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A, M. M., H. A. M. Farghali, A. H. Elsayed, I. A. Emam, E. A. Abdelnaby, and R. RT, "A potential Use of Doppler Sonography for Evaluating Normal Hemodynamic Values of the Hepatic, Pancreatic and Splenic Vessels in Domestic Rabbits", Advances in Animal and Veterinary Sciences, vol. 8, issue 5, pp. 506-518., 2020. aavs_8_5_506-518.pdf
A, R., F. M, M. MD, and S. A, "Investigation of growth factor signaling through macrophage colony stimulating factor (CSF-1) and its receptor (FMS) in the bone marrow stromal microenvironment in acute myeloid leukemia (AML).", Proceedings of the 104th Annual Meeting of the American Association for Cancer Research, Washington, 6 April, 2013.
A, Mahmood, M., M. A. El-fattah, and A. A. Abd El-Aziz, "Clustering model for progression of ocular hypertension to primary open angle glaucoma based on rough mereology", International Conference on Intelligent Information Technologies (ICIIT 2014), Chennai, India, 12/2014.
A, O., A. N, I. N, K. S, and S. A, "Neonatal gastric perforation secondary to a strangulated congenital diaphragmatic hernia", Journal of Pediatric Surgery, vol. 36, pp. 47-49, 2018.
aisha a, Mona, and hala, "Aerobic versus resistive training on selected hematological parameters in elderly", bioscience research, vol. 15, issue 2, pp. 708-715, 2018.
A, M., S. N, A. M, I. Z, and A. -eldin Z, "Vitamin D Levels in Egyptian HCV Patients (Genotype 4) Treated with Pegylated Interferon", Acta Gastro-entrologica Belgica, vol. 76, issue 1, pp. 38-44, 2013.
A, B., R. A, H. A. S. N. E. H. Attia AF, Atef A, and A. E, "Prevalence of extramucosal fungal elements in sinonasal polyposis: a mycological and pathologic study in an Egyptian population", Am J Otolaryngol. , vol. 2011 Jul-Aug, issue Jul-Aug;32(4), pp. 308-317, 2011.
A, I., H. Kandil, M. M. Ghany, H. Risk, R. M. darwish, and D. Osama, Valsalva Maneuver in diastolic heart failure, diastolic dysfunction and systolic heart failure clinically BNP and echocardiography, , pp. 048 - 052, 2018/10/18. Abstract

p>Background: Valsalva maneuver one of the oldest method to diagnose heart failure, it’s cheap ,non-invasive ,bedside tool .Its well-studied in systolic heart failure patients which showed abnormal response either square wave or absent phase IV ,however in diastolic heart failure and diastolic dysfunction were not investigated .Methods: 70 patients were included in our study they were divided into three groups group 1 diastolic heart failure based on echocardiography and BNP above 100pgL/ml , group 2 diastolic dysfunction based on echocardiography and BNP less than 100 pg/ml and group 3 systolic heart failure ,they went all clinical examination ,BNP were taken ,Valsalva maneuver at 30 mmhg for at least 15 sec using two sphygmomanometers first connected to mouth piece and the other to monitor blood pressure while the physician auscultates brachial artery patient is asked to perform forced expiratory effort against closed airway for at least 15 second and then asked to release and absence or presence of Korotkoff sounds assessed and heart rate is recorded baseline and after strain and full study echocardiography and using in apical 4 chamber view Simpson method to measure right and left ventricle area at baseline , peak strain and after release .
Results: Group 2 showed overshooting of systolic blood pressure by a mean of 11 ± 6.41mmHg (p value = 0.001), 95% confidence interval (CI): [3.2-15.14] compared to baseline. Moreover, group 3 showed minimal overshooting with a mean of 3.34±4.17mmHg (p value = 0.002), 95% confidence interval (CI): [2.2-8.2], On the other hand, group 1 showed no overshooting, with a mean change of -3.6 ± 0.63mmHg (p value = 0.001), 95% confidence interval (CI): [9.34-2.5].
We demonstrated that Valsalva maneuver could differentiate patients with diastolic heart failure from those with diastolic dysfunction, with a sensitivity of 68%, specificity 75%, positive predictive value 71.4%, and negative predictive value 72%. Only group 2 in our study showed a clinically significant decrease in RV end-diastolic area during strain as compared to the baseline, with a mean value of 4.5 ± 0.14 cm2 (23.5 ± 0.4%; p value = 0.001),95% confidence interval (CI):[6.65+2.25]. On the other hand, group 1 showed a minimal decrease (0.9 ± 0.25 cm2; 5.3 ± 0.6%) and group 3 showed a minimal increase (1 ± 2.23 cm2; 5.6±5%). Group 2 showed a clinically significant decrease in LV end-diastolic area during strain as compared to the baseline, with a mean value of 6.1 ± 1.01 cm2 (19.3 ± 2%; p value = 0.001) 95% confidence interval (CI) :[8.2+-3.96]. Moreover, group 3 showed a smaller, but significant decrease (4.6 ± 0.98 cm2; 12.6 ± 0.7%), while group 1 demonstrated insignificant change.
Conclusion: VM showed significant overshooting in group 2 compared to other two groups ,not all heart failure patients had abnormal response based as risk factors as NYHA class and diuretics ,stiffness in myocardium affected the Valsalva response in diastolic heart failure group followed by systolic heart failure and finally diastolic dysfunction one ,There is decrease in left and right ventricle area during strain and gradually increase after release during normal Valsalva response which is greatly affected in HF patients .

A, E. - F. H. S., G. A. F, H. N. E, and N. M. Elsayed, "Effect of Buerger Exercises on Improving Peripheral Circulation of the Lower Extremities among Patients with Type 2 Diabetes Mellitus at Selected University Hospital-Egypt", Indian Journal of Public Health Research & Developmen, vol. 10, issue 6, pp. 692- 697, 2019.
A, S., N. A, H. N, and F. I, "Gastrointestinal stromal tumors: A clinicopathologic study of 67 cases.", Kasr El Aini j. Surg, vol. 15, issue 2, pp. 11-18, 2014.
A, A., and F. M.A., "Evaluation of Intralesional Propranolol for Periocular Capillary Hemangioma", Clinical Ophthalmology, 2011. Abstract

Purpose: To evaluate the use of intralesional propranolol injection in the management of periocular capillary hemangiomas.

A, V. K., S. G. E, S. D, S. C, S. YP, Zhang T, V. K. TH, H. C, K. EO, P. MS, et al., "HS3ST2 modulates breast cancer cell invasiveness via MAP kinase- and Tcf4 (Tcf7l2)-dependent regulation of protease and cadherin expression.", Int J Cancer., vol. 135, issue 11, pp. 2579-92, 2014.
A, F., S. - H. A, I. KS, M. A, and A. - R. M, "Effect of Cell Phone-Emitted Electromagnetic Waves on Levels of Male Sex Hormones and Redox Balance in Humans. ", OnLine Journal of Biological Sciences, vol. 21, issue 3, pp. 221-227, 2021.
A, K., S. S, E. E, and E. - R. M, "Epidemiology of Primary Nephrotic Syndrome in Egyptian Children", Journal of Nephrology, vol. 25, issue 5, pp. 732-7, 2011. CU-PDF.pdf
A, T. E. - B. A., Y. I, E. - S. S, and E. A. R, "Pulmonary hypertension in beta-thalassemia major and the role of L-carnitine therapy", Pediatr Haematol Oncol, vol. 25, issue 8, pp. 734-43, 2008.
A, F., El-Sheikh MG, El-Fayoumy H, El-Sergany R, and A. E. B. A., "Effect of extracorporeal shock wave lithotripsy on kidney growth in children.", The Journal of urology. , vol. (3), issue 188, pp. 928-31., 2012.