Al-Azhar University Hospitals Research Articles

Clinical relevance of chest pain during dobutamine stress echocardiography

Introduction: Chest pain is a common presentation in emergency units in daily life. Dobutamine stress echocardiography (DSE) was considered an early non-invasive method that help stratifying the risk for development of CVD. However, many patients experience chest pain shortly after DSE. Methods: 150 patients admitted to catheter unit in Cardiology Department at Al-Azhar university Hospitals between June 2021 and June 2022 with chest pain despite negative DSE. They all underwent coronary angiography. Results: 150 patients were included in the study. Their mean age was 50.99 ± 8.29 years old. 56.7% of patients were males. 24.7% of patients were diabetic. After PCA, 15.3% of patients had severe coronary arteries stenosis. We found that 6% of patients had severe stenosis of Left anterior descending and right coronary arteries (p<0.001). In addition, DM with other risk factors was significantly associated with development of severe stenosis of coronary arteries (P<0.001). Conclusion: 15.3 % of patients with chest pain following DSE had significant coronary arteries stenosis on PCA. DM was associated with that stenosis. That is why, in patients with negative DSE and chest pain, further investigations are required. Special emphasis should be directed to patients with more than one risk factor including diabetes mellitus.

Medical archives management systems in Al-Azhar University hospitals: Al-Hussein University Hospital as a model A study of reality and a vision for development

Medical archives management systems in Al-Azhar University hospitals: Al-Hussein University Hospital as a model A study of reality and a vision for development

Echocardiographic evaluation of Left ventricular function before and after trans-catheter patent ductus arteriosus closure

Introduction: there are limited available studies on LV hemodynamics alteration after trans-catheter PDA closure particularly diastolic function and most of studies are with 2D echocardiography. Objective: to evaluate the effect of trans-catheter closure of PDA on LV systolic and diastolic function in children and young adults using 2D and 3D echocardiography. Materials and methods: Al-Azhar University hospitals hosted this prospective cohort study, which included 20 patients with isolated PDA who had been referred to Cath lab for trans-catheter PDA closure; LV function evaluated by 2D, 3D echocardiography and TDI before, one day after closure and on follow-up. Results: 45% of patients developed post closure LV systolic dysfunction which improved completely after 3 months of follow up, all studied patients showed significant decrease in LAD, LAD/AoD, LVEDd, LVEDs, LVEDVI and LVESVI after 3 months of trans-catheter PDA closure; (LAD/AoD, LVEDVI, LVESVI, FS and LVEF) can be used as predictors of post closure LV systolic dysfunction, diastolic function was worse in individuals with post closure LV systolic dysfunction.

Evaluation of fetal cerebral blood flow perfusion using power doppler ultrasound angiography (3D-PDA) in growth-restricted fetuses

Background: Fetal growth restriction is a common complication of pregnancy and, in severe cases, is associated with elevated rates of perinatal mortality, neonatal morbidity, and poor neurodevelopmental outcomes. Aim of the work: The main purpose of our study was to explore the potential of 3D Power Doppler Angiography to evaluate the cerebral circulation in growth restricted fetuses in pregnant women. Patients and Methods: This was a prospective cohort study; the study including 100 patients were recruited in this study and divided in to two groups, group (A) High risk group including 50 pregnant patients with IUGR and hypertension of pregnancy and group (B) control group including 50 pregnant without risk factors, The study was conducted in Al Azhar university hospital. Results: The mother age in high risk group ranged from 23 to 38 years with mean ±SD= 30.24± 5.15 years while the in control group the mother age ranged from 22 to 38 years with mean ±SD= 29.74± 4.59 years with no statistical significant difference between the two groups.

Comparative study between using of radio frequency ablation and endovenous laser ablation in the treatment of primary lower limb varicose veins

Background: Varicose veins are a frequent vascular issue. Radiofrequency ablation (RFA) and Endo-venous laser ablation (EVLA) are endo-venous treatments for varicose veins. Endo-venous therapy demonstrated superior outcomes than standard high ligation and stripping in terms of pain, quality of life, healing, and recurrence. The RFA and ELA surpass vein stripping in morbidity, outcome, and neovascularization (recurrence), which is attributed for greater recurrence rates. Aim: We aim to compare between using of radio frequency ablation and endo-venous laser ablation in the treatment of primary lower limb varicose veins as regard to complications, treatment failure,recurrence. Methods: This prospective randomized controlled study was conducted in the vascular surgery department at Al-Azhar university hospitals (Al-Hussein and Sayed Galal), in the period from September 2020 to June 2022 (20 months). The study included 50 patients, males were 22(44%) while females were 28(56%), Presented by primary varicose veins. Results: In EVLA group Recanalization of short-segment occlusion was done in 4 patients, Recanalization of long-segment occlusion was done in 2 patients and recurrent varicose veins happened in 5 patients.

Comparison between percutaneous and open repair in acute tendon Achilles rupture in active young patients

Background; the Achilles tendon is the strongest and yet most commonly ruptured tendon,in the human body, its rupture is known to be increasing. It occurs more commonly in men in the third or fourth decade of life and more frequently on the left side. Most ruptures occur during sports activities. Aim and objectives; to compare between percutaneous and open repair of acute tendon Achilles rupture in active young patients who are willing to resume sports activity after the repair. Subjects and methods; This prospective comparative study was conducted, including 30 patients divided randomly into two groups A and B (each consists of 15 patients). Group A underwent percutaneous repair while group B were managed by open repair. The study was conducted at Al-Azhar university hospitals (Al-Hussien and Sayed Galal). The duration of the study ranged from 6-12 months. Result; No statistically significant difference was detected between the two techniques regarding functional results (full weight-bearing, return to activity, muscle strength, and AOFAS score) at last follow-up. However, patients in the percutaneous group were able to achieve significantly larger degrees of ankle plantar flexion compared to the open group.

Assessment of coagulation markers, serum zinc and copper in children with beta-thalassemia major in Egypt.

Thalassemia is one of the commonest single gene disorders usually associated with many complications. Coagulation changes as well as trace elements levels alterations have been described in children with β thalassemia. Activation of coagulation can be assessed by measuring thrombin-antithrombin (TAT) complex, plasmin-antiplasmin (PAP) complex and β-thromboglobulin (β-TG). A total of 200 children and adolescents were enrolled in the study; 100 were from the Al-Azhar University hospital's pediatric hematology clinic diagnosed as thalassemia major, while the other 100 were apparently healthy volunteers who acted as the control group. Complete blood count, liver function test, kidney function tests, TAT complex, PAP complex, β-TG as indicators of coagulation changes, serum zinc and copper were performed on all participants. Significantly higher levels of TAT complex, PAP complex and β-TG in thalassemia children than the controls. Decreased serum zinc and increased serum copper levels in thalassemia children compared to the controls. A negative correlation was observed between the serum level of TAT and hemoglobin level, besides the negative correlation of TAT complex and β-TG with the serum zinc. Thalassemia major was associated with increased serum level of coagulation activation markers, increased serum copper while decreased serum zinc.

IgG4-Related Dacryoadenitis in Egyptian Patients: A Retrospective Study.

PurposeTo report clinical, serological, and histopathological findings in Egyptian patients with dacryoadenitis associated with ImmunoglobulinG4-related disease (IgG4-RD).MethodsWe retrospectively revised medical records of patients presented to Al-Azhar University Hospitals with lacrimal gland (LG) swelling between June 2016 and February 2022. We included patients with definite IgG4-related disease (IgG4-RD) diagnosis and excluded those with possible, probable, or unlikely IgG4-RD based on The Japanese Ministry of Health, Labour, and Welfare’s 2011 guidelines.ResultsSixteen cases were included in the study (Fourteen females and two males, mean age 39.2±12.2 years); Seven cases met the criteria of Mikulicz disease, and nine cases met full clinical, serological, and histopathological criteria. Mean reported serum IgG was 1792.5 ± 313.7 (range 1063–2134) mg/dl, mean serum IgG4 was 576.25±215.3 (range 112–841) mg/dl, and mean Serum IgG4/IgG ratio was 31.9 ± 12.4%. The mean number of IgG4+ plasma cells/HPF was 74 ± 21.2, and the mean IgG4+ plasma cell percentage was 55 ± 9.7%. Serum IgG4 level showed a positive correlation to tissue IgG4+plasma cell percentage, while serum IgG4/IgG ratio positively correlated to both percentage and number of IgG4+plasma cells. Steroids had a good initial response, but recurrences were common.ConclusionA considerable proportion of patients with lacrimal gland swelling fall within the range of IgG4-RD. Proper diagnosis requires clinical, serological, and histopathologic correlation. Patients require long follow-up periods.

Evaluation of subfoveal choroidal thikness in patients with posterior uveitis

Background: Posterior uveitis can have inflammation involving the retina and choroid along with inflammation adjacent structures such as vitreous, optic nerve head, retinal vessels. Aim and objectives: The main aim of this study was to detect the changes in subfoveal choroidal thickness in posterior uveitis using OCT with enhanced depth of focus. Subjects and methods: This prospective study was carried on thirty patients presented with posterior uveitis attending to ophthalmology department of Al azhar university hospitals and Kobry El Qobba Military specialized eye hospital, Cairo, Egypt. The study duration ranged from 6-12 months. Results: as regard the main fundus changes distribution among the studied patients; the most prevalent finding was Chorioretinitis (46.5%) while choroiditis was found in 30.2% and retinitis was found in 23.3%. Also the SFCT was significantly higher in patients than control eyes. Conclusion: increase SCFT may be a clue for detection of sub clinical inflammatory activity of retina and choroid during quiescent phase.

Evaluation of the value of using simple elastic abdominal binder during colonoscopy

Background: Colonoscopy is a well-established endoscopic procedure widely used for screening, diagnosis, and treatment. Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel, using some techniques that allow for more frequent cecal intubation, quicker time to cecum, or less pain. One obstacle that must be overcome during this procedure is looping of the colonoscope shaft. Objective: The aim of the work is to evaluate the use of simple elastic abdominal binder during colonoscopy and its outcome on the ease, safety, duration and success of the procedure.Successful colonoscopy means demonstration of the ileocecal valve (cecal intubation).Duration of colonoscopy means time in minutes since insertion of tip of colonoscope shaft through anus till reaching ileocecal valve. Patients and methods: This study was carried out on 120 patients undergoing elective colonoscopy ( during period from April 2018 toAugust 2019) who were enrolled from Hepatology,Gastroenterology& Tropical Medicine department in Al Azhar University Hospitals (El-Hussein and BAB El-Shaarea).

Evaluation of uterine cavity after myomectomy by ultrasonography and hysteroscopy

Background: Uterine fibroids are tumor of the smooth muscles and the connective tissue of the uterus. They are considered to be the most common benign tumor of the pelvis. Objective: The aim of the study was to evaluate uterine cavity after myomectomy by hysteroscopy and ultrasonography. Methods: A prospective (observational) analytical design will be used in this study. This study was including 50 patients was selected from the outpatient gynecological clinic, (Dar Al-Om Medical Center & Fares Medical Center & Al-Azhar University Hospital “Al-Hussien and Sayed Galal”). Results: We aimed to evaluate uterine cavity after myomectomy by hysteroscopy and ultrasonography. This study was including 50 patients was selected from the outpatient gynecological clinic, (Dar Al-Om Medical Center & Fares Medical Center & Al-Azhar University Hospital “Al-Hussien and Sayed Galal”). Conclusion: From our study we could conclude that hesteroscopy improves results 3-4D ultrasound imaging it’s not currently available in all units, its use has significant implications in terms of cost and training. Saline infusion on the other hand may be undertaken easily using various dedicated systems or modifications of readily available cheaper catheters such as Intra-uterine Insemination catheter or a paediatric feeding tube.

Acute Kidney Injury in the Neonatal Intensive Care Unit: Incidence and Risk Factors

Introduction and Aim: Acute Kidney Injury (AKI) is a common medical problem, especially in neonatal intensive care unit. However, the reported incidences and associated risk factors are widely heterogenous and sometimes absent for developing countries. Thus, the current work designed to explore the incidence and potential risk factors of AKI for critically ill neonates.
 Patients and methods: The current work was an observational prospective study, completed between March 2019 and March 2022. It included 459 newborns admitted to the NICUs at Al-Azhar University Hospital (New Damietta) and Damietta General Hospital (Ministry of Health, Damietta, Egypt). For all neonates, careful history and clinical examination were done and data was documented. Then, repeated creatinine measurements and arterial blood gas analysis were performed. Discharge or death was the primary end point of the study. Other comorbid conditions were the secondary outcome.
 Results: The incidence of AKI was 92.2% and there was no significant difference between AKI and non-AKI regarding neonatal age, sex and mode of delivery. Patients with AKI had significantly lower gestational age, reduced birth weight, pH and HCO3. The serum creatinine showed significant increase during the first week of NICU admission in AKI than non-AKI groups, while basal values did not. Sepsis, nephrotoxic medications, hypoxic ischemic encephalopathy, umbilical catheter, duration of admission and mortality, all were significantly higher in AKI than non-AKI groups. Sepsis was reported among 44.8% and 27.7%, while mortality was reported for 20.9% and 4.9% of AKI and non-AKI groups, respectively. The duration of admission was 15.25±3.19 vs 9.50±2.21 days respectively.
 Conclusion: AKI was relatively higher (29.2% of admitted neonates) and associated with prematurity and lower birth weight. Neonatal sepsis and exposure to nephrotoxic drugs were among the commonest predisposing factors for AKI.

Cancer Cervix and Human Papilloma Virus (HPV) among Women Attending Gynecological Out Clinic Patients Al-Azhar University Hospitals: Newly Screening Technique

Cancer Cervix and Human Papilloma Virus (HPV) among Women Attending Gynecological Out Clinic Patients Al-Azhar University Hospitals: Newly Screening Technique

Efficacy of combining intravitreal injections of ranibizumab with micropulse diode laser versus intravitreal injections of ranibizumab alone in diabetic macular edema

Background: Diabetic retinopathy (DRP) and diabetic macular edema (DME) are diseases of the retina that are caused by complications of diabetes mellitus. Aim and objectives: the aim of the study was to evaluate the efficacy of combining intravitreal injections of ranibizumab with micropulse laser versus intravitreal injections of ranibizumab alone in diabetic macular edema. Subjects and methods: This prospective, randomized, comparative, interventional and hospital-based study was carried out in ophthalmology department of Al Azhar university hospitals and Kobry El Qobba Military specialized eye hospital, Cairo, Egypt. The study included 80 eyes of diabetic macular edema were divided into two groups, each of them included 40 eyes:Group 1: Patients with diabetic macular edema underwent three intravitreal injections of ranibizumab alone. Group 2: Patients with diabetic macular edema received one intravitreal injection of ranibizumab with two sessions of adjuvant micropulse diode laser.The duration of the study ranged from 6-12 months. Results: there is statistically significant increase in the best corrected visual acuity after treatment than before treatment. Further analysis demonstrated that visual acuity at 3 and 6 months of follow up were statistically significantly higher than visual acuity before treatment in diabetic patients with macular edema who received ranibizumab and laser therapy.

Comparitve study between synthetic brachio - axillary and brachio - vena comitans grafts for haemodialysis

Background: Hemodialysis is dependent upon the construction, maintenance and preservation of a good vascular access. Objectives: To compare between brachio venacomittant graft and brachio Axillary graft in patients with chronic renal failure with exhausted upper extremity superficial venous accesses, for the purpose of regular haemodialysis, as regard to patency, function criteria (fistula thrill) and complications. Subjects and methods: This prospective randomized study was being conducted on 50 patients with end stage renal disease. It was being carried out at the department of vascular surgery, Al-Azhar University Hospitals (Al-Hussein and Bab-Alsheryah University Hospitals). Cases were being divided into two groups: Group (A): 25 patients were undergone Brachio axillary graft and Group (B): 25 patients were undergone Brachio venacomittant graft. Results: Regarding Access failure, 12.0% at 6 m, in group A. 32.0% at 6 m, in group B, regarding Primary patency, 68.0% at 6 m, in group A. 56.0% at 6 m, in group B, regarding secondary patency, 72.0% at 6 m, in group A. 56.0% at 6 m, in group B. There was insignificant difference between both groups as regard Access failure, primary and secondary patency. 

Evaluation the results of antiglide plating of vertical medial malleolus fractures

Background; Vertical shear fractures of the medial malleolus occur through supination–adduction loading of the talus onto the articular surface of the medial malleolus, Aim and objectives; to assess the radiological and functional outcomes of open reduction and internal fixation with antiglide plate of vertical shear medial malleolus fracture, Subjects and methods; This prospective case series study was carried out at the Orthopedics Departments of Al-Azhar University and Health Insurance Hospitals. The study included 22 patients with antiglide plating of vertical medial malleolus fracture. The duration of the study ranged from 6-12 months, Result; Number of patients with Antiglide plate for medial malleolus Management in the study population was 9 (40.91%). Number of patients with Antiglide plate for medial malleolus & Semitubular Plate of lateral malleolus Management in the study population was 13 (59%), Conclusion; Surgical management of vertical shear of medial malleolus fracture gave excellent anatomical reduction and rigid fixation to restore articular congruity, help to facilitate early mobilization and hence to achieve optimal ankle function. The antiglide plate fixation is readily available and cost significantly less than a precountoured anatomicspecific type of fixation.

Role of fractional carbon dioxide laser resurfacing in post-operative transconjunctival lower eyelid blepharoplasty

Background: Transconjunctival blepharoplasty is the management of lower eyelid structures via the conjunctival approach and is usually applied to the cosmetic improvement of the lower eyelid using this approach. Aim and objectives: The study aimed to evaluate and compare the aesthetic result for residual fine wrinkles after transconjunctival lower eyelid blepharoplasty alone or combined with post-operative fractional CO2 laser. Subjects and methods: The present study was carried out on 20 patients with lower eyelid puffiness without skin redundancy just fine wrinkles who were selected from patients that were admitted to department of plastic and reconstructive surgery, AL-Azhar University hospitals. Results: Skin tightening and residual wrinkles improvement in group (A) show that 9(90.0%) were improved and 1(10.0%) were not improved while in group (B) 6(60.0%) were not improved and 4(40.0%) were worsen. There was highly statistically significant differences between groups where P<0.001 with better result in group (A) in comparing with group (B). Conclusion: Our results demonstrated that both lower eyelid transconjunctival blepharoplasty alone or with combination with postoperative fractional CO2 laser were safe and effective in the treatment of lower eyelid puffiness. Both of the investigated methods had comparable outcomes in terms of complications and satisfaction.

Management of posterior column tibial plateau fracture via a posterior approach

Background: Posterior tibial plateau fracture (PTPF) is a relatively uncommon injury. This kind of fracture appears confusing on initial radiographs because of the small displacement, so it is a special injury pattern. Aim and objectives: the aim of the study was to evaluate the safety and efficacy via a posterior approach in the posterior shearing tibial plateau fracture. Subjects and methods: The study was prospective study carried out in the Department of Orthopaedic surgery, Al-azhar university Hospital in Damietta. This study had been carried out on 24 patients. Results: there is statistically significant difference between immediate post-operative reduction and other post-operative reduction after 6 weeks, 3 months and 5 months. Conclusion: Posterior tibial plateau fracture is relatively rare in tibial plateau fractures. Our study highlights the importance of posterior tibial plateau fracture which was deemed unimportant in the past. Our results highlight the importance of fixation of PTPF and achieving an early and satisfactory functional outcome.

Correlation between fecal (calprotectin and lactoferrin) results and colonoscopic findings in chronic diarrhea and recurrent abdominal pain in children and adolescents

Background: Currently, endoscopy with biopsy is still considered the gold standard for the evaluation and diagnosis of mucosal inflammation and a number of scores exist to assess endoscopic activity in Crohn’s disease (CD) and ulcerative colitis (UC). Aim and objectives: the aim of the study was to determine the benefit of using both of fecal markers (calprotectin and lactoferrin) in patients presenting with chronic diarrhea and recurrent abdominal pain for differentiation between organic diseases, particularly inflammatory bowel disease (IBD) from non-organic disease, making colonoscope unnecessary. Subjects and methods: This prospective, observational and analytic study was carried out on 44 children who fulfilling the designed inclusion criteria. The study was carried out from Outpatient Clinic of Pediatric gastroenterology unit and from the Inpatient Units of the Pediatric department Faculty of Medicine, Al-Azhar University Hospitals (Al-Hussein & Sayed Galal Hospitals), as well as referral from other hospitals complaining of recurrent abdominal pain and chronic diarrhea from March 2020 to March 2022. Results: there was statistically significant difference between IBD group and functional abdominal pain group as regard fecal calprotectin with p-value≤ 0.001. There was statistically significant difference between IBD group and functional abdominal pain group as regard fecal lactoferrin with p-value≤ 0.001.

Aspartate transferase-to-platelet ratio index-plus: A new simplified model for predicting the risk of mortality among patients with COVID-19.

BACKGROUNDCoronavirus disease 2019 (COVID-19) has a spectrum of clinical syndromes with serious involvement of the lung and frequent effection of the liver and hemostatic system. Blood biomarkers are affordable, rapid, objective, and useful in the evaluation and prognostication of COVID-19 patients.AIMTo investigate the association between aspartate transferase-to-platelet ratio index (APRI) and in-hospital mortality to develop a COVID-19 mortality prediction model.METHODSA multicenter cohort study with a retrospective design was conducted. Medical records of all consecutive adult patients admitted to Al-Azhar University Hospital (Assiut, Egypt) and Chest Hospital (Assiut, Egypt) with confirmed COVID-19 from July 1, 2020 to October 1, 2020, were retrieved and analyzed. The patient cohort was classified into the following two categories based on the APRI: (1) COVID-19 presenting with APRI ≤ 0.5; and (2) COVID-19 presenting with APRI (> 0.5 and ≤ 1.5). The association between APRI and all-cause in-hospital mortality was analyzed, and the new model was developed through logistic regression analyses.RESULTSOf the 353 patients who satisfied the inclusion criteria, 10% were admitted to the intensive care unit (n = 36) and 7% died during the hospital stay (n = 25). The median age was 40 years and 50.7% were male. On admission, 49% had aspartate transferase-dominant liver injury. On admission, APRI (> 0.5 and ≤ 1.5) was independently associated with all-cause in-hospital mortality in unadjusted regression analysis and after adjustment for age and sex; after stepwise adjustment for several clinically relevant confounders, APRI was still significantly associated with all-cause in-hospital mortality. On admission, APRI (> 0.5 and ≤ 1.5) increased the odds of mortality by five-times (P < 0.006). From these results, we developed a new predictive model, the APRI-plus, which includes the four predictors of age, aspartate transferase, platelets, and serum ferritin. Performance for mortality was very good, with an area under the receiver operating curve of 0.90. CONCLUSIONAPRI-plus is an accurate and simplified prediction model for mortality among patients with COVID-19 and is associated with in-hospital mortality, independent of other relevant predictors.