Al-Azhar University Hospitals Research Articles

Sensorineural hearing loss in post-COVID-19 patients

<b>Background: </b>Hearing loss (HL) is one of the most common chronic conditions after hypertension and arthritis. Mounting indices suggest that sensorineural hearing loss (SNHL) may be one of the adverse effects of severe acute respiratory syndrome coronavirus 2.<br /> <b>Objective: </b>This work aimed at studying SNHL in post-COVID-19 patients, alongside with exploring the relationship between severity of the disease and degree of hearing disability.<br /> <b>Materials and methods: </b>This prospective cross-sectional study was conducted at Al-Azhar University Hospitals, Cairo, Egypt. It included 100 post-COVID-19 patients selected according to the study inclusion and exclusion criteria. Pure tone audiometry was done to confirm the presence of HL and to determine its degree.<br /> <b>Results: </b>Hundred patients with recent oncent hearing symptoms after documented COVID-19 infection were included. Males (71%) were more affected than females (29%). The most of our cases had bilateral moderate HL (45%). Tinnitus was the most frequently associated otological symptom (96.96%). The time of HL onset varied from days to weeks (55% had time onset between 11-30 days post-confirmed infection). Higher thresholds were detected in all frequencies of affected ears with more deterioration of hearing as frequencies increase. All degrees of HL were detected; mild, moderate, severe and profound. There was no significant correlation between severity of COVID-19 infection and severity of HL.<br /> <b>Conclusions: </b>SNHL is one of the extrapulmonary complications of COVID-19. COVID-19 patients may develop hearing affection regardless the severity of the infection. It is recommended to assess hearing functions in patients after COVID-19 for early detection and proper management.

Acinetobacter infections in intensive care unit patients at Al-Azhar University Hospitals in Assiut

Acinetobacter infections in intensive care unit patients at Al-Azhar University Hospitals in Assiut

Clinical Significance of Implementing Robson’s Classification at Al-Azhar University Hospital in Assiut

Clinical Significance of Implementing Robson’s Classification at Al-Azhar University Hospital in Assiut

Effect of the WHEY protein on pregnancyneonatal outcomes and prophylactic effect on fetal growth restriction cases: A randomized clinical trial

Background: WHEY protein is a high-quality protein source that is easily absorbed and utilized by the body. It has a beneficial effect on pregnancy and neonatal outcomes. Aim: To evaluate the impact of WHEY protein on pregnancy-neonatal outcomes and its prophylactic effect on Fetal growth restriction (FGR) cases. Patients and methods: This study was a prospective randomized, controlled clinical trial conducted on 300 pregnant females from attendees of obstetrics and gynecology clinics of Al Azhar University Hospitals. They were randomly divided into two groups: Case group: The intervention group (150 cases) received a daily WHEY protein supplement containing 25 grams of protein, and the Control Group: 150 cases received a placebo supplement. Results: There was no statistically significant difference between the studied groups regarding demographic criteria (P>0.01), and the prevalence of FGR was (20% vs 18.75) in the studied groups. According to fetal biometry at birth, there was no statistically significant difference regarding sonographic parameters between the appropriate gestational age (AGA) in the studied groups (P>0.01). There was no statistically significant difference between the two groups regarding complete blood parameters, platelets, or PTT (P>0.01). There was a highly statistically significant difference regarding PT between the studied groups (P<0.001). There was no statistically significant difference between the two groups regarding liver and kidney function tests (P>0.01). There was a highly statistically significant difference regarding total proteins and serum calcium between the studied groups (P<0.001). Conclusion: WHEY protein supplementation did not affect fetal growth, but it improved some maternal parameters, such as total protein and PT.

Clinical Experience of Extracorporeal Shock Wave Lithotripsy in Treatment of Renal Stones Employing the Recent [Richard Wolf, PiezoLith 3000Plus] at [Al-Azhar University Hospital, Assiut Branch

Clinical Experience of Extracorporeal Shock Wave Lithotripsy in Treatment of Renal Stones Employing the Recent [Richard Wolf, PiezoLith 3000Plus] at [Al-Azhar University Hospital, Assiut Branch

Male sexual disorder in coronavirus disease 2019 pandemic

Background At the end of 2019, a new coronavirus infection disease, named COVID-19, emerged in China. In this context, couples’ sexual lives could have been significantly altered. Fear of the COVID-19 pandemic implications affects their lives, or the lives of friends and relatives might produce feelings of anxiety and panic. Sometimes, these feelings can degenerate into further negative psychological reactions, including adjustment disorder and depression. Aim To find the relation between COVID-19 pandemic and occurrence of male sexual disorders. Patients and methods In this retrospective study 300 cases with past history of COVID-19 virus infection were included in this study. They were recruited from the Dermatology Outpatient Clinic of Al-Azhar University (Assiut) Hospital. Results There was a statistically significant difference between the prepandemic and postpandemic erectile dysfunction scores (P=0.043). There was a statistically significant difference between prepandemic and postpandemic scores according to premature ejaculation (P=0.022). There was a significant difference among erectile dysfunction and both depression degree (χ 2=90.706, P<0.001) and anxiety degree (χ 2=263.652, P<0.001) likewise, it has been found that there was a significant difference among premature ejaculation and both depression degree (χ 2=109.542, P<0.001) and anxiety degree (χ 2=165.382, P<0.001). Conclusion Significant difference between prepandemic and postpandemic scores according to erectile dysfunction and premature ejaculation. Among erectile dysfunction and both depression degree and anxiety degree likewise, it has been found that there was a significant difference among premature ejaculation and both depression degree and anxiety degree.

Effect of early prone positioning among critically ill patients admitted with acute respiratory distress syndrome during the COVID-19 pandemic: A comparative retrospective observational study

Background and objective: COVID-19 has offered an opportunity to the clinicians to try and study various oxygenation enhancing maneuvers in the patients. These included lung protective measures and prone positioning of participants admitted to the ICU with acute respiratory distress syndrome. We aimed to identify the effects of early prone positioning on the length of stay, discharge rate, and frequency of tracheostomies in the ICU patients. Methodology: This retrospective study was conducted on critically ill patients needing mechanical ventilation with lung protective strategy, admitted to the Intensive Care Units of Al-Azhar University Hospitals between March 2020 to April 2022. All patients in the study were interpreted retrospectively by examining the patient's records. Group A (n = 39) included patients who had been early placed in prone positions within 24 h of intubation, and Group B (n = 31) included patients who had not been placed in prone positions. All patients received a lung protective strategy for ARDS. In both groups, PaO2, PaCO2, pH, SpO2, and PaO2/FiO2 ratio were checked initially and later every 24 h for 6 days. Data was evaluated for the total days of both hospital and ICU length of stay, number of successful discharges to home from the hospital, and the total number of tracheostomized patients. Results: After prone positioning, lower SOFA and APACHE II scores were noticed in the prone group. There was no significant difference in the rate of discharge between the two groups. We observed non-significant shorter hospital and ICU stays and higher frequency of tracheostomy procedures in the prone group. We noticed a significant improvement in PaO2/FiO2 ratios in the prone group starting from day 2 to day 6. We observed a significant improvement in PO2 in the prone group in comparison to the non-prone group. Conclusions: Early prone positioning of patients admitted to the ICU with acute respiratory distress syndrome during COVID-19 pandemic led to a significant improvement in both PaO2 and PaO2/FiO2 ratio with a non-significant decrease in both hospital and ICU length of stay as shown by the collected data over consecutive six days. Abbreviations: ARDS- acute respiratory distress syndrome; FiO2: The fraction of inspired oxygen; CPAP: Continuous Positive Airway Pressure; PaO2: Arterial oxygen partial pressure; PEEP: Positive End-Expiratory Pressure; SOFA- Sequential Organ Failure Assessment Keywords: Prone; Lung protective measures; ARDS; APACHI II; SOFA Citation: Seyam SHA, Ahmed IMA. Effect of early prone positioning among critically ill patients admitted with acute respiratory distress syndrome during the COVID-19 pandemic: a comparative retrospective observational study. Anaesth. pain intensive care 2024;28(4):626−632; DOI: 10.35975/apic.v28i4.2504 Received: February 12, 2024; Reviewed: May 14, 2024; Accepted: May 15, 2024

Validation, Reliability, and Clinical Significance of the Arabic Version of Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire.

Clinically relevant fatigue in rheumatoid arthritis (RA) patients significantly affects their quality of life. Almost all studies have assessed fatigue in this population using non-specific scales. The present multi-centric study aimed to assess the validity, reliability, and clinical significance of the Arabic version of the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ). The present cross-sectional multicentric study was conducted at Aswan, Mansoura, Port Said, and Al-Azhar University Hospitals over a 6-month duration. The study included 311 patients with RA diagnosed according to the 2010 criteria of the American College of Rheumatology. The Arabic version of BRAF-MDQ was developed to assess fatigue in these patients. All patients were subjected to careful history taking, thorough clinical assessment, and standard laboratory work-up. The obtained Arabic BRAF-MDQ was tested for construct validity, internal consistency, testretest reproducibility, and criterion validity. Construct validity was evaluated using factor analysis with the Kaiser Meyer Olkin tool of sampling adequacy and Bartlett's sphericity test. Internal consistency of subscales was assessed using Cronbach's alpha. Test-retest reproducibility was assessed after a 1-week interval using the intraclass correlation coefficient. Pearson's correlation coefficient was used to correlate numerical variables. Predictors of fatigue were identified using binary logistic regression analysis. The present study included 311 RA patients. Construct validity assessment showed a high loading of questionnaire items within the proposed construct subscales with a KMO measure of sphericity of 0.927 and Bartlett's test of sphericity p-value < 0.001. Internal consistency assessment showed adequate Cronbach's alpha of Arabic BRAF-MDQ subscales. Total Arabic BRAFMDQ had excellent criterion validity, as indicated by the high correlations with MAFS (r=0.95, p < 0.001) and SF-36 vitality subscale (r=-0.91, p < 0.001). Clinically significant fatigue was identified in 214 patients (68.8%). Multivariate logistic regression analysis revealed age (OR (95% CI): 1.07 (1.02-1.12), p < 0.001), disease duration (OR (95% CI): 1.82 (1.43-2.33), p < 0.001), DAS28CRP (OR (95% CI): 8.62 (4.63-16.02), p < 0.001), and mHAQ (OR (95% CI): 3.85 (1.07-13.9), p = 0 .039) as significant predictors of fatigue development in the studied patients. The Arabic version of the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire is a valid, consistent, and reliable tool for the assessment of fatigue in Egyptian rheumatoid arthritis patients. Clinically significant fatigue was identified in 214 patients (68.8%). Further, risk factors for fatigue included older age, longer disease duration, and higher disease activity.

Driving Pressure During Mechanical Ventilation of Acute Respiratory Distress Syndrome

Background: Driving pressure has been identified as a more accurate indicator of mortality risk than low tidal volume (VT) and pulmonary compliance (Ppl). It was also noted that when this pressure surpasses the 18 cm H2O mark, there is a significant elevation in the relative risk of death. This study aimed to evaluate the effect of driving pressure guided ventilation in acute respiratory distress syndrome (ARDS). Patients and Methods: The study included 64 subjects selected from the respiratory intensive care unit (RICU) of Al-Azhar University Hospital (Damietta). All participants received management through a protective lung strategy that was informed by driving Pressure. The study outcomes included 1). Determination of weaning categories; 2). Adverse events; 3). Length of ICU stay and duration of mechanical ventilation; 4). Mechanical Ventilation-free days, and 5). Organ/s dysfunction. Results: The commonest cause of admission was pneumonia (36%), and least percentage was septic shock (1.6%). The median ICU stay was 7 days (4 to 25 days) and weaning success rate was 76.6% with mortality rate of 23.4%. The severity was mainly severe (40.6%) and moderate (31.2%). Driving pressure at day 1 of ≤ 21 had sensitivity of 97.96%, specificity of 80.0% and area under curve (AUC) of 0.952. The driving pressure was significantly increased in cases with failure weaning than the success weaning (24.67 ± 1.05 vs 16.86 ± 1.24, respectively). In addition, it was significantly increased in died than alive patients. There was progressive significant increase of driving pressure from mild to moderate to severe cases. Pneumothorax was recorded among 9.4% and pleural effusion was recorded for 7.8% of patients. Conclusion: Use of driving pressure guided ventilation in patients with ARDS improves lung compliance, decreases the duration of mechanical ventilation and the length of ICU stay. Driving pressure &lt; 21 can predict mortality.

Male Infertility – An Overview of Management

Objectives: In search of a qualitative indicator of ovarian function, we sought to determine if antral follicles' reproductive competence is correlated with their Follicular Output Rate (FORT), which indicates how sensitive they are to FSH administration. Patients and Methods: After ethical committee approval and informed consent from the patients, this Prospective Cohort study was performed on 300 IVF-ET candidates, aged between 20 and 35, who had undergone controlled ovarian hyper-stimulation with comparable beginning levels of FSH and had primary infertility without apparent cause from January 2020 to June 2022 at Al-Azhar University Hospital and in a private IVF unit in Cairo, Egypt. Antral follicle (3–8 mm) count (AFC) and pre-ovulatory follicle (18–24 mm) count (PFC) were performed, respectively, at the achievement of pituitary suppression (before FSH treatment) and on the day of hCG administration. The FORT was calculated by PFC × 100/AFC. FORT groups were set according to tercile values: low (4.3%; n = 13), average (30.7%; n = 92) and high (65%; n = 195). Results: The odds ratio for clinical pregnancy increases with increasing endometrial thickness, number of collected oocytes, and follicular output rate, with odds ratios of 1.123, 1.121, and 1.312, respectively. Conclusion: The observed association between IVF-ET result and the proportion of antral follicles attaining pre-ovulatory maturity that successfully react to FSH injection shows that FORT may be a qualitative mirror of ovarian follicular competency. More research with broader inclusion criteria and more tailored techniques is required to verify these findings.

Evaluation of the Serum Levels of thyroid hormones in newly diagnosed patients with Chronic Lymphocytic Leukemia

Background: Chronic lymphocytic leukemia (CLL) is the most prevalent form of adult leukemia in Western societies, constituting 25% of all adult leukemias and 25% of non-Hodgkin lymphomas. The current work designed to evaluate the serum levels of thyroid hormones as an indicator of prognosis for newly diagnosed chronic lymphocytic leukemia.&#x0D; Patients and methods: This research employed a cross-sectional design and included fifty newly diagnosed patients. All patients were chosen from outpatient clinic and inpatients of Internal Medicine department, Al-Azhar University Hospitals (Damietta). All submitted to systematic clinical evaluation. Then, thyroid hormones were measured and correlated with the disease severity.&#x0D; Results: There was significant correlation between Free T3, spleen size, white blood cells, absolute lymphocytic count, platelet count, C-reactive protein, and albumin. Although no substantial correlation was observed between free T3, age, hemoglobin and free-t4. Area under the curve was 0.57 for differentiation between mild and moderate conditions. Area under the curve was 0.81 for differentiate between mild and severe conditions (p=0.003).&#x0D; Conclusion: Thyroid hormones in cases of CLL could be used as predictors of disease severity and prognosis.

Fifteen Years' Experience of Thoracoscopic Sympathetic Chain Interruption for Palmar Hyperhidrosis in Children and Adolescents: Evaluation of Different Techniques.

Background: Thoracoscopic sympathetic chain interruption is a definitive and effective therapy for severe primary palmar hyperhidrosis (PPH). Well-known methods include sympathectomy, sympathotomy, and clipping, but the occurrence of compensatory sweating offsets these methods. This study aims to report our experience with thoracoscopic sympathetic chain interruption in a large group of patients of age <18 years with PPH, focusing on surgical outcomes, complication rates, and patient satisfaction. Patients and Methods: This retrospective study included patients who underwent thoracoscopic sympathectomy, sympathotomy, or clipping for severe PPH between April 2008 and March 2023 at the Pediatric Surgery Department, Al-Azhar University Hospitals. Demographic and clinical data, operative steps, postoperative outcomes, complications, and patient satisfaction were reviewed from the patients' medical records. Results: During the 15-year study period, 420 children with PPH underwent bilateral thoracoscopic sympathetic chain interruption by either sympathectomy, sympathotomy, or clipping, with a sex ratio of 60% being females. The mean ages were 12 ± 3.48, 13 ± 2.45, and 13 ± 2.45 years, respectively. Sympathectomy was performed in 190 patients (45.2%), sympathotomy in 170 patients (40.5%), and clipping in 60 patients (14.3%). All patients had completed follow-up, with mean periods of ∼43 ± 5 months, 45 ± 3 months, and 42 ± 6 months, respectively. Complete palmar dryness was achieved in 405 patients (overall 96.4%) (97.8% after sympathectomy, 97.05% after sympathotomy, and 90% after clipping), whereas 2.1%, 2.9%, and 10% of patients experienced symptom recurrence, respectively, denoting significant statistical differences. Overall, 94 patients (22.4%) experienced compensatory sweating. Eventually, 409 patients (97.4%) were satisfied with the outcome, whereas 11 patients (2.6%) reported dissatisfaction, yet no significant differences found. Conclusion: The presented three modalities of thoracoscopic sympathetic chain interruption for PPH in children and adolescents are safe and effective, with overall very high postoperative satisfaction, despite a relatively high rate of compensatory sweating in sympathectomy group. Other major complications in this age population were scanty.

Relationship between vitamin D receptors gene polymorphism and arteriogenic erectile dysfunction.

Over the past few decades, a number of studies have linked vitamin-D deficiency with ED (Erectile dysfunction) risk factors. There is a clear correlation between VD (vitamin-D) levels and ED, according to observational and interventional researches that have been reported in the literature. This crucial information encouraged scientists to investigate the impact of VD on erectile function in greater detail. The fact that vitamin D is a component of a healthy penis that begins in early life has just come to light, however there haven't been many research looking at the connection between vitamin D receptor gene polymorphism and erectile dysfunction. To evaluate the relationship between arteriogenic erectile dysfunction and the vitamin D receptor gene polymorphism. Between October 2022 and October 2023, at Al-Azhar University Hospitals, 40 patients with arteriogenic ED and 40 healthy controls underwent informed consent, a detailed history, a physical examination, a penile duplex ultrasound and the extraction of peripheral blood to determine the type of polymorphism for each of the vitamin D receptors: FokI, BsmI, ApaI and TaqI by polymerase chain reaction (PCR). There is no statistically significant association between arteriogenic erectile dysfunction and the vitamin D receptors (VDR) gene polymorphisms FokI, BsmI, ApaI and TaqI. Since there is no statistically significant association between the polymorphism of the vitamin D receptor (VDR) gene and arteriogenic erectile dysfunction, it is advised to investigate other VDR gene polymorphisms as well as alternative clinical subtypes of erectile dysfunction.

Evaluation of the impact of breast-conserving surgery on cancer outcomes of multiple (multifocal or multicentric) ipsilateral breast cancer

Background Breast conservative therapy (BCT) includes conservative breast surgery (CBS) with adjuvant radiotherapy and is now considered a standard treatment for early-stage breast cancer to achieve survival with acceptable aesthetic outcomes. Management of multiple ipsilateral breast cancer (MIBC) is a challenge, since the choice of optimal surgical procedures is controversial. Recently, many breast surgeons have advocated CBS is technically feasible to safely excise MIBC in selected cases. Aim This study aimed to evaluate the outcome of MIBC patients who received CBS with special attention on local control and recurrence. Patient and method This retrospective study was carried out on 90 patients at Al Azhar University Hospital and Ain Shams University Hospitals between January 2021 and January 2023. Results The majority of patients 85 (94.4%) had two foci of disease while five (5.5%) patients had three foci. The distance between the lesions ranges between 0.5 and 6.5 cm. The most common type of CBS was wide local excision en bloc resection of all lesions with normal tissue in between was done in 85 (94.4%) patients and five (5.5%) patients had two separate incisions leaving normal tissue in between. Clear margins were reported in 79 (87.7%) patients. 15 (5.5%) patients had different pathological lesion types (heterogeneous). One patient had a recurrence and another had distant metastases. Conclusion With good patient selection, there is no difference between CBS and mastectomy in the management of MIBC. CBS is oncological safe provided that an adequate excision with clear margins followed by whole-breast radiation therapy and adjuvant systemic therapy.

Comparative study between surgical partial inferior nasal turbinectomy and coblation assisted inferior turbinate reduction in cases of inferior nasal turbinate hypertrophy

BackgroundThe inferior turbinate is located in the inferior part of the nose, and contribute to the nasal valve formation. Inferior turbinate hypertrophy causes chronic nasal obstruction.AimWe aimed to assess the effectiveness of coblation-assisted reduction of the inferior turbinate hypertrophy using a specially designed coblator probe. Additionally, this study aimed to compare this technique with traditional surgical partial turbinectomy as the control arm and follow up with patients to identify potential complications.MethodsThis study involved 40 patients with nasal obstruction, those patients attended the Otorhinolaryngology Department of Al Azhar University Hospital in Assiut and diagnosed with enlarged inferior turbinate that did not respond to medical treatment. Also, Pre- and post-operative CT scanning was performed to objectively evaluate the improvement.ResultsCoblation group has more advantages over the traditional group like less operative time, less intraoperative blood loss, less post-op pain, less post-op nasal crusts, early return to daily activity (P value < 0.001). Significant decrease in postoperative nasal obstruction among partial inferior turbinectomy group in comparison with coblation group (P value < 0.001).ConclusionCoblation assisted inferior turbinate reduction of the hypertrophied inferior turbinate is the technique of less complications (i.e. post-operative pain, bleeding, and nasal crust), which are commonly encountered with traditional methods. Traditional method is a bit better in patient self-satisfaction after surgery and relieving post-operative nasal obstruction.

Modified gastro-soleus turn-down flap for chronic or neglected achilles tendon ruptures

BackgroundAchilles’ tendon chronic rupture is a common entity that is usually misdiagnosed or mistreated. Hence, she was presented to us later or with complications affecting her gait. Surgical resection is needed to either bridge the gap or reinforce the strength of the tendon repair.ObjectivesOur study's goal was to assess the clinical results of repairing chronic Achilles’ tendon lesions employing the middle segment of the proximal portion of the tendon (gastro-soleus), as a turn-down flap.MethodsOur prospective interventional single arm study included 18 patients with chronic Achilles’ tendon rupture attending at Al-Azhar university hospitals in Cairo, Egypt from May 2020 to April 2023. Diagnosis of the patients was confirmed by radiographic and clinical investigations. They were all treated with the same open reconstruction procedure using a modified GSF. The average follow-up was 12 months. The results of this study were assessed by the Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) score, and capacity to perform repeated heel raises on the affected side.ResultsThe mean operative time was 72.77 min. The median (IQR) time of reconstruction was 10 (8–12) after the injury. The median (IQR) length of flab was 4.5 (4.3–5) 9 (Table 2). No intraoperative complications occurred. The typical follow-up period was 12 months (6–18 months). In terms of the ATRS, we found a significant reduction from 82.8 ± 3 preoperatively to 20.8 ± 6.7 at 12 months postoperatively (P value = 0.001). As regards the AOFAS score, it was increased from 49.5 ± 10 preoperatively to 83.8 ± 8.5 12 months postoperatively (P = 0.001). In terms of the post operative complications, there was no re-rupture. Two patients experienced superficial wound infection which improved with daily dressing and antibiotics. Additionally, two patients had slight ankle stiffness four months after the operation, which improved after programmed rehabilitation at the sixth month.ConclusionThe modified GSTF is a simple, safe, well-tolerated and effective method of treatment with excellent functional results and greater patient content.

Antral Follicle Responsiveness to Follicle Stimulating Hormone Administration Assessed by the Follicular Output Rate (FORT) May Predict In Vitro Fertilization-Embryo Transfer Outcome

Objectives: In search of a qualitative indicator of ovarian function, we sought to determine if antral follicles' reproductive competence is correlated with their Follicular Output Rate (FORT), which indicates how sensitive they are to FSH administration. Patients and Methods: After ethical committee approval and informed consent from the patients, this Prospective Cohort study was performed on 300 IVF-ET candidates, aged between 20 and 35, who had undergone controlled ovarian hyper-stimulation with comparable beginning levels of FSH and had primary infertility without apparent cause from January 2020 to June 2022 at Al-Azhar University Hospital and in a private IVF unit in Cairo, Egypt. Antral follicle (3–8 mm) count (AFC) and pre-ovulatory follicle (18–24 mm) count (PFC) were performed, respectively, at the achievement of pituitary suppression (before FSH treatment) and on the day of hCG administration. The FORT was calculated by PFC × 100/AFC. FORT groups were set according to tercile values: low (4.3%; n = 13), average (30.7%; n = 92) and high (65%; n = 195). Results: The odds ratio for clinical pregnancy increases with increasing endometrial thickness, number of collected oocytes, and follicular output rate, with odds ratios of 1.123, 1.121, and 1.312, respectively. Conclusion: The observed association between IVF-ET result and the proportion of antral follicles attaining pre-ovulatory maturity that successfully react to FSH injection shows that FORT may be a qualitative mirror of ovarian follicular competency. More research with broader inclusion criteria and more tailored techniques is required to verify these findings.

(203) Impact of Smoking on Sperm Chromatin Integrity

Abstract Introduction Semen analysis is an essential component of infertility evaluation, but it may still fail to detect subtle sperm defects present in patients with male factor infertility. Although estimates vary, approximately 15% of patients with male factor infertility have normal spermiograms It is necessary to identify diagnostic measures for male infertility that are easy to perform, inexpensive, and provide an accurate diagnosis. Tests that assess sperm quality should not only identify the ability of spermatozoa to reach the oocyte but also their ability to fertilize the oocyte and activate embryo growth. The estimation of sperm DNA damage fills the above need in the diagnosis of male infertility Abnormalities in the male genome characterized by damaged sperm DNA may be indicative for male subfertility regardless of routine semen parameters, and these parameters do not reveal sperm DNA defects Men with normal semen analysis may also have a high degree of DNA fragmentation, which can be a major cause of undiagnosed/unexplained infertility. Sperm DNA fragmentation may result from aberrant chromatin packaging during spermatogenesis, defective apoptosis before ejaculation or excessive production of reactive oxygen species (ROS) in the ejaculate. Objective To study the impact of cigarette smoking on sperm chromatin integrity in infertile patients. Methods The present study included eighty infertile male patients recruited from the Andrology Outpatient Clinic at Al-Azhar University Hospitals The patients were divided into two groups: - Group I: forty nonsmoker infertile males. (Control Group). Group II: forty cigarette smoker infertile males. (Study Group) Results The current study revealed that smoking increases the abnormality of sperm chromatin integrity in sperms of smokers. This is evident by the positive correlation of increased head stainability of sperms in smokers compared to nonsmokers. The value of partially stained sperm heads using aniline blue is calculated from the total staining score formula, this score was found to increase significantly among smokers in comparison to nonsmokers. In the present study, the increased severity of smoking (smoking index), was not correlated with the degree of sperm head stainability. This mean that, smoking insult on sperm chromatin integrity is crucial regardless the duration or the amount of the consumed cigarettes Conclusions There is a significant increase of sperm chromatin damage in smoker infertile patients than nonsmoker infertile patients and these damages may affect the quality of the ejaculated spermatozoa and decrease their fertility potential. Not only semen parameters but also sperm chromatin condensation is affected significantly by smoking. Aniline blue staining is an effective and inexpensive tool for assessment of the fertilization potentiality of infertile patients. A significant correlation was found between the percentage of spermatozoa with normal sperm chromatin condensation and normal morphology. Cigarette smoking may have a negative impact on sperm quality and DNA integrity. Therefore, it would be advisable for men to abstain from smoking to avoid decreased fertility. Disclosure No.

(202) Comparative Study of the Efficacy of Avanafil and Atorvastatin Daily Dose in Management of Vasculogenic Erectile Dysfunction

Abstract Introduction Erectile dysfunction (ED) is defined as the “consistent inability to attain or maintain a penile erection, or both, sufficient for adequate sexual relations”. ED is not only a medical problem but affects the marital relations and patient's self-esteem and causes the quality of life to decrease. which in turn causes the patient to go into depression or develop anxiety. In the past, erectile dysfunction was considered, in most cases, to be a purely psychogenic disorder, but current evidence suggests that more than 80% of cases have an organic aetiology. Causes of organic erectile dysfunction can now be broadly divided into nonendocrine and endocrine. Of the nonendocrine aetiologies, vasculogenic (affecting blood supply) is the most common and can involve arterial inflow disorders and abnormalities of venous outflow (corporeal veno-occlusion). Avanafil is a second-generation phosphodiesterase type 5 inhibitor approved for erectile dysfunction by the FDA on 2012 and by EMA in 2013. With a high selectivity for phosphodiesterase type 5 isoform AND faster onset of action compared with other PDE5 inhibitors, it offers more tolerability and less adverse events. Atorvastatin is 3-hydroxy-methylglutaryl (HMG)-CoA reductase inhibitor act on the rate-limiting step in cholesterol biosynthesis (the conversion of HMG-CoA to mevalonate) and are effective in treating dyslipidemia. statins reverse endothelial dysfunction by decreasing the action of oxidized low-density lipoprotein (LDL) on endothelial cells, resulting in an increase of NO activity. Objective is to evaluate and compare the efficacy of avanafil and atorvastatin daily dose in management of patients with vasculogenic erectile dysfunction. Methods A 60 adult heterosexual males complaining of vasculogenic erectile dysfunction proven by penile duplex were collected from outpatient andrology clinics of Al-Azhar University Hospitals. The patients were divided into two treatment groups: (Group A): 30 patients received daily dose of 100 mg avanafil. (Group B): 30 patients received daily dose of 40 mg atorvastatin, The main outcome measures and the difference in penile duplex ultrasound results and IIEF-EF scores between the two groups are evaluated and compared at the end of the study, Age of patients between 20 and 50 years, established diagnoses of Vasculogenic erectile dysfunction, Normal lipid profile, Normal Total and Free testosterone levels and No contraindications to the study medications were included criteria. However patients who failed to fulfill any of the inclusion criteria, psychogenic or neurogenic erectile dysfunction, dyslipidemia Patients with Renal or Hepatic insufficiency and Patients with advanced cardiovascular diseases such as heart failure and coronary artery disease on antianginal drugs especially nitrates were excluded. Results Our study revealed statistically significant improvement in Penile Doppler ultrasonography parameters (PSV, EDV&amp; RI) and IIEF-EF scores in avanafil group compared to atorvastatin group. Conclusions avanafil 100 mg daily dose leads to significant improvement in men with vasculogenic erectile, while atorvastatin 40 mg caused no significant differences, neither positively nor adversely. In summary, avanafil at dose of 100 mg can be a therapeutic appropriate choice in cases of vasculogenic ED. Disclosure No.

The correlation between the frequent intake of dietary migraine triggers and increased clinical features of migraine (analytical cross-sectional study from Egypt)

Despite the high prevalence of primary headaches, the role of food in modifying clinical characteristics among migraine patients is often overlooked. The aim is to detect the correlation between adopting unhealthy dietary habits and migraine severity and identify foods that have a greater chance of triggering specific subtypes of migraine. The present study was a cross-sectional analytical study that was conducted at Kasralainy Hospital, Cairo University, headache clinic at Alexandria University Hospital, and Al-Azhar University Hospitals from January to June 2020. We included 124 patients fulfilling the ICHD-3 criteria for migraine. A full clinical profile for migraine headaches was reported using a headache sheet applied to the Al-Azhar University headache unit. A nutritionist obtained data collected about dietary habits using many reliable scales and questionnaires such as food frequently sheets questionnaire. Logistic regression and Pearson correlation coefficients have been used to identify foods that are more likely to be associated with increased clinical features of migraine. Our participants reported that the fried meat, fried chicken, processed meats, fava beans, falafel, aged cheese “Pottery salted cheese” and “Rummy cheese”, salted-full fatty cheese “Damietta cheese”, citrus fruits, tea, coffee, soft drinks, nuts, pickles, chocolate, canned foods, sauces, ice cream, smoked herring, in addition to the stored food in the refrigerator for many days were significantly associated with the diagnosis of chronic migraine CM compared to episodic migraine (EM). Margarine, pickles, and smoked herring were significantly associated with the diagnosis of migraine with aura (MA) compared to migraine without aura (MO). Adopting unhealthy eating habits was a more prevalent dietary consumption pattern among people with chronic migraines compared to those with episodic migraine.