Samir Rafla

Background: Arrhythmias after acute myocardial infarction are common. Bradyarrhythmias need specific insight into when and how to treat them. Objective: Is to delineate the incidence, course, and management of different types of bradyarrhythmia after acute myocardial infarction, study period was 5 years. Methods: Four hundred and fifty-three patients with acute myocardial infarction (AMI) were admitted to intensive care in 5 years. ECGs were analyzed for the presence of bradyarrhythmias and details of management. Results: Sixty-five patients with bradycardia were found. Sinus bradycardia in 40, sick sinus syndrome in 10, junctional rhythm in 10, second-degree block in 10, complete heart block in 24. We divided patients with sinus bradycardia into stable and unstable. Unstable sinus bradycardia is more prevalent in cases with hypotension or shock, slower heart rates, gross or transmural infarction, changeable morphology of the P wave, and inferior rather than anterior infarction. The indications and danger of atropine are defined. Complete heart block was found in 24 patients (0.053%). Thirteen were managed by drug therapy (isoprenaline, corticosteroids, and atropine); 11 were paced. Fourteen out of the 24 patients died (58%), the total mortality rate among the 453 patients was 22%. The prognostic factors of CHB were defined. Techniques of introducing lead in RV without fluoroscopy are described. Conclusions: Sinus bradycardia in AMI is accompanied by a lower incidence of mortality. Atropine is not a safe drug to be given as routine. Complete heart block predictors of mortality are the association with heart failure, early onset, and persistence of the block.

Background: We planned to study cases of Infective endocarditis (IE) to define diagnostic criteria and to arrange treatment
protocol.
Methods: The study included 1121 patients, divided in to two groups. Group 1 included 57 patients with IE. Those were collected over a period of 37 months. Group 2 included 1064 patients who under went cardiac surgery or intervention. Patients
were examined clinically, had ECG, X-ray, Echocardiography, and blood culture. Then they were followed up for six months.
Results: The incidence of IE was 15 patients/ 1000 cardiac admissions. The incidence of Prosthetic Valve Endocarditis
(PVE) was found to be 1.7% of PV replacement. Group I (57 IE patients). Preexisting heart disease was present in 55 patients
(96.5%). The underlying heart diseases were rheumatic in 39 (68.4%). Echocardiography detected vegetations in 86% of patients with NVE, while only 28.6% of PVE. Positive blood culture was found in 72%. 58% lived the follow-up period (33/57).
The causes of death were heart failure, pulmonary embolism, and cerebral hemorrhage. There was no correlation between the
change in vegetation size and success of therapy.
Conclusions: We defined diagnostic criteria of IE and set the antimicrobial protocol of management.

This is a review of features in ECG to diagnose the culprit artery responsible for the infarction. Localization of the occluded vessel in acute myocardial infarction is important for many reasons: to know which artery is to dilate and stent; to assess the severity of the lesion; to compare with the echocardiographic area with hypokinesia or akinesia and to differentiate the recent from the old occluded vessel. The ST-segment changes in 12-lead ECG form the basis of diagnosis, management, and prognosis.

Background: Little are known about the prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndromes (ACS). Objective: Describe the prevalence of these risk factors with focus on gender-specific data and patients with premature presentation. Methods: From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, with focus premature ACS. Results: The vast majority were males (74%) and the most prevalent age group was (56-65 years) representing 37% of whole study population. Among female patients, 92% were post-menopausal. The prevalence of premature ACS was 51%. Forty five percent of total males and 69.6% of total females with ACS had premature presentation (P<0.001). Abdominal obesity was the most prevalent risk factor (66%). Nearly half of the entire study patients were current smokers (48%). We showed a high

Background: Pacemaker‑induced cardiomyopathy (PICM) is reported in different articles but with variable incidence. Aim: The aim of the
study is to determine the validity of speckle tracking echocardiography as a predictor of the deleterious effect of right ventricular (RV) pacing
on left ventricular (LV) function, using two-dimensional guided global and segmental longitudinal strain. Materials and Methods: Fifty
patients with conventional indications for permanent pacemaker implantation were studied; they were classified to Group A (37 = 74%)
patients who didn’t show a significant reduction of ejection fraction (EF) (>10%) and Group B (13 = 26%) represent patients who showed a
significant reduction of EF. Group C constituted 25 healthy persons (control group). We defined PICM when EF is reduced >10%. Results:
The incidence of pacemaker-induced ventricular dysfunction was 26%. Statistical analysis revealed that left atrial volume index (LAVI), global
longitudinal strain (GLS), native‑QRS duration, and ischemic heart disease were significant predictors of reduction of LV function, however,
on multivariate regression analysis, only the LAVI and GLS were independent predictors of reduction of LVEF after permanent pacing.
Conclusions: Speckle tracking echocardiography is a new, unique and evolving tool to assess the myocardial deformation which can detect
LV systolic dysfunction much earlier than can be reflected in LVEF. The importance of defining predictors is to predict whom patient will be
at risk for the deleterious effect of RV pacing on LV function, and who will need observation with possible upgrading to biventricular pacing.

Objectives: The aim of this study was to evaluate the ability of D-Dimer for the diagnosis of left atrial appendage (LAA) thrombus in patients with chronic atrial fibrillation (AF). Methods: 80 patients with chronic AF who fulfilled the inclusion and exclusion criteria were studied prospectively. 45 patients had LAA thrombus diagnosed by transesophageal echocardiography (TEE) constituted group I (LAA thrombus group). The other 35 patients without LAA thrombus constituted group II. All the 45 patients (100%) in group I with LAA thrombus had elevated D-Dimer levels while only 10 patients (28.5%) in group II without LAA thrombus had elevated D-Dimer levels (P < 0.001). All the patients received oral anticoagulation with warfarin keeping the INR between 2 and 3 for 3 months. TEE was done to all the patients at 3-month follow up. Results: 12 patients (26.7%) in group I had elevated D-Dimer levels. The number of patients with positive D-Dimer decreased significantly at 3-month follow up (P < 0.001) while on warfarin. LAA thrombus resolved completely in 35 patients (77.8%) at 3-month follow up. In group II, all the 35 patients (100%) had negative D-Dimer levels at 3-month follow up. At 6-month follow up all the patients in group I and II had negative D-Dimer levels (100%). Conclusion: The sensitivity of D-Dimer for the diagnosis of LAA thrombus is 100%. The specificity of D-Dimer for the diagnosis of LAA thrombus is 71.4%. So, patients with positive and elevated D-Dimer levels should undergo TEE for the diagnosis of LAA thrombus. While a negative D-Dimer test result makes the diagnosis of LAA thrombus is extremely unlikely. Appropriate oral anticoagulation results in complete resolution of LAA thrombus within 6 months.

This is a review of features in ECG to diagnose the culprit artery responsible for the infarction. Localization of the occluded vessel in acute myocardial infarction is important for many reasons: to know which artery is to dilate and stent; to assess the severity of the lesion; to compare with the echocardiographic area with hypokinesia or akinesia and to differentiate the recent from the old occluded vessel. The ST-segment changes in 12-lead ECG form the basis of diagnosis, management, and prognosis.

Percutaneous balloon mitral valvuloplasty (PBMV) is
an effective form of treatment for patients with mitral
valve stenosis (MS). The commissural (com.)
appearance is a factor that is not assessed by the mitral
valve (MV) scores (as the Wilkins score). The aim of
this study was to determine whether the presence of
calcium in the MV coms. as demonstrated
echocardiographically, could predict restenosis at 3
years follow-up after PBMV. 220 consecutive patients
with rheumatic MS who underwent successful PBMV
by using the Inoue balloon catheter were studied
prospectively. Com. calcification (calc.) was present
in 70 patients (32%). Com. splitting occurred
immediately after PBMV in all the 220 patients
studied. Bilateral com. splitting was present more
significantly in patients without com. calc. than in
patients with com. calc. (P < 0.001). 140 patients
presented at 3 years follow-up. Com. calc. was present
in 35 patients (25%) while the other 105 patients
(75%) had no com. calc. Bilateral com. splitting was
present more significantly in patients without com.
calc. than in patients with com. calc. (P < 0.001).
Severe MR was present in 20 patients (14.3%). It was
present more significantly in patients with com. calc.
than in patients without com. calc. (P < 0.001).
Restenosis occurred in 30 patients (21.4%).
Conclusion, patients with com. calc. have a lower
incidence of bilateral com. splitting; have a higher
incidence of severe MR at one year and at 3 years follow-up after PBMV. Old age, large LAD, high total
echo score of the MV, MV score  8, lower MVA
before PBMV, low incidence of bilateral com.
splitting, low MVA after PBMV and the presence of
com. calc. are significant predictors of restenosis at 3
years follow-up. Com. calc. is a strong predictor of
restenosis at 3 years follow-up after PBMV.

Citation: Samir Rafla, Ahmed Gaber, Gehan Magdy, Ahmed Abdelaaty. A New Score of Positivity in Thallium Studies of Ischemic Patients. Cardiology and Cardiovascular Medicine 4 (2020): 045-057. Abstract The aim of this work was to detect means to increase accuracy of prediction of Thallium perfusion results. Also, we aimed to investigate the incidence and severity of chest pain during radionuclide myocardial perfusion imaging and its relation to the stress modality. The study was conducted on two groups of patients that presented for radionuclide myocardial perfusion imaging. The first group included fifty patients subjected to exercise stress testing. The second group included fifty patients subjected to dipyridamole pharmacologic stress testing. The 2 groups were compared regarding chest pain, dyspnea, electrocardiographic changes, left ventricular dilatation, and increased lung thallium uptake. Exercise was associated with a statistically significant higher incidence and severity of chest pain compared to dipyridamole (p<0.001). The incidence and severity of chest pain were related to the number of vessel territories affected in the dipyridamole group (p=0.037), but not in the exercise group. Exercise was associated with a statistically significant higher incidence of electrocardiographic (ECG) changes compared to dipyridamole (p<0.001). There was no statistically significant difference in the incidence of left ventricular dilatation between the 2 groups. The incidence of left ventricular dilatation was related to the number of vessel territories affected in the exercise group (p=0.011) as well as the dipyridamole group (p=0.007). There was no statistically significant difference in the incidence of increased lung thallium-201 uptake between the 2 groups. The incidence of increased lung thallium-201 uptake was related to the number of vessel territories affected in the exercise group (p=0.017) but not in the dipyridamole group. We summed four parameters 1-chest pain (one or two or three points), 2-ECG changes > 1mm (two points), 3-LV dilation (two points), and 4-Lung thallium Cardiol uptake (two points), so maximum can be 9 points for each patient. We compared the results in every patient with the degree of perfusion defects (meaning number of vessels affected) (each vessel territory if it shows perfusion defect is given two points; three vessel areas are given 6 points). Correlation revealed significant relation P <0.05 thus we postulated new score of validation of positivity of perfusion defects, the higher the score of these parameters the higher the expected percent of perfusion defect; that is confirmation of positivity of ischemia. To our knowledge this is new score of assessing thallium perfusion.

Percutaneous balloon mitral valvuloplasty (PBMV) is an effective from of treatment for patients with mitral valve stenosis (MS). It has been documented that the dominant mechanism by which MS is relieved by PBMV is splitting of one or both of the fused commissures (coms.). However, the commissural (com.) appearance is a factor that is not assessed by the mitral valve (MV) scores (as the Wilkins score). The aim of this study was to determine whether the presence of calcium in the MV coms. as demonstrated echocardiographically, could predict restenosis at 3 years follow-up after PBMV. 220 consecutive patients with rheumatic MS who underwent successful PBMV by using the Inoue balloon catheter were studied prospectively. Com. calcification (calc.) was present in 70 patients (32%). It was unilateral com. calc. {43 patients (61.4%) had anterolateral com. calc. and 27 patients (38.6%) had posteromedial com. calc.}. The other 150 patients (68%) had no com. calc. Com. splitting occurred immediately after PBMV in all the 220 patients studied. Bilateral com. splitting was present more significantly in patients without com. calc. than in patients with com. calc. (P < 0.001).
190 patients presented at one year follow-up. Com. calc. was present in 56 patients (29.5%) while the other 134 patients (70.5%) had no com. calc. Bilateral com. splitting was present more significantly in patients without com. calc. than in patients with com. calc. (P < 0.001). Severe MR was present in 17 patients (8.9%). It was present more significantly is patients with com. calc. than in patients without com. calc. (P < 0.001). Restenosis occurred in 10 patients (5.3%). All the 17 patients with severe MR and the 10 patients with restenosis were not followed up.
140 patients presented at 3 years follow-up. Com. calc. was present in 35 patients (25%) while the other 105 patients (75%) had no com. calc. Bilateral com. splitting was present  more significantly in patients without com. calc. than in patients with com. calc. (P < 0.001). Severe MR was present in 20 patients (14.3%). It was present more significantly in patients with com. calc. than in patients without com. calc. (P < 0.001). Restenosis occurred in 30 patients (21.4%). The patients were classified into 2 groups. Group I (restenosis group) included 30 patients (21.4%) with restenosis. Group II (no restenosis group) included 110 patients (78.6%) without restenosis. Old age, large LAD, high total echocardiographic (echo) score of the MV, MV score  8, , low mitral valve area (MVA) before PBMV, low incidence of bilateral com. splitting, low MVA after PBMV and the presence of com. calc. were significant predictors of restenosis at 3 years follow-up after PBMV. New York Heart Association (NYHA), functional class (F.C.) > II was present more significantly in patients with restenosis than in patients without restenosis (P < 0.001). Severe MR occurred more significantly in patients with restenosis than in patients without restenosis (P < 0.001).

The Egyptian Project "one hundred million Wellness", has achieved great success, was appreciated by the WHO and many countries. The country assigned expert personnel in over 6128 places to investigate and examine people for the following: • Hepatitis C virus • Blood pressure • Random blood pressure • Wight and height and calculated body mass index. The Egyptian population above age >18 is 55 million, those who attended the exam were 49922543 (say 5 million). This is a great achievement because the organizing personnel reached people in every place and the advertisement was very active and effective. Results Figure 1: Summary of the results of the project.

Percutaneous Balloon Mitral Valvuloplasty (PBMV) involves atrial septostomy during the procedure. One of the consequences of transseptal puncture is the creation of an Atrial Septal Defect (ASD). Transesophageal Echocardiography (TEE) can detect Left to Right (L-R) shunts too small to be detected by other methods. The aim of this study was to evaluate the 3 years follow-up of ASD closure after PBMV by TEE. 200 consecutive patients with rheumatic Mitral Stenosis (MS) who underwent successful PBMV by using the Inoue balloon catheter were studied prospectively. ASD with small L-R atrial shunting occurred in all the patients (100%) immediately after PBMV. Total study 200 patients. All the ASDs were small in size (≤ 5 mm). The puncture site (ASD site) occurred in the fossa ovalis (Fo.Ov) in 120 patients (60%), while it occurred outside the Fo.Ov (either in the superior limbus or in the inferior limbus of the Interatrial Septum (IAS)) in the other 80 patients (40%). 180 patients presented at 6 month follow-up. ASD was closed in 117 patients (65%), while it was persisted in 63 patients (35%). 95 patients presented at 3 years follow-up. ASD was closed in 76 patients (80%) (Group I), while it was persisted in 19 patients (20%) (Group II). All the 74 patients who had ASD immediately after PBMV in the Fo.Ov, presented with ASD closure at 3 years follow-up. Only 2 patients who had ASD immediately after PBMV outside the Fo.Ov, presented with ASD closure at 3 years follow-up. All the 19 patients who presented at 3 years follow-up with ASD persistence had ASD immediately after PBMV outside the Fo.Ov (14 in the superior limbus and 5 in the inferior limbus). No patient presented at 3 years follow-up with ASD persistence, had ASD immediately after PBMV in the Fo.Ov Large LAD, high total Echocardiographic (echo) score of the Mitral Valve (MV), thick Fo.Ov, thick superior limbus, thick inferior limbus and ASD site immediately after PBMV outside the Fo.Ov were signifi cant predictors of ASD persistence at 3 years follow-up. In conclusion, ASD with L-R atrial shunting occurs in all the patients after PBMV by using the Inoue balloon catheter. ASD after PBMV persists in 20% of the patients at 3 years follow-up. Predictors of ASD persistence at 3 years follow-up are: large LAD, high total echo score of the MV, thick Fo.Ov, thick superior limbus, thick inferior limbus and ASD site immediately after PBMV outside the Fo.Ov. ASD closes at 3 years follow-up in all the patients who had ASD in the Fo.Ov immediately after PBMV. All the patients with ASD persistence at 3 years follow-up had ASD outside the Fo.Ov after PBMV. It is recommended that operators doing transseptal puncture during PBMV by using the Inoue balloon catheter should aim to do it in the Fo.Ov.

Prolongation of the QRS duration has been shown to be associated with adverse outcomes post-myocardial infarction (MI). The relation to thrombolytic therapy was not widely studied before. The study included 30 patients with ST-segment elevation myocardial infarction who were given thrombolytic therapy. Results: ST segment deviation score (STD score) ranged from 5 to 23 with a mean of 14. ECG one hour after thrombolysis showed: Number of patients with successful thrombolytic therapy was sixteen (53.3%). ECG one day after thrombolysis showed: ST segment deviation score ranged from 0 to 10. QRS minimum duration ranged from 84 to 117 msec with a mean of 100. QRS maximum duration ranged from 85 to 118 msec with a mean of 102 msec. ECG measurements were repeated after thrombolytic therapy by one hour, 1 day, 2 days and on discharge. The 30 patients included in this study were divided into three groups according to the QRS maximum duration. The relation between QRS max before thrombolysis and the incidence of successful thrombolysis: Number of patients with successful thrombolytic therapy was not different in relation to QRS duration. QRS duration was compared with complications. Comparison between the success of the thrombolysis and the change of the QRS max before thrombolysis and before discharge showed that the shortening of the QRS duration in patients with successful thrombolysis was significant. Conclusion: improvement of QRS duration is a marker of successful thrombolysis. The incidence of complications (arrhythmias, heart failure, shock, pulmonary edema, mortality) increases with the increase of the QRS duration.

Background: The investigations of predictors of success or failure of cardiac resynchronization therapy were studied previously. Assessment of success in patients already on dual or single pacemakers and upgraded to cardiac resynchronization therapy (CRT) were not extensively studied before. How to select patients in whom this may be the most optimal strategy is unclear. We sought to determine factors associated with success or failure in this group of patients who were already paced for heart block. Methods: 81 pts were subjected to upgrade to CRT implantation after being on pacemaker. The study was conducted in Germany. Data was presented as Median (Min.-Max.) for abnormally distributed data or Mean ± SD. for normally distributed data. Parameters that revealed no statistical significance in response: Age, sex, EF, diabetes, renal disease, GFR, MR, QRS duration (all above 150 ms), history of ablation, AF recurrence, previous pacemaker, optimization. The following parameters revealed significant influence on response to CRT: Less responders with: Higher C reactive protein (CRP), presence of tricuspid incompetence (TR), presence of pulmonary hypertension (PHN), presence of previous MI, being ischemic vs nonischemic cardiomyopathy (CM) (less responders with ischemic CM). Conclusions: The findings through light on specific parameters that predict response to upgrade to CRT after usual pacemaker. Ó 2017 Alexandria University Faculty of Medicine. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: Low- and middle-income countries have experienced an increase in the prevalence of CVD and 80% of the global burden of CVD occurs there. Despite the universal agreement upon the traditional cardiovascular risk factors (CVRFs) for coronary artery disease, yet the distribution of theses CVRFs may be different in various geographical areas and could be affected by gender differences as well as among different age groups. The availability of such information in Egypt and middle east countries could help implementing appropriate prevention programs.
Methods: A cross sectional, multicenter, observational study of patients presenting to coronary care units (CCUs) in Egypt and diagnosed with acute coronary syndrome(ACS). A web-based case report form (CRF) was designed to collect demographic data, anthropometric measures, history of CVRFs, laboratory parameters as well as noninvasive and invasive procedures performed. Statistical analysis was performed, and date were compared in men and women and in different age groups.
Results: The study population comprised 1681 subjects, of whom 425 (25%) were women, most women (72%) were aged over 55y, while 46% of men were aged 55 y or younger (P <0.001). A larger proportion of men presented with STEMI (49%), while other presentations (unstable angina and NSTEMI) were more frequent in women (32% each; P <0.001. Central obesity (defined as a waist/height ratio >=0.5) was extremely prevalent in both men (80%) and women (90%). Men were more frequently current smokers (62%, vs 5% of women); P <0.001). Women had a higher frequency of most other traditional risk factors, including type 2 diabetes (53% vs 34% of men), hypertension (69% vs 49%), dyslipidemia (60% vs 45%), and obesity (71% vs 41%; P <0.001 for all). Diagnostic coronary angiography was performed in a similar proportion of men and women (62% and 59% respectively). However, radial access was more likely to be used in men (P <0.001). vs 34% of men).
Conclusions: Obesity, smoking, hypertension and diabetes were the most common traditional risk factors among Egyptian patients presented with ACS, the incidence of hypertension and obesity was significantly higher in Egyptian females than males. Smoking was the more prevalent CVRF in younger age groups compered to hypertension in older patients. Only 54% of the STEMI patients underwent primary PCI, this was because many of the centers that involved in the study were non- PCI capable centres. This is an interim analysis for phase (II) of the first Egyptian study to evaluate the pattern and prevalence of risk factors among Egyptian patients using web-based software for randomization. After completion of data collection, this study may help in providing a database for the initiation of a national guideline and appropriate management protocols.

Abstract: This analysis assesses the effect of Robotic technique on the results of ablation of paroxysmal atrial fibrillation (AF).
Methods: We studied 150 patients (pts) (86 males and 64 females) having a mean age of 51.3 yrs (54 > 50, 96 below 50 yrs), who suffered from symptomatic drug refractory paroxysmal AF. Work was done in Institute of Clinical and Experimental Medicine (IKEM) hospital in Prague. Cardiac Multi-slice computer tomography (MSCT)  image integration to the 3D electroanatomic LA map was used in 106 pts (70.6%, however all of them underwent intracardiac echo guided imaging during the ablation procedure. 40 pts underwent manual RF ablation using electroanatomic mapping system (CARTO, Biosense Webster®), 40 pts underwent ablation using NavX system®, 70 pts underwent robotic ablation using Sensui system. Pulmonary vein isolation was done to all pts using either pulmonary vein (PV) antral isolation in 116 (77.3%) or circumferential pulmonary vein ablation in 34 pts (22.7%). All pts were followed at 3, 6, 9, and 12 months. 
Results: Procedural time was significantly longer in manual (202.0 ± 19.4 minutes) compared to Robot group (146.4 ± 10.8 minutes). Total fluoroscopy time was significantly shorter in Robot group (6.9 ± 1.9 minutes) compared to non-robotic group (19.9 ± 3.1 minutes). The mean fluoroscopy dose area-product was significantly lower in Robot group (552.7 ± 194.1 µ Gy.cm2) compared to manual group (2257.2± 568.1 µGy.cm2).
Conclusions: The robotic group showed evident and clear benefit of the use of robotic navigation system in the form of much shorter total procedure time, shorter total fluoroscopy time and fluoroscopy exposure dose with less number of ablation points.

Instability and rupture of atherosclerotic plaques result in acute coronary syndrome.

LDL-C is usually related to ASCVD.

Statin medications are first-line therapy for LDL-C lowering Post ACS.

Rosuvastatin 20mg and 40 mg significantly increase HDL-C levels compared with Atorvastatin 80 mg

Atrial FibrillationRate versus Rhythm Control: For each patient with AF, the two principal goals of therapy are symptom control and the prevention of thromboembolism.
Rate- and rhythm-control strategies improve symptoms, but neither has been conclusively shown to improve survival compared to the other. 

• ‫البالغين‬ ‫بين‬ ‫انتشارا‬ ‫االكثر‬ ‫الفيروسات‬ 1-(‫الدماغ‬ ‫التهاب‬ Encephalitis) ‫هو‬ ‫ًا‬ ‫شيوع‬ ‫األكثر‬ ‫السبب‬ ‫ولكن‬ ‫أسباب،‬ ‫عدة‬ ‫له‬ ‫ويوجد‬ ‫المخ،‬ ‫أنسجة‬ ‫يصيب‬ ‫التهاب‬ ‫عن‬ ‫عبارة‬ ‫هو‬ ‫الفيروسية.‬ ‫العدوى‬ (‫إنتيرو‬ ‫عائلة‬ ‫إلى‬ ‫تنتمي‬ ‫التي‬ ‫الفيروسات‬ ‫وهي‬ ‫الدماغ،‬ ‫اللتهاب‬ ‫كمسببة‬ ‫شائعة‬ ‫أخرى‬ ‫فيروسات‬ ‫وتوجد‬ Enterovirus ،) (Arbovirus (‫النكاف‬ ‫وفيروس‬) Mumps .) 2-(‫البشري‬ ‫الحليمي‬ ‫الورم‬ ‫فيروس‬ HPV) ‫ينتقل‬ ‫الفيروس،‬ ‫لهذا‬ ‫نوع‬ ‫مئة‬ ‫من‬ ‫أكثر‬ ‫يوجد‬ ‫و‬ ، ً ‫جدا‬ ‫شائع‬ ‫فيروس‬ ‫هو‬ ‫الشرج‬ ‫منطقة‬ ‫ويصيب‬ ‫الجنسي‬ ‫االتصال‬ ‫خالل‬ ‫من‬ ‫التناسلي.‬ ‫أنواع‬ ‫بعض‬ ‫أن‬ ‫البشري‬ ‫الحليمي‬ ‫الورم‬ ‫فيروس‬ ‫اإلصابة‬ ‫قليلة‬ ‫حاالت‬ ‫في‬ ‫لالخرين‬ ‫يمكن‬ ‫بينما‬ ‫الثاليل،‬ ‫تسبب‬ ‫أن‬ ‫يمكن‬ ‫والشرج.‬ ‫والمهبل‬ ‫والفرج‬ ‫الرحم‬ ‫عنق‬ ‫بسرطانات‬ • 3-‫اإليدز(‬ ‫البشرية/‬ ‫المناعة‬ ‫نقص‬ ‫فيروس‬ HIV) AIDS HIV, the virus that causes ‫الفيروس‬ ‫هذا‬ ‫ويدمر‬ ‫ًا،،‬ ‫جنسي‬ ‫تنتقل‬ ‫عدوى‬ ‫عن‬ ‫عبارة‬ ‫البشري‬ ‫المناعة‬ ‫نقص‬ ‫فيروس‬ ‫ال‬ ‫الجهاز‬ ‫مناعي‬ ‫من‬ ‫يحد‬ ‫وبالتالي‬ ‫لإلنسان‬ ‫األمراض.‬ ‫تسبب‬ ‫التي‬ ‫الجراثيم‬ ‫مقاومة‬ ‫على‬ ‫الجسم‬ ‫قدرة‬ ‫الرضاعة.‬ ‫أو‬ ‫الوالدة‬ ‫أو‬ ‫الحمل‬ ‫أثناء‬ ‫االبن‬ ‫إلى‬ ‫األم‬ ‫من‬ ‫أو‬ ‫ملوث‬ ‫دم‬ ‫مع‬ ‫التالمس‬ ‫طريق‬ ‫عن‬ ‫ينتشر‬ ‫تط‬ ‫من‬ ‫ا‬ ً ‫كثير‬ ‫تبطئ‬ ‫أن‬ ‫يمكن‬ ‫عالجات‬ ‫هناك‬ ‫لكن‬ ‫البشري/اإليدز‬ ‫المناعة‬ ‫نقص‬ ‫لفيروس‬ ‫عالج‬ ‫يوجد‬ ‫ال‬ ‫المرض.‬ ‫ور‬ 4-(‫الصفراء‬ ‫الحمى‬ ‫فيروس‬ Yellow fever) ‫الصفراء‬ ‫الحمى‬ ‫الصفراء‬ ‫أصباغ‬ ‫تتجمع‬ ‫حيث‬ ‫والكبد‬ ‫الكليتين‬ ‫وخاصة‬ ‫الجسم‬ ‫أنسجة‬ ‫بتدمير‬ ‫يقوم‬ ‫فيروسي‬ ‫مرض‬ ‫عن‬ ‫عبارة‬ ‫هو‬ ‫ا‬ ‫في‬ ‫االصفرار.‬ ‫إلى‬ ‫مائال‬ ‫الجلد‬ ‫لون‬ ‫يصبح‬ ‫حتى‬ ‫لجلد‬ ‫يحتاج‬ ‫حيث‬ ‫بسرعة‬ ‫وينمو‬ ‫الجسم‬ ‫إلى‬ ‫الميكروب‬ ‫يدخل‬ ‫حيث‬ ‫البعوض‬ ‫بواسطة‬ ‫الفيروس‬ ‫هذا‬ ‫وينتقل‬ 9 ‫إلى‬ 12 ‫إحداث‬ ‫إلى‬ ‫يوم‬ ‫الصفراء.‬ ‫الحمى‬ ‫ضد‬ ‫طويلة‬ ‫مناعة‬ ‫المرض‬ ‫هذا‬ ‫من‬ ‫يشفون‬ ‫الذين‬ ‫المرضى‬ ‫ويحقق‬ ‫الصفراء،‬ ‫الحمى‬ 5-‫الفيروس‬ ‫الكبد‬ ‫التهاب‬ (‫ي‬ HCV) ‫حدوث‬ ‫إلى‬ ‫النهاية‬ ‫في‬ ‫يؤدي‬ ‫وقد‬ ‫الكبد‬ ‫بالتهابات‬ ‫اإلصابة‬ ‫أسباب‬ ‫أكثر‬ ‫من‬ ‫واحد‬ ‫ويعتبر‬ ‫الكبد‬ ‫خاليا‬ ‫يصيب‬ ‫الدم‬ ‫في‬ ‫فيروس‬ ‫هو‬ ‫أو‬ ‫الكبدي‬ ‫الفشل‬ ‫إلى‬ ‫أو‬ ‫بالكبد‬ ‫أضرار(خطيرة)‬ ‫الكبد‬ ‫سرطان‬. ‫إجهاد‬ ‫الشهية،‬ ‫فقدان‬ ‫صداع،‬ ‫الحرارة،‬ ‫درجة‬ ‫في‬ ‫ارتفاع‬ ‫مثل‬ ‫أعراض‬ ‫عدة‬ ‫أو‬ ‫واحد‬ ‫بعرض‬ ‫الفيروسي‬ ‫الكبد‬ ‫التهاب‬ ‫يبدأ‬ ‫وقد‬ ‫بالبطن.‬ ‫واالم‬ ‫إسهال،‬ ‫قيء،‬ ‫غثيان،‬ ‫شديد،‬ 6-(‫القوباء‬ ‫فيروسات‬ Impetigo) ‫الهر‬ ‫أو‬ ‫المنطقية‬ ‫القوباء‬ ‫يصيب‬ ً ‫جدا‬ ‫شديد‬ ‫فيروسي‬ ‫التهاب‬ ‫عن‬ ‫عبارة‬ ‫هو‬ ‫العصبي‬ ‫بس‬ ‫حمراء.‬ ‫بدوائر‬ ‫محاطة‬ ‫شفافة‬ ‫حويصالت‬ ‫فيظهر‬ ‫الجلد‬ ‫أعصاب‬ ‫ترتبط‬ ‫القوباء‬ ‫بج‬ ً ‫مباشرا‬ ً ‫ارتباطا‬ ‫الفيروس‬ ‫ألن‬ ‫الماء‬ ‫دري‬ ‫حياته.‬ ‫طوال‬ ‫واحدة‬ ‫مرة‬ ‫اإلنسان‬ ‫تصيب‬ ‫قد‬ ‫التي‬ ‫األمراض‬ ‫من‬ ‫ويعد‬ ‫نفسه‬ ‫الفيروس‬ ‫هو‬ ‫المرضين‬ ‫لهذين‬ ‫المسبب‬