The Scientific Journal of Al-Azhar Medical Faculty, Girls最新文献

{"title":"Serum osteopontin in relation to insulin resistance in obese adults","authors":"Lamia Altholaya, H. Kandeel, Doaa Mohammed, A. Abdul-Mohymen","doi":"10.4103/sjamf.sjamf_107_21","DOIUrl":"https://doi.org/10.4103/sjamf.sjamf_107_21","url":null,"abstract":"Background Obesity is characterized by chronic low-grade inflammatory responses, which may explain the development of obesity-related pathologies, such as insulin resistance and metabolic syndrome (MetS). It is also associated with abnormal levels of cytokines, and osteopontin may be one of them. Aim To assess serum osteopontin level in obese adults with and without MetS and to study its relation to insulin resistance. Patients and methods This comparative study was conducted on 50 obese adults recruited from Endocrinology and Metabolism Department of Al-Zahraa University Hospital. They were divided into two groups according to the presence of MetS. Group 1 included 25 patients without MetS, and group 2 included 25 patients with MetS. Detailed history, clinical examination, and anthropometric measurements were assessed for all selected patients. Fasting plasma glucose, glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, fasting insulin, and osteopontin were measured, and then insulin resistance index (IR) was measured as follows: [INLINE:1] Results TC, TGs, LDL-C, fasting plasma glucose and insulin, HBA1c, and osteopontin were statistically significantly higher in group 2 as compared with group 1. A significant positive correlation was found between osteopontin on one hand and systolic blood pressure, diastolic blood pressure, fasting blood sugar, LDL-C, TC, TG, HbA1c, fasting plasma insulin, and homeostatic model assessment of insulin resistance on the other. No correlation was found between osteopontin and high-density lipoprotein cholesterol. Conclusion Elevated serum osteopontin level is associated with MetS and its different components and thus it may serve as a diagnostic biomarker for MetS.","PeriodicalId":22975,"journal":{"name":"The Scientific Journal of Al-Azhar Medical Faculty, Girls","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82101301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pattern of coronary artery diseases in relation to various risk factors in Egyptian women in Upper Egypt","authors":"Esraa Abdel Wahab, Bassem Abdel Hady, Ghadami Ahmad, T. Nagib","doi":"10.4103/sjamf.sjamf_136_21","DOIUrl":"https://doi.org/10.4103/sjamf.sjamf_136_21","url":null,"abstract":"Background Coronary artery disease (CAD) constitutes one of the leading causes of death in women. Awareness of CAD as the primary cause of mortality in women has been slowly increasing. Coronary angiography (CA) is a useful tool for diagnosis and treatment of CAD. Sex differences play an important role in the pathophysiology of CAD that may contribute to different outcome. Aim To assess the pattern of CAD in women in Upper Egypt undergoing CA. Patients and methods A total of 100 women living in Upper Egypt who experienced chest pain and were indicated for coronary angiography were enrolled in the study. They were classified into two groups according to their age: group 1, with age less than 55 years old (45 patients) and group 2, with age more than 55 years old (55 patients). Interpretation of coronary angiography included detailed assessment of the presence, distribution, and severity of coronary lesions. Severe CAD was considered in patients with left main (LM) disease, patients with multivessel disease, and patients with bifurcation lesions. Result The study revealed normal coronary angiography in 20%, nonsignificant lesions in 13%, and obstructive CAD in 67% of our study population. There was significantly higher incidence of normal coronaries among patients in group 1 compared with patients in group 2 (P=0.012) and significantly higher obstructive lesions and severe CAD in patients in group 2 compared with patients in group 1 (P=0.002 and 0.011, respectively). Multivariate regression analysis for the presence of severe CAD revealed that diabetes mellitus and positive family history of premature CAD were highly significant independent predictors (P<0.001), whereas both age more than or equal to 55 years and dyslipidemia were significant independent predictors (P=0.003 and 0.002, respectively). Conclusion The incidence of CAD is high among women undergoing coronary angiography in Upper Egypt. Normal vessels, single-vessel disease, and simple lesions tend to be more in younger women, whereas severe and complicated lesions are more in elderly women.","PeriodicalId":22975,"journal":{"name":"The Scientific Journal of Al-Azhar Medical Faculty, Girls","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80805943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relation of gut microbiota-dependent metabolite trimethylamine-N-oxide with insulin resistance and cardiovascular risk indices in type 2 diabetic patients","authors":"L. Azel, H. Kandeel, I. Ahmad, A. Althoqapy","doi":"10.4103/sjamf.sjamf_124_21","DOIUrl":"https://doi.org/10.4103/sjamf.sjamf_124_21","url":null,"abstract":"Background Gut microbiota dysbiosis in type 2 diabetes mellitus (T2DM) causes an increase in the metabolite, trimethylamine-N-oxide (TMAO) that contributes to increased cardiovascular disease risk and exacerbates hyperglycemia. Aim The aim of this study was to assess serum TMAO and its relation with insulin resistance (IR) and cardiovascular risk indices in type 2 diabetic patients. Patients and methods This case–control study was conducted on 60 type 2 diabetic patients and 28 healthy age- and sex-matched individuals. Patients were divided into two groups according to the presence of ischemic heart disease (IHD). Fasting and 2-h postprandial blood glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, glycosylated hemoglobin, fasting serum insulin, and serum TMAO were measured. Assessment of IR index by using Homeostatic Model Assessment HOMA-IR was done. Neck ultrasound was done to assess carotid intima-media thickness (CIMT). Results All diabetic patients had significantly elevated TMAO values than controls. TMAO levels correlated positively with fasting serum insulin and HOMA-IR in IHD-diabetic patients, and correlated negatively with CIMT in diabetic patients both with and without IHD. Conclusion Serum TMAO levels were significantly higher in type 2 diabetic patients than controls. TMAO showed a positive correlation with fasting insulin and HOMA-IR in the IHD-diabetic patients and a negative correlation with CIMT in diabetics both with and without IHD. Serum TMAO more than 7 ngml may be considered a potential diagnostic biomarker for T2DM with IHD in Egyptians with T2DM. HOMA-IR level of more than 1.25 can be used for the diagnosis of IR.","PeriodicalId":22975,"journal":{"name":"The Scientific Journal of Al-Azhar Medical Faculty, Girls","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76804220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes of corneal topography indices after corneal collagen crosslinking for treatment of keratoconus assessed by scheimpflug camera","authors":"Amr Alamin, Adel Khalil, H. El-Rahman","doi":"10.4103/sjamf.sjamf_106_21","DOIUrl":"https://doi.org/10.4103/sjamf.sjamf_106_21","url":null,"abstract":"Introduction Keratoconus is a bilateral, progressive ectasia of the cornea resulting in irregular astigmatism and myopia. We can use spectacles or contact lenses to correct the symptoms of keratoconus, whereas in advanced cases, corneal grafting is the only treatment. Corneal collagen cross-linking (CXL) is a promising treatment to strengthen and stabilize the cornea in cases of keratoconus. Aim To evaluate changes in corneal topography indices after corneal CXL in patients with keratoconus and analyze these changes. Patient and methods CXL was performed in eyes with keratoconus. Quantitative descriptors of corneal topography were measured with the Pentacam topographer and included seven indices: index of surface variance, index of vertical asymmetry, keratoconus index, central keratoconus index, minimum radius of curvature, index of height asymmetry, and index of height decentration. Follow-up was 6 months. Results The study comprised 50 eyes of 35 patients with keratoconus. In the entire patient cohort, there were significant improvements in the index of surface variance, index of vertical asymmetry, keratoconus index, and minimum radius of curvature at 6 months compared with baseline (all P<0.001). Conclusion There were improvements in four of seven topography indices 6 months after CXL, suggesting an overall improvement in corneal shape.","PeriodicalId":22975,"journal":{"name":"The Scientific Journal of Al-Azhar Medical Faculty, Girls","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76502113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between pulsatile tinnitus and degree of carotid stenosis","authors":"T. Elkholy, Hoda Ebrahim, Hala K. Maghraby, Maisa A Abdel Wahab","doi":"10.4103/sjamf.sjamf_111_21","DOIUrl":"https://doi.org/10.4103/sjamf.sjamf_111_21","url":null,"abstract":"Background A pulsatile tinnitus may be the first and sole manifestation of carotid artery atherosclerosis and stenosis. The objective of this study was to detect the association between pulsatile tinnitus and degree of carotid stenosis by carotid Doppler ultrasound parameters. Patients and methods This prospective cross-sectional analytical study has been conducted on 40 selective cases complaining from pulsatile tinnitus. Carotid duplex ultrasonography scanning was done. Research has been approved by the Research Ethical Committee of Otolaryngology Department, Faculty of Medicine for Girls, AL-Azhar University. Results Carotid artery atherosclerosis and stenosis were diagnosed as a cause of pulsatile tinnitus in five patients (12.5%). The internal carotid artery (peak systolic velocity and end diastolic velocity) values were significantly higher in patients whose intima-media thickness was greater than 1 mm and the lumen diameters were smaller. Conclusion A pulsatile tinnitus may be the first, unusual, and sole manifestation of carotid artery atherosclerosis and stenosis. So, early screening and accurate diagnosis of atherosclerosis will prevent stroke and other central nervous system complications.","PeriodicalId":22975,"journal":{"name":"The Scientific Journal of Al-Azhar Medical Faculty, Girls","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84326425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bovine lactoferrin in preterm labor with sterile inflammation","authors":"Hend Elmenam, M. Farouk","doi":"10.4103/sjamf.sjamf_63_21","DOIUrl":"https://doi.org/10.4103/sjamf.sjamf_63_21","url":null,"abstract":"Background Preterm delivery (PTD) that occurs before the 37th week of gestation complicates 10% of all pregnancies. Iron deficiency, iron-deficiency anemia, and inflammatory processes either related to infection or sterile inflammatory response represent risk factors for PTD (Genc and Ford, 2010). Bovine lactoferrin (BLF), an emerging important regulator of iron and inflammatory homeostasis, can represent a new therapeutic approach for PTD, with significant improvement of maternal serum interleukin 6 (IL-6) after oral administration. Aim The goal of the study was to evaluate the role of BLF in preventing PTD associated with sterile inflammation between the gestational age of 28 and 34 weeks. Patients and methods The study was carried out at Al Zahra University Hospital at the Department of Obstetrics and Gynecology, including 50 patients, with single pregnancy, no previous preterm birth, gestational age between 28 and 34 weeks, rhythmic uterine contraction (three to five contraction in 10 min; every one last from 40 to 60 s), cervical dilation of 2–4 cm and cervical effacement of ∼50–80% by local pelvic examination, and cervical length 2–3 cm and/or funneling by ultrasound. On admission, all patients were given 100 mg BLF and subjected to withdrawal of 5-ml blood, and samples were sent to Clinical Pathology Department to detect IL-6 before and after BLF intake. Results Oral BLF administration blocked further shortening of cervical length and prolonged pregnancy. This prospective study provides strong evidence for a role of BLF in PTD treatment, thus extending the therapeutic potential of this multifunctional protein. Conclusion Determination of maternal serum IL-6 may be useful for management of patients with preterm labor, and BLF can represent a new therapeutic approach of PTD.","PeriodicalId":22975,"journal":{"name":"The Scientific Journal of Al-Azhar Medical Faculty, Girls","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78463872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Desflurane versus total intravenous anesthesia in improving the postoperative outcome for the patient undergoing spinal fixation","authors":"S. Hamouda, A. Awad, Ruqaya Elsayed, Tarek M.Elsaid Awdan, Radwa S. Ibrahim","doi":"10.4103/sjamf.sjamf_93_21","DOIUrl":"https://doi.org/10.4103/sjamf.sjamf_93_21","url":null,"abstract":"Background Total intravenous anesthesia (TIVA) and volatile inhalation anesthesia are both standardized techniques for lumbar laminectomy and discectomy procedures. Objective To compare TIVA versus desflurane anesthesia in improving postoperative recovery for patients undergoing spinal fixation. Patients and methods This prospective, double-blind, randomized study was carried out on 60 patients undergoing spinal fixation. Patients were randomized into two equal groups: group D received desflurane anesthesia, and group T received TIVA technique. Induction was done by propofol, fentanyl, and rocuronium. Anesthesia was maintained using desflurane in oxygen air mixture in group D. Still, anesthesia was maintained by intravenous infusion of propofol and dexmedetomidine in group T. Intraoperative vital signs, recovery time, postoperative nausea and vomiting, visual analog score, postanesthetic care unit stay time, total first 24 h postoperative analgesic needs, and serum cortisol and interleukin 6 preoperative and postoperative were assessed. Results TIVA group had lower intraoperative heart rates and mean arterial blood pressure. TIVA group also had a faster recovery time, shorter postanesthetic care unit stays, lower postoperative visual analog score for pain assessment, lower total analgesic requirements, and lower incidence of nausea and vomiting. Conclusions TIVA provided better postoperative recovery with fewer postoperative adverse effects and analgesia need.","PeriodicalId":22975,"journal":{"name":"The Scientific Journal of Al-Azhar Medical Faculty, Girls","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88248849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A study of leukocyte surface antigen CD64, as a marker of early-onset and late-onset sepsis in preterm and full-term neonates","authors":"Doaa A. Younis, Eglal Algohary, Eman Ahmed, H. Elaal","doi":"10.4103/sjamf.sjamf_30_21","DOIUrl":"https://doi.org/10.4103/sjamf.sjamf_30_21","url":null,"abstract":"Background Neonatal sepsis is an important cause of morbidity and mortality among newborns. Its diagnosis depends mainly on blood culture that takes at least 48 h to give results. Therefore, searching for biomarkers for early diagnosis is of value. We aimed to assess neutrophil CD64 as an early diagnostic biomarker in early-onset and late-onset neonatal sepsis in full-term and preterm neonates and to compare it with other diagnostic markers, blood culture, and neonatal scores of sepsis. Patients and methods A case–control study was conducted on 60 neonates with clinical sepsis and 30 neonates as control aged from 1 to 28 days of life admitted to NICU in Damanhour Teaching Hospital during the period from 1/8/2018 to 1/4/2019. Studied neonates were evaluated using clinical and laboratory indicators for sepsis, and neutrophil CD64 was measured by flow cytometry. Results There was a statistically significant increase in CD64 of early-onset sepsis and late-onset sepsis groups than control group (P>0.001), either in full-term and preterm neonates, whereas there was no statistically significant difference between early-onset sepsis group and late-onset sepsis group regarding CD64. CD64 at a cutoff point more than 30% had sensitivity of 100%, specificity of 100%, positive predictive value of 100, negative predictive value 100, and area under a curve=1, which means CD64 is the gold standard test. However, C-reactive protein (CRP) at a cutoff point more than 6 mg/l had sensitivity of 71.67%, specificity of 83.33%, and area under a curve=0.78, which means CRP is a good test. Conclusion The level of CD64 was equally increased in neonates with early-onset and late-onset neonatal sepsis and not affected by age or sex and was highly sensitive and specific in diagnosis of neonatal sepsis. There were positive significant correlations between CD64 and both CRP and neonatal score of sepsis, whereas there was an insignificant relation between mean values of CD64 and blood cultures results.","PeriodicalId":22975,"journal":{"name":"The Scientific Journal of Al-Azhar Medical Faculty, Girls","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91469134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum irisin level and its relation to diabetic nephropathy in patients with type 2 diabetes mellitus","authors":"Doaa E. A. Salama, Fatma Hammad, Eman Mohamed, I. Ahmad","doi":"10.4103/sjamf.sjamf_79_21","DOIUrl":"https://doi.org/10.4103/sjamf.sjamf_79_21","url":null,"abstract":"Background Irisin is an adipo-myokine, which has broad implications for metabolism and energy homeostasis. However, evidence about its association with diabetic nephropathy (DN) is limited. Aim To evaluate serum irisin level and its relation to DN in patients with type 2 diabetes. Patients and methods This case–control study was conducted on 60 patients with type 2 diabetes and 30 healthy age-matched and sex-matched individuals. Patients were divided into three groups according to urinary albumin–creatinine ratio (ACR), namely, normoalbuminuric group, which included 15 patients; microalbuminuric group, which included 30 patients; and macroalbuminuric group, which included 15 patients. Detailed history, clinical examination, and anthropometric measurements were assessed for all participants. Fasting blood glucose and 2-h postprandial blood glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, urea, creatinine, uric acid, estimated glomerular filtration rate, and irisin were measured for all participants. Glycosylated hemoglobin and urinary ACR were measured for patients only. Results Irisin was significantly lower in diabetic groups compared with controls. Irisin was positively correlated with estimated glomerular filtration rate but negatively correlated with fasting blood glucose, creatinine, and ACR. Multivariable regression analysis revealed that lower irisin level was considered as an independent predictor for DN. Conclusion Serum irisin is significantly related to diabetic kidney disease, and it might be progressively decreasing with development of the different stages of DN.","PeriodicalId":22975,"journal":{"name":"The Scientific Journal of Al-Azhar Medical Faculty, Girls","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87920196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous dexmedetomidine enhances the experience of visceral pain in parturients during cesarean delivery under spinal anesthesia","authors":"A. Elsawy","doi":"10.4103/sjamf.sjamf_74_21","DOIUrl":"https://doi.org/10.4103/sjamf.sjamf_74_21","url":null,"abstract":"Background and hypothesis Visceral pain is a common incidence in cesarean delivery under spinal anesthesia. Dexmedetomidine (DEX) has analgesic, sedative, anxiolytic effect, as it is an α 2-receptor agonist. Intraoperative visceral pain resulting from manipulation of the uterus and traction of the peritoneum is still a challenge for anesthetists. The present study hypothesized that single intravenous bolus dose of DEX added as a supplement to intrathecal anesthesia for an elective cesarean section could reduce intraoperative visceral pain, lessen blood pressure swings, and produce an acceptable sedative effect, with minimal fetal and maternal consequences. Patients and methods A randomized double-blinded placebo-controlled study was conducted. A total of 70 patients were randomly allocated to receive either intravenous DEX or placebo (saline) before spinal anesthesia. The primary outcomes were decreased intraoperative visceral pain. Secondary outcomes included the stability of hemodynamic parameters (blood pressure and heart rate), sedation score, time to rescue analgesia reduction, neonatal APGAR score, and any adverse effects (nausea and vomiting). Results There was a significant difference between the groups in the incidence of moderate to severe visceral pain (P<0.001), intraoperative fentanyl requirements (P=0.004), and longer time to rescue analgesia (P<0.001). Both groups had comparable mean blood pressure (P>0.005); however, there was a highly significant difference in heart rate (P=0.01). Moreover, a significantly higher sedation score was seen in the DEX group (2.08±0.8) in comparison with the control group (1±0). APGAR score was comparable in the studied groups. Conclusion As a single intravenous bolus, DEX seems to be an excellent supplement to intrathecal anesthesia for an elective cesarean section. It can reduce intraoperative visceral pain and lessen blood pressure swings and produce an acceptable sedative effect with minimal fetal and maternal influence.","PeriodicalId":22975,"journal":{"name":"The Scientific Journal of Al-Azhar Medical Faculty, Girls","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85123208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}