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.Bastami, M. A., M. M. Amer, and D.G.khilfa, "Viral nephritis induced by an isolant related to infectious bronchitis virus. I. Isolation and identification of the isoilant", Assut. Vet. Med. J. , vol. 19, issue 37, pp. 173-179., 1987.
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5- Hegazy, A. K., S. L. Al-Rowaily, H. F. Kabiel, M. Faisal, and M. H. Emam, "Variations of plant macronutrients and secondary metabolites content in response to radionuclides accumulation.", Journal of Bioremediation and Biodegradation, vol. 4, issue 3, pp. 185, 2013. 2-omics_paper.pdf
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A, S., F. H, A. A, H. Y, M. T, and M. K, "The value of prednisolone acetate provocative test before intravitreal triamcinolone acetonide injections.", European Journal of Ophthalmology, vol. DOI: 10.1177/1120672119842731, issue DOI: 10.1177/1120672119842731, 2019.
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, 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., G. T., S. B. R., R. R.E., and A. E. H. S. M., "Value of hematological indices versus VEGF as biomarkers of activity in Behçet’s disease", Clinical Rheumatology, vol. 38, pp. 01-10, 2019.
A.Abdel-Gawad, S., A. K. A. Suwailem, and S. S. AlShowiman, Validated High Performance Liquid Chromatographic Quantification of Pamidronate in Bulk and Dosage Form, , 2020.
A.Basha, M., M. K. A. El-Rahman, L. I.Bebawy, and A. A. Moustafa, "Validated TLC stability indicating methods for the quantitative determination of some veterinary drugs", Microchemical Journal , vol. 146, pp. 157-163, 2019.
A.Hegazy, M., S. S. Abbas, S. A. Weshahy, H. A. M. Hendawy, and M. A. Y. H. ABDELWAHAB, "Validated HPTLC and HPLC methods for determination of fluorometholone and sodium cromoglycate in presence of their impurities and degradation products; application to kinetic study and on rabbit aqueous humor", Journal of Liquid Chromatography & Related Technologies , 2018. mai_hassan__p2.pdf
A.M.Al-Sherbini, E. - S., A. H.ElNoury, M. N. E. Rouby, and T. Ibrahim, "Vitamin E (a-tocopherol) enhances the PDT action of hematoporphyrin derivatives on cervical cancer cells", Medical Laser Application , vol. 24, pp. 65–73, 2009.
A.M.Al-Sherbini, E. - S., A. H.ElNoury, M. N. E. Rouby, and T. Ibrahim, "Vitamin E(a-tocopherol) enhancesthePDTactionofhematoporphyrin derivatives oncervicalcancercells", Medical LaserApplication, vol. 24, issue 24, pp. 65–73, 2009. 38.pdf
A.M.Kamel, M.M.El-Hamamy, and H.M.Omar, "Verminous Pneumonia in The Egyptian Fre-Rangeing Red Foxes(Vulpes vulpes)caused by Filaroides hirthi", Minofyia Veterinary Medical Journal, vol. 1, issue 1, pp. 359 - 364, 2000.
A.M.Kamel, M.M.El-Hamamy, and H.M.Omar, "Verminous Pneumonia in The Egyptian Fre-Rangeing Red Foxes(Vulpes vulpes)caused by Filaroides hirthi", Minofyia Veterinary Medical Journal, vol. 1, issue 1, pp. 359 - 364, 2000.
A.M.Kamel, M.M.El-Hamamy, and H.M.Omar, "Verminous Pneumonia in The Egyptian Fre-Rangeing Red Foxes(Vulpes vulpes)caused by Filaroides hirthi", Minofyia Veterinary Medical Journal, vol. 1, issue 1, pp. 359 - 364, 2000.
A.M.M.Al-Naggar, M.M.M.Atta, and H.T.O.Hassan, "VARIABILITY AND PREDICTED GENETIC GAIN FROM SELECTION FOR GRAIN OIL CONTENT AND YIELD IN TWO MAIZE POPULATIONS ", Egypt. J. Plant Breed., vol. 15, issue 1, pp. 1-12, 2011. variability.pdf
A.S.Soliman, M.B.Mostafa, and G.A.Ragab, "Vascular changes in the soft tissues of the fetlock joint of donkeys undergoing various hoof deformities", Alex.J.Vet.Science, vol. 8, issue 1, pp. 7-12, 1992. 8767_001.jpg
A.Tawfik, M.Wahba, H.Mansour, and T.Harko, "Viscous Quark-gluon Plasma in the Early Universe", Annalen der Physik, 2011. CU-PDF.pdf
A.Y.Abul-Magd, M.H.Simbel, and M.Y.H.Farag, "Volume integrals and root - mean - square radii of the optical potential", Canadian Journal of Physics, vol. 58, pp. 1230, 1980.
AA, S., A. RSAEHA, K. OO, S. NA, and et al, "Validation of Montreal Cognitive Assessment - Basic in a sample of elderly Egyptians with neurocognitive disorders", Aging Ment Health, vol. 9, pp. 1-7, 2018.
Abd, E. M. M., S. Bakry, L. Rashed, D. Hesham, and others, "Validation of Urinary PD-1 and FOXP3 mRNA in a Cohort of Egyptian Renal Allograft Recipients.", Annals of transplantation, vol. 21, pp. 17–24, 2016. Abstract
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Abd El Aziz, R., mary wadie fawzy, Z. S. Noha Khalil, and S. A. Elaty, "Vascular affection in relation to oxidative DNA damage in metabolic syndrome", Therapeutic advances in endocrinology and metabolism, issue 9(2), 2018.
Abd El Kader, A., H. Salama, A. R. Zekri, H. A. E. L. H. Marzouk, and S. E. Deeb, "variation of natural killer cells phenotype and activity in various stages of hepatitis c virus infection in Egyptian patients", EGYPTIAN JOURNAL OF ZOOLOGY, vol. 62, issue 10.112816/0009346, pp. 255-274, 2014.