Al-Azhar University Research Articles

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& 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 Role of Endowments in Achieving the Goals of Security and Freedom

This research explores the expansive concept of freedom within Islamic endowments, or Waqf, emphasizing liberation from societal constraints like poverty and disability. It asserts that moral constraints restrict human freedom, necessitating a call to Allah for liberation. Historical examples, such as Al-Azhar University, highlight endowments' pivotal role in fostering independence from state pressures, particularly in the realms of thought and education. Endowments are depicted as vital in sustaining and liberating society, offering financial autonomy to scholars and educational institutions. The text also delves into the economic impacts of endowments, detailing their role in employment, income redistribution, and fostering various industries. Legal perspectives on lending within the Islamic context are explored, along with the role of endowments in liberating captives and supporting those engaged in jihad. The research concludes by advocating for directing endowments towards knowledge and scholars to combat ignorance and achieve societal liberation.

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.

A Prospective Study of Chest Trauma Scoring System as A Morbidity and Mortality Predictor in Patients with Blunt Chest Trauma.

Predicting the outcome of blunt chest trauma by scoring systems is of utmost value. We aimed to assess the role of the chest trauma scoring system (CTS) in predicting blunt chest trauma outcomes among Egyptians. A prospective observational study included 45 patients admitted to the cardiothoracic emergency unit of Al-Azhar University hospitals. We documented their demographic data, history, cause and mode of trauma, vital parameters, and necessary investigations (e.g., chest X-ray and Computed Tomography) when the patient was admitted to the cardiothoracic department. All patients were assessed using the chest trauma scale (CTS) and followed up till death or discharge. The patient's age ranged between 18 to 76 years (mean 42.67 years). Eighty percent were males, and 48% needed mechanical ventilation (MV). The period of MV was ranged from 1 to 5 days (mean 2.81 days). Twenty-two patients had pneumonia. Eight patients died with a chest trauma scale ranging from 2 to 12 with a median of 6. About 87 percent of patients had unilateral lesions, and 5 had criminal causes. Road traffic accidents were the most typical cause of trauma (60%). There was a significant relation between mortality among the studied patients and each MV, length of ICU duration, chest trauma scale, laterality of trauma, and associated injuries. There was a statistically significant relation between the chest trauma scale and the need for MV, the timing of MV, the presence of pneumonia, and mortality. CTS ≥ 6.5 can predict mortality with 100.0% sensitivity, specificity of 62.2%, and accuracy of 68.9%. However, a score of ≥ 5.5 can predict the development of pneumonia with a sensitivity of 81.8%, specificity of 78.3%, and accuracy of 80%.

Heart Failure and Echocardiography Derived Myocardial Wall Stress Link in Diabetic Cases with Acute Myocardial Infarction Managed by Revascularization.

Diabetes is associated with left ventricular remodeling. Myocardial wall stress is a measurable factor connected to the ventricular breadth and force and is related to myocardial thickness; it can be measured by echocardiography. The present study aimed to assess the link between heart failure (HF) and echocardiography-derived myocardial wall stress in diabetic patients with ST elevation myocardial infarction (STEMI) who were managed with revascularization. This study was a comparative prospective study that took place between February 2022 and February 2023. It included 100 diabetic patients presented with STEMI and managed by percutaneous coronary intervention (PCI). Patients were selected from the cardiology departments at Al-Azhar University Hospital, Damietta, Egypt. During the hospital stay, patients were checked for HF symptoms and signs. They were also observed for 3 months after discharge for detection of HF. Those who did not develop HF were assigned to group I, and those with HF were assigned to group II. The mean value of end-systolic wall stress (ESWS) was 77.09 ± 12.22 and 97 ± 13.44, and the mean value of end-diastolic wall stress (EDWS) was 12.61 ± 2.76 and 15.87 ± 2.86 in groups I and II respectively, with significant differences between the 2 groups. The cutoff point to detect HF was 88 KPa for ESWS and 13.5 KPa for EDWS, with a sensitivity of 70% and 79% and a specificity of 80% and 61% for ESWS and EDWS, respectively. Elevated left ventricle (LV) myocardial stress is related to increased HF in diabetic patients whose HF was managed by PCI after STEMI. LV wall stress is a potentially helpful risk stratification tool using routine echocardiography to determine the treatment plane according to the risk status.

Endoscopic callosotomy as a minimally invasive approach to treat paediatric refractory epilepsy: case series.

Endoscopic callosotomy has emerged as a promising and minimally invasive technique for the treatment of refractory epilepsy. This paper aims to review the clinical outcomes and advancements associated with endoscopic callosotomy as a therapeutic option. This study includes 14 Paediatric patients diagnosed and managed at Al-azhar university hospitals. Those 14 patients were studied over 2 years. All patients underwent a corpus callosotomy using the bimanual endoscopic technique. Endoscopic anterior corpus callosotomy was done in 13 patients while one case underwent endoscopic complete callosotomy. The most frequent complication was transient disconnection syndrome followed by transient Urinary incontinence and one case had minor CSF leak. As regard seizure freedom outcome (Engel's Outcome Scale): 4 cases (28.6%) became seizure free (Engle class I), 5 cases (35.7%) with Engle class II, 1 case (7.1%) with Engle class III and 4 cases (28.6%) classify as Engle class IV. As a minimally invasive technique with a favorable impact on cognitive function, less complications and a significant reduction in seizure frequency and severity in the majority of paediatric patients, endoscopic corpus callosotomy offeres substantial benefits in managing refractory epilepsy in paediatric.

Isolation and Identification of Saccharomyces boulardii as a Probiotic Yeast and Investigation of its In vitro and In vivo Beneficial Applications

Background: Yeasts are becoming increasingly popular as possible new resources to improve the nutritional value of food qualities like flavor, color, and vitamin content, as well as tools for preventing food spoiling due to their anti-microbial capabilities. Objective: This study aims to test the role of isolated Saccharomyces boulardii as a promising probiotic as well as Jerusalem artichoke as a prebiotic in a feeding animal model to test their possible functions in regulating lipid profile and bacterial count in the faeces of tested animals. Methods: For the isolation of yeast cultures on YM agar medium, five milk samples were randomly obtained from the Faculty of Agriculture at Al-Azhar University in Cairo, Egypt. S. boulardii was morphologically, physiologically, and molecularly identified and deposited in the gene bank; additionally, identification was confirmed using the BIOLOG system. For 30 days, researchers compared the roles of S. boulardii as a probiotic and Jerusalem artichoke as a prebiotic in controlling serum lipid profile and faeces microbial count in the tested animal groups. Results: The acid and bile tolerance tests illustrate the promising ability of S. boulardii. Additionally, S. boulardii could survive on simulated stomach and intestinal fluids. An in vivo feeding test showed that rats fed S. boulardii grew and gained weight faster. Furthermore, eating S. boulardii causes a marked increase in HDL levels and a marked drop in LDL, cholesterol, and triglycerides. Rats that consumed Jerusalem artichokes and a probiotic strain had significantly lower numbers of coliforms and Staphylococcus sp. in their stools. Conclusion: These results revealed the possible beneficial role of S. boulardii in overcoming hyperlipidemia, which should be applied on a large scale after verification of outcomes.

Non-penetrating deep sclerectomy versus combined trabeculotomy-trabeculectomy in primary congenital glaucoma.

The primary mode of therapy in children with primary congenital glaucoma (PCG) and mild or no corneal edema is goniotomy, which has a high success rate. However, in developing countries, the diagnosis of PCG is usually delayed, and corneal cloudiness interferes with goniotomy. Therefore, trabeculotomy may be the best choice in such eyes. We compared the short-term efficacy and safety of primary combined trabeculotomy-trabeculectomy (primary CTT) with that of non-penetrating deep sclerectomy (NPDS) in managing PCG. This prospective, randomized, comparative study included patients with PCG referred to Al-Azhar University Hospitals within a 1-year period. Eyes were randomly allocated to one of two groups: eyes in NPDS group underwent NPDS, and those in primary CTT group underwent primary CTT. Baseline and frequent postoperative assessments of intraocular pressure (IOP), cup-to-disc ratio (C/D ratio), corneal diameter, and axial length were performed for up to 6 months. The success rates were recorded in both groups. Forty eyes of 26 patients were included, with 20 eyes allocated to each group. The mean (standard deviation) age of all patients was 12.9 (9.5) months, with comparable ages and sex ratios between groups (both P > 0.05). Both groups demonstrated a significant reduction in IOP and C/D ratio at each postoperative visit compared to the baseline visit (all P < 0.001), with no significant difference detected between the groups (all P > 0.05), except for a significantly lower IOP in NPDS group at 1 month (P < 0.05). The corneal diameter and axial length were comparable between groups at baseline and remained unchanged at all postoperative visits (all P > 0.05). The groups had comparable success rates (P > 0.05). No serious complications were detected. CTT and NPDS both yielded reasonable IOP control and reversal of cupping in eyes with PCG. We observed equal effectiveness of the surgical procedures without major safety concerns. Further large-scale clinical trials with longer follow-up periods are needed to verify our preliminary findings.

Evaluation of Tubularized Incised Plate Urethroplasty with Spongioplasty-Dartosoraphy Reinforcement in Pediatric Hypospadias: A Randomized Controlled Study.

The original description of tubularized incised plate urethroplasty (TIPU) was provided by Snodgrass in 1994. The results were significantly improved by several modifications. To decrease the incidence of complications, interposing a vascularized flap after tubularization of the neourethra is recommended. The extent to which the type of interposed tissue has a direct effect on the rate of complications and cosmetic outcomes after TIPU repair is considered the answer to the main hypothesis of this study. This prospective controlled randomized trial was conducted in the Department of Pediatric Surgery, Al-Azhar University, Cairo, Egypt, between May 2019 and May 2023. A total of 220 patients were included in this study. Patients were randomly assigned to either group A or group B. Group A included 110 patients who underwent TIPU with spongioplasty-dartosoraphy reinforcement. The other 110 patients (group B) underwent TIPU with dorsal dartos flap interposition, without spongioplasty. Complications developed in 34 of 220 patients (15.4%). In group A, complications developed in 11 of 110 patients (10.0%). In group B, complications occurred in 23 of 110 patients (20.9%). Although the fistula rate, glanular dehiscence, disruption, and meatal stenosis were not significantly different between the study groups, the skin necrosis rate was significantly lower in group A than in group B. The overall complication rate was significantly lower in group A than in group B. Also, the difference in the mean Hypospadias Objective Scoring Evaluation between the two groups was statistically significant. TIPU with spongioplasty-dartosoraphy reinforcement is an effective modification of conventional TIPU. This modification appears to reduce the rate of complications and yield better cosmetic outcomes.

Pemahaman Hadis Kontemporer Yusuf Al-Qardhawi Dan Muhammad Al- Ghazali

Hadith is anything in the form of words, actions, tacit approval, or characteristics (self-description) that is attributed to the Prophet Muhammad. What is meant by the nature (self-description) of the Prophet in this definition is the physical description and morals of the Prophet as reported by the narrators, such as his body being strong, his chest broad, he was a polite person and so on. Muhammad al-Ghazali was a famous scholar who was born in al-Buhairah, Egypt, precisely in Nakla Inab, a village which gave birth to many prominent Islamic figures of his time such as Muhammad 'Abduh, Mahmud Syaltut, Hasan alBana and Muhammad al-Madani, Yusuf Al -Qardhawi. He was born in the village of Shaft Turab in the middle of the Nile River Delta, Mahallah al-Kubra area, he already memorized the Koran. Completing his education at Ma'had Thantha and Ma'had Tsanawi, Qaradawi continued on to al-Azhar University, Cairo, Egypt, at the Ushuluddin Faculty, majoring in religious studies and graduating in 1952 where he received the shahadah 'aliyah. Then he continued his Arabic language studies for two years and graduated with the best achievement among five hundred students. These people have an understanding of hadith, then in this research we discuss the Understanding of Contemporary Hadith According to Yusuf Al-Qardhawi and Al-Ghazali. In this research, the qualitative approach used by researchers is library research, namely. activities related to library data collection methods. In terms of Hadith material, according to Yusuf Al-Qardhawi and Muhammad Ghazali: Related to current problems. As an effort to reinterpret the hadith in accordance with the current context.

Relationship between effectiveness of asthma management and genetic variants in asthmatic Egyptian children

BackgroundPersonalized asthma medicine research identifies critical genes like ADRB2 and ADH5 that affect disease and treatment outcomes, necessitating a deeper exploration of these genetic influences on asthma prevalence and management in Egyptian children. This study aimed to examine the relationship between asthma control and specific genetic variants in Egyptian children, focusing on four significant SNPs within four key genes.MethodsA cross-sectional genetic study was conducted between December 2020 and May 2021 at two hospitals affiliated with Al-Azhar University to assess gene polymorphisms in adolescent asthmatic patients. Blood samples were taken from participants, with portions dedicated to DNA extraction and serum level measurements. The extracted DNA was then genotyped using the real-time PCR technique, and specific genotypes were identified based on their fluorescence characteristics.ResultsA total of 93 subjects were enrolled in the study. Cases (asthmatic children) had a significantly higher BMI than controls—healthy children—(33.65 ± 3.88 vs. 21.10 ± 3.48, p < 0.001). A notable distinction was observed in residence, with 30.6% of cases from urban areas versus 85.7% in controls (p < 0.001). Cases had a markedly higher incidence of familial asthma history (86.1% vs. 0.0%, p < 0.001), atopy (95.8% vs. 0.0%, p < 0.001), food allergies (80.6% vs. 9.5%, p < 0.001), and animal contact (79.2% vs. 14.3%, p < 0.001) compared to controls. The genetic marker rs4795399's CC allele was found in 10.0% of controls but not in any cases (p = 0.024), and the AA allele of rs7927044 was significantly more common in controlled asthmatics than in uncontrolled ones (p = 0.030).ConclusionThe studied genetic variants were not significantly associated with asthma severity; however, patients with uncontrolled asthma were associated with significantly higher polymorphism of GG and AG alleles of rs7927044. Additionally, there was a significant difference between the asthmatic patients and healthy individuals in terms of the polymorphism of the rs4795399 TT allele.

Comparison of perceived masticatory ability in completely edentulous patients treated with thermoplastic complete denture versus single implant-retained mandibular overdenture: a single-center prospective observational study.

This study aimed to compare the perceived masticatory ability (PrMA) in completely edentulous patients (EDPs) with thermoplastic conventional complete dentures (CDs) versus single implant-retained mandibular overdentures. The current study was conducted in the outpatient Prosthodontic Clinic, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt. PrMA was evaluated in 45 completely edentulous patients (46% males, mean age 50.4 ±4.7 years). Each patient received a thermoplastic PMMA complete denture (Polyan IC TM Bredent GmbH & Co.KG, Germany). The PrMA was evaluated at one-month and six-month intervals of denture use. An immediate loading single implant was placed into the mid-symphyseal for each patient, and the denture was adjusted. Subsequently, the PrMA was reevaluated after one month and six months. The data were collected and statistically analyzed using the SPSS@V25 to assess the changes in PrMA. The PrMA demonstrated improvement after six months of thermoplastic conventional denture use. However, this improvement was not statistically significant (p=0.405). In addition, the PrMA showed a substantial increase following a single implant placement at one and six months (p<0.001) of the overdenture use compared to the conventional denture. The PrMA insignificantly improved (p=0.397) after six months of the single implant retained overdenture use. The study's findings indicate that using immediate loading single implant-retained mandibular overdentures significantly improved PrMA in completely edentulous patients.

The association of oxidative stress of neonatal hyperbilirubinemia and vitamin E supplementation.

Jaundice in newborns is a sign of skin and sclera pigmentation. Hyperbilirubinemia and these phenomena do, however, have a relationship. According to many clinical studies, elevated blood bilirubin and low vitamin E (VE) levels in newborns are associated. The aim of the study was to investigate the association of oxidative stress of neonatal hyperbilirubinemia in patients who underwent phototherapy with additional vitamin E supplementation (25 mg/kg/day over the course of three days) and patients without additional vitamin E. A set of 100 neonatal indirect hyperbilirubinemia patients was enrolled at neonatal intensive care units (NICUs) of the pediatric departments at Al Azhar University Hospitals during the period from February 2021 to October 2022 after obtaining signed written informed consent of all neonates' parents with an explanation of the aim of study. Significant differences were found between the studied groups regarding serum bilirubin on the third day of admission (p = 0.039). Patients who were treated with vitamin E had lower serum bilirubin on the third day of admission (8.25 ±3.41) than the control group (11.66 ±3.22). Also, among the VE group, serum bilirubin was significantly decreased on the third day of admission (8.25 ±3.41) compared to zero days of admission (14.10 ±4.39) (p = 0.041). Vitamin E supplementation has an important role in treatment of indirect hyperbilirubinemia in neonates. Early administration of vitamin E in preterm neonates resulted in a significant decrease of serum bilirubin and increased total antioxidant capacity. Vitamin E supplementation in full term decreased the duration of phototherapy.

Aflibercept or ranibizumab for diabetic macular edema.

Vascular endothelial growth factor (VEGF) is the primary substance involved in retinal barrier breach. VEGF overexpression may cause diabetic macular edema (DME). Laser photocoagulation of the macula is the standard treatment for DME; however, recently, intravitreal anti-VEGF injections have surpassed laser treatment. Our aim was to evaluate the efficacy of intravitreal injections of aflibercept or ranibizumab for managing treatment-naive DME. This single-center, retrospective, interventional, comparative study included eyes with visual impairment due to treatment-naive DME that underwent intravitreal injection of either aflibercept 2 mg/0.05 mL or ranibizumab 0.5 mg/0.05 mL at Al-Azhar University Hospitals, Egypt between March 2023 and January 2024. Demographic data and full ophthalmological examination results at baseline and 1, 3, and 6 months post-injection were collected, including the best-corrected distance visual acuity (BCDVA) in logarithm of the minimum angle of resolution (logMAR) notation, slit-lamp biomicroscopy, dilated fundoscopy, and central subfield thickness (CST) measured using spectral-domain optical coherence tomography. Overall, the 96 eyes of 96 patients with a median (interquartile range [IQR]) age of 57 (10) (range: 20-74) years and a male-to-female ratio of 1:2.7 were allocated to one of two groups with comparable age, sex, diabetes mellitus duration, and presence of other comorbidities (all P >0.05). There was no statistically significant difference in baseline diabetic retinopathy status or DME type between groups (both P >0.05). In both groups, the median (IQR) BCDVA significantly improved from 0.7 (0.8) logMAR at baseline to 0.4 (0.1) logMAR at 6 months post-injection (both P = 0.001), with no statistically significant difference between groups at all follow-up visits (all P >0.05). The median (IQR) CST significantly decreased in the aflibercept group from 347 (166) µm at baseline to 180 (233) µm at 6 months post-injection, and it decreased in the ranibizumab group from 360 (180) µm at baseline to 190 (224) µm at 6 months post-injection (both P = 0.001), with no statistically significant differences between groups at all follow-up visits (all P >0.05). No serious adverse effects were documented in either group. Ranibizumab and aflibercept were equally effective in achieving the desired anatomical and functional results in patients with treatment-naïve DME in short-term follow-up without significant differences in injection counts between both drugs. Larger prospective, randomized, double-blinded trials with longer follow-up periods are needed to confirm our preliminary results.

To B or not to B: the application of uterine compression sutures to reduce blood loss after myomectomy.

The aim was to assess the hemostatic impact of B-Lynch sutures following an open myomectomy for efficacy. In this prospective clinical research, performed in Alazhar university hospitals (Al-Hussain, Damietta, Assiut) and Minia University Maternity Hospital, 250 women scheduled for open myomectomy between January 2021 and January 2023 had multiple fibroid uteri with uterine sizes corresponding to 12-22 weeks. There were two groups of women. Group I (125) underwent standard open myomectomy surgery, whereas Group II (125) underwent normal open laparotomy surgery followed by B-Lynch sutures. Certain inclusion and exclusion criteria were applied to every patient. We recorded vital data, length of the procedure, complications (bleeding during the procedure, bleeding from multiple bites, bladder injury, fever, wound infection), complete blood count before and after surgery, need for blood transfusion, postoperative vital data, time until ambulation, passing flatus, and ability to eat and drink, as well as the amount of blood lost during and after the procedure. There was no statistically significant difference between the two groups in age, parity, weight, number of fibroids, or uterine size as measured by ultrasonography. Between groups I and II, there was a significant difference in the average intraoperative blood loss (Group I lost 562.6 ml, whereas Group II lost 411.3 ml) as well as the mean blood loss following surgery (205 ±82 ml in Group I and 117 ±41 ml in Group II). No significant difference was observed in the mean length of hospital stay between groups I and II (2 ±0.3 days and 2 ±0.6 days, respectively). Using a B-Lynch suture can help minimize blood loss during and after an open myomectomy. Therefore, if the uterus is large and has a lot of fibroids, it is recommended to be done frequently.

REFORMASI MANAJEMEN KELEMBAGAAN DAN KURIKULUM PENDIDIKAN MUHAMMAD ABDUH DI MESIR

The research aimed to understand the reforms implemented by Muhammad Abduh in Egypt and to analyze the restructuring of institutional management and curriculum he conducted. The research methodology was a literature review with content analysis to reveal Muhammad Abduh's thoughts related to his mission. The findings indicate that Abduh's thoughts significantly influenced the modernization of Islamic education, particularly at al-Azhar University. He stressed the need to integrate modern sciences and technology with Islamic teachings. These reforms were intended to strengthen Islam's position amidst the advancement of science and modernization challenges.

Clinical Performance of Two CAD/CAM Fabricated Ceramic Restorations with Different Designs for MIH Rehabilitation: A Randomized Controlled Trial

Background: Molars affected with severe molar incisor hypomineralisation (MIH) require extensive restorations, which do not last for a long time and often require treatment in the form of onlays or full coverage restorations. Objective: A randomized clinical trial evaluated the clinical performance of two CAD/CAM fabricated ceramic restorations, Vita Suprinity (VS) and Vita Enamic (VE), with different preparation designs, occlusal veneer and endocrown, for rehabilitation of the first permanent molar affected by MIH. Materials and Methods: The study was registered with NCT05434884 clinical trial ID with 68 patients ranging from 8 to 13 years old, who attended the dental clinic of Al-Azhar University, Girls Branch, and suffering from a severe form of molar incisor hypomineralization. The patients were divided equally into two groups, group I, i.e., occlusal veneer (OV) group, and group II, i.e., endocrown (EN) group, according to different preparation designs related to different severity levels of first permanent molars’ hypomineralization (moderate and severe); each group was subdivided equally and randomly into two subgroups, subgroup A, i.e., Vita Suprinity (VS), and subgroup B, i.e., Vita Enamic (VE), according to the material used for fabrication of the restoration. The survival and success rates of restorations were assessed using the clinical United States Public Health Service (USPHS) criteria at 1 week, and 3, 6, 12, and 18 months' recall times after cementation, and statistical analysis was performed. Results: There was no statistically significant difference between groups and subgroups in terms of all evaluation parameters during the whole observational period. Conclusion: Based on observations, occlusal veneer and endocrown designs fabricated from CAD/CAM VS and VE showed similar clinical success in the rehabilitation of first permanent molars with severe MIH over 18 months of evaluation.

Speckle Tracking Analysis of Mitral Annular Calcification and Left Ventricular Mechanics

BACKGROUND: Clinical echocardiography often reveals mitral annular calcification (MAC), and this condition has been connected to atherosclerosis and cardiovascular risk factors. To this day, our knowledge of the left ventricle’s (LV) physiology is still somewhat restricted. Using 2D speckle tracking echocardiography, we analyzed the connection between MAC and LV mechanical functions (2DSTE). AIM: The purpose of the current investigation is to assess how left ventricular mechanics are impacted by MAC. MATERIALS AND METHODS: Between April 2020 and October 2021, this prospective and cross-sectional study was carried out in Islamic Center of Cardiology Al Azhar University and Cardiology Department of Al Hussien University Hospital. Eighty participants were utilized in the study. When necessary, patients were referred to the Cardiology Clinics at the Medical Schools of Al Azhar University for follow-up care. Sixty MAC patients were studied with 20 healthy controls of similar age and gender. All patients had a 2D echocardiogram. Sixty consecutive patients with a MAC diagnosis and 20 age- and sex-matched controls with normal cardiac evaluations made up the study population. The patients were all given a 2D echocardiogram. RESULTS: The longitudinal strain significantly decreased as the MAC severity rose. The LV’s rotating mechanics varied greatly among MAC organizations. The E/A ratio, the global longitudinal speed (GLS), and the systolic tissue velocity were all shown to have a negative correlation with MAC thickness. Additional variables were found to have statistically significant connections. There were significant correlations between MAC severity and age, LV mass index, and t-LV UR. Age, LV mass index, and linear speed were significantly related to MAC severity. CONCLUSION: The LV ability to contract systolically and diastolically is compromised when MAC is both present and severe. The LV ability to contract systolically and diastolically is likewise impacted by an increase in MAC severity.