Background: Over the years, surgeons have used a midline sternotomy to repair atrial septal defects (ASD) with good long-term outcomes but unsatisfactory cosmosis.Because of this, less intrusive surgical procedures are employed to lessen surgical trauma and improve the final cosmetic outcome.Aim of the study: to assess ASDs repair using right-anterolateral minithoracotomy (RALT) versus median sternotomy in terms of surgical outcomes.Patients and Methods: Our study was prospective, comparative, nonrandomized ,non-blinded study that carried out at our institution between June 2016 and October 2018. It included forty surgical candidates who had isolated ostium secondum ASDs; patients were allocated to either group I (RALT group) (n=20),or group II (conventional sternotomy) (n=20). Results: before surgeries, demographic and echocardiographic data were comparable in both groups except for more female patients(80%) in group I(p-value=0.022) and more patients with low body surface area in group II(p-value=0.002).Group II had considerably shorter total bypass time than group I(p-value=0.004).After surgeries, data were identical in both groups regarding ICU and total hospital stay, chest tube drainage,and amount of blood transfusion.However,group I had significantly shorter mechanical ventilation time(p-value=0.002) and smaller length of wound (p <0.001).Wound infection rate was substantially higher in sternotomy group(p-value=0.035).Patient satisfaction was higher in minithoracotomy group(90%) than in sternotomy group(60%).No cases required conversion to sternotomy in group I. Neither residual defects nor mortality were encountered in both groups. Conclusion: Right anterolateral minithoracotomy approach is safe, effective,cosmetic, less traumatic, and saving resources.

Background:The effects of cerebellar low-frequency repetitive transcranial magnetic stimulation (rTMS) in individuals suffering from essential tremor (ET) are controversial. Aim of The Work:To evaluate repetitive transcranial magnetic stimulation (rTMS) can help people with essential tremors. Patients and Methods: This case study involved 30 subjects divided into an active group of 15 ET patients and a sham group of another 15 ET patients who were treated in tertiary care at Al-Hussein and Sayed Galal Hospitals, Al-Azhar University. The Fahn, Tolosa, Marin (FTM) Tremor Rating Scale has been used to evaluate and scale tremors at baseline, as well as a day, one month, two months, and three months following the (sham and active) repetitive transcranial magnetic stimulation sessions. Results:The results of this study showed that repeated active rTMS over the cerebellum enhanced total and specific subcores (tremor, drawing, and functional disability).The influence lasted for 3 months following the final session. The sham group's total and specific FTM subcores (tremor, drawing, functional disability) showed no significant differences. Conclusion: For patients suffering from severe essential tremor, cerebellar rTMS can be an effective therapy choice.

Aim: This study was carried out to evaluate clinically and radiographically using of nanocrystalline hydroxyapatite (NcHA) and platelet-rich fibrin (PRF) as a grafting materials around the implant after narrow alveolar ridge splitting and expansion by piezoelectric surgery. Subjects and methods: twenty systemically healthy patients with partial edentulous narrow maxillary alveolar ridges were selected from those attending at the Out-

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