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International Journal of Medical Arts

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1 Comparative study between fascial defects closure and non-closure in laparoscopic incisional and ventral hernia repair , Ayman Elwan; Mohammed Eid Department of Surgery, Dameitta Faculty of Medicine, Al-Azhar University, Egypt
Background: Incisional hernias are common after abdominal surgery. Laparoscopic repair has advantages over open repair. Traditionally, laparoscopic ventral repair of hernia has been done as a bridged repair to accomplish circumferential overlap of the fascial defect. More recently, there has been a growing trend to do primary fascial closure to reapproximate the fascia before mesh insertion. Aim of the work: to present our experience with laparoscopic ventral and incisional repair of hernia to determine outcomes and different results of fascial defects closure and non-closure. Patient and methods: From January 2016 to April 2018, 68 patients suffering from ventral and incisional hernias were treated in New Damietta University Hospital. Laparoscopic repair was decided for all patients. Results: Operative time for group A ranged from 50-120 minutes (average 96.8 min), 30-90 minutes (average 66 min) for group B. Chronic postoperative pain reported in 12.9% in group A and 6.6% in group B. 16.1% from group A had seroma lasting 4 weeks, while it was reported in 36.7% from group B, which remain for 6 weeks. There were 7 patients from group A complaint of post-operative respiratory embarrassment which resolved conservatively except for one patient, who necessitated ICU admission for two days. No one from group B complaint of post-operative respiratory complications. Conclusion: Although there were no major statistical differences between fascial closure and non-closure groups, the seroma and recurrence were less in fascial closure group.
2   Comparative Study between Fascial Defects Closure and Non-closure in Laparoscopic Incisional and Ventral Hernia Repair   , Ayman Elwan  1; Mohammed Eid2  
Background: Incisional hernias are common after abdominal surgery. Laparoscopic repair has advantages over open repair. Traditionally, laparoscopic ventral repair of hernia has been done as a bridged repair to accomplish circumferential overlap of the fascial defect. More recently, there has been a growing trend to do primary fascial closure to reapproximate the fascia before mesh insertion. Aim of the work: to present our experience with laparoscopic ventral and incisional repair of hernia to determine outcomes and different results of fascial defects closure and non-closure. Patient and methods: From January 2016 to April 2018, 68 patients suffering from ventral and incisional hernias were treated in New Damietta University Hospital. Laparoscopic repair was decided for all patients. Results: Operative time for group A ranged from 50-120 minutes (average 96.8 min), 30-90 minutes (average 66 min) for group B. Chronic postoperative pain reported in 12.9% in group A and 6.6% in group B. 16.1% from group A had seroma lasting 4 weeks, while it was reported in 36.7% from group B, which remain for 6 weeks. There were 7 patients from group A complaint of post-operative respiratory embarrassment which resolved conservatively except for one patient, who necessitated ICU admission for two days. No one from group B complaint of post-operative respiratory complications. Conclusion: Although there were no major statistical differences between fascial closure and non-closure groups, the seroma and recurrence were less in fascial closure group.  
3 The effect of metabolic syndrome on outcome of acute exacerbation of chronic obstructive pulmonary disease (COPD)   , Abo-bakr Helal Al-Asmar1; Kamel Abd Elgafar Hassan2; Gamal Ahmed Mohamed3; Mohamed Elsayed Abd Elattif Elsherbiny  4 1Chest Disease Department; Faculty of Medicine; Al-Azhar University (Cairo) 2Chest Disease Department, Faculty of Medicine, Al-Azhar Faculty of Medicine (Damietta), Egypt 3Clinical Pathology Department, Al-Azhar Faculty of Medicine (Damietta), Egypt. 4Chest Disease Department; Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Abstract Background: Metabolic syndrome is a multiorgan disease and it could aggravate other diseases. Its effect on chronic obstructive pulmonary disease needs to be addressed. Aim of the work:  to examine if metabolic syndrome increases the frequency, duration and severity of acute exacerbations of chronic obstructive pulmonary disease. Patients and methods: 60 patients who admitted with COPD exacerbation were included and were divided into two groups: Group 1 (COPD without metabolic syndrome). Group 2 (COPD with metabolic syndrome). All submitted to full history taking, clinical examination, laboratory and radiological examination. Results: COPD severity was GOLD class II in 25.0%, class III in 51.7% and class IV in 23.3%; and disease severity was significantly higher in patients with metabolic syndrome. The frequency of COPD exacerbations showed significant increase in group 2 when compared to group 1 (2.17±0.65 vs 1.43±0.57 respectively). In addition, the duration of hospital stay increased significantly in group 2 when compared to group 1 (4.33±0.80 vs 3.37±0.61). Conclusion: metabolic syndrome could play a role in pathogenesis- or may be a consequence of- COPD. Thus, metabolic syndrome had a harmful effect on the outcome of COPD exacerbations.  
4 The effect of metabolic syndrome on outcome of acute exacerbation of chronic obstructive pulmonary disease (COPD)   , Abo-bakr Helal Al-Asmar1; Kamel Abd Elgafar Hassan2; Gamal Ahmed Mohamed3; Mohamed Elsayed Abd Elattif Elsherbiny  4 1Chest Disease Department; Faculty of Medicine; Al-Azhar University (Cairo) 2Chest Disease Department, Faculty of Medicine, Al-Azhar Faculty of Medicine (Damietta), Egypt 3Clinical Pathology Department, Al-Azhar Faculty of Medicine (Damietta), Egypt. 4Chest Disease Department; Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Metabolic syndrome is a multiorgan disease and it could aggravate other diseases. Its effect on chronic obstructive pulmonary disease needs to be addressed. Aim of the work:  to examine if metabolic syndrome increases the frequency, duration and severity of acute exacerbations of chronic obstructive pulmonary disease. Patients and methods: 60 patients who admitted with COPD exacerbation were included and were divided into two groups: Group 1 (COPD without metabolic syndrome). Group 2 (COPD with metabolic syndrome). All submitted to full history taking, clinical examination, laboratory and radiological examination. Results: COPD severity was GOLD class II in 25.0%, class III in 51.7% and class IV in 23.3%; and disease severity was significantly higher in patients with metabolic syndrome. The frequency of COPD exacerbations showed significant increase in group 2 when compared to group 1 (2.17±0.65 vs 1.43±0.57 respectively). In addition, the duration of hospital stay increased significantly in group 2 when compared to group 1 (4.33±0.80 vs 3.37±0.61). Conclusion: metabolic syndrome could play a role in pathogenesis- or may be a consequence of- COPD. Thus, metabolic syndrome had a harmful effect on the outcome of COPD exacerbations.  
5 Transthoracic Echocardiography as A friend to Pulmonologist in Respiratory Intensive Care   , Atef Wahdan Elrifai   1; Sayed kinawy2; Naggeh Mohammed Mahmoud3; Muhammad Reihan4 1Chest disease Department; Al-Azhar Faculty of Medicine (Damietta) 2Chest Disease, Faculty of Medicine, Aswan University 3Cardiology Department; Faculty of Medicine, Aswan University 4Cardiology Department, Faculty of Medicine; Al-Azhar University  
Background: Bedside echochocardiography is a useful tool in critical care setting. Several studies support the performance of echocardiography by non-cardiologist. Aim of the work: To evaluate if bedside transthoracic echocardiography (done by intensivist) is useful to provide diagnosis of cardiovascular pathologies of patients with acute respiratory failure in respiratory intensive care, and to assess the interobserver variability between measurements done by intensivist and expert echocardiographer. Methods: Sixty patients with acute respiratory failure admitted to respiratory critical care unit were evaluated by echocardiography by an intensivist and expert echo cardiographer. Interobserver agreement for both readings was done. Results: results of the present work revealed that, there was strong agreement between the reading of both the intensivist and echocardiographer. In addition, significant abnormalities were present in the examined cases especially diastolic dysfunction. conclusions: The intensivist detected most abnormalities detected by the expert echocardiographer. The bedside echocardiography is a useful instrument in respiratory critical care unit.  
6 Awake fiberoptic versus awake videolaryngoscopy in difficult intubation   , Saud Mohammed Erwi1; Ibrahim Mahmoud  2; Neazy Abdmokhles Abdelmottaleb2 1Pulmonologist and Intensivist at Armed Forces Hospital, Jazan, KSA 2Anesthesiology and Intensive Care Department, Faculty of Medicine, Al-Azhar University, New Damietta City, Egypt  
Background: Difficult intubation is usually encountered in daily work of anesthesia and intensive care. Different inventions and techniques were tried to deal with difficult intubation. Aim of the work:  To investigate the difference between awake fiberoptic and awake videolaryngoscopy in difficult intubation Methods: A two-years, randomized comparative study was conducted and included patients with ASA classes I to III, who were scheduled for elective surgical procedures with anticipated difficult intubation. Patient randomly allocated to fiberoptic intubation (FI) and videolaryngoscopy (VL) intubation. The outcome measures were time to tracheal intubation, intubation success, number of attempts and operator evaluation of the procedure. Results: Both groups were comparable as regard to patient demographics, ASA classifications, number of attempts and number of patients who experienced desaturation. The time to intubate was significantly shorter in VL when compared to FI group. The sedation score and ease scores were significantly lower in VL when compared to FI groups. Conclusions: Videolaryngoscopy-guided intubation in difficult cases was associated with better outcome than fiberoptic intubation. However, no failure was reported in both groups  
7 Spinal Bupivacaine-Dexmedetomidine versus Bupivacaine-Fentanyl for lower Limb Amputation Surgery. Effects on Early Stump and Phantom Pain   , Ezzedeen Ismaeil Fekry1; Mohammed Samy Sharf2; Yousry Abdelsalam Kandil 3; Salama A Harby   4 1Anesthesia Department; Al-Azhar Faculty of Medicine (Cairo) 2Anesthesia and Intensive care, Al-Azhar faculty of Medicine (Damietta) 3Anesthesia Department; Al-Azhar Faculty of Medicine (Damietta) 4Al-Azhar University, Faculty of Medicine Anesthesia and Intensive Care  
Background: in neuroaxial anesthesia, there was many adjuvants used with the purpose of increasing anesthesia duration and reduction of postoperative analgesia. Objective: comparison between dexmedetomidine and fentanyl when added to 0.5% hyperbaric bupivacaine, for lower limb amputation on early stump and phantom pain after spinal anaesthesia. Patients and Methods: Ninety patient arranged for lower limb amputation surgery were randomly allocated into three groups (each 30 patients). Each patient received 2 ml of hyperbaric bupivacaine (0.5%) plus 0.5 ml normal saline in control group (Group B) or 5µ dexmedetomidine diluted in 0.5 ml normal saline in BD group or 25 µ fentanyl diluted in 0.5 ml normal saline in BF group. Anesthesia, analgesia, sedation, hemodynamic changes, adverse effects and post-operative pain up to one month were recorded. Results: The studied groups showed no significant differences regarding demographic characteristics and hemodynamic (heart rate and mean arterial pressure). Patients in group BD had significant increase of sensory and motor block time compared to BF B groups. Post-operatively, there was a significant decrease of pain in BD group in the first 24 hours when compared to control or BF group. The postoperative mean total consumption of analgesics during the first day was significantly decreased in BD when compared to BF and control groups. Conclusions: dexmedetomidine (5μg) represents a good alternative to fentanyl (25μg) as a spinal adjuvant to bupivacaine in surgery for the lower limb.  
8 Evaluation of S100B serum level as a biomarker of disease activity in vitiligo patients   , radwa abd El-Halim  1; Hasan Mohamed2; Ibrahim Fouda2; Hesham Abd El-Samee3 1Resident at Dermatology and Leprosy Hospital, Egypt 2Dermatology and Venereology Department, Al-Azhar Faculty of Medicine (Dameitta), Egypt. 3Clinical Pathology Department, Al-Azhar Faculty of Medicine (Damietta), Egypt.  
Background: Vitiligo is a depigmenting disorder characterized by the appearance of circumscribed white macules in the skin. The aetiology of vitiligo is not clear, and although various hypotheses have been proposed. It has been suggested that autoimmunity plays an important role in the pathogenesis of vitiligo. Objective: To evaluate the serum levels of S100B as it could be used as biomarker of disease activity in vitiligo patients. Patients and Methods: The current study included 45 patients with vitiligo and 45 healthy controls. Patients were divided into two groups, segmental vitiligo (group I) including 4 patients and generalized vitiligo (group II) including 41 patients. All participants were recruited from the outpatient clinic of Al-Azhar University hospital (Damietta) and Dermatology, Venereology, Leprosy in June 2018. Results: S100B serum levels were high in patients with vitiligo as compared to the control subjects. S100B were significantly higher in non segmental vitiligo. S100B serum levels were higher in active vitiligo patients as compared to inactive vitiligo patients. There was no significant difference between the studied groups regarding age, gender, duration of the disease and Fitzpatrick skin phototype. Conclusion: Vitiligo patients have been associated with high levels of S100B, indicating its possible involvement in its pathogenesis. Levels of S100B may be a potential target for treatment. It is needed to perform further studies with larger sample size including patients and controls and follow up monitoring of activity in needed to evaluate of S100B.  
9 Impact of serum level of vitamin D on term neonates with early onset sepsis   , Yasmine Soliman  1; Magdy Sakr2; Tarek Emran 3; Mohamed El Samanoudy2 1Pediatrics Department, Faculty of Medicine, Mansoura university, Egypt 2Pediatrics Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 3Clinical Pathology Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: Neonatal sepsis a major health challenge associated with major morbidity and mortality. Neonatal care improved recently. However, different challenges regarding management still exist. Vitamin D deficiencies was proposed as a predictor of neonatal sepsis. Objective: To highlight the impact of vitamin D levels on early onset sepsis in full term neonates. Methodology: It is a case control which carried out at the neonatal intensive care unit of Al-Azhar university hospital (Damietta), from March to April 2019. It included 50 full-term neonates with probable sepsis and 50 healthy controls of matched age and sex with no signs of sepsis. Results: vitamin D level showed significant negative correlation with sepsis, C-reactive protein (CRP), positive blood cultures; and significant positive correlations with Apgar score, hemoglobin concentration and platelets count. Regression analysis revealed that, higher CRP and lower vitamin D were associated risks of neonatal sepsis in univariate analysis. Multivariable regression analysis revealed that only lower vitamin D level is the predictor for early neonatal sepsis. Conclusion: Vitamin D levels were significantly lower in septic neonates with high sensitivity and specificity. Vitamin D supplementation to mothers during pregnancy could prevent early onset neonatal sepsis.  
10 Effect of Lactoferrin Supplementation on Iron Deficiency Anemia in Primary School Children   , Abeer El-Khawaga  ; Hussein Abdelmaksoud Pediatric Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: many other studies were done to evaluate the effect of oral lactoferrin administration on iron deficiency anemia. Objective: This study was designed to assess the effects of lactoferrin supplementation on primary school children having iron deficiency anemia. Patients and Methods: Prospective cohort study was conducted on 94 patients with iron deficiency anemia. They were 58 females and 36 males. Their ages range from 6 years to 12 years with mean age of 8.4 years. In the period between October 2018 and January 2019. Each child was submitted to full history taking, complete clinical examination and laboratory investigations including complete blood count, Serum ferritin, serum iron and total iron binding capacity. Results: oral administration of bovine lactoferrin (BLf) significantly increases the number of red blood cells, hemoglobin, serum ferritin and total iron after thirty days of the treatment. BLf is a more effective and safe alternative than elemental iron for treating iron deficiency and iron deficiency anemia. Conclusion: lactoferrin is a better substitute for elementary iron in treatment of iron deficiency.  
11 Ondansetron VS Pethidine for The Prevention of Postoperative Shivering   , Medhat Noaman1; Fouad Ibrahim Mohamed1; Adel Al-Hady Ahmed Diab  2 1Department of Anesthesia and Intensive care, Faculty of medicine (Damietta), Al-Azhar University 2Department of Anesthesia and Intensive care, Faculty of medicine (Damietta), Al-Azhar University.  
Objective: The aim of the present study was to evaluate the effects of ondansetron for prevention of postoperative shivering. Patients and Methods: The study was carried out on 40 patient ASA I or II scheduled for lower abdominal surgery. They were categorized into two equal groups Group I (Group P): Patients were receiving intravenous pethidine in a dose of 0.5 mg/kg. Group II (Group O): Patients were received intravenous ondansetron in a dose of 4 mg. just before induction of spinal block. Results: The studied groups showed no significant difference regarding demographic data, or postoperative shivering. However, postoperative nausea, vomiting and sedation were significantly increased in pethidine when compared to ondansetron group.  Conclusion: Ondansetron is effective as Pethidine for prevention of postoperative shivering. However, side effects postoperative nausea & vomiting were significantly higher in pethidine group. Thus, ondansetron could be used as a safe and effective alternative for pethidine for postoperative shivering.  
12 Ondansetron VS Pethidine for The Prevention of Postoperative Shivering   , Medhat Noaman1; Fouad Ibrahim Mohamed1; Adel Al-Hady Ahmed Diab  2 1Department of Anesthesia and Intensive care, Faculty of medicine (Damietta), Al-Azhar University 2Department of Anesthesia and Intensive care, Faculty of medicine (Damietta), Al-Azhar University.  
Objective: The aim of the present study was to evaluate the effects of ondansetron for prevention of postoperative shivering. Patients and Methods: The study was carried out on 40 patient ASA I or II scheduled for lower abdominal surgery. They were categorized into two equal groups Group I (Group P): Patients were receiving intravenous pethidine in a dose of 0.5 mg/kg. Group II (Group O): Patients were received intravenous ondansetron in a dose of 4 mg. just before induction of spinal block. Results: The studied groups showed no significant difference regarding demographic data, or postoperative shivering. However, postoperative nausea, vomiting and sedation were significantly increased in pethidine when compared to ondansetron group.  Conclusion: Ondansetron is effective as Pethidine for prevention of postoperative shivering. However, side effects postoperative nausea & vomiting were significantly higher in pethidine group. Thus, ondansetron could be used as a safe and effective alternative for pethidine for postoperative shivering.  
13 Feasibility and Accuracy of Two-and Three-Dimensional Transthoracic Echocardiography in patients with Right Atrial Dilatation using the Right Parasternal Approach   , Khaled Ibrahim Najeeb1; Mohamed Sayed Bashandy1; Reda El-Sayed Abd Elfattah  2 1Cardiology Department, Faculty of Medicine (Dameitta), Al-Azhar University 2Cardiology Department, Faculty of Medicine (Damietta), Al-Azhar University  
Background: Echocardiography increasingly used for diagnosis of right atrial dilatation. Three dimensional is superior than two dimensional echocardiography. However, advances and new windows continues to emerge to increase its accuracy Aim of the work: to show the feasibility and accuracy of right parasternal approach and its usefulness in qualitative and quantitative assessments of right atrium in patients with right atrial dilatation in comparison with transesophageal approach. Patients and Methods: The study included thirty patients with right atrial dilatation. All patients underwent full history taking, clinical, 12-lead electro-cardiography and echocardiography. Transesophageal Echocardio-graphy was used as a gold standard for the accuracy of the right parasternal approach. Results: The study includes 30 patients with right atrial dilatation the right parasternal (RPS) view obtained in 18 patients (60%), and not obtained in 12 patients (40%). There was significant decrease of SVC anteroposterior minimal diameter (Min AP), crista terminalis (CT) width, CT length, right atrial appendage (RAA) base Maximum diameter and RAA base Minimum diameter, in 2D Echocardiography   when compared to 3D Echocardiography. On the other side, there was no statistically significant difference in Right parasternal approach (3D) and Transesophageal approach. Conclusions: Parasternal approach is feasible in imaging right heart structures.  In addition, three dimensional TTE had an incremental value over two dimensional TTE in the assessment of these structures  
14 Assessment of Left Ventricular Dyssynchrony and Cardiac Function in Patients with Different Pacing Modes Using Real-Time Three-Dimensional Echocardiography: Comparison with Tissue Doppler Imaging   , Waseem Omar Ahmed  1; Mansour Mohammed Mostafa2; Mohamed Sayed Bashandy3; Ahmed Mohamed Ahmed Mostafa4; Mohamed Moheyaldeen2; Mohamed Samy Abdalsamee2 1Cardiology Department, Faculty of Medicine, Al-Azhar University (Damietta) 2Cardiology Department, Faculty of Medicine, Al-Azhar University 3Cardiology Department, Faculty of Medicine (Al-Azhar University; Damietta) 4Cardiology Department, Al-Azhar University, Faculty of Medicine  
 Background: Previous studies revealed that right ventricle apex pacing with different modes may yield abnormal electrical activity and left ventricle dyssynchrony. Aim of the work: To evaluate systolic function of left ventricle and mechanical dyssynchrony with different modes of pacing using real time three dimensional echocardiography [the RT3DE] and tissue Doppler imaging [TDI]. Patients and Methods: The study included thirty-five individuals with permanent dual chamber pacemaker with atrial leads placed in right atrial appendage and right ventricular leads placed in right ventricular apex, the pacemakers were programmed to different modes. Imaging parameters were obtained following pacing for 24 hours in each mode. Results: The results revealed that the RT3DE and TDI-derived dyssynchrony indices in the atrial demand pacing [AAI] mode were significantly lower than those in the dual chamber demand pacing [DDD] and ventricular demand pacing [VVI] modes; however, there was no significant difference between the DDD and VVI modes. Also, left ventricular ejection fraction [LVEF] during AAI and DDD modes was significantly higher than that during VVI mode; however, there was no significant difference between the DDD and AAI modes. There were negative correlations between LVEF and Ts-MD and Ts-SD, and there was positive strong correlation between RT3DE and TDI-derived dyssynchrony indices. Conclusions: Left ventricular systolic synchronicity in AAI mode was superior to that in DDD and VVI modes. Left ventricular ejection fraction in the AAI and DDD pacing modes are superior to that in the VVI mode.  
15 The Validity of Dermoscopic Findings in Diagnosis of Scabies   , Asmaa Sabry Mohamed1; Rabie Bedair Atallah2; Ahmed Amer  2 1Department of Dermatology, El-senbellawin Hospital, Ministry of Health and Populations, Egypt 2Department of Dermatology, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Scabies is a common parasitic infestation of the skin. Signs and symptoms of scabies are the result of a hypersensitivity reaction to proteins released by the mites. Diagnosing scabies is problematic and confirmed by direct tests showing the presence of mites or their eggs. Dermoscopy is viewed as a sensitive and valuable tool in diagnosing scabies in vivo Objective: to assess the validity of dermoscopic findings in diagnosis of scabies. Patients and methods: This study included 40 patients complaining of generalized itching or multiple localized itching. All the patients were subjected to full history taking and clinical examination including general examination, dermatological examination and photography of any lesions in the suspected sites. These lesions were examined by the dermoscope. Results: The results of the study revealed that dermoscope had 87.5 % sensitivity and 100% specificity in the diagnosis of scabies as compared to clinical examination. The overall accuracy of dermoscope in diagnosis of clinically suspected cases was 90%. Conclusion: Scabies is a common skin disease that affects both genders mainly in the middle age group. Dermoscope has been shown to be as an effective and non-invasive technique in diagnosis of scabies  
16 Role of Balloon Angioplasty in Non-mature Arteriovenous Fistula caused by Stenosis   , Almetwaly Ragab Ragab Ibrahim  Vascular Surgery Department; Faculty of Medicine (Damietta), Al-Azhar University  
Background: Arteriovenous fistula (AVF) is a significant procedure for patients in need for hemodialysis. Failure of maturation due to stenosis is a challenge, which need further intervention. Aim of the work: To present our experience in therapeutic intervention for non-mature arteriovenous fistula caused by stenosis using balloon angioplasty. Patients and Methods: 25 patients who had stenosis of primary AVF were included. The mean age was 57.28±6.97 years and patients were 16 males and 9 females. Patients were Followed-up every three months up to 1 year. Collected data included patient demographics, cause of renal failure, characters of primary AVF, and variables of balloon angioplasty (e.g., clinical success and complications), primary patency and recurrence of stenosis. Results: AVF type was radiocephalic (60.0%), brachiobasilic (24.0%) and brachiocephalic (16.0%). The fistula segment was juxta-anastomotic (44%), anastomosis (36.0%) and efferent in 20.0%. Technical success was 100%; the patency rate at 6 months was 80.0%, at 9 months was 64.0% and at 12 months was 56.0%. There was puncture site hematoma in 2 patients (8.0%) that were treated conservatively. The recurrence was reported in 9 patients (36.0%) (8 cases due to re-occlusion and one patient due to thrombus formation). Recurrence was significantly associated with older age and high coronary artery disease. Conclusions: Balloon angioplasty is effective and safe procedure for treatment of AVF non-maturation due to stenosis.  
17 Prevalence of Psoriatic Arthritis among Psoriatic Patients in Damietta Governorate   , Aisha Ahmed Mohamed  1; Emad Elgmal2; Osama Hashem 3 1Dermatology,alazhar university, Damietta 2Dermatology department Al-Azher university 3Dermatology department, Al-Azher university  
Background: Psoriasis is a chronic inflammatory skin disease affecting approximately 1-6% of population in the world. Aim of the work: To screen psoriatic patients for psoriatic arthritis [PsA] to improve optimal PsA management and outcome. Patients and Methods: This study included one hundred and tow patients with psoriasis recruited from the dermatology outpatient clinics in Damietta, [Al-Azhar University Hospital, Dermatology and Leprosy Hospital and El-Maasarah Hospital]. Patients should fulfill a Simple Psoriatic Arthritis Screening Questionnaire [SiPAS] to calculate the prevalence of psoriatic arthritis among psoriatic patients in Damietta. Results: The study included 42 [41.2%] females and 60 [58.8%] males with age range between 6 -88 years old with mean age 45 years old. Among the 102 included patients with psoriasis, 36 patients [35.3%] had score [≥3]; [63.9%] of them were men and [36.1%] were women with mean age 51 years old, mean age of onset of psoriasis 31 years old and mean duration of psoriasis 19.14 . [77.8%] of them had psoriatic nail lesions. On the other side, 66 patients [64.7%] had score [<3] with mean age 45.19 years old, mean age of onset of psoriasis 32 and mean duration of psoriasis 9 years. Conclusion: Early diagnosis of PsA could prevent permanent joint damage or spinal fusion and could improve long-term patient outcome. The SiPAS questionnaire can be a powerful tool to help dermatologists to quickly screen PsA during their clinical practice. The SiPAS questionnaire is able to quickly screen psoriasis patients for PsA. A SiPAS score ≥3 is an indication for referral to a rheumatologist.  
18 Evaluation of the Prevalence and Risk of Metabolic Syndrome in Vitiligo Patients   , Eman Ahmed Rashed  1; Ibrahim Fouda2; Emad Elgmal3 1Dermatology Department, Alexandria university 2Dermatology, medicine,Alazhar, Damietta 3Dermatology department Al-Azher university  
Background: Vitiligo is a common disease of the skin, affecting epidermis and hair follicles. Both genders are affected. The main pathogenic mechanism of the disease is the destruction or inhibition of the epidermal melanocytes which is manifested clinically by presence of variable sized areas of skin depigmentation that can affect any site of the body. Aim of the work: To estimate the prevalence and risk of metabolic syndrome in vitiligo patients. Patients and Methods: This is a case control study that was conducted on 90 patients with vitiligo recruited from outpatient clinic, dermatology department of Al Azhar University Hospital in Damietta, and 60 healthy controls. Full history was taken from all the subjects included in the study. The cases were also subjected to careful general examination and dermatological examination to determine the site and the type of the lesion and the presence of any dermatological diseases, laboratory investigations including HDL, TG and FBS were done. Results: In this study we found that 35.6% of cases have metabolic syndrome while 33.3% of healthy controls have metabolic syndrome. We also found that there is no relation between presence of metabolic syndrome and disease extent, progression or stage. Conclusion: Incidence of metabolic syndrome is slightly higher in cases with vitiligo as compared to the control group. Presence of metabolic syndrome is not associated with disease severity, extent or stage.  
19 Evaluation of the Prevalence and Risk of Metabolic Syndrome in Vitiligo Patients   , Eman Ahmed Rashed  1; Ibrahim Fouda2; Emad Elgmal3 1Dermatology Department, Alexandria university 2Dermatology, medicine,Alazhar, Damietta 3Dermatology department Al-Azher university  
Background: Vitiligo is a common disease of the skin, affecting epidermis and hair follicles. Both genders are affected. The main pathogenic mechanism of the disease is the destruction or inhibition of the epidermal melanocytes which is manifested clinically by presence of variable sized areas of skin depigmentation that can affect any site of the body. Aim of the work: To estimate the prevalence and risk of metabolic syndrome in vitiligo patients. Patients and Methods: This is a case control study that was conducted on 90 patients with vitiligo recruited from outpatient clinic, dermatology department of Al Azhar University Hospital in Damietta, and 60 healthy controls. Full history was taken from all the subjects included in the study. The cases were also subjected to careful general examination and dermatological examination to determine the site and the type of the lesion and the presence of any dermatological diseases, laboratory investigations including HDL, TG and FBS were done. Results: In this study we found that 35.6% of cases have metabolic syndrome while 33.3% of healthy controls have metabolic syndrome. We also found that there is no relation between presence of metabolic syndrome and disease extent, progression or stage. Conclusion: Incidence of metabolic syndrome is slightly higher in cases with vitiligo as compared to the control group. Presence of metabolic syndrome is not associated with disease severity, extent or stage.  
20 Lower Urinary Tract Symptoms Related to Neurological Diseases in Egyptian Patients   , Ahmed Yousef Aboelsaad   1; Mohie-eldin Tharwat Mohamed2; Mohamed Abdallah Hindawy3 1Urology Department, Faculty of Medicine (Damietta), Al-Azhar University 2Neurology Department, Faculty of Medicine, Al-Azhar University (Cairo) 3Urology Department, Faculty of Medicine, Al-Azhar University (Cairo)
Background: Lower urinary tract symptoms [LUTS] have a marked impact on the quality of life in patients with neurological ailments. They are also linked to a high risk of serious morbidities. Aim of the work: was to evaluate the LUTS associated with neurological disorders in a sample of Egyptian patients. Patients and Methods: This study conducted on 104 patients treated in our Neurology and urology clinic at Al-Azhar University hospitals from January 2018 to January 2019. Patients divided into several subgroups according to the neurological diagnosis, and the following data were collected: age, sex, irritative symptoms [frequency, urgency, and urge incontinence], obstructive symptoms [straining, slow stream, hesitancy, retention of urine], timing [before or after neurological disease], and finally evolution of symptoms either solved or persistent. Results: We studied 104 patients; 53 were females and 51 males. LUTS were found in 44 out of 104 patients [42.3%]. LUTS were more presented in patients with neurovascular, spinal cord and demyelinating disorders. Urinary urge incontinence was the most common symptom [70.4%]. It was found to be predominant in the neurovascular and demyelinating diseases. In 30 out 44 subjects, the urinary symptoms persist, in 14 out of them the urinary problems were treated. Conclusions: Storage symptoms are more common, mostly urge urinary incontinence. Neurovascular diseases, spinal cord, and demyelinating diseases are the most common neurological disorders associated with LUTS. A multidisciplinary method should be encouraged for the management of these patients including the whole team of rehabilitation.  
21 Prevalence of Intrauterine Adhesions after Hysteroscopic Myomectomy by Integrated Bigatti Shaver [IBS]   , Eman Yahia Awad  1; Mohammed Anter2; waleed Ahmed Ayad3 1Obstetrics and gynaecology.al-azhar university new damitta 2Obstetrics and Gynecology department,Faculty of medicine,Al-Azhar University,New Damieta 3Obstetrics and Gynecology department,Faculty of medicine.Al-Azhar University,New Damieta  
Background: Myomectomy is the best procedure for treatment of uterine fibroids. However, post-myomectomy adhesions represent a major problem. The introduction of hysteroscopic myomectomy thought to reduce these adhesions. However, the incidence is not determined after different shavers. Aim of the work: To assess the prevalence of adhesions in women undergoing IBS-myomectomy for uterine fibroids. Patients and methods: The study included 70 women indicated for IBS myomectomy. Eligible females were submitted to full history taking, clinical examination and routine laboratory investigations. In addition, all patients underwent transvaginal ultrasonography. Fibroid grade was defined and hysteroscopic myomectomy. Then office hysteroscopy was done after 3 months of the procedure, and any pathology especially intrauterine adhesions was reported. Patients were classified into two groups; with adhesions and without adhesions. Results: The incidence of adhesions was 5.7%. The development of adhesion was usually associated with multiple myomas present in posterior position who need long resection time and usually the resection is incomplete. The adhesions were usually mild [75%] and there was no complications were reported after hysteroscopic myomectomy. Conclusion: The incidence of intrauterine adhesion after the hysteroscopic myomectomy by IBS is low  
22 Surgical Field Visibility during Functional Endoscopic Sinus Surgery: Esmolol-induced Hypotensive Anesthesia versus Hypotensive Total Intravenous Anesthesia   , Mostafa Eid Mohamed Ahmed1; Mahmoud Mohamed Elsayed2; Nabil Abdelghany Sarhan  3; Mohamed Abdelkawy Fathallah4 1Anesthesia and Intensive Care Department, Faculty of Medicine, Al-Azhar University (Assuit) 2Anesthesia and Intensive Care Department, Faculty of Medicine; Al-Azhar University 3Otorhinolaryngology, Al-Azhar faculty of Medicine (Damietta) 4Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University (Damietta)  
Background: Functional endoscopic sinus surgery is widely practiced during daily otorhinolaryngology practice. It usually done under low blood pressure. However, the ideal hypotensive drug or technique is yet not well established. Aim of the work: To evaluate outcome of functional endoscopic sinus surgery under esmolol-induced hypotensive anesthesia [EHA] versus hypotensive total intravenous anesthesia [H-TIVA]. Patients & Methods: 72 patients were randomly divided into two groups; Group A: H-TIVA and Group B [EHA]. After induction of anesthesia, remifentanil/ propofol and esmolol infusions were adjusted to maintain mean arterial pressure at 60-70 mmHg. After completion of surgical procedure, esmolol infusion was stopped, while remifentanil/propofol infusions were adjusted to allow restoration of blood pressure. Operative field bleeding and visibility were graded using Fromme scale. Primary outcome is the efficacy of EHA to minimize intraoperative bleeding to an extent that allows satisfactory completion of surgery. Results: Esmolol bolus significantly attenuated pressor reflexes to induction and intubation than induction by remifentanil. Intraoperative [IO] heart rate and MAP measures were significantly lower with EHA. At 10-minures after infusion stoppage, patients of group B still had significantly lower HR and MAP, while at 10-min later, the difference was non-significant. HA minimized IO blood loss down to no to slight bleeding in 16.7% and 55.5% of studied patients and improved field visibility to satisfactory-to-good levels in 51.4% and 43.1% of surgeries, respectively. Moreover, EHA provided better field visibility, so allowed significant reduction of operative time than with TIVA. Conclusion: Hypotensive anesthesia is safe and appropriate modality for FESS and improves surgical and clinical outcome. Both esmolol and remifentanil provided satisfactory results. Esmolol is superior to remifentanil.  
23 Surgical Aspects of Space Medicine   , Nagah Atwa Salem  General Surgery Department; Faculty of Medicine (Damietta); Al-Azhar University  
Although the perception of surgery in space may appear obscure, it is vital to initiate planning early if new frontiers in space travel are to be accomplished. Conditions necessitating surgery in space are rare, but they are challenging in their management. Telemedicine can allow consultation and instruction at the time of surgical intervention. This may permit optimal guidance for conduction of simple surgical maneuvers by non-medical crew members. Robots could be used for more complex interventions in the absence of a trained crew member. Earth-to-space telesurgery is yet to be attained. However, National Aeronautics and Space Administration [NASA] has successfully did several basic procedures at an underwater facility, simulated the space environment. The communication delay between craft and earth is the main potential issue affecting telesurgery. For example a communication delay of radio signals between 4 and 22 minutes is expected between earth and Mars. Thus, available telesurgical capabilities are not suitable for a Mars mission. In addition, to facilitate endogenous repair of injured structures, the use of absorbable nanoparticulate scaffolds could offer temporary structure support, while eluting drugs stimulate endogenous mesenchymal stem cells to differentiate into osteoblasts. Otherwise, direct delivery of extrinsic mesenchymal stem cells to injured sites via nanoparticulate delivery system provide a reasonable alternative. The use of 3D printing allows fabrication of complex surgical tools from a computer-aided design template from a digital database of nearly each instrument. In addition, 3D-printed surgical tools may be disposable, meaning no requirement for space-occupying sterilization appliances.  
24 Evaluation of Vitamin D3 level in Sino-nasal Polypi   , Ali Abd-Allah Abdel-Rahman1; Mahmoud El-Said El-Sobky1; Amr Ahmed Rezk2; Mohamed Salah Emara  3 11Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University 2Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University 3ENT department, New Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Vitamin D is a group of fat-soluble corticosteroid responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and multiple other biological effects. In humans, the most important compounds in this group are vitamin D3 [also known as cholecalciferol] and vitamin D2 [ergocalciferol]. Aim of the work: The aim of this thesis is to assess Vitamin D3 [VD3] level in patients with sino-nasal polypi in comparison with normal individuals. Patients and Methods: This prospective comparative [case-control] study conducted by the Department of ENT, Al-Azhar University Hospitals in the period from March 2019 to September 2019 and included 40 individuals who were selected by inclusion and exclusion criteria, both genders, all patients had been counseled about the nature of the study and informed written consent has been obtained. Results: Serum level of VD3 in patients with chronic rhinosinusitis with sinonasal polyps [CRSwNP] and allergic fungal rhinosinusitis [AFRS] was significantly lower than that of control subjects. Vitamin D levels ranged from 8.74 to 39 ng/ml, and there was statistically significant decrease of serum vitamin D levels in patient group when compared to control group [16.20±4.29 vs 30.56±4.83 respectively]. In addition, there was significant increase of patients with deficient and insufficient vitamin D levels in patient group when compared to control group. Conclusion: VD3 may constitute an inexpensive prophylactic and cost effective option in the therapeutic armamentarium in reducing inflammation either by itself or as a synergistic agent to traditional agents in patients suffering from sino-nasal polypi.  
25 Propofol versus Midazolam in Sedation for Upper Gastrointestinal Endoscopy   , Foad Ibrahim Mohamed  1; Yosry Abdelsalam Kandil2 1Anesthesia and Intensive Care, Faculty of Medicine (Damietta), Al-Azhar University 2Department of Anesthesia and Intensive care, Faculty of medicine [Damietta], Al-Azhar University  
Background: Upper gastrointestinal endoscopy [either diagnostic or therapeutic] is widely practiced under conscious sedation. However, the standard sedative agent or drug combination is not yet well established. Aim of the work: Comparison between propofol-fentanyl and midazolam-fentanyl for sedation in upper gastrointestinal endoscopy. Patients and methods: Sixty patients from those scheduled to undergo upper gastrointestinal endoscopy at the Gastrointestinal Endoscopy Unit were included. Patients were divided into two equal groups: propofol-fentanyl and midazolam fentanyl. The Anesthetist scheduled to perform the procedures was oriented by the drug, while patients did not know the sedating drug. Prior to the procedure, a clinical history and physical examination was carried out, and throughout the procedure the patient was monitored for blood pressure, heart rate, respiratory rate, and oxygen saturation. Both groups were compared regarding time to recovery, patient satisfaction, physician satisfaction and adverse events. Results: Recovery time was significantly shorter, patient and physician satisfaction scores were significantly higher among propofol group. On the other side, systolic blood pressure was significantly lower in propofol group at midpoint and recovery times, while oxygen saturation was significantly reduced in midazolam group at intermediate point of the procedure. Finally, hypoxia was significantly higher among midazolam group [reported in 20.0%], versus [none] in propofol group. No other adverse events were encountered. Conclusion: Propofol is better sedative than midazolam for upper gastrointestinal endoscopy. Thus, it should be used as a first-line drug in sedation in our endoscopy units.  
26 Ocular Complications in Rheumatoid Patients at Damietta Governorate: Correlation with Age, Gender and Disease Activity   , Saad Alzokm  1; Ali A. Ghali2 1Department of Rheumatology and Rehabilitation, Damietta Faculty of Medicine, Al-Azhar Univeristy, Egypt 2Department of Ophthalmology, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Ocular complications are one of the well-recognized extra-articular complications of rheumatoid arthritis [RA]. The most common ocular complications of RA are Keratoconjunctivitis sicca, episcleritis, scleritis, marginal thinning of the cornea with keratolysis, stromal corneal opacities with peripheral vascularization, and iridocyclitis. The ocular complications were found to be significantly higher in patients with long duration of RA. Aim of the work: This study was conducted to determine the common ocular complications that occur with RA and to determine the correlation of this complications with age, gender, duration, and activity of RA. Patients and methods: Tow hundred eyes of one hundred patients [males and females] with symptomatic evidence of RA were studied. All patients subjected to full clinical evaluation, laboratory assessment, plain X-ray hand and detailed ocular examination [visual acuity, slit lamp, fundus examination and Schirmer’s test]. Results: Our research showed that 47.0% of the studied cases were aged from 41 to 60 years old, 93.0% of them were females, 57.0 % of them had RA more than 2 years [longstanding RA] and 40.0 % of them had ocular complications. The most common eye complications among the studied cases were dry eye, episcleritis, and scleritis [28.5 %, 4.0 %, and 3.0 % respectively]. Conclusion: RA patients have a higher risk of ocular complications. Eye examination should be included as a routin for RA patients to facilitate early diagnosis and management of ocular complications.  
27 Clusterin and Psoriasis; What is the Relation? , Osama Hashem   1; Zakaria Obaid1; Heshm Abd Alsamee2; Fatma Youssef3 1Department of Dermatology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Department of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Damietta General Hospital, Ministry of Health, Egypt.  
Background: Atherosclerotic infarction accounts for a sizable proportion of cerebral infarcts whether occurs from extracranial or intracranial atherosclerotic disease. Despite recent studies on stroke risk factors; it is still unclear whether or not single risk factor specifically affect extracranial or intracranial arteries in stroke patients. Aim of the work: To determine the difference between intracranial and extracranial steno-occlusive atherosclerosis and its correlation with risk factors of acute ischemic stroke using Magnetic Resonance Angiogram (MRA) and/or Computed Tomography Angiography (CTA) with Duplex. Patients and methods: All cases diagnosed as acute ischemic stroke were subjected to detailed history, full neurological examination, routine laboratory tests, extracranial vessels assessed by duplex, intracranial vessels assessed by MRA and/or CTA. Results: 61 patients included in the study (38 males and 23 females), with mean age (64.5 ± 11.4). Extracranial stenosis was (57 patients, 93.4%), while intracranial stenosis was (49 patients, 80.3%). But the intracranial significant stenosis was (45 patients, 73.77%), while the extracranial significant stenosis (26 patients, 42.62%). Hypertension (72.1%), obesity (62.3%), diabetes (57.4%), dyslipidemia (54.1%) and smoking (39.3%), were risk factors equally affecting the extracranial and the intracranial systems in the same descending order. There was a higher prevalence of hypertension among patients with intracranial significant stenosis showing a significant P-value of 0.048. Conclusion: Extracranial stenosis was more common than the intracranial stenosis, but the intracranial significant stenosis is more prevalent than the extracranial. Hypertension is a significant risk factor for intracranial significant stenosis  
28 The Effect of Phototherapy on Serum Level of Tumor Necrosis Factor Alpha in Neonates   , Mohamed Ali Neam  1; Mohamed Abdelsalam Zannoun2 1Department of Pediatrics, Damanhour General Hospital, Ministry of Health, Egypt 2Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Jaundice is one of the most common conditions confronting neonatologists daily. Phototherapy is generally regarded as a safe method for treating hyperbilirubinemia, but it may also lead to undesired effects, one of these effects that it can affect the function of the immune system of the newborn. Aim of the work: The aim of the work was to study the effect of phototherapy on the serum level of tumor necrosis factor- alpha [TNF-α] in neonates. Patients and methods: A total of 35 cases of term neonates with Neonatal Jaundice and indirect hyperbilirubinemia high to the level that need phototherapy for 72hrs or more according to the guidelines of the American Academy of Pediatrics were included in this study, and 15 healthy matched newborns were selected as controls. TNF-α was measured before exposure and after 72 hours phototherapy and from control group at the time of examination. Serum levels of TNF alpha were measured using enzyme linked immunosorbent assay kits. Results: The results showed that there was no statistically significant in patient group before phototherapy in comparison to control group as regards TNF-α, patient demographics or laboratory data. On the other side, serum TNF-α levels significantly increased after exposure to phototherapy for 72 hours when compared to values before phototherapy (151.49±61.97 vs 61.36±31.96 respectively), indicating the influence of phototherapy on serum level of TNF-α. Conclusion: The results demonstrated increased serum TNF-α level after 72 hours may affect the immune system in neonates.  
29 The Effect of Maternal Exposure to Textile Industry-Induced Pollution on Pregnancy and Its Outcome   , Rania Abo El gheit  1; Abd Elraouf Mohammad Oun2; Alaa Hamed El Arshal3 1Department of Obstetrics and Gynecology, Al-Mahalla General Hospital, Egypt 2Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Obstetrics and Gynaecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Inside textile mills, pregnant women employees are inevitably exposed to a huge pollution that can result in adverse pregnancy outcomes. Aim of the work: We aimed to evaluate the potential effect of exposure to textile industry induced pollution, among women textile workers, on pregnancy outcome. Patients and methods: A case-control study was carried out at Misr Spinning/Weaving Company, El Mahalla El Kubra, Egypt. The exposed and control group consisted of 142, and 143 eligible participants respectively. All underwent full history taking, clinical examination and ultrasound investigations during first, second and third trimesters. Pregnancy outcome was documented. Results: 64.1% of exposed group’ pregnancies were complicated versus 16.1% of control group. Of which pregnancy induced hypertension (PIH, 19.0%), preterm birth (23.2%), term low birth weight (TLBW, 19.7%), and congenital anomalies (2.1%), in contrast to 4.9%, 7.7%, 2.8%, and 0.7% respectively, in the control group. Conclusion: We concluded from our results that textile induced pollution exposure was significantly associated with adverse pregnancy outcomes (OR=1.652, CI: 1.287-1.954), and this risk was significantly proportional to duration of exposure (OR=2.110, CI: 1.334-3.338).  
30 Outcome of First Trimester Pregnancy in Cases with Impending Embryonic Demise   , Hend Maher Hassan  1; Mohammed Galal Nasr2; Walaa Mohammed El-Bassioune2 1Obstetrics and Gynecology Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Department of Obstetrics and Gynecology, Damietta Faculty of Medicine; Al-Azhar University, Egypt  
Background: Miscarriage is the most common adverse pregnancy outcome which has detrimental psychological consequences for the woman and her partner and delays successful childbearing. Normal embryonic heart rate is about [100-200] bpm at 5 weeks gestation then it increases progressively over the subsequent 2-3 weeks. Fetal demise often occurs within one week after the slow embryonic heart rate and always occurs by the end of the first trimester. Aim of the work: The aim of the present study was to investigate the relation between first trimester miscarriage and slow embryonic heart rate at sixth week of gestational age and other risk factors of miscarriage. Patients and methods: A prospective observational cohort study was conducted in the department of Obstetrics and Gynecology, Al-Azhar Faculty of medicine [Damietta] during the period from September 2017 to September 2018 on 90 pregnant women who had slow embryonic heart rate [80-100] bpm at sixth week of gestational age. All were submitted to full history taking, clinical and ultrasound examination and followed up till the end of their pregnancy and outcome was documented. Results: Percentage of aborted cases at the 8th week of gestational age was [38.9%], while, [20%] at the 10th week and [15.4 %] at 13th week. Whom fetus had a heart rate less than 90 were at risk 23.8 times for experiencing abortions more than other females.
31 Relationship between Psychological Resilience and Frequency of Relapse and Rehospitalization in A sample of Schizophrenic Patients Visiting Port-Said Mental Health and Addiction Treatment Hospital   , Aly Abdulrahman1; Muhammad Ramadan2; Ayman Abdelmaksoud3; Amjad Ibrahim Muhammad Ibrahim   4 1Department of Psychiatry, Faculty of Medicine, Al-Azhar University, Egypt 2Department of Psychiatry, Faculty of Medicine, Al-Azhar University, Egypt 3Department of Psychiatry, Damietta Faculty of Medicine, Al-Azhar University, Egypt 4Port-Said Mental Health and Addiction Treatment Hospital, Port-Said, Egypt  
Background: Relapse is common and causes a high burden in schizophrenic patients. Stress is a main factor in relapse, so stress-resistant factors are proposed to have an important role to prevent it and improve outcomes in schizophrenia. One of these factors is Resilience. Aim of the work: To find the relationship between resilience and frequency of relapse among schizophrenic patients, and to help in developing new therapeutic programs that may lead to decrease the frequency of relapse in schizophrenic patients. Patients and Methods: This is a cross-sectional study. Eighty schizophrenic patients were selected among patients attending Port-Said Mental Health Clinic; 56 were males and 24 were females. Psychotic state was assessed using Positive and Negative Syndrome Scale (PANSS); Medication adherence was assessed using Morisky-8 scale. Resilience was assessed using The Resilience Attitude Scale. Results: There were generally no age, gender, work type, educational or social state differences in relation to frequency of admission. In addition, there was no statistical relation to frequency of admission as regards to education and marital state. On the other side, patients who were admitted less than or equal twice have generally high resilience level than who were admitted more than twice. Conclusion: Resilience is a very important protective factor against relapse in patients with schizophrenia.  
32 Effect of Life Style Behaviors on Assisted Reproductive Techniques [ART]   , Mohamed Elsawy  1; Khattab Abdelhaleem Omar2; Moahmed Abd Elaal3; Mahmoud Salah Mahmoud 4 1Department of Obstetrics and Gynecology, Damietta General Hospital, Ministry of Health, Egypt 2Department of Obstetrics and Gynecology Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Obstetrics and Gynecology, The International Islamic Center for Population Studies and Research, Egypt 4Department of Obstetrics and Gynecology Damietta Faculty of Medicine, Al-Azhar University  
Background: Infertility means a couple in their reproductive age not bearing a child after a year’s unprotected intercourse. It has a global prevalence of 12% to 15%. Aim of the work: The aim of this study is to evaluate the combined effect of several lifestyle behaviors [Exercise, smoking, alcohol, dietary habits and stress] on assisted reproductive techniques [ART] outcomes. Patients and Methods: This study included 700 patients undergoing intracytoplasmic sperm injection. Patients answered a questionnaire [simple life style questionnaire; SLIQ] and analysis examined the relationship between lifestyle with the intracytoplasmic sperm injection cycles outcomes. Comparison of SLIQ scores as measured by the scoring template with scores obtained by the health professionals’ blinded assessment of the questions validated our scoring scheme. We achieved a correlation coefficient of 0.77 [P<0.001] between SLIQ scores and blinded reviewers’ scores. Results: The mean number of oocytes was 6.31±5.5; and [73%] of oocytes were of good quality; the mean number of embryos was 3.22±3.36 and 69.0% were of good quality. Finally, 399 patients [57%] get pregnant. There was significant relation between life style behaviors and results of ART. There was Positive correlation between [total score and each of quality of oocytes, quality of embryos and pregnancy test. Conclusion: This study has highlighted that lifestyle behaviors can adversely affect general health and reproductive performance.  
33 Analysis of Cerebrospinal Fluid Flowmetry in Evaluating the Efficiency of Endoscopic Third Ventriculostomy in Aqueductal Stenosis   , Mohammed Hossam ElDien Abo Shahba1; Mohammed El-Gebaly Ahmed Alhady  1; Hatem Mohammed El Samouly2; Islam Mohammed Elshwihi3 1Neurosurgery Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Department of Neurosurgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 3Nuerosurgery Department, Mansoura New General Hospital, Ministry of Health and Populations, Egypt.  
Background: Endoscopic third ventriculostomy (ETV) approach was gaining popularity over shunt placement in obstructive hydrocephalus. Postoperative ETV assessment and patients follow up remains a matter of controversy and challenge to ensure efficiency and patency of ventriculostomy. Aim of the work: To assess whether cerebrospinal fluid (CSF) flow is restored after ETV and similarity to flow in normal aqueduct with patients clinical and ventricular size changes assessment. Patients and Methods: From April 2016 to April 2019, 30 patients with hydrocephalus due to aqueductal stenosis (AS) were treated with ETV. They were followed up for ventriculostomy patency within the 1st, 6th and 9th month after surgery and compared to 22 persons as a control group of normal aqueductal flow with phase contrast magnetic resonance imaging (PC MRI). Results: Twenty-three (23) patients restored pulsatile bidirectional pattern of CSF flow across the ventriculostomy similar to that of aqueductal flow. While one patient had no flow during the 1st follow up and 6 patients showed initial pulsatile flow then developed flow disturbance during the 2nd follow up period. Absolute stroke volume values showed significant statistical difference between ETV and control groups (p value < 0.001). The value of 85 μl showed sensitivity and specificity of 84.3% and 81.7%, respectively as a cutoff value of ETV efficiency. Conclusion: ETV is an efficient technique to restores the physiological pulsatile Cerebrospinal fluid flow. Absolute stroke volume was a good predictor of ETV efficiency.  
34 Pediatric Female with Adult Type Small Intestine Gastrointestinal Stromal Tumor [GIST]: A case report   , Abdulmohsen Abdulla Alsuwaigh  Consultant General Laparoscopic and Bariatric Surgery, Laparoscopic and Bariatric Fellowship [Germany]; Faculty of Health Science [Al-Ahsaa, Kingdom of Saudia Arabia]  
Background: Gastrointestinal stromal tumor [GIST] is commonest mesenchymal tumor, mainly affects adults. But, 1.5% to 2% GISTs were reported in pediatrics and adolescents. The treatment of GIST is managed as in adult because of lack of information about pediatric GIST. Aim of the work: Here we presented a case report of pediatric GIST. Current literature was reviewed and a summary was formulated to form a base for future optimal treatment of childhood GIST. Case summary: A 14 years Saudi female presented with vague abdominal pain and easy fatigability for 8 months. The pain located in lower abdomen, mild, waning, no aggravation or reliving factor and not radiating.  Clinically, there was peri umbilical round, firm and not tender mass extending to right side of the abdomen till right hypochondrium, with no movement with respiratory movements. Investigations demonstrate severe microcytic hypochromic anemia. A computed tomography [CT] abdomen and pelvis showed evidence of soft tissue mass, about 13*11*12cm, of heterogeneous pattern and enhancement with area of hypodensity and cystic degeneration. There was necrosis of mesentery with some calcification seen inside the lesion suggestive of query GIST or Lymphoma. En block resection of the mass done with safety margin, biopsy from lymph node and side-to-side anastomosis done using linear stapler. The histopathological examination revealed ill and well defined fasicles of tumor cells that have spindle, oval and round shape nuclei invading mesentery and small bowel. Mitotic figurer 5-10/50 HPF, reactive lymph node. Immunohistochemistry showed diffused strong positive CD117 and CD34, negative S-100  
35 Correlation between Diabetic Retinopathy and The Severity of Coronary Artery Disease Determined by Coronary Angiography in Patients with Type II Diabetes Mellitus   , Mohamed Adel Attia1; Moahmed Ibrahim Elraghy  2; Akram Fekry Elgazar3; Sherif Ragab Nayel2 1Department of Cardiology; Damietta Faculty of Medicine, Al-Azhar University 2Department of Cardiology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Ophthalmology, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Diabetes mellitus [DM] is one of the most widespread chronic diseases. It is commonly known by its serious vascular complications including micro-vascular [as retinopathy] and macro-vascular [as ischemic heart diseases] complications. So, a correlation between those complications may be found. Aim of the work: To investigate the correlation between diabetic retinopathy and increased risk of coronary artery diseases. Patients and methods: This study enrolled fifty patients with type 2 diabetes mellitus [DM] who were referred for coronary angiography. Full History, clinical examination, biochemical tests, electrocardiography [ECG], Echocardiography, coronary angiography and fundus examination were carried out. Diabetic retinopathy was detected and classified; patients were classified into two groups: a group [A] with diabetic retinopathy [DR] and a group [B] without diabetic retinopathy. Coronary diseases were assisted by coronary angiography using two different scores. Results: Population characters, including age, risk factors, duration of DM, lipid profile, angiography scores, were comparable between the two study groups. Patients in group [A] had significantly higher number of diseased vessels and higher Gensini score than those of Group [B]. The correlation was significant between the presence of the DR and both the number of diseased vessels [r = 0.532 P < 0.001] and Gensini score [r = 0.881, P < 0.001]. Conclusion: The diabetic retinopathy is a serious risk factor for increasing the severity of coronary artery diseases and can consider as a predictor of CHD in patients with DR.  
36 Effect of Parenting Style on Severity of Attention-Deficit/Hyperactivity Disorder among Children Attending Al-Azhar University Hospital, New Damietta Mohamed Elsayed Elemam  ; Ayman Al-Husseini Abdelmaksoud; Mohammed Metwaly Abo-Elabbas Psychiatry Department, Damietta Faculty of Medicine, Al-Azhar University   , Mohamed Elsayed Elemam  ; Ayman Al-Husseini Abdelmaksoud; Mohammed Metwaly Abo-Elabbas Psychiatry Department, Damietta Faculty of Medicine, Al-Azhar University  
Background: Having an attention deficit hyperactivity disorder (ADHD) child has a disruptive effect on parenting style. As it demands more efforts to be managed and control their behaviors. Insufficient parenting style in childhood can affect the progress of the disorder, worse its signs and symptoms, and increases the risk of development of other behavioral problems, as an oppositional defiant disorder. Aim of the work: We were aiming in this study to assess the relationship between the severity of ADHD and parenting style. Patients and methods: This cross-sectional study was conducted on 100 children who had been attending the psychiatry outpatient clinic from January to June 2019. ADHD was diagnosed with an interview. The ADHD severity and parenting style were assessed by Conner’s Parent Rating Scale (CPRS-R-L) and parenting style scale, respectively. Results: The mean age of the enrolled children was 7.91 ± 2.39 years, and 72% were males. The severity of ADHD was 9% mild, 36% moderate, 32% severe, and 23% very severe. There was a statistically significant relation between “negative” or authoritarian parenting style and severity of ADHD (p <0.001). Conclusion: The results of this study demonstrated that ADHD was more common among males with statistically significant relation with parenting style, and a “positive” parenting style may help in decrease the severity of ADHD symptoms.  
37 Serum Zinc Level in Neonates with Indirect Hyperbilirubinemia   , Saeda Reda Ali  1; Mohamed Abdel-aal 2; Mohamed Elsamanoudy3; Sabah Ibrahim4 1Department of Pediatrics, Kafr-Elsheikh General Hospital, Ministry of Health, Egypt 2Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 3Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt 4Department of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar university, Egypt.  
Background: The most common cause of hospital admission in the first month of life is the neonatal jaundice. Some factors [e.g., prenatal, neonatal factors, maternal factors, and environmental factors (such as zinc) influence the frequency of neonatal jaundice. In terms of neonates, it is proposed that there is a correlation between serum zinc quality and hyperbilirubinemia. Aim of the work: To evaluate the level of serum zinc in term neonates with indirect hyperbilirubinemia. Patients and Methods: A case control study carried out at the neonatal intensive care unit (NICU) and pediatric outpatient clinic of New Damietta, Al-Azhar University Hospital, from June 2018 to February 2019. It included 75 neonates with neonatal jaundice as cases group and 75 healthy neonates of matched age and sex as a control group. All were assessed clinically and serum zinc levels were determined and documented. Results: Level of serum zinc in neonates with non-hemolytic hyperbilirubinemia (103.3±36.56 ug/dl) was significantly lower than healthy neonates without jaundice (128.62 ± 40.83 ug/dl) and zinc deficiency in jaundiced neonates (25.3%) was statistically significant more than healthy neonates) 6.7%). There was no significant relation between the level of serum zinc and other factors like the maternal age, parity, pattern of feeding, gender and weight, but there was significant correlation with maternal zinc intake during pregnancy. Conclusion: We concluded that serum zinc level in term neonates with neonatal jaundice was statistically significant decreased than healthy term neonates.  
38 Plasma Homocysteine Level in Children under Treatment with Antiepileptic Drugs and its Relation to Intelligence Quotient   , Mohammed Abo Al-maaty   1; Mohamed Elmazahy2; Tarek Mustafa Emran 3; Hany El-khaleegy4 1Pediatric department, Al-Azhar University, New Damietta 2Pediatric Department, Al-Azhar Faculty of Medicine (Damietta) 3Professor of Clinical Pathology, Al-Azhar Faculty of Medicine (Damietta) 4Al-Azhar University, Pediatric Department (Damietta)  
Background: Epilepsy is one of the most common neurological disorders in children. It often requires long-term antiepileptic drug (AED) therapy. AEDs are frequently associated with cognitive and behavioral dysfunctions. Also, there is a relationship between AEDs use and homocysteine levels. Elevated homocysteine has been associated with cognitive dysfunction. However, such effect among epileptic children has not been well-studied. Aim of the work: To study plasma homocysteine level in children under treatment with AEDs and its relation to intelligence quotient (IQ). Patients and Methods: A case control study included 56 epileptic children on AED therapy for at least 6 months, and 36 healthy children (Controls). Study was conducted at Al-Azhar University Hospital (Damietta) from June 2016 to June 2018. Plasma homocysteine was measured using Enzymatic Recycling (Biotecnica Instruments SpA). IQ testing was conducted using Stanford-Binet Intelligence Scales, Fifth Edition. Results: Epileptic children exhibited significant elevation of Homocysteine level (P=0.005), and significant affection of all IQ parameters. There was significant negative correlation between homocysteine level with total working memory, total verbal IQ and total IQ. Multivariate regression analysis revealed that homocysteine showed a significant and independent association with total working memory, total verbal IQ and total IQ. None of the other studied factors revealed such association. Conclusion: Homocysteine was a significant and independent risk factor for low total working memory score, low total Verbal IQ and low total IQ scores. Further studies are required to confirm these results, and to evaluate the effect of homocysteine-lowering treatment on cognitive function in epileptic children.  
39 Hypertension and Health-Related Quality of Life: A Community Based Epidemiological Study in An Egyptian Village   , Mohamed Ahmed Elmosalami1; Ayman Ahmed Mahammoud2; Marzouk Al-Khawaja  3 1Public Health and Community Medicine Department, Faculty of Medicine, Al-Azhar University, Egypt 2Public health and Community Medicine Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Community Medicine, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: High blood pressure is the most important modifiable risk factor for stroke, associated with 54% episodes of stroke worldwide and 45% of Ischemic Heart Disease deaths are attributable to high systolic blood pressure. Aim of the work: To identify the prevalence rate of hypertension among adult inhabitants of Badaway village, Al-Mansoura District, Al-Dakahlia Governorate, to identify the epidemiological characteristics and risk factors of hypertension compared to non-hypertension individuals, to assess the (HRQOL) among hypertensive patients compared to non- hypertension individuals, and to evaluate the effect of an educational health program on health-related quality of life (HRQOL) among hypertensive patients. Subjects and methods: A study was conducted on 1100 of adult populations aged 30 years and older living at the studied village, A cross sectional study using questionnaire to assess the participant's HRQOL by SF-36 questionnaire, and interventional study included application of intervention program on hypertension group. Results: The total prevalence of hypertension was 28.2% of the total studied sample. The important predictor's factors were overweight, obese, older age, unmarried status, employment, and high socioeconomic level. The mean of Physical Component Summary and Mental Component Summary and their items of HRQOL were statistically higher among the normal group compared with hypertension group. The intervention program has a significant effect on improving means of PCS and MCS of HRQOL. Conclusion: Application of simple health education intervention program can lead to significant positive impact on knowledge, behaviors and HRQOL of hypertension patients.  
40 Surgical Treatment of Unstable Pelvic Ring Fracture by Anterior Plating of Sacroiliac Joint   , Mohamed Mustafa Elmenawy1; Fathy Hamza Salama2; Samir Ahmed El-Shoura2; Ammar Fathy Abd-ELhamied Hussein  3 1Orthopedic Surgery Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Orthopedic Surgery Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 3Orthopedic Surgery Department, Damietta Faculty of Medicine, Al-Azhar Univeristy, Egypt  
Background: Pelvic ring fractures is not uncommon, and represented a challenge in their fixation. Anterior plating of sacroiliac joint seems to have less good outcome and low complications rate when compared to other approaches. Aim of the work: The aim of this work is to assess the results of surgical treatment of unstable pelvic ring fractures with stabilization of sacroiliac joint with anterior plating, the results assessed clinically and radiologically. Patients and methods: Fifteen patients with unstable pelvic ring fractures were included. All underwent full history taking, clinical and radiological evaluations and scheduled for anterior plating of sacroiliac joint. All were followed up for at least 15 months postoperatively. Results: Radiologically, 53.3% had anatomic, 20.0% had moderate and 26.7% had nearly anatomic results. Clinically, satisfaction was reported by 80.0%. The union was achieved in 86.7% and no complications was reported among 80.0%. Complications were significantly associated with non-satisfactory outcome, and radiological outcome was significantly associated with AO-OTA classification. Conclusion: Anterior pelvic plating combined with percutaneous sacroiliac joint screw fixation is effective treatment for unstable pelvic ring fractures with high success rate and low complications.  
41 Comparison Between Unilateral and Bilateral Sacrospinous Ligament Fixation for Management of Vault Prolapse   , Mahmoud Mahmoud   Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Hysteropexy is an effective procedure for vault prolapse as abdominal sacrocolpopexy but easier and simple. Right sacrospinous fixation has the same results of bilateral fixation. Aim of the work: To evaluate the value and safety of unilateral or bilateral sacrospinous fixation [SSF]. Patients and methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology, Al-Azhar University, Damietta over a period of two years [July 2017 to June 2019]. A total of 32 patients posted for 16 cases unilateral sacrospinous ligament fixation to vault and 16 cases for bilateral fixation were enrolled after informed consent. Results were recorded under headings of procedure time [min], blood loss [ml], major intro-operative complications and post-operative complications, postoperative pain and duration of hospital stay. Results: The result of unilateral transvaginal sacrospinous ligament fixation technique, as part of the vaginal repair procedure for massive uterovaginal [Pelvic Organ Prolapse stage III and stage IV and vault prolapse] was evaluated as better than bilateral approach with the same efficacy, less time consuming, less blood loss and low post-operative pain. Conclusion: Unilateral transvaginal sacrospinous ligament fixation revealed a significant reduction in intraoperative blood loss, procedure time, immediate post-operative pain, and mean length of hospital stay.  
42 Prevalence of Noise Induced Hearing Loss among Employees at Wood Industry in Damietta Governorate   , Waheed Elsaidy   1; Ayman Mahmoud2 1Department of Community Medicine, Damietta faculty of Medicine, Al-Azhar University, Egypt 2Department of Community Medicine, Damietta faculty of medicine, Al-Azhar University, Egypt  
Background: Occupational noise-induced hearing loss (ONIHL) is a major health issue with high prevalence globally and has major social, economic and psychological effects. Aim of the work: Assessment of noise induced hearing loss (NIHL) prevalence among employees at wood industry in Damietta governorate. Patients and methods: The present cross-sectional study was carried out in New Damietta city, Damietta governorate, Egypt. Ten workplaces were selected through convenience sampling. From these ten workplaces, one hundred fifty (150) employees agreed to participate in the study. Pure-tone audiometry between 500 and 8000Hz frequencies determined the hearing condition of the participants and noise readings were conducted at the selected workplaces. Results: Among all study participants, the prevalence of noise induced hearing loss (NIHL) was 39% of carpenters and 44.4% of sawyers with no statistically significant difference (P = 0.253) between both groups. Noise levels ranged from 73 to 91.5 dBA in the various furniture factories and from 74.9 to 94.1 dBA in the different saw mills. Conclusion: Occupational noise induced hearing loss (ONIHL) is highly prevalent in Damietta governorate among wood workers, which might be due to lack of knowledge, awareness about NIHL among employers, workers, and health care workers along with absence and or implementation of hearing conservation programs in the work places.  
43 Effect of Fixed Node Maneuver on Migration of Lumboperitoneal Shunt: A pilot study   , Mohamed Hasan Mansour1; Mohammed El-Gebaly Ahmed Alhady  2; Hatem Saad Elkhouly1 1Department of Neurosurgery, Faculty of Medicine, Al-Azhar University 2Neurosurgery Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Shunt migration after Lumboperitoneal [LP] shunt procedures can occur upward into the spinal subarachnoid space and downward into the abdominal cavity. Cranial migrations are less common than downward migration into the abdominal cavity. Defects of the fixation devices in the shunt system are considered the main cause. Aim of the work: To evaluate fixed node maneuver, a new technique to avoid shunt migration. Patients and methods: Among many cases of shunt installations, we selected 30 patients who received a first-time shunt installation for different causes [pseudotumor cerebri [24 cases], primary cerebrospinal fluid [CSF] rhinorrhea [5 cases] and one case for persistent postoperative lumbar CSF leak]. All cases underwent LP shunt with fixed node in group [A; 15 patients] and the traditional mode of fixation in group [B; 15 patients], with evaluation of postoperative clinical improvement and shunt migration. Results: Clinical improvement occurred in 27 [90%] patients. However, shunt migration was recorded in 2 [13.3%] patients of the second group [B], while in group [A], no recorded shunt migration. Conclusion: We advocated clinical efficacy of fixed node maneuver of lumboperitoneal shunt to avoid shunt migration.  
44 Histological and Immunohistochemical Studies on The Role of Stem Cells on The Burned Skin of Adult Male Albino Rats   , Fatma M. Abd Allah  1; Ashraf M Moustafa2; Lotfy S Moahmmed2; Ezz El-Dein E Abd Allah3 1Department of Histology, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 2Department of Histology, Faculty of Medicine, Al-Azhar University 3Department of Histology, Damietta Faculty of Medicine, Al-Azhar University, egypt  
Background: Mesenchymal stem cells have delivered new approaches to the management of burn healing in severe skin injuries. Aim of the work: To evaluate the effect of bone marrow-derived mesenchymal stem cells (BMSCs) on healing of induced deep 2nd degree skin burns in albino rats. Methodology: 55 male albino rats weighed 200gm were divided into 5 groups, 5 animals in group I (control) and group II (burn model), 15 animals in group III (untreated), group IV and group V (MSCs treated). Groups III, IV and V were subdivided into 3 subgroups that were sacrificed after 7, 14 and 21 days respectively. Deep 2nd degree burn wounds were induced on a 4 cm2 area on the back of rats in groups II, III, IV and V by brass probes stabilized at 88–90°C and contacted to the shaved dorsal skin of rats for 20 seconds without exerting any external pressure. Mesenchymal stem cells were isolated from the bone marrow of 5 young rats, weighed 100gm then intra-dermally and intraperitoneally injected. Results: By the end of the third week, the wounds of BMSCs-treated groups showed full regeneration of epidermis, re-organization of collagen and decrease in VEGF immunopositive cells. Delayed wound healing was seen in 20% of systemically treated rats. Significant increase in the mean area percent of collagen fibers was detected in topically treated group. Conclusion: Both methods of BMSCs injection were effective in healing of full thickness skin wound but topical method was more effective.  
45 A comparative Study Between Pethidine, Granisetron and Tramadol in Prophylaxis Against Perioperative Shivering After Spinal Anesthesia   , Yousry Abdelsalam   Anesthesia and Intensive Care Department, Damietta Faculty of Medicine, Al-Azhar University  
Background: Peri-operative shivering a challenging discomfort faced in anesthesiologists’ daily practice. Many drugs were used as a prophylaxis, but there was no consensus on ideal or standard drug yet. Aim of the work: To compare the effectiveness and safety of pethidine, granisetron and tramadol in prophylaxis against perioperative shivering after spinal anesthesia. Patients and methods: Sixty adult patients, who underwent spinal anesthesia, were included. They were randomly assigned to granisetron, pethidine or tramadol (20 in each group), and submitted to standard intraoperative monitoring and follow up for postoperative 4 hours. Monitoring included electrocardiography, oxygen saturation, respiratory rate, temperature, non-invasive blood level, conscious level and sedation score. Side effects were documented. Results: Intra- and post-operatively, there was significant reduction of heart rate in granisetron and tramadol groups. Mean arterial pressure significantly decreased in granisetron group at the time from 30 minutes to the end of surgery and during the first two postoperative hours. Respiratory rate significantly decreased in pethidine group during the complete intra- and post-operative period. Granisetron had no sedative effect at all, but sedation was significantly increased among pethidine group. Finally, perioperative shivering was reported in 25%, 15% and 15% of pethidine, granisetron and tramadol groups respectively. Nausea/vomiting was reported in 20%, 10.0%, and 0% of pethidine, tramadol and granisetron groups respectively. Pruritus was confined to 30% pethidine group with significant difference. Conclusion: Granisetron, tramadol and pethidine, all are effective as a prophylaxis against perioperative shivering after spinal anesthesia. However, granisetron seems to be the most suitable drug.  
46 Prognostic Factors of Anterior Surgical Approach in Management of Cervical Spondylotic Myelopathy   , Mohamed Ahmed Ataya  1; Mohamed Hossam eldin Aboshahba2; Hedaya Hendam3; Hatem Mohamed Al samoly4 1Neurosurgery Department,Damietta Faculty of Medicine,Al-Azhar University Neurosurgery Department ,Nasser institute for research and treatment,Ministry of Health 2Neurosurgery Department,Damietta Faculty of Medicine,Al-Azhar University 3Department of Neurosurgery, Damietta Faculty of Medicine, Al-Azhar University 4Neurosurgery department,Damietta Faculty of Medicine, Al-Azhar university  
Background: Spondylotic cervical myelopathy is defined as spinal cord dysfunction secondary to extrinsic compression of the spinal cord and/or its vascular supply so it is the commonest cause of cord dysfunction in patients over 55 years. Main Surgery target is to prevent the progression of symptoms also to improve existing symptoms. Aim of the work: To determine prognostic factors of patients with spondylotic cervical myelopathy that surgically managed through anterior approach in relation to outcome clinically and radiologically. Patients and methods: From July 2015 till December 2018, forty patients with cervical myelopathy were operated by anterior surgical approach (anterior cervical discectomy with fusion and/or corpectomy with fusion. Only patients with confirmed spondylotic myelopathy were included; we exclude those with an infectious, inflammatory or neoplastic etiology. Results: Patients ages were ranged from (40-67) years, with a mean age 53.2 years. Duration of myelopathy ranged from 2-18 months with a mean duration of 8.55 months. 72.5% patients were treated by discectomy with fusion and 27.5%cases were treated by combined discectomy and corpectomy with fusion. Excellent outcome was reported in 22.5%, while 62.5% cases had good outcome,15% patients had fair outcome. Patient age, disease severity, duration, bowel & bladder manifestations and affection of dorsa column were the prognostic factors in studied patients. Conclusion: Our study reveals that the significant prognostic factors are: age of patient, severity of myelopathy, duration of myelopathy, presence of bowel or bladder symptoms, dorsal column affection and high signal intensity of T2 weighted MRI.  
47 Correlation between Vitamin-D Level and Pulmonary Function Tests in Children with Bronchial Asthma   , Magdy Sakr1; Mohamed Elsamnody2; Atef Elrifai 3; Hesham Abd-Al-Samee 4; Ahmed Saad   2 1Department of Pediatrics , Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 3Department of Chest Disease, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 4Department of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: Bronchial asthma Affecting 1-18% of children in different countries, it widely distributed chronic respiratory disease. vitamin-D increase calcium absorption from the gastrointestinal tract, determines bone health and regulates neuromuscular function. In addition, vitamin-D is a potent immune system regulator, and it has a potential role in various allergic diseases. Aim of the work: To estimate the association between asthma and Vitamin-D in pediatrics. Patients and methods: The present work is a case control study included 150 (100 asthmatic children and 50 healthy control) children aged between 5 and 12 years. Serum 25- hydroxy vitamin-D levels were evaluated and compared between two groups. Association between vitamin-D and pulmonary function was studied in asthmatic children. Results: Cases had significantly lower values of FEV1%, FEV1/FVC ratio and vitamin-D levels when compared to controls (53.20±6.27, 68.64±4.42, 24.44±20.92 vs 126.44±10.15, 107.20±5.05 and 84.25±41.79 successively). In addition, vitamin-D was positively and significantly correlated with pulmonary function tests (FEV1% and FEV1/FVC ratio). Conclusion: Children with bronchial asthma suffered from marked reduction of vitamin-D which correlated with asthma severity.  
48 Efficacy of Ombitasvir/Paritaprevir/Ritonavir plus Ribavirin in Treatment of Chronic Hepatitis C Patients with End Stage Renal Disease on Regular Hemodialysis   , Naglaa Atef El-Gendy  1; Fathiya Mostafa EL-Raey2; Sherif A Nassib3; Noha Elsadany4 12Department of Hepatogastroenterology and Infectious Diseases, Faculty of Medicine for Girls, Al-Azhar University, Egypt. 2Department of Hepatogastroenterology and Infectious Diseases, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 3Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt 4Department of Internal Medicine, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Hepatitis C virus (HCV) infection is associated with more significant morbidity and mortality among dialysis patients than in healthy populations. The fixed-dose tablet (ombitasvir/ paritaprevir/ritonavir) in combination with ribavirin was effective and generally well tolerated in treatment of chronic HCV infected patients with end stage renal disease (ESRD) on hemodialysis. However, limited published data are known about the usefulness of this regimen for treatment of HCV patients with ESRD on hemodialysis. Aim of the work: The aim of this study was to evaluate the safety and efficacy of treatment regimen of ombitasvir (OBV) 25 mg /paritaprevir (PTV) 150 mg /ritonavir (RTV) 100 mg plus generic ribavirin (RBV) 200 mg in Egyptian HCV-infected naive patients with ESRD on regular hemodialysis. Patients and methods: A prospective cohort study involved 40 chronic HCV on regular hemodialysis patients, who were eligible for treatment with combined oral antiviral therapy. Results: The results showed that thirty-five patients [35/40(87.5%)] completed 12 weeks of HCV therapy; they had a virological response at end of therapy and sustained virological response. Anemia was the main observed side effect which lead to discontinuation of the treatment in five patients (12.2%). As these patients were not responding to anemia correction measures (blood transfusion, erythropoietin-stimulating agents, and modification of RBV dose). Conclusion: OBV/PTV/RTV plus Ribavirin can be used in treatment of chronic HCV patients with ESRD on regular hemodialysis.  
49 A Comparison between Intracranial and Extracranial Arteries Using Neuroimaging in Acute Ischemic Stroke and Its Relation to Risk Factors   , Sayed El Zayat1; Emad Fawzy1; Mohamed zaki  1; Gamal Zakaria2; Haitham Abdel Ghaffar3; Mohamed Raouf1 1Department of Neurology, Faculty of Medicine, Al-Azhar University, Egypt 2Department of Clinical Pathology, Faculty of Medicine, Egypt 3Department of Radiology, Faculty of Medicine, Agouza Police Hospital, Egypt  
Background: Atherosclerotic infarction accounts for a sizable proportion of cerebral infarcts whether occurs from extracranial or intracranial atherosclerotic disease. Despite recent studies on stroke risk factors; it is still unclear whether or not single risk factor specifically affect extracranial or intracranial arteries in stroke patients. Aim of the work: To determine the difference between intracranial and extracranial steno-occlusive atherosclerosis and its correlation with risk factors of acute ischemic stroke using Magnetic Resonance Angiogram (MRA) and/or Computed Tomography Angiography (CTA) with Duplex. Patients and methods: All cases diagnosed as acute ischemic stroke were subjected to detailed history, full neurological examination, routine laboratory tests, extracranial vessels assessed by duplex, intracranial vessels assessed by MRA and/or CTA. Results: 61 patients included in the study (38 males and 23 females), with mean age (64.5 ± 11.4). Extracranial stenosis was (57 patients, 93.4%), while intracranial stenosis was (49 patients, 80.3%). But the intracranial significant stenosis was (45 patients, 73.77%), while the extracranial significant stenosis (26 patients, 42.62%). Hypertension (72.1%), obesity (62.3%), diabetes (57.4%), dyslipidemia (54.1%) and smoking (39.3%), were risk factors equally affecting the extracranial and the intracranial systems in the same descending order. There was a higher prevalence of hypertension among patients with intracranial significant stenosis showing a significant P-value of 0.048. Conclusion: Extracranial stenosis was more common than the intracranial stenosis, but the intracranial significant stenosis is more prevalent than the extracranial. Hypertension is a significant risk factor for intracranial significant stenosis.  
50 Severe Polymorphic Eruption of Pregnancy Developing in A Late Term Primigravida: A Case Report and Review of Literature   , Shashwati Sen   1; Harish Srivastava1; Gautam Sen2 1Mohak Hospital and Research Centre, Stanley Road, Prayagraj 2Sr. DMO, Railway Hospital, Prayagraj  
Background: Polymorphic eruption of pregnancy [PEP] is a benign inflammatory dermatosis of pregnancy of unknown etiology developing in the third trimester as an intensely pruritic rash and inflamed striae with peri-umbilical sparing. It is a self-limiting condition which resolves after delivery and has no maternal or fetal adverse effects. There are no specific investigations. Diagnosis is based on history and typical clinical features. Emollients, topical corticosteroids and oral antihistamines provide symptomatic relief, though a few patients with severe symptoms may require a short course of oral or injectable corticosteroids. Autologous hemotherapy is a safe option and can be considered in severe conditions. Case summary: This report describes an unusual patient with singleton pregnancy presenting at 41 weeks gestation with sudden onset intense itching and rash on abdomen, upper part of legs and arms. We have summarized current literature related to PEP and evaluated the variations in clinical presentations, relevant etiopathogenesis and treatment options.  
51 Prevalence of Otitis Media with Effusion in Children of Damietta Governorate (Egypt)   ,
Mohamed Hussein Abdelazim  1; Ahmed Ibrahim Zaghloul2; Mohamed Elbakly3 1Department of Otorhinolaryngolgy, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Depatment of Otorhinolaryngology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Audiolvestibular , Assuit Faculty of Medicine, Al-Azhar University, Egypt mobile: 01006356181  
52 Management of Anterior Cerebral Circulation Aneurysms by Endovascular Coiling   , Mohammed Hossam ElDien Abo shohba1; Mohamed Nasr Mohamed Shadad2; Mahmoud Elkholy  1 1Department of Neurosurgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt  
Background: Endovascular management of cerebral aneurysms is relatively a new modality of management in Egypt. So, studies are needed to evaluate efficacy, safety, and outcome; especially with this rapid evolution in both materials and equipment. Aim of the work: To asses safety, efficacy, and outcome of our case series with cerebral aneurysm managed by endovascular coiling. Patients and Methods: Here we documented the clinical, treatment, and outcome variables of cerebral aneurysm case series treated by endovascular coiling between May 2018 and December 2019 in a single center in Egypt. Results: In 30 patients, 34 aneurysms were found, 31 aneurysms [91.1%] were treated by coiling, and only 3 aneurysms [2 cases] [8.9%] failed to be treated by coiling. Total occlusion was achieved in 25 aneurysms [80.6%]. Neck remnants were present in 6 aneurysms [19.4%]. Regarding functional outcome, 26 patients had good outcome and 2 patients had poor outcome. Conclusion: Endovascular coiling is safe and effective method for management of cerebral aneurysm and should considered as the first choice in management.  
53 Comparative Study between Titanium Mesh and Autogenous Iliac Bone Graft through Anterior Approach for Treatment of Lumbar Spondylodiscitis   , Mohamed Selim Oda Selim  1; Shehab Mohamed Mohamed El khadrawy2; Mohamed Mohamed Yousef Hassan1 1Department of Neurosurgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Egypt  
Background: Spondylodiscitis is an inflammation of the vertebral disk space often related to infection. Different treatment modalities were present. However, no full consensus is found about the ideal treatment. Aim of the work: To compare between titanium mesh and autogenous iliac bone graft through anterior approach for treatment of lumbar spondylodiscitis. Patients and Methods: A total of 30 patients with spondylodiscitis were included in the study. They were assigned for surgical intervention. They were allocated into titanium mesh or autogenous iliac bone graft through anterior approach. All underwent full history taking and clinical examination, radiological evaluation and surgical outcome was documented. Results: There was no significant difference between the two studied groups as regard the bony fusion after follow up period and there is no significant difference between the two studied techniques as regard outcome. Favorable outcome was not related to patient gender. But, the favorable outcome was associated with younger age [all patients younger than 40 years had favorable outcome, while 73.7% of those older than 49 years had been improved. Conclusion: Titanium mesh cages were found to be similar to autogenous iliac bone graft for restoring vertebral height when treating single-segment lumbar spondylodiscitis and obtained same clinical efficacy as autogenous iliac bone.  
54 Comparative Study between Subannular T- Tube and Repetitive Transtympanic T-Tube Technique   , Mohamed Eldabaa1; Ahmed Ibrahim Zaghloul2; Ahmed Fayez Ahmed  3 1Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Egypt 2Depatment of Otorhinolaryngology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Al-Azhar University Faculty of Medicine Damietta - Dumyat Al Jadidah  
Background: Otitis media [OM] is the second most common disease of childhood after upper respiratory tract infection. There was no consensus on the ideal treatment modality yet.   Aim of the work: To compare the use of trans-tympanic T tube [TTTT] and subannular T tube [SATT] in recurrent otitis media, recurrent otitis media with effusion or tympanic membrane retraction. Patients and Methods: This is a prospective controlled study, which was conducted at Al-Azhar university hospital [Damietta]. It included 40 patients that were randomly divided into two groups A and B: Group A: include 20 patients who were submitted to trans-tympanic T-tube. Group B included 20 patients who were submitted to sub annular T-tube. Patient data and outcome were documented and compared. Results: The duration that TTTTs and SATTs remained in place ranged from 4 to 19 months with a mean of 10.62 and there was a significant decrease of duration in TTTT in comparison to SATT groups [7.28 vs 14.80 respectively]. Besides, in 14 cases in the SATT group, the tube is still in place. Extrusion was reported in 10 cases [8 in the TTTT group and 2 in the SATT group] and finally removal was reported in 6 patients [2 in TTTT group and 4 in the SATT group. Conclusion: The use of SATTs for long term middle ear ventilation is safe and more efficient than V-T Grommet TTTTs for maintaining middle ear ventilation and prevention of recurrent interventions in children with less otorrhea and plugged tubes.  
55 Outcome of Transpedicular Screw Fixation with Posterior Interbody Fusion in Management of Spondylolysthesis.   , Abd Elhalim Abd -Alrazik Moussa; Mohamed Shaban Ali; Mohamed Galal  Department of Neurosurgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Spondylolysthesis represents a particular and relatively frequent mechanism of intervertebral instability. It could cause low back pain due to forward or anterior displacement of one vertebra in relation the adjacent lower vertebra. There are many treatment intervention. However, there was no consensus on the ideal approach. Aim of the work: To assess the outcome of trans-pedicular screw fixation with posterior inter-body fusion in management of lumber and lumbosacral Spondylolysthesis. Patients and methods: This is prospective study, included twenty patients who underwent surgical lumbar laminectomy and disc removal with lumbar pedicle screw fixation with inter body fusion for patients with Spondylolysthesis who failed conservative measures. Results: The mean preoperative visual analogue score (VAS) for pain was 7.75 ± 0.72 that decreased to 1.35 ± 0.59 at the end of postoperative sixth month, with statistically significant decrease. In addition, the majority of cases had no significant complications, although complication rate was 25%. Conclusion: Posterolateral fusion with pedicle Screws fixation minimizes dislocation, achieves adequate decompression, corrects the sagittal axis, and accomplishes fusion. We successfully achieved solid fusion with good mechanical alignment in majority of the patients.  
56 Laparoscopic Hysterectomy versus Abdominal Hysterectomy for Obese Women with Benign Diseases   , Mohamed Elsayed Thapet  1; Mahmoud Farouk Midan2; Mahmoud Salah Mahmoud Rady 3; Hossam Abdelmageed Abdou4 1Department of Obstetrics and Gynecology, Damietta Faculty of Medicine Al-Azhar University, Egypt 2Department of Obstetrics and Gynecology; Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Obstetrics and Gynecology; Damietta Faculty of Medicine, Al Azhar University, Egypt 4Department of Obstetrics and Gynecology, Faculty of Medicine, Helwan University, Egypt.  
Background: Obesity is a challenging health problem in gynecologic surgery. Laparoscopic has the potential advantages than abdominal hysterectomy of being quicker, efficient with low estimated blood loss. Aim of the work: To compare the safety and effectiveness of laparoscopic and abdominal hysterectomy for benign conditions in obese patients. Patients and Methods: Sixty patients were submitted to history taking, clinical examination, Lab investigations, abdominal ultrasound and biopsy for suspicious pathology. Patients divided into two equal groups. The first for total laparoscopic hysterectomy and the second for trans-abdominal hysterectomy. Patients were followed for six months after surgery. Data collected include operative time, amount of blood loss, complications and duration of hospital stay. Results: BMI was significantly higher among open when compared to laparoscopic group (43.69±3.86 vs 34.5±4.02 respectively), and low parity and low cesarean deliveries were significantly increased in laparoscopic group. The highest indication of hysterectomy in laparoscopic group was adenomyosis (43.3%) followed by fibroid (30.0%), while in open group, the most common indication was fibroid (53.3%) followed by adenomyosis (26.7%). Operative time showed significant decrease in laparoscopic when compared to open hysterectomy groups (56.23±21.5 vs 78.87±8.22 minutes respectively) and blood loss was significantly decreased among laparoscopic group. Finally, the length of hospital stay was significantly decreased in laparoscopic when compared to open groups (the median was 10 versus 24 hours respectively). Conclusion: Laparoscopic hysterectomy is superior to abdominal hysterectomy in obese females with benign conditions in terms of safety and efficacy.  
57 Benefits and Risks of Laparoscopic Gastric Surgery for Management of Morbidly Obese Patients   , Ahmed Salama Sayyouh1; Ayman Mahmoud Elwan2; Rabea Abdelghaffar Hassan  3 1Department of General Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Department of General Surgery, Damietta Faculty of Medicine, Al-Alzhar University, Egypt 3Department of General Surgery, Damietta Genera Hospital, Ministry of Health and Populations, Egypt  
Background: Conservative management for obesity had limited role in treatment of obesity. Otherwise, surgical treatment is effective, But associated with many comorbidities. Aim of the work: To evaluate laparoscopic sleeve gastrectomy, greater curvature plication and gastric bypass in morbidly obese patients. Patients and Methods: Thirty patients were included. They were divided into three groups: A for laparoscopic greater curvature plication, B for laparoscopic sleeve gastrectomy, and C for laparoscopic gastric bypass. All subjects underwent full history taking, clinical examination, laboratory investigations, abdominal ultrasonography, and upper gastrointestinal endoscopy. Follow up carried out at the first two weeks then at 1, 3, 6, 12 months for late postoperative complications, changes in comorbidities (hypertension, diabetes mellitus, arthritis) and percentage of excess weight loss. Results: Studied groups were comparable as regard to patient demographics, preoperative comorbidities, intraoperative bleeding or postoperative complications. Operative time was significantly decreased in group B. EBWL differ significantly between groups at all postoperative follow up visits. For example at the second postoperative week, there was significant increase of EBWL in groups B and C when compared to group A (5.75±3.96 and 8.4±5.54 vs 1.15±0.81 respectively). Failure was 40%, 10% and 0% in groups A, B and C respectively. Only one patients died after operation in the bypass group. Morbidities were improved after surgery. Conclusion: Laparoscopic greater curvature plication, is lower than laparoscopic sleeve gastrectomy and laparoscopic gastric bypass surgery as the procedure for weight loss, despite of its less cost. In addition, it had higher complications, reoperations and weight gains.  
58 Total Knee Arthroplasty for Treatment of Osteoarthritis of the Knee with Severe Malalignment   , Osama Mohammed Khalil  1; Asharaf Ezzedeen2; Samir Ahmed El-Shoura3; Mohamed Abdalah Hassan 2 1Department of Orthopedic Surgery, Damietta specialized hospital, Ministry of Health and Populations, Egypt 2Department of Orthopedic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Orthopedic Surgery Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: Total knee Replacement proved to be an effective surgery that leads to restoration of joint function, limb alignment, beside elimination of pain in patients with osteoarthritis. Aim of the work: To assess the results of treatment of osteoarthritis of the knee with severe malalignment by total knee arthroplasty. Patient and Methods: 30 patients (12 males & 18 females) aged from 48 - 68 years who had advanced knee arthritis were operated by total knee replacement at Al-Azhar University Hospital [Damietta] and Damietta Specialized Hospital and followed up for average 12 months from December 2016 to March 2019. All patients were assessed by history taking, examination, radiological and laboratory investigations, and all were subjected to a three-phase postoperative rehabilitation protocol. Results: 19 patients (63.3 %) had excellent final result, 8 patients (26.7%) had good result, 2 patients (6.7 %) had fair result and one patient (3.3 %) had poor final result. In addition, there was significant improvement in pain relief and joint function Conclusion: Total Knee Replacement in severe malalignment is a challenging surgery. However, it leads to significant changes in the quality of life in most patients; regarding pain relief, improvement in joint function and early return to daily activities.  
59 Role of Musculoskeletal Ultrasound and Matrix Metalloprteinase-2 serum Level in the Diagnosis of early Knee Osteoarthritis   , Tarek M. Nasrallah   1; Hesham Eldesoky Abdel wahab1; Mostafa M. Shakweer2; Sabah Abd Al Raheem3; Hanan I. Mehesin4 1Department of Rheumatology and Rehabilitation, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Department of Radiology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Clinical Pathology, Faculty of Medicine, Cairo University, Egypt 4Department of Rheumatology and Rehabilitation, Fariskur General Hospital, Ministry of Health, Egypt  
Background: Osteoarthritis (OA) is the most common joint disease, causing disability and reduction of quality of life and participation in social activity. Now considered a whole joint disease, OA is characterized by cartilage loss, subchondral bone changes, synovial inflammation and meniscus degeneration1. Aim and objectives: The evaluation of the role of musculoskeletal ultrasound and MMP-2 serum in the diagnosis of early knee OA. Subjects and methods: The present study was conducted on 50 patients with early knee OA patients attending the Outpatients Clinic of the Rheumatology Department Damietta Faculty of Medicine, Al-Azhar University matched with 25 age and sex healthy volunteers. Musculoskeletal ultrasound (MUS) was performed by experienced radiologist according to the EULAR recommendations by using a 12–5-MHz linear transducer (voluson E6) and Metalloprteinase-2 (MMp2) was detected by Elisa technique. Results: MMP-2 is highly significant and overexpressed in patient group and its early detection is positively correlated with weight and BMI. Our results appear that family history, BMI and weight are the main risk factor for the onset of knee osteoarthritis (KOA) in the patient group. MUS clarifies most patients (88% and 80%) have Medium osteophyte on LT and RT respectively, followed by 44% of participants have Mild osteophyte on RT. Conclusion: MMP-2 is a diagnostic biomarker at the early stage of OA. MSU is an excellent imaging technique to detect early osteoarthritis.  
60 Maternal Plasma Lipid Concentration in Third Trimester of Women with Preeclampsia and Normotensive Pregnancy   , Ghada Khalil Mohammed  1; Waleed Ahmed Ayad2; Usama Bahgat El-Gazzar3; Samia Mohamed Eid2 1Department of Obstetrics and Gynecology, Nabaruh General Hospital, Ministry of Health, Egypt. 2Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Medical Biochemistry, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Preeclampsia is one of complications of pregnancy. It is responsible for morbidity for mother and fetus. Preeclampsia is a pregnancy multisystem disorder. Abnormal lipid profile has an effect on endothelial dysfunction. The association of serum lipid profile with preeclampsia is suggested to reflect new diagnostic tools. Pregnancy dyslipidemia is associated with an increased risk of preeclampsia. Compared to healthy pregnancy, women with preeclampsia have an abnormal lipid profile.  Aim of the work: The aim of this work is comparison between normotensive women and preeclamptic women by serum lipid profile at third trimester. Patients and Methods: The present study conducted on 70 pregnant women in the Department of Obstetrics and Gynecology, at Al-Azhar University hospital [Damietta], which was conducted during 2019 [from April to December]. A study comprised 35 normotensive pregnant women as controls and 35 preeclampsia cases. The blood samples were analyzed for serum triglycerides [TGs], total cholesterol [TC], high-density lipoprotein-cholesterol [HDL-C], low-density Lipoprotein-Cholesterol [LDL-C], very low-density Lipoprotein-Cholesterol [VLDL-C], Apo lipoprotein- A1 [Apo-A1] and Apo lipoprotein- B[Apo-B]. Results: There was significant difference between group A and B as regard Apo B/ Apo A1, cholesterol, TGS, LDL and VLDL. They are higher in group B. Conclusion: In the third trimester of pregnancy, preeclamptic women have altered levels of serum lipid profile. The most significant test is Apo B/A1 ratio with accuracy [72.7%].  
61 Transthyretin as a Novel Biomarker for Diagnosis of Hepatocellular Carcinoma in Cirrhotic Patients   , Magda Hussin Ibrahim  1; Fathiya Mostafa El-Raey2; Naglaa Fathy3; Kadrey El-Bakrey4 1Department of Physiology (Zoology), Faculty of Science, Damietta University, Egypt 2Department of Hepatogastroenterology and Infectious Diseases, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Zoology (Physiology), Faculty of Scicene, Damietta University, Egypt 4Department of Zoology (physiology) Faculty of science, Damietta University, Egypt  
Background: Hepatocellular carcinoma [HCC] is one of the leading causes of cancer-related deaths worldwide. A major problem with HCC surveillance is the lack of reliable biomarkers. Serum transthyretin [TTR] may be a sensitive marker for the diagnosis of patients with liver cell damage, liver cirrhosis or hepatocellular carcinoma.  Aim of the work: This study aimed to evaluate the potentiality of serum transthyretin [TTR] as a novel biomarker for detection of HCC in cirrhotic patients. Patients and Methods:This Current study was conducted on 70 patients with chronic liver disease. Also, 20 healthy person matched for age and sex were included as a control group. Patients were classified into 2 groups [30 cirrhotic patients with newly diagnosed HCC & 40 cirrhotic patients without HCC]. Serum TTR levels were measured using enzyme linked immunosorbent assay technique. Results: Serum levels of TTR were significantly much lower in HCC patients when compared to cirrhotic patients without HCC or control group [p<0.0001]. Significant decrease of serum TTR in HCC patients, with portal vein invasion or nodal invasion than in HCC without vascular or nodal invasion. The diagnostic accuracy of TTR was higher than that of AFP regarding sensitivity [83.3%] and negative predictive value [81.4%] in diagnosis of HCC. Conclusion: detection of lower level of TTR alone or in combination with other validated markers may be potentially informative biomarker for detection of HCC among cirrhotic patients at early noninvasive stage where curative treatment can be applied.   
62 Effects of Whole-Body Vibration on Egyptian Patients with Chronic Obstructive Pulmonary Disease   , Tarek M Nasrallah   1; Hossam Emam2; Ismail M Alwakil3; Ashraf Abdelsalam Ahmad1 1Department of Rheumatology and Rehabilitation, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Department of Neurology, Faculty of Medicine, Al-Azhar University, Egypt 3Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Egypt  
Background: Chronic obstructive pulmonary disease [COPD] is a chronic lung disease affecting other body systems, like musculoskeletal system causing weakness. Muscle weakness is a major problem, causing poor functional lung capacity; and a negative impact on daily life activity. Muscle weakness in COPD may be a form of disuse and/or a form of myopathy is a question need answer. Exercise is a basic unit of pulmonary rehabilitation causing increased quality of life. So, PR regarded as effective non-pharmacological treatments in COPD.  Aim of the work: Whole-body vibration [WBV] is a type of exercise that improve muscle function specially in debilitated patients like COPD,WBV not yet studied in Egyptian patients with COPD. Patients and Methods:Fifty patients with COPD were assessed for an 18-weeks in outpatient rehabilitation center, the patients were randomly assigned into: Group 1, using dynamic exercise on a side alternating vibration platform at 25–30 Hz three times per week [WBV], and group 2 as a control group [CON] with the same amount of exercise without WBV. Results: Pulmonary function tests results: showing FEV1 pred. 39.8 ± 12.2 and 41.3±4.6 before and after intervention respectively. PaO2:  49.60 ± 80and 82±90 before and after intervention respectively; PaCO2:  65 ± 70and 33±50before and after intervention respectively the difference was significant in intervention group than in control. The distance walked [DW] increased after the WBV period [397±133m] compared with the control period [359±111m]. Conclusion: WBV was good complementary training exercise which could be an effective new modality for COPD patients.   
63 Lidocaine versus Dexmedetomidine as an adjuvant to General Anesthesia for patients undergoing Elective Abdominopelvic Surgeries   , Sameh Seyam  Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Egypt; Mustasharak Hospital, Khamis Mushayt, Asir province, Kingdom of Saudi Arabia [KSA].  
Background: The fundamental impact of dexmedetomidine on the cardiovascular framework obstruction is the extra component of narcotic saving impact. Similarly, fundamental Lidocaine that is utilized as a consistent mixture during the operation period has pain-relieving, antihyperalgesic, and calming chattels.  Aim of the work: To analyze the effectiveness of lidocaine given intravenously with that of dexmedetomidine as an adjuvant to general anesthesia for candidates listed for elective abdominal and pelvic surgery. Patients and Methods:120 patients of both sexes undergoing elective pelviabdominal procedures were enlisted. Patients were assigned randomly to one of three equal groups: group 1 received a loading lidocaine 1.5 mg/kg, followed by an infusion of 2 mg/kg/h, group 2 received a loading dexmedetomidine1 μg/kg, followed by 0.5 μg/kg/h, and group 3 received normal saline 0.9% in the same design as previous medicines. Hemodynamics, consumption of anesthetic agents, induction and recovery times, and time to the first postoperative analgesic request were reported. Results: The hemodynamics after intubation and in the next records, were significantly lower in groups 1 and 2 when compared with group 3 with no significant variance between groups 2 and 1. The induction dosage of propofol, mean end-tidal sevoflurane concentration and the consumption of fentanyl intraoperatively were significantly lower in group 2 when compared with group 1. The time through anesthesia induction was significantly lower in group 1 and 2 when compared with group 3. The time to the first analgesic demand postoperatively was significantly longer in group 2 when compared with group 1. Conclusion: Both lidocaine and dexmedetomidine could be a beneficial adjuvant to general anesthesia. Though, dexmedetomidine has a much economic effect on intraoperative anesthetic agent consumption and more extended time to the first postoperative analgesic request.   
64 Effects of Bariatric Surgery on Indices of Obstructive Sleep Apnea and Pulmonary Function Tests   , Atef Wahdan Alrifai  1; Mostafa Samaha Samaha1; Hassan Aref2 1Chest Disease Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Chest Disease Department, Faculty of Medicine, Cairo University, Egypt  
Background: Obesity reaches the epidemic situation. Obstructive sleep apnoea is a major concern in obese patients.  Aim of the work:To analyse apnoea hypopnea index and to evaluate changes in pulmonary functions before and after bariatric surgery in obese patients. Patients and Methods: We identify 160 patients who met our inclusion criteria. However, 121 patients returned for follow up evaluation. They were 98 women and 23 men. 84 had Raux-en-Y gastric bypass and 37 had sleeve gastrectomy. They were subjected to full history taking, clinical examination, objective measures of obstructive sleep apnoea [apnoea hypopnea index, body mass index, mean oxygen saturation, low oxygen saturation, nasal continuous positive airway pressure and Pulmonary function tests]. In addition, all patients were submitted to a sleep study. Results:Statistically significant improvement was obtained postoperative for apnoea hypopnea index, body mass index, nasal continuous positive airway pressure requirement, mean oxygen saturation and low oxygen saturation. The spirometry and lung volume finding showed statistically significant improvement in lung function parameters after surgery. There was a significant positive correlation between body mass index and apnoea hypopnea index, with significant negative correlation between body mass index and forced vital capacity. Conclusion: Bariatric surgery is associated with significant improvement in pulmonary functions and obstructive sleep apnoea indices  
65 Alteration of Sexual Function among Females after Laparoscopic and Abdominal Hysterectomy   , Ahmed Adel Mahmoud   1; Walaa Mohammed El-Bassioune2; Ayman Alhosseiny Abdelmaksoud3; Ahmed Mohamed Abd-Eltawab 4 1Department of Obstetrics and Gynecology, Dikirnis General Hospital, Ministry of Health, Egypt. 2Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Psychiatry, Damietta Faculty of Medicine, Al Azhar University, Egypt 4Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Alteration of the female sexual functions after hysterectomy have a great concern to patients and clinicians. The introduction of many assessment tools as the Female Sexual Function Index (FSFI) allowed researchers to assess the sexual functions in a more standardized method. Aim of the work: to assess the consequence of abdominal and laparoscopic hysterectomy on sexual functions. Methods: 60 women aged between 30 to 60 years who underwent hysterectomy (abdominal or laparoscopic) for benign reasons were included in this study, and divided into two groups, total abdominal hysterectomy (TAH) and total laparoscopic hysterectomy (TLH). Using FSFI questionnaire, the sexual functions were assessed 1 day preoperatively and six months postoperatively. Results: The score for Desire was 5.08+0.62 for TAH, 5.06+0.60 for TLH preoperatively; and 5.12+0.58 for TAH, 5.20+0.62 for TLH postoperatively. Arousal was 5.14+0.42 for TAH, 5.19+0.42 for TLH preoperatively and 5.15+0.53 for TAH, 5.22+0.46 for TLH postoperatively. Lubrication was 5.05+0.49 for TAH, 5.15+0.52 for TLH preoperatively and 5.23+0.48 for TAH, 5.23+0.53 for TLH postoperatively. Orgasm was 5.01+0.62 for TAH, 5.00+0.57 for TLH preoperatively and 5.04+0.59 for TAH, 5.13+0.59 for TLH postoperatively. Satisfaction was 4.89+0.63 for TAH &4.89+0.60 for TLH preoperatively and 5.00+0.66 for TAH, 5.20+0.60 for TLH postoperatively. Pain was 4.95+0.48 for TAH, 4.95+0.51 for TLH preoperatively and 5.12+0.53 for TAH, 5.01+0.51 for TLH postoperatively. Conclusion: there was a significant improvement in the female sexual functions after laparoscopic hysterectomy, but after abdominal hysterectomy, there was no improvement. Keywords: Female Sexual Function Index, Arousal, hysterectomy.  
66 Ultrasound in Prediction of Threatened Abortion in Early Pregnancy: A clinical Study   , Shimaa Shaker Zeed Saleh  1; Khattab Abd El-halim Omar Khattab2; Ehab Mohammed Elhelw2 1Department of Obstetrics and Gynecology, Damietta Specialized Hospital, Ministry of Health, Egypt 2Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: early pregnancy loss is a challenging health problem and the prediction of exposed females is mandatory to permit early intervention and prevention. Aim of the work: to assess utility of ultrasound in detection of threatened abortion in early pregnancy. Patients and methods: one hundred females with history of threatened abortion were included. A written consent was obtained from each participant. Patients were divided into two groups: Group (I): 85 Cases who continued their pregnancy. Group (II): 15 Cases ended by abortion. All females were submitted to: detailed history, clinical examination (General and abdominal) and investigations in the form of ultrasound. Data were collected and statistically analyzed. Results: 15% of studied females had early miscarriage. There was a significant relation between occurrence of abortion and gestational age as abortion was more frequent with reduced gestational age. In addition, high parity (P1-2) was significantly associated with abortion. Also, current abortion associated with abortion in previous pregnancy, sub-chorionic hematoma, irregular wall of gestational sac and low fetal heart rate. The best cutoff of fetal heart rate is 100 beat/minute. The sensitivity of fetal heart rate in prediction of abortion was 67.1%, specificity was 80.0%, PPV was 95.0%, NPV was 30.0% and overall accuracy was 69%. Conclusion: The sonographic findings have a prognostic value that interacts with other clinical and maternal factors analyzed. Some parameters considered as prognostic factors and include irregular wall of gestational sac, perigestational hemorrhage and embryonic bradycardia  
67 Inhaled Salbutamol for the Treatment of Transient Tachypnea of the Newborn   , Ahmed Abdelaty Salama  ; Lotfy Abdel-Fattah El-Seheimy; Mohamed Ibrahim Elsamanoudy Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Transient tachypnea of the newborn [TTN] is a common physiologic lung disorder. Stimulation of β-adrenergic receptors could alleviate the condition. Aim of the work: The study was undertaken to assess the efficacy and safety of inhaled salbutamol in reduction of TTN, oxygen treatment and hospitalization.  Patients and Methods:This clinical study included 150 [50 control group, 50 single dose of salbutamol and 50 double-doses of salbutamol] infants between 35th-39th week's gestation. Inhaled salbutamol was given and comparison between the three groups was carried out. Results: Treatable and control groups were comparable as regard neonatal and maternal characteristics. Heart rate was significantly increased in group B when compared to control group half and one hour after treatment. In addition, respiratory rate was significantly increase in group B when compared to group A at half hour after treatment and continued till 8 hours after treatment. The TTN score after treatment was significantly lower in group B when compared to group A at one hour after nebulized salbutamol and continued till 8 hours. Furthermore, time before initiation of feeding was significantly reduced in group B when compared to group A [26.72[±3.68] vs [39.66[±4.7] and also there was significant reduction of hospitalization days in group B when compared to group A [3.78 [±1.25] vs [7.36[±1.28]. Conclusion: Inhalational salbutamol reduced duration of supplemental oxygen therapy, the duration of hospitalization and time before initiation of feeding, and no adverse effects were reported. Thus, inhaled salbutamol seems to be effective and safe in TTN.   
68 Frequency of Mitral Valve Prolapse in Apparently Healthy Children in Alexandria Governorate   , Nada Alaa Mohamed Diab  1; Lotfy Abdel-Fattah El-Seheimy2; Aly Mohamed Abd Elmohsen3 1Department of Pediatrics, Sporting student hospital, Alexandria, Egypt. 2Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt  
Background: Mitral valve prolapse is common with a reported prevalence ranging from 2–3%, Mitral valve prolapse and its possible complications is not yet studied in Egyptian children. Aim of the work: To study the frequency of mitral valve, prolapse in apparently healthy children aging between 3 to 15 years old.  Patients and Methods:A cross sectional study, the study sample contained 150 apparently healthy child selected by non-systemic random sample, 78 males (52.0%) and 72 females (48.0%), with age ranged from 3-15 years old, the mean age was 2.36 years, living at Alexandria governorate and fulfilling the inclusion criteria coming for outpatient office visits for well child care at sporting students’ hospital, Alexandria, through the period from March 2018 through April 2019. Results: The frequency of mitral valve prolapse in children in Alexandria governorate was found in 18 cases (12.0%), 17 cases of them (11.4%) had mitral regurge [MR]. MVP was more frequent among females (63.6%) than males (36.4%) but the difference did not reach statistically significant difference (p>0.05). echocardiographic examination reflects the mild nature of the disease. Conclusion: Mitral valve prolapse reported in 12% of apparently healthy children, which reflects the magnitude of the problem. Female children were more affected. This indicates the importance of screening healthy children to early diagnose the condition and permit early treatment.    
69 Intrapartum Ultrasound Measurement of Fetal Head Circumference for Prediction of Prolonged Second Stage of Labor   , Mohamed Abdel Magid Tobar  1; Khattab Abdelhaleem Khattab2; Ehab Mohamed Elhelw2; Abdelrahman Ali Hassan Emam3 1Department of Obstetrics and Gynecology, Manzala Central Hospital; Ministry of Health, Egypt 2Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: Fetal head circumference was suggested to play a role in determination of the mode of delivery in nulliparous women. Aim of the work: To determine the capability of intrapartum ultrasound measurement of head circumference to monitor second stage of labor progress in an accurate and objective manner as well as its role as a predictor of successful normal vaginal birth.  Patients and Methods:130 females who attended to the labor room and fulfil the inclusion criteria underwent ultrasonographic examination prior to the start of labor, and then followed up until delivery. Every woman was followed up by cervical dilatation, and head station every 4 hours. Woman was transferred to operating room when the cervix is fully dilated and head is engaged to determinate the duration of second stage. Fetal heart sounds were auscultated every 30 minutes and plotted on partogram. Shifting to cesarean section was considered when delivery failed to progress, delayed second stage or fetal bradycardia. Results: By using value of 37.0 for Intrapartum head circumference as a cut-off point, we observed a significant difference between both groups [smaller or larger than 37.0] regarding duration of the 2nd stage of labor [P=0.00] & Mode of delivery [P=0.00]. No statistical difference was observed regarding Maternal morbidity [P=0.374] or Neonatal outcome [P=0.412]. Conclusion: There was significant relation between intrapartum head circumference and length of second stage. Intrapartum fetal head circumference is a useful tool to expect the progress of delivery.    
70 Role of Left Ventricular Twist and Torsion in Assessment of Reperfusion in Acute ST-Elevation Myocardial Infarction Patients   , Ayman Gad  1; Mohamed Sayed Bashandy 1; Abd Elrahman Abd El-Gawad Sharaf2 1Department of Cardiology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Department of Cardiology, Faculty of Medicine, Al-Azhar University, Egypt  
Background: Myocardial infarction is an acute emergency which needs rapid assessment, especially for myocardial reperfusion. Aim of the work: To evaluate left ventricle [LV] twist/torsion for assessment of myocardial reperfusion after acute ST-elevation myocardial infarction [STEMI] and to explore its relationship with LV function after 3 months.  Patients and Methods:Forty-five patients with acute STEMI [30 anterior and 15 inferior] with a single culprit lesion were analyzed against 50 healthy subjects. Apical and basal rotations and LV twist/torsion were measured by two-dimensional speckle tracking imaging. Results: LV twist [13.5±2.4 vs 20±0.5] and LV torsion [1.8±0.2 vs 2.9±0.1, P=0.001] were reduced in all STEMI patients. Basal rotation was larger in anterior STEMI than in inferior STEMI and control [-8.09±0.7 vs -3.1±1.03 -6.2±0.6 successively], while apical rotation was significantly lower in anterior STEMI. LV twist and torsion were lower in anterior vs inferior STEMI [11.9±1.1 vs 16.6±1 and 1.7±0.1 vs 2.1±0.1, P=0.001 respectively]. There was moderate positive correlation between baseline LV torsion and LV ejection fraction at 3 months [r=0.500, P=0.001], while negative moderate correlation between baseline LV torsion and LV volumes [LV end-diastolic volume & LV end-systolic volume] [r=-0.444 & r=-0.479 respectively] was reported. Post reperfusion, the best cut-off point of LV torsion predicting LV remodeling was 1.9 with sensitivity 81.3% and specificity 82.8% [AUC =0.85]. Conclusion: Global LV torsion was decreased in acute STEMI patients, soon after reperfusion it showed marked improvement in LV torsion/twist. LV torsion early after reperfusion can predict LV remodeling at 3 months follow up.    
71 Penile Necrotizing Fasciitis (Fournier's Gangrene) after Penile Prosthesis Implant in diabetic patient treated conservatively – A case report.   , Nabeel Joda Kuwaijo   1; Mohammed Sayed Abo Elmagd2; Ponnusamy Mohan3 1Department of Urology, The Galway Clinic, Royal College of Surgeons, Ireland 2Department of Urology, Mater Misericordiae University Hospital, Dublin, Ireland 3Department of Urology, Andrology & Transplant, Beaumont Hospital, Beaumont Road, Dublin, Ireland  
Background: Penile abscess and necrotizing fasciitis are very rare. Diabetes mellitus is the common risk factors. In our practice, this is the first reported case of penile necrotizing fasciitis after penile prosthesis insertion. Aim of the work: We intended to present our case of penile necrotizing fasciitis treated conservatively. A written consent has been signed by the patient to release information for this study. Case description: Our patient is a 52 years old male, who had a history of painless skin loss of the penis (ventral aspect of the lower parts of the shaft) for 7 days. The skin necrosis started 21 days after implantation of penile prosthesis. He had controlled type-2 diabetes mellitus. No specific signs were detected by general examination. There was discrete tenderness on penile wound; which was 2.5*4.2 cm of skin loss, with white patches, purulent discharge, elevated edges and erythema. The management consisted of use of antibiotics (oral combination of amoxicillin-clavulanic acid and local fusidic acid) with 0.9% normal saline washout on regular intervals. There was excellent wound healing with minimal tissue loss. Conclusion: Our case report revealed that, the serious complication of necrotizing fasciitis may occur after implantation of penile prosthesis. Surgical intervention was not indicated and conservative medical treatment was successful.  
72 Spinal versus General Anesthesia for Elective Cesarean Section: Immediate outcome   , Tarik Saber Sarhan   1; Adel Al-Hady Ahmed Diab2; Mohamed Ibrahim Abdel-aal 3 1Department of Anesthesia and Intensive Care, Damietta Faculty of Medicine, Al-Azhar University, Egypt; Emergency Medical Service and Critical Care, Inaya Medical College, Saudi Arabia. 2Department of Anesthesia and Intensive Care, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Recent interest has focused on the influence of obstetric anesthesia types on the immediate neonatal and maternal outcome. Aim of the work: The study was intended to assess the immediate neonatal and maternal outcome in relation to the maternal anesthesia type during cesarean section. Patients and methods: the present study included 200 full term neonates whose mothers underwent elective cesarean section (CS). They were grouped according to type of anesthesia given to mothers into group 1: included 100 newborns whose mothers had general anesthesia and group 2: included 100 newborns whose mothers had spinal anesthesia. Each newborn evaluated for short-term outcome including Apgar score, need for NICU admission and blood gas analysis. Mothers assessed for postoperative outcome. Results: No significant differences were discovered between the types of anesthesia used in regard to the general maternal characteristics. Neonatal outcomes on the other hand showed no significant differences as regard Apgar score (P=0.33) and NICU admission (P= 0.57), PaCO2, HCO3, Na and K; while PH and PaO2 were significantly lower with spinal anesthesia (P= 0.02 and 0.008 respectively). Additionally, spinal anesthesia was associated with rapid recovery of bowel and less need for postoperative analgesia. Conclusion: The type of anesthesia used in mothers undergoing full term elective cesarean deliveries does not seem to affect the immediate neonatal outcome. Both may be safely used in full term elective cesarean deliveries. However, spinal anesthesia had the advantage of lower need for postoperative analgesia with rapid recovery of bowel  
73 Incidence of Esophageal Reflux after Laparoscopic Sleeve Gastrectomy for Morbid Obesity   , Ahmed El-Sayed Orouk   1; Ahmed Salama Sayyouh2; Nagah Atwa Salem3 1Department of General Surgery 2Professor and Head Department of General Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of General Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: Obesity is considered as an epidemic globally, which associated with gastroesophageal reflux disease (GERD). Bariatrics surgery tends to reduce GERD manifestations. However, some reports noticed development of GERD after bariatric surgery; the problem which not addressed well in our community. Aim of the work: To estimate incidence of postoperative GERD after laparoscopic sleeve gastrectomy (SG) in patients with no history of GERD symptoms prior to surgery. Patients and Methods: Fifty morbidly obese patients who were scheduled for laparoscopic SG with no history of preoperative symptoms suggesting GERD and normal upper gastrointestinal endoscopy were included. All were assessed clinically and radiologically and followed-up for clinical or endoscopic GERD manifestations. Results: Females were predominant (76.0%). Weight, body mass index and waist/hip ratio were significantly reduced after SG. Postoperative complications were leak (2.0%), wound infection (2.0%), bleeding (2.0%), stricture (4.0%) with overall rate of 8.0%. Incidence of GERD was 22.0% (11 patients; 4 grade A, 5 grade B and 2 grade C). There was significant increase of Waist/hip ratio (both pre-and postoperatively) in patients who developed GERD when compared to those who did not develop GERD. In addition, there was significant increase of sleep related problems and stricture in patients who developed GERD when compared to those did not develop GERD (63.6%, 18.2% vs 17.9%, 0.0% respectively). Conclusion: the incidence of GERD after SG was 22.0%. It was of mild or moderate nature, which denotes safety of SG. The procedure is also associated with marked weight reduction.  
74 Urolithiasis in Post Renal Transplant Recipients: Case series   , Nabeel Kuwaijo   1; Ponnusamy Mohan2; Mohammed Sayed Aboelmagd Mohammed3; sadiq Lala4 1The Galway Clinic - Royal College of Surgeons in Ireland 2Transplant Unit, Beaumont Rd, Beaumont, Dublin Ireland 3Mater University Hospital, Urology Department 4Urology and Transplant The royal hospital Oman  
Renal transplantation represents the optimal management option for end-stage renal disease. it is associated with favourable outcome. Urolithiasis after renal transplant is an extremely rare condition, with an incidence less than 1% after renal transplantation. We reported six post renal transplant patients who had renal stones. The stones located in the transplanted kidney, its ureter or both. Transplanted kidney and ureteric stones had been reported 2 – 3 years after transplantation, while the urinary bladder calculi reported 8 – 10 years after transplantation, at the site of ureteral implantation to the bladder over the site of sutures and in the absence of any post-transplant complications. A written consent has been signed by the patient to release information for this study. The treatment was individualized for each patient. Interestingly, one patient with asymptomatic post-transplant renal stone needs no intervention “we watched and see” and he passed the stone within shortest follow up period that confirmed by ultrasound examination. Others, underwent extracorporeal wave lithotripsy or percutaneous nephrostomy and antegrade double-J stent insertion.   
75 Comparative Study between Mathieu Repair and Snodgrass Repair in Distal Hypospadias   , Ahmad Alaa eldeen Hassouna  1; Abdo Abdo Arnous2; Esam Ali Taman3; Ibrahim Mahmoud Elsayaad 4 1Department of General Surgery, Damietta General Hospital, Ministry of Health, Egypt 2Department of Pediatric Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 3Department of Plastic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt 4Department of Peidatric Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: Hypospadias is a congenital condition characterized by tissue hypoplasia of the ventral aspect of the penis, with incidence of one in 300 males [0.3%]. There is an increase incidence in those with first-degree relatives having hypospadias to about 13 times more than those without family history.  Aim of the work: To compare between the meatal-based flap "Mathieu" technique and tubularized incised plate [TIP] "Snodgrass urethroplasty in treatment of distal hypospadias. Patients and Methods:This study was carried out at the Department of Surgery, Al-Azhar university hospital [Damietta], Egypt., The study consists of forty male children, suffering from distal penile hypospadias. Patients were blindly assigned into two groups;20 patients underwent Mathieu technique and another 20 patients underwent "Snodgrass urethroplasty”. Results: Both groups were comparable regarding patient age, consanguinity, maternal drug intake, urethral plate characteristics and duration of hospital study. However, Snodgrass urethroplasty is associated with significant increase of operative time [80.0±16.1 vs 60.0±9.6 minutes], significant lower complication rate [10% vs 30.0%], significantly good cosmetic appearance of the penis [100% excellent versus 40% excellent, 40% good, and 20% torsion of the shaft] and 100% slit like and vertically oriented meatus. Conclusion: Snodgrass and modified Mathieu repair are safe, and the choice of one of the techniques will depend on the surgeon's decision. Its procedure had its own advantages and disadvantages and final decision should be attributed to surgeon preferences.   
76 Incidence of Endometriosis among Women Prepared for Laparoscopy in Unexplained Infertility and Chronic Pelvic Pain   , Mohammed Mahmoud Mahmoud El-flahgy  1; Walaa Mohammed El-Bassioune1; Waleed Ahmed Ayad2 1Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 2Department of Obstetrics and Gynecology Faculty of Medicine, Al-Azhar University (Damietta) Egypt  
Background: Unexplained infertility continues to be a health challenge irrespective of revolution in medical care. Endometriosis could be associated with infertility. However, its prevalence is underestimated, as it need laparoscopy for definite diagnosis.  Aim of the work: To estimate the incidence of typical and atypical (subtle) pelvic endometriosis among women with unexplained infertility and chronic pelvic pain. Patients and Methods:A total of 100 patients with unexplained infertility [50 patients] and chronic pelvic pain [50 patients] who underwent diagnostic laparoscopy had been included in the current study. All were assessed clinically after full history taking and underwent ultrasound, then prepared for laparoscopy. The main outcome was laparoscopic and histopathologic diagnosis of pelvic endometriosis, and the association between endometriosis and different patient characteristics and other risk factors had been analyzed. Results: Endometriosis was diagnosed by laparoscopy in nearly 33 of patients included in this study of which 29 cases [12 with unexplained infertility and 17 with chronic pelvic pain] were confirmed by histopathologic examination. Thus, the final incidence of endometriosis was 29%. Development of endometriosis was significantly associated with positive family history, dysmenorrhea and higher CA125. Conclusion: Pelvic endometriosis is a frequent association with unexplained infertility and chronic pelvic pain. It should be considered in those women particularly when there was positive family history, dysmenorrhea or higher CA125.   
77 Predictive Value of both Serum Placental Protein-13 Level and Uterine Artery Doppler for Prediction of Pre-Eclampsia   , Marwa Samir El-hassab   1; Rashed Mohamed Rashed2; Magdy Zaky Elghannam3; Alaa Eldin Mahmoud Megahed2 1Department of Obstetrics and Gynecology, Sammanoud General Hospital, Ministry of Health, Egypt. 2Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Preeclampsia [PE] is one of the commonest medical emergencies. It had high morbidity for the mother and her infant. Early diagnosis could reduce such morbidity.  Aim of the work: To evaluate the role of maternal serum placental protein [PP13] levels and uterine artery Doppler in early prediction and prognosis of preeclampsia. Patients and Methods: The study included 60 pregnant women in their first and early second trimester with high risk for preeclampsia. Patients were divided into three groups: control, mild and sever preeclampsia. All were subjected to proper history taking, clinical and obstetrical examination, laboratory investigations and ultrasound examination. Results: Cesarean delivery was significantly increased in preeclampsia compared to controls [55% of mild and 20% of severe disease compared to 15% of controls]. Both uterine artery resistance index [RI] and pulsatility index [PI] were significantly increased in PE when compared to control and in severe when compared to mild PE groups. Finally, PP13 was significantly decreased in patients with severe PE [171.7±35.9] when compared to mild PE [213.1±41.8] or control group [254.8±51.1]. In addition, there was significant decrease in cases with mild PE when compared to control group. Finally, there was inverse [negative], moderate and statistically significant correlation between PP-13 from one side and each of systolic BP, diastolic BP, uterine artery RI and PI. In addition, both RI and PI were proportionally correlated with PI and RI. Conclusion: The present study showed that PP13 combined with PI or RI can predict PE with a good sensitivity and specificity.   
78 Factors Affecting Nodal Status in Breast Cancer   , Diaa Moahmmed Aboelata  1; Amr Abdel-ghany Sarhan2; Mohammed Al Sayed Abo Mira3; Sami Abdallah Mohammed4 1Department of General Surgery, Tanta Cancer Center, Ministry of Health, Egypt. 2Department of General surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of General Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt 4Department of Pathology, Damietta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: Nodal status in breast cancer [BC] is the most prognostic factor for survival and prognosis, and affects treatment decisions. Nodal status had reciprocal relation with pre- and post-operative factors. All these reflect the crucial importance of nodal status in BC. Aim of the work: Evaluation of pre- and post-operative factors related to nodal status in breast cancer. Patients and Methods: The current work included 40 patients with confirmed BC, who had been scheduled for modified radical mastectomy or conservative breast surgery with axillary evacuation. All were assessed in a systematic manner preoperatively. In addition, an intraoperative and post-operative evaluation had been carried out. Postoperative histopathological examination of excised tissues had been done for all specimens. Both intra- and post-surgical complications and factors associated with positive nodal status were documented.  Results: The most significant factors associated with high positive nodal status were age (patient ≤ 45 years was significantly associated with increased positive nodes when compared to > 45 years (37.68±35.23 vs 17.66±19.45 respectively), obesity (30.66±27.33 vs 18.49±25.07 nodes for obese and lean individuals respectively)., tumors greater than 2 cm, positivity of the human-epidermal-growth-factor receptor 2 [Her2]/neu, positive lymphovasular invasion, tumors of the upper quadrant, and the type of histopathology. Conclusion: Nodal status affected by pre- and post-surgery factors (e.g., age, obesity, tumor site, tumor size, Her2/neu, lymphovascular invasion and histopathological type of the tumor). Thus, these factors help in planning of the treatment such as the type of surgery, endocrine therapy, radiation therapy and the adjuvant chemotherapy.    
79 Office Hysteroscopy Versus Three-Dimensional Ultrasound in Assessment of Uterine Cavity in Recurrent Pregnancy Loss   , Mohamed Atef Farag  1; Mahmoud Salah Mahmoud 2; Rashed Mohamed Rashed3 1Department of Obstetrics and Gynecology El-Mahalla General Hospital, Ministry of Health, Egypt. 2Department of Obstetrics and Gynecology; Damietta Faculty of Medicine, Al-Azhar University, Egypt. 3Department of Obstetrics and Gynecology; Damietta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: Recurrent pregnancy loss [RPL] is one of the most frustrating and difficult areas in reproductive medicine. Aim of the work: This prospective study aims to evaluate the roles of ultrasound and hysteroscopy in recurrent pregnancy loss. Patients and Methods: A total of 100 patients who had a history of two or more RPL had been included. All patients had been subjected to complete history taking, thorough clinical and gynecological examination, three-dimensional [3D] ultrasound and hysteroscopy.  Results: The mean age was 27.43 years. In addition, 45% of the included females had two previous RPL while 55% of them had three or more RPL. Hysteroscopy revealed normal findings in 80 cases [80%], endometrial polyp in 7%, submucous myoma in 3%, uterine septum in 6%, and uterine synechiae in 4%. On the other side, three-dimensional ultrasound [3D US], normal findings had been detected in 83 cases [83%], endometrial polyp in 6%, submucous myoma in 3%, uterine septum in 5%, bicornuate uterus in 1%, and uterine synechiae in 2%. There was a statistically significant correlation between the two techniques in detection of the uterine findings in cases of RPL [p =0.001]. Conclusion: Three-dimensional ultrasonography is the best tool for diagnosis of different types of Mullerian duct anomalies whereas hysteroscopy is better in diagnosis of intracavitary lesions.   
80 Vestibular Evoked Myogenic Potential in Multiple Sclerosis (MS)   , Iman Ibrahim Mohamed Eladawy   1; Amal Beshr2; Reda Behairy3; Alaa Ameen4 1ENT Department, faculty of medicine for girls (Cairo) , Al-azhar University 2ENT Department, Faculty of medicine for girls (cairo) , Al-azhar University 3ENT Department, faculty of medicine, for girls (cairo), Al-azhar University 4ENT Department, faculty of Medicine for Girls (cairo), Al-azhar university.  
Background: Involvement of the brainstem in multiple sclerosis [MS] has significant implications on the disease course and can be presented with different symptoms. There are many tests able to detect brain-stem involvement in MS with various degrees of success. Aim of the work: To study the changes in vestibular evoked myogenic potential [VEMP], in patients with MS, and to detect its sensitivity for detection of the brain-stem lesions previously diagnosed with magnetic resonance imaging [MRI] in MS patients. Patients and Methods: Sixty participants had been enrolled and divided into two groups: 30 healthy subjects [Control group] and 30 MS patients [Study group]. Both groups had been subjected to otological examinations, pure tone audiometry, acoustic impedance, cervical vestibular evoked myogenic potential [cVEMP], ocular vestibular evoked myogenic potential [oVEMP] and MRI.  Results: In MS group, oVEMP mean latencies of n1 and p1 and cVEMP mean p13 and n23 latencies were significantly prolonged. In addition, 14 MS patients [46.7%] had brainstem lesions as confirmed by MRI. Finally, oVEMP test had higher sensitivity than the cVEMP in prediction of brainstem lesions. Conclusion: oVEMP seems to be useful and more sensitive than cVEMP as an adjunct test in the evaluation of brain-stem dysfunction in MS patients.   
81 Robotic Assisted Laparoscopic Partial Cystectomy and En Bloc Resection of Urachus and Umbilicus for Rare Case of Mucin Producing Urachal Adenocarcinoma: A Case Report   , Nabeel Joda Kuwaijo   1; Stephanie Curran2; Paddy O'Malley1 1Department of Urology, The Galway Clinic, Royal College of Surgeons, Ireland 2Department of Pathology, The Galway Clinic, Royal College of Surgeons, Ireland  
Background: Urachal carcinoma accounts for <1% of all bladder cancers, 90% are adenocarcinomas, accounting for 10% of the bladders’ adenocarcinomas. For its rarity, there is no consensus about the nomenclature, staging, diagnosis and treatment.  Case report: We described a 42 years old male, who complained of post-voiding mucinous discharge for a long period (10 years). after extensive clinical evaluation and radiologic investigation and cystoscopy, the diagnosis of an early stage urachal adenocarcinoma had been confirmed. It had been completely excised with no metastasis. The surgical resection of the tumour done en-bloc through laparoscopy, robotic-assisted surgery. No chemotherapy nor radiotherapy had been indicated, the patient has been submitted to close follow-up, with our hoping look for recurrence of the disease. Excised specimen had been further submitted to histopathological and immunostaining examination. Histopathological grading had been done according to most recent staging systems (it confirmed the early staging mucinous adenocarcinoma of urachal origin). Conclusion: Here we described our experience with a rare case report of mucinous cystadenoma of urachal origin, robot-assisted laparoscopic surgery and early stage of cancer permits partial cystectomy, good outcome with no need for chemical or radiotherapy.   
82 Relation between Placental Thickness Measurements and Fetal Outcome in Patients with Intra- Uterine Growth Restriction [IUGR]   , Ahmed Shahat Emam  1; Walaa Mohammed El-Bassioune2; Abdelrahman Ali Hassan Emam1; Abd Elraouf Mohammad Oun3 1Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 2obstetrics and gynaecology, Al-Azhar faculty of medecine (damietta) 3Obstetric and Gynecology Department; Faculty of Medicine (Damietta), Al-Azhar University  
Background: Placental thickness appears to be a promising parameter for estimation of gestational age of the fetus due to steady increase in placental thickness with gestational age.  Aim of the work: To investigate the relationship between placental thickness and fetal outcome in patients with intrauterine growth restriction [IUGR]. Patients and Methods:This study included patients with fetuses diagnosed clinically and by ultrasound as IUGR [estimated fetal weight <10th percentile for gestational age], singleton pregnancy, gestational age between 28 – 40 weeks of gestation, maternal age between 20-40 years old and body mass index between 18-30 kg/m2. The placental thickness was measured at the second and third trimesters and correlated with the fetal outcome. Results: Results revealed that, estimated fetal weight significantly increased in normal placenta when compared to either thin or thick placentae. In addition, thin placentae had significantly low fetal birth weight [1936.4±409.2] when compared to thick placentae [2236.4±410.1] or normal placentae [2636.4±421.4]. Also, Apgar score was significantly higher and need for NICU admission were significantly lower with normal placentae. In addition, there is significant positive correlation between 3rd trimester placental thickness and fetal birth weight, placental weight and APGAR score. Conclusion: Placental thickness could predict deviations from norms of birth weight in late pregnancy. It seems to be promising for estimation of gestational age of the fetus and predicting fetal outcome.   
83 Our Experience with The Treatment of Hydrocephalus in Infants: Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt: A retrospective Comparative Study   , Mohammed El-Gebaly Ahmed Alhady  1; Mohamed Youssef2 1Neurosurgery Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Department of Neurosurgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Hydrocephalus is the commonest pediatric neurological disorder and usually treated by cerebrospinal fluid (CSF) diversion. This diversion accomplished by third ventriculostomy or ventriculo-peritoneal shunt. However, the optimal management is still controversial.  Aim of the work: To compare the endoscopic third ventriculostomy (ETV) to ventriculo-peritoneal (VP) shunt in management of Infantile hydrocephalus. Patients and Methods:We conducted a retrospective analysis for 40 infants with hydrocephalus. The treatment used was CSF diversion by ETV or VP shunt. Results: oth treatment groups were comparable regarding age, gender, cause of hydrocephalus, incidence of postoperative re-obstruction, OFC change, hematoma, revision surgery, mortality or success rate. However, the operative time was significantly reduced among ETV when compared to VP shunt group (48.80±9.13 vs 66.75±7.65 minutes, respectively). The rate of postoperative infection was significantly decreased in ETV when compared to VP shunt groups (15.0% vs 45.0% respectively). Finally, the overall mortality during postoperative one year follow up duration was 42.5% with no significant difference between ETV and VP shunt groups (35.0% vs 50.0% respectively). In addition, the overall failure rate was 50.0%, which was lower among ETV when compared to V shunt groups (35.0% vs 65.0% respectively) with no significant difference. Conclusion: Endoscopic third ventriculostomy is effective and safe intervention for treatment of infantile hydrocephalus (for infants between 6 and 3 years of age). It is superior to VP shunt as it is associated with lower postoperative infection and shorter operation time, when compared to shunt.   
84 Update in Management of Congenital Penile Curvature complex [CPCC]   , AbduAllah Mohsen Zidan   1; Mohammed mohammed shahin2; Abdo Abdo Arnous3 1General surgery department ,pediatric surgery unite, faculty of medicine,Al-Azher university,New Damietta city ,Egypt. 2Department of Surgery (pediatric surgery unit) Faculty of Medicine, Al- Azhar University,new Damietta city,Egypt 3Department of Pediatric Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: Congenital curvature of the penis results from abnormal efflorescence of the tunica albuginea of the corpora cavernosa and not accompanied with urethral anomaly. Complex Congenital curvature of the penis has two abnormal elements: mal-rotation either clockwise or anti clockwise and curvature of the penis either dorsal or ventral.  Aim of the work: To present update in management of congenital curvature complex of the penis. Patients and Methods:This prospective study done at Al-Azhar University Hospital in Damietta. Fifteen patients [15] with congenital curvature complex of the penis were evaluated and corrected from June. 2019 to January 2020, their mean age was 5.1 ± 2.34 years [range 2–10 year]. The direction of torsion was anticlockwise in 12 patients and in 3 patients was clockwise. Four patients had dorsal curvature and Eight patients had ventral curvature, while three patients had lateral curvature. All patients treated at first by modified Nesbit's procedure for correction of curvature, then dorsal flap of dartos layer for correction of penile torsion in one stage. Results: All cases with congenital curvature complex of the penis corrected in one-set surgery, which is simple, familiar and safe procedure with high successful rate. There were only a few transient complications, such as edema, mild bleeding, and penile hematoma resolved spontaneously. No recurrence of mal-rotation or curvature reported. Conclusion: Congenital Penile Curvature Complex can be treated in single-stage surgery with excellent functional and cosmetic outcomes by combination of modified Nesbit's procedure with dorsal flap of dartos layer.  Patients and Methods:This prospective study done at Al-Azhar University Hospital in Damietta. Fifteen patients (15) with congenital curvature complex of the penis were evaluated and corrected from June. 2019 to January 2020 ,their mean age was 5.1 ± 2.34 years (range 2–10 y). The direction of torsion was anticlockwise in 12 patients and in 3 patients was clockwise. Four patients had dorsal curvature and Eight patients had ventral curvature, while three patients had lateral curvature. All patients treated at first by modified Nesbit's procedure for correction of curvature, then dorsal flap of dartos layer for correction of penile torsion in one stage.
85 Comparative Study Between Intramedullary K-wire Fixation Versus Transverse Pinning in Treatment of Fifth Metacarpal Neck Fracture   , Ismaeel Shaker Eraky Sallam  1; ashraf eltabie ezzeldeen2; Samir Ahmed El-Shoura3 1Department of Orthopedic Surgery, Nasser General Hospital, Ministry of Health, Egypt 2Department of Orthopedics, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Orthopedic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: Fifth metacarpals and phalangeal fractures are common, and neck fractures of the fifth metacarpal is the commonest. Improper treatment is associated with negative economic impact due to its associated disabilities.  Aim of the work: To compare between intra-medullary and transvers K-wires for fifth metacarpal neck fractures. Patients and Methods:Thirty patients with 5th metacarpal neck fracture were included. Fifteen treated by intramedullary k-wire fixation, and fifteen treated by transverse k-wire pinning. Preoperatively, patients were evaluated by clinical, radiological and laboratory studies. Postoperatively, they were assessed clinically and by imaging studies. Objective assessment had been achieved by the total active range of motion [TAM] and hand-grip strength. Results: Both groups were comparable as regard to patient and injury characteristics. Punch was the most common mechanism of injury. The right side was affected in 80%, and the transverse fracture was the most common [reported in 53.3%].  Finally, outcome was slightly better in group 1, except for one patient of non-union. The results based on TAM% were excellent, good, fair and poor among 60.0%, 26.7%, 6.7% and 6.7% in group 1, compared to 83.3%, 40.0%, 0.0% and 6.7% in group 2 with the same order. The time to union ranged between 6 and 14 weeks. Finally, complications were reported in 20% of group 1 and 33.3% of group 2. Conclusion: Intramedullary K-wire Fixation and Transverse Pinning provide an optimal treatment options for Fifth Metacarpal Neck Fracture. Intramedullary K-wire Fixation provide slightly better outcome. However, the superiority is not statistically significant.   
86 Comparative Study between Intranasal Injection of Botulinum Toxin-A and Combined Intranasal Medical Treatment for Allergic Rhinitis   , Nabil Sarhan  1; Mohamed Fathallah2; Ashraf Abdalla Wahba3; Ahmed Alwan4 1Department of Otorhinolaryngology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University, Egypt. 3Department of Otorhinolaryngology, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 4Department of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: Allergic rhinitis is one of the most common diseases, with no consensus on its ideal treatment. Botulinum Toxin-A was proposed to be an effective treatment.  Aim of the work: To estimate the outcome of intranasal injection of Botulinum Toxin-A [BTX-A] as a sole therapy for allergic rhinitis. Patients and Methods:Ninty patients with classic symptoms of allergic rhinitis were clinically evaluated and asked to complete the score for allergic rhinitis [SFAR] questionnaire using cutoff at >8 as diagnostic AR. Two blood samples [venous] and nasal smears were obtained at the beginning of the study and at the end of 12-weeks after initiation of therapy for estimation of human immunoglobulin E [IgE] and eosinophilia grading. Control group included patients who chose to receive combined medical treatment. BTX-A, 2.5 units were injected intranasally, under 0o rigid telescope guidance. Study outcome was the treatment success rate at the end of 12-w follow-up period. Results: Intranasal BTX-A injection provided significantly maintained relieve of allergic rhinitis manifestations especially for running nose than combination therapy. The treatment success rate of 1.9 versus 0.7 item/patient in study versus control group with significant difference in favor of BTX-A injection. Serum IgE levels and eosinophilia grades were significantly lower in control patients. Patients' satisfaction grading was significantly more with BTX-A injection. Conclusion: Intranasal BTX injection could be a safe and effective sole therapeutic modality for patients with long-lasting AR  
87 Mycoplasma Pneumoniae and Bronchial Asthma in Children   , hala mohammed kamal Elzawawy  1; Magdy Mohammed Sakr2; Mohammed Ibrahim Abdel-Aal3; hesham samir abd al-samee 4 1Damanhoor medical national institute, Minstry of health 2damietta, faculty of medicine,Al-Azhar University 3faculty of medicine, Al-Azhar university 4Lecture of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar University, New damietta, Egypt.  
Background: Bronchial asthma is a chronic inflammatory disorder of the airways resulting in recurrent episodes of wheezing, breathlessness, chest tightness and cough, particularly at night and early morning. Mycoplasma pneumonia is a frequent cause of acute respiratory infections in children. It can cause pharyngitis, otitis media, tracheobronchitis or community acquired pneumonia, but may also remain totally asymptomatic.  Aim of the work: The aim of the study is to find out the relation between Mycoplasma Pneumoniae infection and bronchial asthma in children. Patients and Methods:A cross sectional study carried out at the Al-Azhar University Hospital in Damietta in the period from October 2018 to October 2019. It included 80 asthmatic children in acute attack. Patient demographics, asthma severity and laboratory investigations had been documented. In addition, IgM for Mycoplasma pneumoniae had been determined, and associated with other factors.   Results: Mild asthma reported in (76.25%), moderate asthma (17.5%), and severe asthma (6.25%). Eosinophils had significantly increased in severe asthma (5.00±3.24) when compared to moderate (3.57±1.55) or mild asthma (2.33±1.11). Similarly, IgM of M. pneumoniae was significantly increased in severe asthma (1.03±0.69) when compared to moderate (0.67±0.45) or mild asthma (0.61±0.21). None of children with mild asthma had positive IgM while 14.28% of moderate asthma had positive results and 80.0% of severe asthma had positive IgM for M. Pneumoniae.   Conclusion: Mycoplasma Pneumoniae infection is common in children with acute attacks of asthma and Mycoplasma Pneumoniae infection is associated with the trigger asthma exacerbation and associated with the severity of asthma.  
88 Effect of Vitamin-D Supplementation on Recurrence of Acute Otitis Media in Pre-School Children   , Osama Mohamed Refaat 1; El Bakry Mohamed Tharwat  2; Ahmed Mohamed El-Gamal3 1Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar university, Egypt 2Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Egypt  
Background: Acute Otitis media (AOM) and its recurrence is a prevalent health problem among pre-school children. Different strategies to prevent recurrent have been established with questionable efficacy. Vitamin D is suspected as a possible preventable risk factor.  Aim of the work:To evaluate the effect of vitamin-D supplementation on recurrence rate of acute otitis media among Pre-school children. Patients and Methods:60 pre-school children with a recurrent episode of acute otitis media [by history and otoscopic examination] were included. After diagnosis, all children received standard treatment and after recovery, serum levels of vitamin-D were estimated; those with reduced vitamin D had been included, then divided into: Study group (30 children, received oral vitamin-D supplementation for 4 months; and Control group (30 children; received placebo). New attacks of AOM had been document during the regular visits for the six months. Vitamin D had been re-estimated after 6 months. Results: Both groups were comparable regarding studied variables at the start. Upper respiratory tract infection and ear discharge significantly decreased; vitamin D significantly increased among study group at 6 months. Recurrent AOM after 6 months, had been significantly reduced among study vs control group (1.43±0.62 vs 3.46±0.62 respectively). Also, vitamin-D significantly increased at the end in study vs control group (21.76±5.95 vs 14.53±4.73 ng/ml respectively). The mean percentage of increase of vitamin-D in study group was 135.98% compared to 33.91%. In control group. Conclusion: Vitamin D supplementation to children with a history of rAOM plays a significant role in reduction of attack frequency.  
89 Ondansetron Compared with Doxylamine and Pyridoxine for Treatment of Nausea and Vomiting in Pregnancy   , Mohamed Kamal Yahia   1; Khattab Khattab Abdelhalim Omar Khattab2; Alaa Ebrahim Hamed2 1Department of Obstetrics and Gynecology, Damietta General Hospital, Ministry of Health, Egypt 2Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Nausea and vomiting affects up to 80% of the pregnant women population and are the third leading causes of maternal hospitalization during pregnancy. Many pregnant females, and even some healthcare professionals, dread using antiemetic drugs due to a false beliefof their teratogenicrisk.  Aim of the work:This study aimed to evaluate ondansetron to a combination of doxylamine and pyridoxine in controlling pregnancy-related nausea and vomiting. Patients and Methods:This randomized controlled trial included 156 pregnant women, at 16 weeks of gestation, with mild-to-moderate nausea and vomiting. Meanwhile, women with severe symptoms indicating admission, those already on anti-emetics, and those who wouldn’t be able to show up for follow-up visits were excluded. Seventy-eight patients received intravenous injection of ondansetron [Zofran] at a dose of 8 mg once daily for 5 days, whereas the other 78 patients received oral pyridoxine at a dose of 25 mg plus doxylamine at a dose of 12.5 mg [Diclegis] twice daily for 5 days. Each patient was subjected to full history taking, complete clinical examination and investigations. Results: Women on Ondansetron reported better alleviation of nausea compared to those receiving pyridoxine and doxylamine [96.2% vs. 52.6%, P<0.001, respectively]. The most frequently reported side effects were headache, dry mouth, gastrointestinal [GI] disturbances, and abdominal pain, and the differences in their occurrence between the two groups were statistically insignificant. Conclusion: Ondansetron was found superior to the combination of pyridoxine and doxylamine in improving pregnancy-related nausea and vomiting occurring without a significant increase in side effects.   
90 Comparative study: Transseptal approach versus Transatrial approach in mitral valve replacement in redo patients   , Mohamed Abdelazeem Hitawy  1; Mohamed Shaffik Hassan2; Farag Ibrahim Abdelwahab3; Mohamed Elsayed Mousa2 1Department of Cardiothoracic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Department of cardiothoracic surgery, Faculty of Medicine, Al-Azhar University, Egypt 3Department of cardiothoracic surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Previous cardiac operations may complicate mitral valve exposure, as adhesions and loss of mobility in the surrounding tissues may be present. In such cases, the conventional left atrial (LA) incision may not offer satisfactory visualization in the surgical site of the valve. Therefore, several alternative approaches have been proposed for satisfactory visualization of the mitral valve intraoperatively. Aim of the work: to evaluate the outcome of the transseptal and transatrial approaches for mitral valve replacement in patients undergoing redo mitral valve surgery. Patients and Method: This is a prospective study that was conducted at Cardio-thoracic surgery department of Al-Azhar University hospital (Damietta) and other centers during the period from the January 2018 to May 2019. It included 30 patients undergoing redo mitral valve surgery; 15 of them had transseptal approach and 15 with transatrial approach. Results: Age was comparable between studied groups. There was 6 males (40.0%) in group I and 7 males (46.7%) in group II. Smoking was reported in 8 (53.3%) in group I and 7 (46.7%) in group II. Hypertension and pulmonary disease were reported in 6 (40.0%) versus 7 (46.7%) and 2 (13.3%) versus 3 (20.0%) in groups I and II respectively. Diabetes mellitus was reported in 9 (60.0%) in group I versus 4 (26.7%) in group II. Finally, there was no significant difference between both approaches as regard to intraoperative or postoperative data. Conclusion: Transatrial approach has been used in most of previous studies; the transseptal approach appears to be equally effective.  
91 Assessment of Anti-Streptolysin O Titre in Healthy School Age Children in El Behira Governorate   , Mona Kordy  1; mohamed Abdel Salam zannoun1; Magdy zaki El Ghanam2 1Department of Pediatrics Al-Azhar University-Faculty of medicine, Damietta, Egypt 2Department of Clinical Pathology, Al-Azhar University-Faculty of medicine, Damietta, Egypt  
Background: Group-A streptococcal serology is used for post-streptococcal disease diagnoses, such as acute rheumatic fever, and occasionally for diagnosis of streptococcal pharyngitis. The prevalence of rheumatic fever in school children aged 6 to 15 years ranges between 0.2 to 0.75 per 1000 children per year. The prevalence of rheumatic heart disease in 1000 children ranges from 1 to 5.4.  Aim of the work: To determine upper limit of the normal range of Antistreptolysin O titre in healthy school children, aged 6-15 years old in El Behira governorate. Patients and Methods:A cross-sectional study had been performed in EL Behira Governorate and the collected sample were tested in clinical pathology Lab [Al-Azhar University Hospital, Damietta]. A total of 3000 [1609 Males, 1391 Females] serum samples had been collected from children aged 6-15 years, had been tested for Anti-streptolysin O titer [ASO] by turbidimetry. Results: Normal value for the ASO titer rose sharply during early childhood and then declined gradually with age. The estimated titer that was 80% of the upper limit or normal at age 10 years was 287 IU/ml for ASO. Conclusion: This study provides the upper limit of normal value for ASO titre of school children. The "more than 400" rating should instruct clinicians in the treatment of post-streptococcal diseases in patients and provide valuable longitudinal evidence for potential intervention trials against streptococcal diseases in group A.   
92 Diagnosis of Peripherally Located Bronchogenic Carcinoma: Utility of Non-Guided Flexible Bronchoscopy   , Sawsan Bakr Elsawy  705 Elmethak st, Zahraa Nasr City  
Background: The role of flexible bronchoscopy in diagnosis of peripheral pulmonary neoplasia remains controversial.  Aim of the work: To assess the diagnostic yield of non-guided flexible bronchoscopy biopsy techniques in diagnosis of peripherally located bronchogenic carcinoma. Patients and Methods:This cross-sectional study was conducted on 49 out of 85 patients with confirmed bronchogenic carcinoma; they were subjected to flexible bronchoscopy forceps biopsy [FB], bronchoalveolar lavage [BAL], transbronchial needle aspiration [TBNA], and bronchial brushing [BB]. Results: Diagnostic yield of bronchoscopy was positive in 40.8%. The procedures were; BAL in 26.5% of patients with positive yield in 15.0%, FB in 18.4% of patients with positive yield in 70.0%, TBNA in 26.5% of patients with no positive yield [0.0%] and BB in 18.4% of patients with positive yield in 15.0%. More than ≥6 Biopsy were taken in 79.6% and < 6 biopsies was taken in 20.4%. Lesions in the lower lobes had a high diagnostic yield [60.0%] [P0.007]. Lesions > 3cm had a diagnostic yield of 70% compared to 30 % in lesions ≤ 3 cm [P 0.001]. Cases with CT-Bronchus sign had a higher diagnostic yield [85.0%] [p 0.003]. Also, ≥ 6 Biopsy had higher diagnostic yield than those with lesions ˂ 3cm [100.0% and 34.5% respectively] [P 0.003]. The presence of bronchial lesions and its lobar locations had higher diagnostic yield. Conclusion: The diagnostic yield of bronchoscopy in peripherally locating bronchogenic carcinoma depends on a several factors, including lower lobe location, lesion size≥ 3cm, presence of CT bronchus sign, presence of bronchial lesion, and ≥ 6 biopsies.   
93 Study of Sexual Dysfunction among Females with Combined Oral Contraception [COC] versus Intrauterine Hormonal Device   , Alaa Talaat  1; abd elraouf mohamad oun2; Waleed Ahmed Ayad3 1Mansura General hospital 2Obstetrics and Gynecology Faculty of Medicine, Al-Azhar University (Damietta) 3Obstetrics and Gynecology Faculty of Medicine, Al-Azhar University (Damietta) egypt  
Background: Sexuality in females is a multidimensional issue of psychological, physiological and cultural components. Evaluation of sexual partner, intimate relationships, and past abusive relationships or sexual trauma is crucial in female sexual dysfunction (FSD).  Aim of the work: The present study was designed to evaluate the sexual dysfunction among female using combined oral contraception and a hormone releasing intra-uterine device [IUD] as a method of contraception. Patients and Methods:This was observational study which was conducted on 80 women to show the effect of contraception on sexual dysfunctions from February 2019 to last of August 2019. This study includes two groups; Group I: 40 women on combined oral contraceptives [COC] and group II: 40 women on hormonal intrauterine device. All females had been assessed for different domains of sexual function by Female Sexual Function Index [FSFI] questionnaire. Results: Age, parity and body mass index were comparable between both groups; group I [COC] and group II [IDU]. On the other side, females on COC had lower sexual function index (49.4±4.15) than women with hormonal IUD (67.27±6.88). These results confirmed on nearly all domains of FSFI. Thus, sexual dysfunction is significantly higher among COC group. Conclusion: Intrauterine hormonal device contraception is better than combined oral contraception (COC) which has little side effect and has better results on sexual desire, arousal, lubrication and satisfaction in addition to little effect on sexual pain than combined oral contraception.   
94 Effect of Inhaled Corticosteroids on Blood Glucose Homeostasis in Asthmatic Children   , Alshaimaa Mohammed Essam  1; Mohamed Ibrahim Abdel-Aal2; Hesham Samir Abd Al-samee 3 1Department of Pediatrics, Faculty of Medicine, Mansura University, Egypt 2Department of Pediatrics, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Department of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar University, Egypt  
Background: Asthma is a common disease especially in kids. The development of asthma symptoms appears to involve a combination of genetic predisposition and environmental factors. There are many medicines for asthma management, the most important of which is corticosteroid. High doses of inhaled corticosteroids can be associated with hyperglycemia risk increase.  Aim of the work: To detect the effect of inhaled corticosteroids on blood glucose homeostasis in asthmatic children. Patients and Methods:This study was conducted at pediatric inpatient and outpatient clinic of New Damietta Al-Azhar University Hospital in the period from September 2018 to September 2019, included 90 asthmatic children chosen randomly, 55 of them were males and 35 of them were females, aged from 2 to 12 years, For each child, the demographic data were collected, divided into three groups according to type of treatment, group I [using ICS only for more than 3 months], group  II [using SCS] and group III [using ICS & SCS]. Results: Regarding WBCs and its differentiation there was a significant increase in WBCs [7.8±2.1] and eosinophil [2.7±0.83]  in [group III] more than [group I]; WBCs [5.8±2.2]  and eosinophil [1.4±0.6] and [group II]; WBCs [6.4±2.0] and eosinophil [1.5±0.7].  Regarding blood glucose, [group I] mean value was [89.6±22.8]; [group II] was [91.6±17.3]; [group III] was [104.4±36.1]. There was statistically significant difference between group I with III and group II with III [P2: 0.032 and P3: 0.043]. Conclusion: Blood glucose level increased in children using both inhaled and systemic corticosteroids and it was significant statistically.   
95 Polymerase Chain Reaction versus Slit Skin Smear in Diagnosis of Leprosy; A Cross Sectional Study   , Nehal Magdy Mostafa kamel  1; Osama Hashem 2; Hassan Mohamed Khodair3; Hesham Samir Abd El-Samee4 1Department of Dermatology, elsenbellawin General Hospital, Ministry of Health and Populations, Egypt 2Department of Dermatology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 3Dermatology Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 4Department of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: Leprosy is a chronic infectious disease where delay in diagnosis or treatment can lead to deformities and disabilities for the rest of the patient’s life. Definite diagnosis of leprosy has long been based on clinical picture, histopathology and/or the detection of acid-fast bacilli (AFB) from tissue smears or tissue sections stained by Ziehl-Neelsen.  Aim of the work: We evaluatedin this study, the usefulness of PCR for detection of M.leprae in the serum, as less invasive technique, in comparison to skin slit smear  for the diagnosis of  leprosy. Patients and Methods:This study included 30 non-treated patients of leprosy (9 multibacillary, 21 paucibacillary) skin slit smears had been taken. In addition, serum samples had been collected for polymerase chain reaction [PCR] test. Results: Negative Slit Skin Smear for AFB had been obtained in 20 cases with a rate of positivity of 33%. Serum PCR was positive in 20 patients giving an overall rate of positivity of 67% which confirm the diagnosis in 11 out of 20 cases with slit skin smear [SSS] negative. Conclusion: PCR does show to be more sensitive than slit skin smear [SSS] indicating its future use for diagnostic purposes especially in early leprosy cases.   
96 Comparative Study between Sertraline and Omega-3 Supplementation in The Treatment of Uremic Pruritus in Hemodialysis Patient   , Mohamed Fathy Elghareib  1; Ibrahim Fouda1; Hassan Khodair1; Ahmed Salama Al-Adl2 1Department of Dermatology, Damietta Faculty of Medicine, Al-Azhar University, Egypt 2Department of Internal Medicine, Damietta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: Pruritus in uremic patients decreases the quality of life because of sleep disturbances, depression and anxiety, thus, pruritus remains an important health issue in ESRD patients.  Aim of the work:To evaluate the efficacy and safety of sertraline versus omega 3 supplementation in the treatment of uremic pruritus. Patients and Methods:This randomized case control study was conducted on patients with ESRD patients .All studied subjects had been collected from the Al-Azhar hospital [Damietta] Dialysis Center. This study had been carried out on 50 patients divided into: Group [A] : consists of 25patients had been received 50 mg sertraline twice a day for 8 weeks. Group [B]: consists of 25 patients and had been receive 3 gm omega-3 daily. Results: Although pruritus severity decrease significantly in both groups and both scoring systems [P<0.001], the reduction was significantly more in sertraline group [p Conclusion: Omega-3 fatty acids found to be effective in decreasing of uremic pruritus. So, it seems that Omega-3 fatty acids could be used as an efficient drug for treatment of pruritus in uremic patients. The present study showed that low-dose sertraline was effective for antihistamine-refractory uremic pruritus than omeg3 in renal palliative care patients.  
97 Magnesium Sulfate versus Nitroglycerin in Controlled Hypotensive Anesthesia in Middle Ear Surgeries   , Tawfik Mohamed Noor El-Din1; Mahmoud Fathi Madian2; Eman Ahmed Salem3; Ahmed Hamdy Hamed  4 1Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo. 2Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Assuit 3Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo for girls 4Anesthesia and ICU Department, Faculty of medicine, Alazhar university Damietta  
Background: Controlled hypotension is required for middle ear surgeries to achieve a bloodless operative field and improve its quality, both magnesium sulfate and nitroglycerine used to produce deliberate hypotension.  Aim of the work: This study aimed to compare the efficacy of magnesium sulfate and nitroglycerin in inducing controlled hypotensive anesthesia as a primary outcome and using propranolol if tachycardia occurred as a secondary outcome, in middle ear surgeries. Patients and Methods:The study was carried out on 40 adults’ patients were randomly classified into two equal groups, twenty patients each: Group [M]: Received an intravenous [IV] bolus of magnesium sulfate 30 mg/ kg in 100 ml saline over 10 min followed by infusion of 10 mg/kg/h. Group [N]: Received nitroglycerin IV infusion 0.5-10 mcg/kg/min. Propranolol 1- 2.5 mg IV had been given to both groups if there was tachycardia. Results: Both drugs induced hypotension with statistically significant difference in systolic and mean blood pressure [BP] and there was highly significant increase in heart rate [HR] in nitroglycerin more than magnesium sulfate and high doses of propranolol were administrated in nitroglycerine group. Postoperative pain was significantly increased in nitroglycerin than magnesium sulfate groups which had more analgesic effect. Conclusion: Both drugs induced hypotension. However, magnesium sulfate was better as it provided optimum surgical field, less tachycardia, need less dose of propranolol with less post-operative pain in comparison to nitroglycerin  
98 Effect of Sublingual Misoprostol Prior to Insertion of Intrauterine Device in Women with no Previous Vaginal Delivery   , Zeinab Mohamed Elgharbawy  1; Abd Elraouf Mohamed Oun2; Waleed Ahmed Ayad3 1Department of Obstetrics and Gynecology, Port Fouad General Hospital, Ministry of Health and Populations, Egypt 2Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Egypt. 3Department of Obstetrics and Gynecology, Dameitta Faculty of Medicine, Al-Azhar University, Egypt.  
Background: The intrauterine device [IUD] is a safe and effective method of contraception, fear of pain during insertion discourages some providers to recommend IUDs to women with no previous vaginal delivery.  Aim of the work:The aim of the study is to evaluate sublingual misoprostol 200µg on the cervix one hour before IUD insertion; to facilitate IUD insertion in women with tight cervix or in whom did not deliver vaginally. Patients and Methods:The study was a double blinded randomized controlled trial, compared sublingual 200µg misoprostol with placebo. The study included 260 cases attended the Gynecology Clinic [Al-Azhar University Hospital] from December 2018 to November 2019. All females signed an informed written consent, and then have been randomly divided into 2 groups using a closed envelope technique. Every female had been asked to take the drug sublingually then return after one hour to insert her IUD. Group A included 130 females who used sublingual misoprostol 200µg [Misotac] and group B included 130 females who took a placebo one hour before IUD insertion [Control group]. Results: IUD and uterine sound insertion was unsuccessful in 8.5% of group A versus 13.8% in group B while it was successful in 91.5% of group A versus 86.2% in Group B. Among the successful cases, 88[73.9] were easy in group A versus 77[68.8] in group B. On the other hand, 31[26.1%] and 35[31.2%] were difficult in group A and B respectively. With no significant difference between both groups either in IUD or uterine sound insertion successful or easiness rate [p=0.17 & 0.38 respectively] Conclusion: Using of misoprostol to facilitate IUD insertion in women with tight cervix, has no role in pain reduction or increase the ease of IUD insertion, although results with misoprostol are superior to placebo, but the different did not reach statistical significance  
99 Efficacy of Modified Hyoid Bone Suspension Technique Compared to Midline Glossectomy in Management of Hypopharyngeal Obstruction in Obstructive Sleep Apnea Patients   , Osama Refaat   Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Egypt  
Background: Obstructive sleep apnea (OSA) is a common and challenging health problem, especially in adults, as it is the second most common disease related to sleep. Surgical treatment plays an important role in management of OSA. However, the optimal procedure is not yet determined.  Aim of the work: To compare between modified hyoid bone suspension and midline glossectomy in management of OSA due to hypopharyngeal obstruction. Patients and Methods:40 patients with OSA due to hypopharyngeal obstruction were randomly assigned to either modified hyoid bone suspension (group A; 20 patients) or midline glossectomy (group B; 20 patients). All had been assessed by full history, clinical examination and Lab investigations and underwent pre-assigned surgical intervention. Indicators of OSA such as minimal oxygen saturation, Apnea hypopnea Index [AHI] and Epworth Sleepiness Scale [ESS] had been measured preoperatively and 6 months after surgery. Results: The studied groups were comparable as patient characteristics and preoperative data. However, hyoid suspension was associated with significant decrease of AHI [16.67±6.06 vs 20.72±4.41] and ESS [9.10±2.42 vs 11.20±2.33]. Also, minimal oxygen saturation improved significantly in group A than group B. The percentage of responders increased significantly in group A (75.0% vs 40.0% respectively). Conclusion: Modified hyoid suspension is superior than the midline glossectomy, as a safer and more effective procedure for treatment of OSA due to hypopharyngeal obstruction.