar rats were used in this study and were divided into six groups (10 per group). Group 1: control, Group 2: low dose liraglutide-treated rats(L-lira). Group 3: high dose liraglutide-treated rats (H-lira). Group 4: Gentamicin (GM) treated rats. Group 5: low dose liraglutide- and GM-treated rats (L-lira-GM). Group 6: high dose liraglutide- and GM-treated rats (H-lira-GM). Liraglutide was given daily by subcutaneous injection for three weeks. GM was injected intraperitoneally (IP) starting from day 15 to day 21.<br />Results: GM treatment was associated with histopathological injuries of both renal and cardiac tissues, in addition to significant elevation of renal biomarkers (serum urea and creatinine) as well as cardiac biomarkers (cardiac troponin I (TnI), creatine kinase (CK-MB) and lactate dehydrogenase (LDH). ECG showed prolongation of QRS complex, Q-T and Q-Tc interval, in addition to increased T wave voltage. There was significant increase in the relative weight of the right ventricle and the absolute and relative weights of left ventricles and the whole heart of the GM group. Moreover, GM injection resulted in a significant increase in oxidative and inflammatory markers (MDA, NO, IL-1beta, IL-6 and TNF-α) and diminished antioxidants GSH, SOD, and catalase, in the serum as well as in renal and cardiac tissues. GLP-1R agonist administration before GM injection normalized all the measured parameters only in the high dose group. Liraglutide evidently prevented upregulation of the inducible nitric oxide synthase (iNOS) gene expression in both renal and cardiac tissue of GM-treated animals.<br />Conclusion: GM injected rats exhibited renal and cardiac structural and functional damage. The GLP-1R agonist, liraglutide protects both the kidney and the heart through antioxidant and anti-inflammatory effects. In addition, it downregulates the iNOS expression in renal and cardiac tissues, thus decreasing production of nitric oxide (NO).https://asmj.journals.ekb.eg/article_167313_9312c895f9df4458e35e67e20e06a2be.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301COMPARATIVE STUDY BETWEEN INTRAMEDULLARY FIXATION AND ARTHROPLASTY FOR THE MANAGEMENT OF UNSTABLE TROCHANTERIC FRACTURE IN ELDERLY293916731510.21608/asmj.2021.167315ENIbrahimEl GanzouryOrthopedic Surgery Department, Faculty of Medicine, Ain Shams University, Egypt.OsamaFaragOrthopedic Surgery Department, Faculty of Medicine, Ain Shams University, Egypt.AmrAhmedOrthopedic Surgery Department, Faculty of Medicine, Ain Shams University, Egypt.AhmadSalemOrthopedic Surgery Department, Faculty of Medicine, Ain Shams University, Egypt.David GergisRadyOrthopedic Surgery Department, Nasr City Hospital, Egypt.Journal Article20210428Background: Intertrochanteric fractures involve those occurring in the region extending from the extra capsular basilar neck region to the region along the lesser trochanter proximal to the development of the medullary canal, these fractures account for forty percent of proximal femoral fractures in elderly.<br />Aim of the Work: is to compare intramedullary fixation and hip arthroplasty in treatment of unstable trochanteric fracture in elderly in terms of surgical techniques, clinical and radiological outcome, complications, functional outcome and patient satisfaction.<br />Patients and Methods: The thesis is a prospective comparative randomized study between PFN and Hemiarthroplasty for the treatment of unstable trochanteric fractures in elderly. Patients were followed up at 1, 3, 6, 12 month postoperative, clinical and radiological data collected and documented starting from perioperative data (operative time, blood loss, transfusion).<br />Results: We compared intramedullary fixation and hip arthroplasty in treatment of unstable, comminuted trochanteric fracture in elderly in terms of surgical techniques, clinical and radiological outcome, complications, functional outcome. We did our best to execute it in an objective unbiased scientific manner by allocating patients randomly into two groups using closed opaque envelops. This was confirmed by the mean personal data (Age, sex), side of the fracture, pre-existing comorbidities, and fracture type according to AO classification, both groups were comparable, with no significant difference. Comparison of operative data showed significant difference in operative time, mean operative time was [78.4 min for group 1 Vs 112.6 min for group 2], favoring group 1 as less operative time.<br />Conclusion: Hemiarthroplasty could be valid option in management of unstable trochanteric fractures in elderly, giving the advantage of early full weight bearing, yet it is more technically demanding, require higher surgical experience.https://asmj.journals.ekb.eg/article_167315_6a3cc1f2f4843dc1ece6b7fcce3c1970.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301DETECTION OF CALR EXON 9MUTATIONS IN EGYPTIAN PATIENTS WITH PERSISTENT THROMBOCYTOSIS414816732010.21608/asmj.2021.167320ENDalia AhmedEl-SewefyClinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Gehan MostafaHamedClinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Yasmin NabilElsakhawyClinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Doha OsamaAbdulrahmanClinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Journal Article20210428Background: Thrombocytosis is a commonly encountered clinical scenario, with a large proportion of cases discovered incidentally when complete blood count is obtained for some unrelated reason, creating an important diagnostic challenge.<br />Aim of the Work: To evaluate the diagnostic and prognostic value of CALR mutations testing in patients with persistent thrombocytosis, and study the relation of thismutations with clinical and hematological parameters.<br />Patients and Methods: The present study included fifty patients with persistent thrombocytosis (platelet count > 450×109/L) for at least 3 months. All subjects were genotyped for the CALR gene using high resolution melting PCR (HRM-PCR) technique. The study was approved by the Research Ethics Committee of Ain Shams University.<br />Results: The present study revealed that CALR gene mutations are positive in one-third of cases with 1ry thrombocytosis. The mutations are associated with younger age males with higher platelet count, lower hemoglobin level and lower total leucocytic count (TLC) than CALR wild type counterparts.<br />Conclusion: The present study revealed that CALRexon 9 mutations can influence the clinical and hematological phenotype of the patient and hence the disease diagnosis and prognosis.https://asmj.journals.ekb.eg/article_167320_89992fe803a478152687bfef34eadd78.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301AMINOPHYLLINE VERSUS ACETAMINOPHEN IN THE TREATMENT OF POST-DURAL PUNCTURE HEADACHE495816732410.21608/asmj.2021.167324ENAhmed A.FawazDepartment of Anaesthesiology, Intensive Care and Pain Management Faculty of Medicine Ain Shams University , Cairo, Egypt.Hanaa A.El-GendyDepartment of Anaesthesiology, Intensive Care and Pain Management Faculty of Medicine Ain Shams University , Cairo, Egypt.Ashraf N.SalehDepartment of Anaesthesiology, Intensive Care and Pain Management Faculty of Medicine Ain Shams University , Cairo, Egypt.Mahmoud E.Fath-AllahDepartment of Anaesthesiology, Intensive Care and Pain Management Faculty of Medicine Ain Shams University , Cairo, Egypt.Journal Article20210428Background: Post-dural puncture headache (PDPH) is one of the most common complications of lumbar punctures performed for spinal anaesthesia, neurologic investigation or inadvertent Dural puncture during Epidural anaesthesia. Despite acceptance of the postulated cause of CSF leakage and intracranial hypotension, the exact mechanism of developing PDPH is not clear. Many pharmacological options have been advocated as a therapy for PDPH with a varying degree of success, but problem in choosing main drug therapy is the lack of large randomized controlled trials proving efficacy and safety.<br />Aim of the Work: To compare the efficacy of aminophylline compared to acetaminophen in management of PDPH.<br />Patients and Methods: The current clinical trial included 70 patients aged between 18-40 years old, class I-II according to the American society of anaesthesiology having a headache that developed after Dural puncture for various surgical procedures under regional anaesthesia. Patients were randomly allocated into 2 groups (35 patients each). Patients in the study Group (A) received 250 mg Aminophylline IV infusion while patients in Group (B) received 1gm paracetamol IV infusion for management of PDPH. Baseline VAS scores were recorded before drug administration &at 2 hours, 6 hours and 12 hours after the treatment administration.<br />Results: Mean VAS scores for PDPH intensity were statistically significant lower in Group A compared to Group B at 2 hours, 6 hours & 12 hours, while baseline VAS Score for PDPH intensity was insignificant statistically between Both Groups. There was also statistically significant improvement in Group A compared to Group B according to the Patient Global impression of change (PGIC) between both groups.<br />Conclusion: IV injection of aminophylline is relatively straightforward and non-invasive, safe and effective treatment for PDPH, and has improved early-stage effectiveness.https://asmj.journals.ekb.eg/article_167324_bde9e997176e9d320659a3d545037958.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301ADJACENT SEGMENT DEGENERATION AFTER ANTERIOR CERVICAL DISCECTOMY AND FUSION , ASYSTEMATIC REVIEW AND META-ANALYSIS597016732810.21608/asmj.2021.167328ENFady MichealFahmyDepartment of Orthopaedic Surgery, Faculty of Medicine Ain Shams University, Egypt.Abdel RadyMahmoudDepartment of Orthopaedic Surgery, Faculty of Medicine Ain Shams University, Egypt.Sayed Saied El-SayedEl GhazawyOrthopaedic Resident at El Salam Specialized Hospital, Cairo, Egypt.Journal Article20210428Background: Anterior cervical discectomy and fusion (ACDF), is commonly used for treatment of degenerative cervical spondylotic radiculopathy and myelopathy, and satisfactory out-comes have been reported in many studies. However, subsequent disc degeneration at levels adjacent to the fusion remains an important problem.<br />Aim of the Work: To perform a systematic review and meta-analysis to evaluate incidence, risk factors, and impact of radiographic and clinical postoperative adjacent segment degeneration (ASD) following anterior decompression and instrumented fusion.<br />Method: Medline databases (PubMed, Medscape, Science Direct. EMF-Portal) and all materials available in the Internet till 2020.<br />Data Extraction: If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.<br />Conclusion: If the former is true, index ACDF procedures may be adjusted to include additional levels now identified as higher risk.<br />If the latter is true, motion preserving treatments such as CDR may gain more traction. This review illuminates the heterogeneous methodology of the literature on ASDeg and ASDz after ACDF and the paucity of high-quality data published on these phenomena. Standardized methodology for radiographic evaluation of ASDeg and clinical outcome measures for ASDz are critical before the fundamental question on their etiology can be resolved.https://asmj.journals.ekb.eg/article_167328_18adf78658dd87bc20218632a71ba1c2.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301TRANSTIBIAL VERSUS INDEPENDENT FEMORAL TUNNEL DRILLING TECHNIQUES FOR ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION EVALUATION OF FEMORAL APERTURE POSITIONING718516734510.21608/asmj.2021.167345ENMagedAbouelsoudDepartment of Orthopaedic Surgery, Faculty of Medicine - Ain Shams University, Cairo, Egypt.Haitham KamelHarounDepartment of Orthopaedic Surgery, Faculty of Medicine - Ain Shams University, Cairo, Egypt.Mohamed RezkAllamDepartment of Orthopaedic Surgery, Faculty of Medicine - Ain Shams University, Cairo, Egypt.Journal Article20210428Background: Although numerous clinical and cadaveric studies have compared transtibial (TT) versus tibial independent (TI) either anteromedial (AM) portal or Outside-in (OI) drilling techniques regarding anatomic femoral tunnel aperture placement in single bundle anterior cruciate ligament reconstruction (ACLR), there is no consensus on which technique offers the best anatomic position according to footprint position.<br />Aim of the Work: The aim of this study is to conduct a systematic review and meta-analysis for studies comparing the anatomical position of femoral tunnel aperture in single bundle ACLR using TI and TT techniques. Methods: (PubMed, Cochrane library and Google Scholar) were searched for relative studies that evaluated femoral tunnel aperture position in patients and cadavers underwent arthroscopic single bundle ACLR. Meta-analyses were performed to pool 28 studies included in 15 outcomes measuring femoral tunnel aperture position by estimating the mean differences and their 95% confidence intervals from mean and standard deviation for each study. Results: 48 clinical and cadaveric studies compared femoral tunnel aperture position between TT and TI (AM and OI) techniques were obtained for final research. In these studies, 2384 clinical and cadaveric knees underwent arthroscopic single bundle ACLR, we qualitatively assessed the femoral aperture position in all 48 studies showing that the difference between TI and TT was non significant except in the direction perpendicular to Blumensaat's line (BL), but with low mean difference and anteroposterior (AP) anatomical axis. Conclusions: There was non-significant difference between TI and TT technique regarding placing femoral aperture position closer to footprint position. There was non-significant difference in femoral aperture sagittal plane position along BL or along (proximal-distal) PD axis. Regarding femoral aperture coronal plane placement in the axis perpendicular to BL; modified TT technique improved the femoral aperture position in this axis. While regarding femoral aperture placement in the anteroposterior (AP) anatomical axis; TI technique placed femoral aperture significantly more posterior than TT technique, this was proper position regarding anatomic ACLR, while according to the recent concept of ACL femoral footprint, this might be improper position."https://asmj.journals.ekb.eg/article_167345_df2ed9c707e4a03270b0a705d3420a48.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301THE RISK OF CEREBRAL MICROBLEEDS IN ISCHEMIC STROKE PATIENTS USING ANTIPLATELET THERAPIES879516735010.21608/asmj.2021.167350ENMagd FouadZakariaDepartment of Neurology, Faculty of Medicine- Ain Shams University, Egypt.Azza AbdelnasserAbdelazizDepartment of Neurology, Faculty of Medicine- Ain Shams University, Egypt.Yosra AbdelzaherAbdullahDepartment of Radiodiagnosis, Faculty of Medicine- Ain Shams University, Egypt.Haitham HamdySalemDepartment of Neurology, Ain Shams University, Egypt.Mohammed AmirTorkDepartment of Neurology, Ain Shams University, Egypt.Nabil NasifSaberDepartment of Neurology, Agouza Police Hospital, Cairo, Egypt.Journal Article20210428Background: Interest in cerebral microbleeds (CMBs) has increased based on advances in magnetic resonance imaging (MRI) technology. Both MRI T2-weighted gradient-echo (GRE) and susceptibility-weighted imaging may be sensitive techniques for the detection of past and more recent brain hemorrhage. The prevalence of CMBs in healthy population ranges 3.7–7.7%, whereas in patients with intracerebral hemorrhage is thought to be around 60%.<br />Objective: To evaluate the prevalence and possible risk of microbleeds among patients with ischemic stroke using antiplatelets (Aps).<br />Patients and Methods: The observational hospital-based cross-sectional analytical study involved 150 consecutive patients with ischemic stroke (recent or old ischemic strokes or both), from inpatients of neurology departments of Ain Shams University Hospital and Agouza Police Hospital for a period of 15 months from April 2018 to June 2019.<br />Results: Cerebral microbleeds were present in 13 patients representing 26% of the no AP group, 16 patients representing 32% of the single AP group and 19 patients representing 38% of the double AP group, there was no statistically significant difference between the three groups of patients. Cerebral microbleeds were present in 60% of patients on double APs and 37.5% of patient on single AP for more than two years, compared to 23.3%and 26.9%for the two groups respectively on APs for less than two years, In the current study we found that the significant risk factor for the presence of CMBs was the duration of APs use. There was no statistically significant difference in the laboratory data (including full lipid profile, HbA1c and platelet count) between the three groups.<br />Conclusion: CMBs are significantly associated with long term use of antiplatelets, so careful clinical and radiological follow up of ischemic stroke patients with CMBs using antiplatelets for risk of future intracranial hemorrhage.https://asmj.journals.ekb.eg/article_167350_d801f83a6d3c7f67d9321b9571d15d80.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301ASSESSMENT OF BALANCE FUNCTIONS AND PRIMITIVE REFLEXES IN CHILDREN WITH LEARNING DISABILITY9710316735710.21608/asmj.2021.167357ENNagwaHazzaaAudiology Unit, ORL Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.AmanyShalabyAudiology Unit, ORL Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.SaharHassaneinPediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.FathyNaeemAudiology Unit, ORL Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.AhmedKhattabPhoniatrics Unit, ORL Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.NancyMetwallyAbou El-Monagga central Hospital, Cairo, Egypt.Journal Article20210428Background: Persistence of primary reflexes can indicate poor neurological development and immaturity within the nervous system. As dyslexia is a neurodevelopmental disorder that involves more than just reading difficulties so it’s important to investigate primitive reflexes and balance functions in dyslexics. Aim of the Work: To assess balance functions, primitive reflexes in dyslexics. Subjects and Methods: The present study was conducted on 60 children divided into two subgroups. Control group consists of 20 normal children and study group consists of 40 children with dyslexia (diagnosed by Arabic Reading Screening test (ARST) and Modified Arabic Dyslexia Screening Test (MADST). Both study and control groups aged from 6 6/12 to 9 years old. They were subjected to clinical diagnostic tests for primitive reflexes and balance office tests (Romberg, unilateral stance, Fukuda stepping test, modified clinical test of sensory interaction in balance (mCTSIB). Results: The study group demonstrated poor balance measured with unilateral stance compared to control group. Sixty percent of the study group has retained primitive reflexes. Conclusions: Dyslexic children have poor balance compared to normal children and they have retained primitive reflexes supporting poor neurological development. Assessment of balance functions is recommended to be included within the test battery of dyslexics for better quality of life.https://asmj.journals.ekb.eg/article_167357_2c17329da4964e94dc67bd2ba90ceac8.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301LEFT VENTRICULAR ASSIST DEVICE THERAPY IN HEART FAILURE: A META-ANALYSIS10511816736310.21608/asmj.2021.167363ENAhmed Baheig HosnyEl KerdanyCardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University, Egypt.Hany Abd El MaaboodMetwallyCardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University, Egypt.Ramy Mohamed RedaKhorshidCardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University, Egypt.Sandy YasserEsmaielCardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University, Egypt.+Heliopolis Hospital, Mabart Masr Al-Qadima Hospital (curative institution).Journal Article20210428Background: The current treatment options available for end-stage heart failure include heart transplantation (HTx) and left ventricular assist devices (LVADs). Despite comparable efficacy and safety profiles, the reliability of LVAD therapy as an alternative to the standard HTx still controversial. Moreover, the choice among different LVADs types in candidate patients is unclear.<br />Aim of the Work: To compare HTx vs LVADs in adult end stage heart failure population, evaluate destination therapy (DT) vs bridge to therapy (BTT) as indications for LVADS, and characterizes individual safety profiles for commercially available LVADs including Heart Ware, Heart Mate II, and Heart Mate III.<br />Patients and Methods: A systematic search of Egyptian knowledge bank (EKB), PubMed, and Cochrane databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four types of comparisons were set in the current analysis: HTx vs LVADs, DT vs BTT, Heart Ware vs Heart Mate II, and Heart Mate II vs Heart Mate III. The primary endpoint assessed was the all-cause mortality. Secondary endpoints were the complication rates relevant to either modality including organ failure, infection rates and device related complications (for LVADs only).<br />Results: The present study systemically analyzed 6734 patients derived from 12 studies including 10 observational and 2 randomized controlled trials (RCTs). Comparing HTx to LVAD, there were no significant differences between both modalities regarding mortality, stroke, infection, bleeding, hospital readmission, and renal failure. However, HTx demonstrated significantly higher right ventricular failure (RVF) rates (P = 0.005). When comparing DT vs BTT indications, non-significant differences were found regarding the rates of mortality, infection, bleeding, RVF, and device malfunction. Nevertheless, significantly lower rates of stroke were demonstrated with BTT (P = 0.02). Comparison between different LVADs demonstrated significantly higher rates VAD infections (P = 0.03), neurological complications (P <0.001), and RVF in Heart Ware compared to Heart Mate II. Conversely, Heart Mate III demonstrated significantly lower rates of stroke (P = 0.02) and device malfunction (P< 0.001) compared to Heart Mate II.<br />Conclusion: The findings of this meta-analysis indicate that LVAD may serve as a potential alternative to heart transplantation in patients with end-stage heart failure.https://asmj.journals.ekb.eg/article_167363_47cab64f0d43c65bf16bfb6d3ffe9cb5.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301POST-EXTUBATION SORE THROAT; HOW FAR NEBULIZ11912716736410.21608/asmj.2021.167364ENGihan Seif El NasrMohamedAnesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University, Egypt.Hanan MahmoudFaragAnesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University, Egypt.Raham HasanMostafaAnesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University, Egypt.Soaad Mostafa MohammedAlyAnesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Ain Shams University, Egypt.+Tahrir General Hospital, Ministry of Health, Cairo, Egypt.Journal Article20210428Background: Post-operative sore throat (POST) is a frequent complaint that occurs in 21–65% of patients receiving general anes-thesia (GA) with endotracheal intubation. Effective prevention of postoperative sore throat is thus needed. The inhaled corticosteroids deliver the drug to the site of action without systemic effects. Dexame-thasone is a potent synthetic glucocorticoid with anti-inflammatory ef-fects.<br />Aim of work: To assess how far nebulized dexamethasone de-creases the incidence of POST and hoarseness of voice.<br />Patients and Methods: This double blinded double armed placebo controlled randomized clinical trial was conducted on 60 people divided into 2 groups; Group D: 30 patients received dexamethasone 8 mg in 5 ml normal saline nebulized 15 minutes before general anesthesia and en-dotracheal intubation. Group S: 30 patients received 5 ml normal saline nebulization 15 minutes before general anesthesia and endotracheal in-tubation.<br />Results: Patients’ characteristics (age, sex, weight, ASA and Mal-lampati classification), duration of surgery, type of surgery, intuba-tion attempts and site of endotracheal tube shows non-significant dif-ference between both groups. Peri-nebulization hemodynamics, shows non-significant difference between both groups as regards heart rate and mean arterial blood pressure at all examined timings.<br />Conclusions: In our study the incidence of POST was 2 (6.7) which mean that the pre-operative single dose of nebulized dexame-thasone 8 mg effectively can attenuates the incidence and severity of POST following GA with endotracheal intubation.https://asmj.journals.ekb.eg/article_167364_b1538df24667a16f5c6a88506cb94d0c.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301VNG FINDINGS IN PATIENTS WITH AGE RELATED ISCHEMIC CHANGES.12913716736710.21608/asmj.2021.167367ENNagwa Mohamed Abd El-MonemHazzaaAudiology Unit, Department of Otolaryngeology, Ain Shams University, Egypt.Noha AliShafikAudiology Unit, Department of Otolaryngeology, Ain Shams University, Egypt.Aya Yassin AhmedMohamedRadiology Department, Ain Shams University, Egypt.Amany MohamedAbo El-KhairAudiology resident, ENT Department, Ahmed Maher teaching hospital, Egypt.Journal Article20210428Background: Older people develop gait and balance dysfunction that is associated with gradual onset of cerebral white matter disease. The term cerebral small vessel disease refers to a group of pathological processes with various etiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. White matter disease is easily detected by neuroimaging, whereas small vessels are not, hence the term small vessel disease is frequently used to describe the parenchyma lesions rather than the underlying small vessel alterations.<br />Aim of the work: To investigate the relationship between presence and/or absence of white matter disease identified on magnetic resonance imaging with the vestibular findings in elderly patients with dizziness.<br />Patients and Method: Study population: 30 elderly patients complaining of dizziness & / or instability. Inclusion criteria: Patients above 55 years old with history of vertigo & / or instability. Exclusion criteria: 1- Meniere’s disease. 2- Bilateral vestibulopathy. 3- Recent vestibular neuritis or labyrinthitis. 4- History of head trauma or surgery. 5- Neurological diseases as (Intracranial space occupying lesions, Multiple Sclerosis, Parkinsonism, Paresis). 6- Patients with otologic history of otorrhea or Ear surgery. Study Procedure: 1- Full history taking. 2- Otological examination. 3- Hearing assessment. 4- Immittancemetry. 5- Video-nystagmography test (VNG). 6- Magnetic resonance imaging (MRI) & Magnetic resonance angiography (MRA) “Stroke protocol”.<br />Results: Abnormal VNG test results were significantly higher in patients with atherosclerotic changes (0.04). The most common VNG finding was positional nystagmus.<br />Conclusion: Presence of risk factors for white matter disease (WMD) in elderly patients as hypertension, diabetes mellitus, ischemic heart disease, hyperlipidemia and migraine is an indication for requesting further radiological assessment. The most frequent VNG abnormality in elderly patients with WMD is positional & positioning nystagmus. Presence of atherosclerotic changes is significantly related to presence of VNG test abnormality.https://asmj.journals.ekb.eg/article_167367_fbf1ef966bb3ea385912768636d2974b.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301LEVOSEMINDAN VERSUS INTRA-AORTIC BALLOON PUMP IN LOW EJECTION FRACTION CABG PATIENTS13915016736910.21608/asmj.2021.167369ENShereif Elsayed SolimanAzzabCardiothoracic Surgery, Faculty of Medicine Ain Shams University, Egypt.Yasser MahmoudElnahasCardiothoracic Surgery, Faculty of Medicine Ain Shams University, Egypt.Ibrahim ShawkyElkelanyCardiothoracic Surgery, Faculty of Medicine Ain Shams University, Egypt.Ahmed Mohamed Abd El-SalamMoharmNasser Institute for research and treatment, Ministry of Health, Cairo, Egypt.Journal Article20210428Background: Preoperative left ventricular dysfunction is an independent risk factor for perioperative mortality and morbidity and is also associated with postoperative low cardiac output syndrome. IABP improved outcomes in high-risk cardiac patients. However, installation of the balloon has many disadvantages. Recently, a new drug named Levosimendan is commonly used as an inotropic support. it does not increase oxygen demand of myocardium.<br />Aim of the work: The purpose of our study was to compare the efficiency of levosimendan versus intra-aortic balloon pump in patients with poor left ventricular function undergoing coronary artery bypass grafting (CABG) with ejection fraction less than 35%.<br />Patients and Methods: sixty patients were randomized into 2 groups, according to the treatment they received - either levosimendan (Group A) or intra-aortic balloon counter pulsation (Group B). and compared with respect to The use of inotropic drugs, weaning from CPB, Hemodynamics, transfusion requirements, ICU stay, hospital stay and in-hospital mortality.<br />Results: There were no differences in preoperative characteristics including patients’ age, sex, BMI, and comorbidities. The Levosemindan group had reduced transfusion requirements and shorter ICU stay as compared to IABP group.<br />Conclusion: levosimendan infusion after induction of anesthesia is a good choice with an acceptable option in comparison to IABP. The use of levosimendan in high-risk cardiac patients is comparable to IABP in improving hemodynamics during and after conventional on-pump CABG and results in a shorter ICU stay.https://asmj.journals.ekb.eg/article_167369_90b343f562a8ca3a86296227ca14fa9f.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301LOCAL VANCOMYCIN IN PREVENTION OF SURGICAL SITE INFECTION IN SPINAL SURGERIES15316316737010.21608/asmj.2021.167370ENHany NabilEl ZahlawyOrthopaedic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Zakaria HassanIbrahimOrthopaedic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Gadallah HelalGadallahOrthopaedic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Journal Article20210428Background: SSIs can lead to greater post-operative morbidity, mortality and healthcare costs. Despite current prophylactic measures, SSIs is still being reported in patients undergoing spine surgery. Local application of vancomycin in spine surgery is a low-cost strategy to help reduce SSIs as it is active against pathogens which might contaminate the wound during spinal surgery.<br />Aim of the Work: A systematic review discussing the effect of Local vancomycin in prevention of surgical site in spinal surgeries.<br />Patients and Methods: Literature search and filtration on intra- wound application of vancomycin in spinal surgeries yielded 9 studies with a total of 46,907 patients.<br />Results: Review of the enrolled studies confirmed that intra-wound vancomycin use appears to be safe and effective for reducing postoperative SSIs in spinal surgeries with a low rate of adverse events. However, these studies use different definitions for surgical site infections and different pre-, peri- and postoperative antibiotic regimens. That is why intra wound application of vancomycin in spinal surgeries is recommended to reduce postoperative SSIs and further studies using standardized protocols are needed to confirm findings of the current study.<br />Conclusion: The different follow-up periods, particularly for patients with short-term follow up, may underestimate the incidence of SSIs and adverse events especially in the vancomycin group.https://asmj.journals.ekb.eg/article_167370_59da4bba033412a528fa9d04a9105c9a.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301ACCURACY OF RANDHAWA AND PUJAHARI PREOPERATIVE SCORING SYSTEM IN PREDICTION OF DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY IN EGYPTIAN POPULATION16317116737310.21608/asmj.2021.167373ENAhmed MohamedKamalGeneral Surgery Department, Faculty of Medicine, Ain Shams University, Egypt.Mohamed Mahmoud El-SaidEl-MataryGeneral Surgery Department, Faculty of Medicine, Ain Shams University, Egypt.Ehab Mohamed AliFadlGeneral Surgery Department, Faculty of Medicine, Ain Shams University, Egypt.Nabil Sami SadekGebrilGeneral Surgery Department, Faculty of Medicine, Ain Shams University, Egypt.+Police authority Hospital, Cairo, Egypt.Journal Article20210428Background: Laparoscopic cholecystectomy is the procedure of choice for management of symptomatic gallstone disease and one of the most commonly performed operations by general surgeons. Sometimes, it is difficult and takes longer time or has to be converted to an open procedure due to various difficulties faced while performing the procedure.<br />Aim of the Work: To evaluate the accuracy of Randhawa and Pujahari preoperative scoring system in prediction of difficult laparoscopic cholecystectomy in Egyptian population.<br />Patients and Methods: This is a prospective observational study that has been conducted in department of general surgery, Ain Shams University hospitals, including (60) patients undergoing elective laparoscopic cholecystectomy for symptomatic gall stones disease. The scoring system used was of Randhawa and Pujahari, based on history, clinical examination and radiological finding.<br />Results: Showed that the scoring system is reliable to be used in Egyptian patient with sensitivity 77.78 % and specificity 95.12 %.<br />Conclusion: Ranhawa and Pujahari scoring system are reliable and could be used in Egyptian patients undergoing elective laparoscopic cholecystectomy. This scoring system can help each of patients, surgeons and trainers. With the help of accurate prediction, high risk patient may be informed before operation and hence they may have a chance to make arrangements accordingly. On the other hand, surgeons also may have to schedule the time and team for the operation appropriately.https://asmj.journals.ekb.eg/article_167373_344157055d72b67bfbb3c4b765366931.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301ACCURACY OF MULTI-SLICE 3D-DOPPLER IN DIAGNOSIS OF MORBIDLY ADHERENT PLACENTA IN COMPARISON WITH 2D-DOPPLER17318216737410.21608/asmj.2021.167374ENWalid E.M.KhalilObstetrics & Gynaecology Department, Faculty of Medicine - Ain Shams University Cairo, Egypt.Mortada E.A.Abdel-RahmanObstetrics & Gynaecology Department, Faculty of Medicine - Ain Shams University Cairo, Egypt.Omnia B.BFaragObstetrics & Gynaecology Department, Faculty of Medicine - Ain Shams University Cairo, Egypt.Sahar M. A.SaberObstetrics & Gynaecology Department, Faculty of Medicine - Ain Shams University Cairo, Egypt.Journal Article20210428Background: Morbidly adherent placenta can be diagnosed prenatally by different modalities. 2D, 3D multi-slice Doppler ultrasound and MRI have emerging roles in prenatal diagnosis of morbidly adherent placenta, but histopathological diagnosis is the gold standard.<br />Aim of the work: To detect the accuracy of multi-slice 3D Doppler ultrasound over 2D-Doppler in diagnosis of placenta accreta in relation to postpartum histopathology and intrapartum findings.<br />Patients and Methods: This study was conducted at Ain shams university maternity hospital during the period between March 2020 and September 2020. A total of 50 pregnant women having placenta Previa were included in the study. Patients were included in the study according to the following criteria: Pregnant women with history of previous cesarean section or hysterotomy, placenta previa with its lower edge covering the scar of previous cesarean section, From 28 wks – Full term.<br />Each patient was scanned in a systematic fashion by 2D ultrasonography, 2D-Doppler, Multislice 3D-Doppler preoperatively and results were compared with histopathological examination postoperatively.<br />Results: Crowded vessels over peripheral sub-placental zone had the highest diagnostic characteristics among multislice 3D Doppler signs in diagnosis of placental invasion compared with postoperative histopathology with (sensitivity 95.2%, specificity 93.1%, PPV 90.9%, NPV96.4%, LR 270.00).<br />Hyper vascularity of serosa–bladder interface had the highest diagnostic characteristics among 2D Doppler ultrasonography signs in the diagnosis of placental invasion compared with postoperative histopathology with (sensitivity 90.5%, specificity 89.7%, PPV 86.4%, NPV 92.9%, LR 82.33).<br />Conclusion: Multi-slice 3D Doppler ultrasound is more accurate than 2D ultrasound in diagnosis of placenta accrete and degree of adherence in relation to postpartum histopathology and intrapartum findings.https://asmj.journals.ekb.eg/article_167374_099d8dead198850dd39681b84dba6a2e.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301LAPAROSCOPIC SLEEVE GASTRECTOMY WITH LOOP BIPARTITION MORE PHYSIOLOGICAL TECHNIQUE: ONE YEAR EXPERIENCE18319416737610.21608/asmj.2021.167376ENMohamed K.ManseyDepartment of General Surgery Faculty of Medicine, Ain Shams University, Cairo, Egypt.Ahmed E.MoradDepartment of General Surgery Faculty of Medicine, Ain Shams University, Cairo, Egypt.Karim S.Abd El SameeDepartment of General Surgery Faculty of Medicine, Ain Shams University, Cairo, Egypt.Hossam G.RadwanDepartment of General Surgery Faculty of Medicine, Ain Shams University, Cairo, Egypt.+Specialist of general surgery at mokattum health insurance hospital. Cairo, Egypt.Journal Article20210428Background: Overweight and obesity were estimated to cause 3.4 million deaths, 3.9% of years of life lost, and 3.8% of disability-adjusted life-years (DALYs) worldwide. Bariatric surgery is the most effective modality for long-term weight loss and for resolving the associated comorbidities. However, controversies exist regarding the ideal weight loss metabolic procedure. This allowed continuous search for new techniques.<br />Aim of the work: to evaluate short-term outcomes and associated complications of laparoscopic sleeve gastrectomy with loop bipartition.<br />Patients and Methods: The present study was conducted on fifteen patients who met the National Institute of Health criteria for bariatric surgery. These patients were enrolled in a prospective study at Ain-Shams University Hospitals from December 2015 to May 2017) and they underwent laparoscopic sleeve gastrectomy with loop bipartition. Preoperative work up included full history, full clinical examination, abdominal ultrasonography, biochemical labs. Procedure was performed by laparoscopic approach.<br />Results: excess weight loss percentage at 6 months, 12 months respectively was 67%, 92%. This results were very comparable to mahdy et al. and santoro et al. Sleeve gastrectomy with loop bipartition comorbidities related outcomes were complete remission of 66% in T2DM, 71% in HTN, 100% others comorbidities and another studies for bipartition reached more than 90% in T2DM, 80% in HTN, 85% others comorbidities. In our study we recorded that Sleeve gastrectomy with loop bipartition has strong impact on resolution of comorbidities in comparison with BPD, DS, RYGB.<br />Conclusion: Sleeve gastrectomy with loop bipartition is a new promising procedure that based on a new paradigm of helping GI facing and adapting to the modern diet without adding new morbidities with precise adsjusting of the neurohormonal aspects. Preliminary results points to potent simple safe procedure in treating obesity and metabolic syndrome.https://asmj.journals.ekb.eg/article_167376_d42fa57c984e76b057952f35b8a4d447.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301PSYCHOPATHOLOGY IN OFFSPRING OF PARENTS WITH BIPOLAR DISORDER IN AN EGYPTIAN SAMPLE19520416737710.21608/asmj.2021.167377ENSafeya MahmoudEffatInstitute of Psychiatry, The WHO Collaborating Center for Mental Health Research and Training, Ain Shams University, Department of Neuropsychiatry, Cairo, Egypt.Nahla ElsayedNagyInstitute of Psychiatry, The WHO Collaborating Center for Mental Health Research and Training, Ain Shams University, Department of Neuropsychiatry, Cairo, Egypt.Dalia Abdel MoneimMahmoudInstitute of Psychiatry, The WHO Collaborating Center for Mental Health Research and Training, Ain Shams University, Department of Neuropsychiatry, Cairo, Egypt.Asmaa Abdelwahab EissaAhmedAbbasseyia Mental health hospital, 1 salah salem street, Cairo, Egypt.Journal Article20210428Background: Offspring of parents with Bipolar affective disorder are at risk for a spectrum of future psychiatric disorders. Although the link between family functioning and children’s development remained well-established, there is a small research examining whether family factors play a role in helping children with behavior problems outgrow their difficulties.<br />Aim of the work: The current study was to identify the risk factors that contributes to the development of psychiatric morbidity, to identify the nature of psychiatric morbidity that affects these children. Patients and methods: A sample consist of 200 participants was recruited and divided into 100 offspring of parents diagnosed with bipolar affective disorder using SCID-I, patients were selected from either new or follow up cases, who were attending the outpatient clinics, psychiatry department, Ain Shams University Hospitals) And 100 offspring of parents with irrelevant psychiatric history. Children were also evaluated by The Child Behavior Checklist (CBCL) to screen for psychopathology.<br />Results: offspring of parents with Bipolar affective disorder are at increased risk of developing a wide range of psychiatric disorders and accompanying dysfunction than offspring of healthy or non-BP parents. the most prevalent behavior among cases was attention problems 75%, aggression 63%, social problem 48% Conclusion: These findings demonstrated the Offspring of BD are at significantly higher risk of developing a broad range of affective and non-affective psychopathology when compared to control offspring.https://asmj.journals.ekb.eg/article_167377_9f259390c4de2504b8d2f279e57b43a4.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301DEVELOPMENT OF LEXICAL SEMANTIC AMONG PRESCHOOL EGYPTIAN ARABIC-SPEAKING CHILDREN20521516738010.21608/asmj.2021.167380ENDina M.Abd El MoneimPhoniatrics Unit, Otorhino-laryngology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Hassan H.GhandourPhoniatrics Unit, Otorhino-laryngology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Dina A.ElrefaiePhoniatrics Unit, Otorhino-laryngology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Mona S.KhodeirPhoniatrics Unit, Otorhino-laryngology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.0000-0003-3178-7777Journal Article20210428Background: Lexical-semantic development for preschool children has several applications in research design, assessment, and intervention that were very difficult to obtain before. In English and most Indo-European languages, there is a long tradition of examining aspects of child language by computing different developmental indices from spontaneous language samples and through applying different language tests. However, for the Arabic language, these aspects are lacking in this valuable area of research. Bridging this gap, this work provided the first comprehensive study of the Arabic language lexical-semantic development among preschool Egyptian Arabic speaking children.<br />Aim of the work: to provide a descriptive profile of the lexical-semantic development among the preschool Egyptian Arabic-speaking children.<br />Subjects and methods: This is a descriptive cross-sectional study conducted on 120 typically developed Egyptian Arabic-speaking children. Children were randomly selected by inclusion and exclusion criteria in the age range between 2-4 years. Children were assessed by the lexical-semantic subtest of the standardized Egyptian Arabic Semantic Test (EAST). Children’s total score and scores of the receptive and expressive aspects of the lexical-semantic subtest of EAST were calculated and compared to determine the development of the lexical-semantic among the 4 age-groups.<br />Results: A statistically significant difference was found between lexical-semantic growth among the 4 age groups. Lexical semantic growth is positively correlated to the chronological age of the participated children.<br />Conclusion: The lexical-semantic develops as early as the age of 2 years. Noun classes and verbs started to be identified by children at the age of 2 years. As children grow; noun vocabulary increases both expressively and receptively. Adjectives started to be acquired at age of 2.6 to 3 years and were mostly identified by the age of 3 to 3.6 years.https://asmj.journals.ekb.eg/article_167380_a772b5f725956d5a5fd573015f1e765a.pdfAin Shams University; Faculty of Medicine. Ain Shams Clinical and Scientific SocietyAin Shams Medical Journal0002-214472120210301PROXIMAL FIBULAR OSTEOTOMY VERSUS MEDIAL OPENING WEDGE HIGH TIBIAL OSTEOTOMY TO TREAT MEDIAL COMPARTMENT KNEE OSTEOARTHRITIS: A RANDOMIZED CLINICAL TRIAL21722616738410.21608/asmj.2021.167384ENTarek MohammedKhalilOrthopedic Surgery, Faculty of Medicine, Ain Shams University, Egypt.Wael Ahmed MohammedNassarOrthopedic Surgery, Faculty of Medicine, Ain Shams University, Egypt.Hossam MoussaSakrDiagnostic Radiology Department, Faculty of Medicine, Ain Shams University, Egypt.Zeiad MohammedZakariaOrthopedic Surgery, Faculty of Medicine, Ain Shams University, Egypt.Ashraf MohammedEl SeddawyOrthopedic Surgery, Faculty of Medicine, Ain Shams University, Egypt.Ahmed Mamdouh MokhtarMorsySaudi German Hospital, Cairo, Egypt.Journal Article20210428Background: Osteoarthritis is the most common cause of disability in the older population. Disability is caused by pain and limitations in mobility. Total knee arthroplasty, which aims to relieve pain and improve joint function and mobility, is the main surgical alternative in this patient population.<br />Aim of the work: The aim of this work is to compare the functional and radiological outcomes of proximal fibular osteotomy in medial compartment decompression, with medial opening wedge high tibial osteotomy.<br />Patients and Methods: This prospective randomized clinical trial was done between March 2017 and May 2019 on 40 patients suffering from manifestation of medial compartment osteoarthritis of the knee joint. Patients were allocated into two groups: Control group; 20 patients representing the standard HTO technique and Case group; 20 patients representing the novel technique PFO.<br />Results: In our study we compared the outcome of 40 patient complaining of medial knee OA according to VAS, KSS and radiological assessment of joint space, we found improvement in outcome of HTO than PFO. However, PFO may be a promising alternative in most developing countries because of their financial and healthcare delivery limitations. Furthermore, these patients can still undergo TKA in the future if it becomes necessary, PFO may be considered in patients with mild medial compartment osteoarthritis over HTO.<br />Conclusion: Our preliminary data clearly demonstrate that PFO is a simple, fast and affordable surgery to relieve pain and improve joint function and the medial joint space in human knee osteoarthritis. However, in this study we only assessed the short term follow up, so further studies are needed to assess the long-term outcome.https://asmj.journals.ekb.eg/article_167384_1b1ec3e7f1edcf06571867f7b9f50a2f.pdf