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Background: Peripheral arterial disease (PAD) is common in patients with end-stage renal disease on hemodialysis, but is frequently underdiagnosed. The risk factors for PAD are well known within the general population, but they differ somewhat in hemodialysis patients. This study aimed to determine the prevalence of PAD and its risk factors in patients on hemodialysis. Objective: To assess the prevalence of peripheral arterial disease in end stage renal disease patients on hemodialysis. Patients and Methods: This was across-sectional study carried out at Hemodialysis Unit of Al-Hussein University Hospital over a period of six month; from September 2019 to April 2020, and conducted on 80 hemodialysis patients. Demographic data and clinical information were recorded. Laboratory data including CBC, calcium, phosphate, total cholesterol, triglyceride, high-density lipoprotein, and iron profile were evaluated. The ankle-brachial index was measured in all patients. PAD was diagnosed if ankle-brachial index 0.9. Results: As regard description of demographic data, the mean age of all studied patients was 45.3 ± 8.8 years with minimum age of 24 years and maximum age of 62 years. There were 43 males (53.8%) and 37 females (46.3%). Thirty-five patients (43.7%) were diabetic, and 48 patients (60%) were hypertensive. According to laboratory profile, the mean of WBCs, Hb, platelets, serum calcium, PO4, and iPTH were 6.5 x10³/ul, 10.4 g/dl, 228.2 x10³/ul, 8.3 mg/dl, 9.4 mg/dl and 477.2 ug/ml respectively. Regarding lipid profile, the mean of total cholesterol, HDL and triglyceride were 214.7 mg/dL, 41.9 mg/dL,and 172.2 mg/dL, respectively. Regarding to iron profile, the mean of iron serum, ferritin and TIBC were 62.7 mg/dl, 603.3 ng/ml and 236.7 mg/dl, respectively. According to ABI, there were 22 patients (27.5%) ≤ 0.9, while there were 58 patients (72.5%) > 0.9. The prevalence of peripheral arterial disease among HD patients was 27.5%. Conclusions: High prevalence of peripheral arterial disease in CKD patients on hemodialysis and Ankle –brachial index was clearly more sensitive than physical examination in detecting of peripheral arterial disease in CKD patients on hemodialysis.

Block ciphers cryptanalysis is serious challenge specially with the existing of the powerful block ciphers that require massive number of plaintext-ciphertext pairs to perform a successful attack. Algebraic attack is superior among different attack types as it does require the smallest number of such pairs. On the other hand, the equations describe the input/output relations should be in hand to execute the algebraic attack. In this paper, we present the method of collecting the input/output algebraic equations for 2-key simplified 3-DES as a miniature example of the 2-key 3-DES. The simplified DES has similar structure and characteristics to DES with the privilege of using smaller parameters than DES. Also, we prove that the complementation property of DES can be used to double the number of obtained algebraic equations for 3-DES variants and consequently decreasing the required number of plaintext-ciphertext pairs. Finally, we compared the expected number of obtained equations and variables in both 2-key simplified 3-DES and 2-key 3-DES.

Egypt, as a developing country, is facing many environmental, social, and economic issues in its cities. Those issues are the challenges for The Egyptian government to achieve sustainability and improve inhabitants' quality of life in the future cities vision of the nation. The fourth cyber-physical revolution and the growing exponentially innovations of information and communications technologies (ICT) were the catalyst for the Egyptian stakeholders to target the sustainable smart city concept for the new future Egyptian cities generation. The research aims to characterize the smart concept for the Egyptian environment by proposing an ICT architecture for the smart city model within the Egyptian cities and highlight the innovative ICT that it will affect the future performance of such smart cities. The research attempts also to identify the main Egyptian smart initiatives that would offer appropriate sustainable solutions and improve the quality of life of the Egyptian inhabitants. To achieve the research objectives the innovative ICT installation requirements were studied to propose a compatible ICT architecture for the future city structure and an interview for experts were statistically analyzed to determine the Smart city initiatives and smart component systems prioritization for the future generation Egyptian cities. The research concluded that there is no unique standards of the city smartness concept and a community requirements study must be considered before deciding the smart initiatives and the smart systems components to be installed. The research determines that nowadays mobility, infrastructure and governance are the main smart initiatives of smartness for the Egyptian cities. Water and energy smart components of infrastructure initiative and the solid waste smart component systems of the environmental initiative are the main requirements for the Egyptian cities. Other smart component system requirements depend on the city concerns and the quality of life state of economic district level of the city.

Background: The generalized muscle weakness found in Chronic Kidney Diseases (CKD) patients on hemodialysis primarily affects the lower limbs and the proximal muscles. Patients also present decreased endurance and decreased respiratory muscle strength.Aim of Work: The purpose of this study was to evaluate the effect of incentive spirometer training on diaphragmatic excursion and Quality of Life (QOL) in Hemodialysis (HD) patients.Subjects and Methods: Sixty HD patients (30 men and 30 women) selected from the National Institute of Urology and Nephrology participated in the study, their ages ranged from 45-55 years from July 2017 to January 2018. They were assigned randomly into two groups equal in number; 30 patients each: Group (A) received incentive spirometer training with hemodialysis for 8 weeks, 3 sessions per week. Group (B) maintained on hemodialysis only for 8 weeks 3 sessions per week with pre and post assessment of diaphragmatic excursion by ultrasonography and QOL questionnaire.Results: Incentive spirometer training induced a significant improvement in diaphragmatic excursion and quality of life questionnaire in study group with percent of change 24.62% and 55.67% respectively while a deterioration was observed in control group with percent of change 26.49%, and 38.68% respectively.Conclusions: Incentive spirometer training for 8 weeks in HD men and women results in an improvement of diaphrag-matic excursion and QOL.

Aim: This study aimed to propose a protocol for health needs management among patients having day case laparoscopic cholecystectomy (LC) surgery . Subjects and Method : A descriptive exploratory design was utilized for the conduction of this study in the Outpatients` Clinics and Surgical Departments at El- Demerdash Hospital affiliated to Ain Shams University and Naser Institute Hospital affiliated to Health Insurance . A purposive sample of 120 adult and old age patients involved from both genders having laparoscopic cholecystectomy surgery and were taken from the above mentioned settings . Tools of data collection: 1) Patients, interviewing questionnaire (pre surgery ) to determine patients’ health needs regarding day case laparoscopic cholecystectomy surgery . 2) An observation checklist (pre surgery) to evaluate studied patients' practices in relation to care activities of laparoscopic cholecystectomy surgery and care given for them morning of the surgery. 3) Numerical pain scale (pre surgery) to assess pain severity level. 4) Hamilton’s anxiety rating scale (pre surgery) to determine patients’ levels of anxiety. Results: More than half of the studied patients were female, married and with secondary education. Moreover, they had higher health needs added to elevated pain and anxiety levels pre surgery at both hospitals . Conclusion : On light of the current study results , it can be concluded that more than two thirds of the studied patients had physical, psychological, social, spiritual and educational health needs pre surgery with a statistically insignificant differences between both studied hospitals . Furthermore, less than one third of them had satisfactory level of practices in care activities of LC surgery added to , lower level of care given morning of the surgery . Recommendations : Further research study should be done to implement and investigate effect of such proposed protocol for LC surgery on reducing incidence of complications post surgical technique .

Background and Objective: Cognitive impairment is one of the consequencesof substance abuse. Tramadol abuse is a public health problemin Egypt. The objective of this study was to study the effect of tramadol addiction on cognitive functions, determine if cognitive impairment caused by tramadol is reversible or not and to study the impact of other related factors as duration of intake and dose of tramadol on cognition. Methods: This study included 30 patients with active tramadol abuse, 30 patients abstinent from tramadol for 3 to 6 months and 30 control subjects (matched for age, sex, and education) who were recruited from Kasr Al-Aini psychiatric and addiction hospital (from outpatient clinic and inpatient admitted patients), Egypt.The participants were interviewed using Montreal Cognitive Assessmenttest (MoCA), Trail making test A and B and had urine screening for drugs. Results: 53.33%(n=16) of active group had impaired total MoCA scores compared to 10 % (n=3) in control group.This was statistically significant with P value

INTRODUCTION & AIM OF THE WORK : Depression and anxiety are common psychiatric comorbidities of epilepsy. This work aimed to assess the relationship between psychological disorders (depression and anxiety) and epilepsy and to explore the different factors involved in such relationship. SUBJECTS AND METHODS: We studied 100 patients with epilepsy in the neuropsychiatry department in Qena South Valley University Hospital for comorbid depression and anxiety. Hamilton questionnaire for depression and anxiety (HAMD and HAMA), EEG and brain Imaging were carried out.. RESULTS: Demographic data of the studied population show that the mean ± SD of age is 25.08±13.81, male (64%), age of onset of epilepsy (19.18± 12.597), duration of treatment (4.82± 4.546). HAMD score (9.31±5.74), HAMA score (13.80±7.16). Depression was diagnosed in 48% and anxiety in 36% of patients. Among epileptic patients with depression or anxiety, no significant relation was detected regarding age, sex, educational level, age of onset nor duration of illness Depression was more in those with postictal drowsiness and GTC type of seizures.

Rotifers Brachionus plicatilis are being used worldwide to feed early developmental stages of marine finfish and crustaceans. Further, rotifer transmits adequate supplies of micro and macro-nutrients, vitamins, probiotic, and even antibodies to fish larvae. Food type is regarded as the most important criterion that could affect growth and quality of rotifers. There fore, the present work was performed to study the effect of food type, salinity, water temperature, and initial stocking density on the population growth of rotifers. The first experiment was conducted to during the first phase of the present study investigate the effect of four different algal diets: (1) Nannochloropsis oculata life (N), (2) Spirulina platensis powder (S), (3) 50% N. oculata + 50% beaker yeast (NY), and (4) 50% S. platensis + 50% beaker yeast, on rotifer population (as final number/ml) and fatty acid profile of rotifer batch cultured (72 h) was employed. Rotifer culture treatments were conducted in jars (30 liters) with three replicates for each treatment.The results of the firts phase of the study clearly illustrated that NY diet possessed the highest population growth, Eicosapentaenoic acid (EPA), and Docosahexaenoic acid DHA percentage. Depending on the results of the first phase, the diet NY was candidate to investigate the effect of different salinities (25, 27, and 29 ppt), temperatures (26, 28, 30, 32 oC), and initial rotifer stocking densities (50, 100, 150, and 200 Ind./ml) on rotifer population. The results showed that salinity 25 ppt, temperature 28oC, and initial rotifer density 150 pcs/ml possessed the highest rotifer population growth during a 72-hrs batch culture system of rotifer when fed on 50% N. oculata + 50% beaker yeast (NY) food type

تواجه مصر فى الوقت الراهن بمجموعة کبيرة من التحديات ويعتبر تحدى التنمية من أهم هذه التحديات وحيث أن الريف کان دائما ولا يزال هو عصب المجتمع المصري فان التنمية الريفية المتکاملة هى الأساس للتنمية الاقتصادية والاجتماعية لمصر. ولقرون طويلة من الزمن کان الاهتمام مرکزا على المدن حيث يسکن اهل الحضر، وکانت خدمات الحکومة ومشروعاتها تنفذ اساسا في المدن والفتات فقط من الاموال المخصصة لهذه المشروعات تذهب الى القرى. ولذلک عمرت المدن بالطرق المرصوفة ومياه الشرب والصرف الصحي والکهرباء ووسائل الاتصال وبالمدارس والمستشفيات ومنافذ الترويج، والى جانبهم جميعا اقام اصحاب المشروعات الاقتصادية مصانعهم وتجارتهم واسواقهم الکبيرة ومراکز خدماتهم المتنوعة، وانتعشت دخول اهل المدن وهاجر اليها اهل الريف بحثا عن فرص عمل افضل ومستوى حياة أعلى. ولم تتغير هذه الاحوال بقوة إلا فى السنوات الخمسين الماضية وخاصة بعد ثورة يوليو۲٥۱۹. ووضعت برامج وخططت مشروعات لتحسين أحوال القرى کان هناک دائما اولويات اکثر اهمية من وجهه نظر الحکومة تخصص لها الاموال بوفرة لإقامة المشروعات والخدمات لأحداث تنمية محلية للمجتمعات الريفية. واستهدفت مشروعات التنمية المحلية، من خلال مجالاتها المتعددة ( العمرانية - الخدمية – بنية اساسية – الاقتصادية - الاجتماعية -...)، تهيئة حياة افضل للسکان، وتعتبر المجالات سابقة الذکر ذات صلة رئيسية بالتنمية العمرانية وتأثر علي توجهاتها المختلفة سواء سلبا أو ايجابا أن لم توضع تلک المشروعات في أطر البعد المکاني ويرجع ذلک الي أن التنمية العمرانية تهدف الي تهيئة البيئة العمرانية بمختلف مستوياتها لتوفر مناخ ملائم لنجاح المشروعات المحلية، بحيث تکون هناک موائمة بين هيکل المشروعات المحلية وتوزيعها المکاني بخصائص البيئة العمرانية المحلية، بجانب ايضا الأخذ في الاعتبار المحددات والامکانيات العمرانية التي تصيغها البيئة العمرانية المحلية کأساس لتوزيع تلک المشروعات علي التجمعات العمرانية، وتمثل مشروعات المياه والطاقة أحد المجالات الأساسية الداعمة لأحداث تنمية فعالة للمجتمعات المحلية علي کافة المستويات التخطيطية. يهدف البحث إلي مناقشة وقياس الإرتباط بين خصائص البعد المکاني علي المستوي المحلي الريفي وإختيار وتوزيع مشروعات المياه والطاقة بذلک المستوي وعرض وتحليل منظومة إتخاذ قرار التوزيع المکاني لتلک المشروعات وعلاقته بالخصائص العمرانية والمکانية (المحلية والإقليمية). يتمثل التساؤل الرئيسي للبحث في هل يؤثر البعد المکاني من المنظور التنموي في إختيار وتوزيع مشرعات المياه والطاقة لإحداث تنمية ريفية متکاملة للتجمعات؟ ويعتمد منهج البحث على المنهج التحليلى لتوزيع المشروعات المتعاقبة فى مجالات البنية الاساسية وبخاصة المياه والطاقة لبعض المناطق والقرى الريفية فى المحافظات المصرية وقياس مدى إرتباطها بالبعد المکانى لتحقيق التنمية الريفية، للخروج بأهمية الأخذ فى الإعتبار المعايير المکانية لتوزيع المشروعات التنموية او مشروعات البنية الأساسية کرکيزة لتحقيق التنمية الريفية المتکاملة والمستدامة. The big and mega cities witness several challenges that affect their urban growth and development. These cities can be considered as economical, social and cultural development poles which in turn enhance the urban and demographic growth rates at the national level. As per the pressures of market forces and the real sate development that recently recorded high growth rates, many problems have been appeared. The high speed of informal urban growth is one among these problems. According to the planning concepts of the relationships between the urban centers and periphery at the big cities, a fusion between the center and periphery is existed and formulated another new big center. This phenomenon is famous in literature by the megapolis. This indeed lead to cities' inflation as occurred in Greater Cairo Region (GCR). Recently, the assets of New Cairo city have been sold out for the private enterprises and investors to develop large areas for high income and elite. This in turn affects the values and prices of lands at the new city and also at the city outskirts. This accordingly affected the growth of existing city to the extent that Cairo city boundary extended remotely on the regional external roads in the west and east. It extends on the west at Ismalia and Suez regional roads and also at Alexandria regional road in the west. All of this affected the new-city urban growth for particular types of housing and for informal uncontrolled growth of the existing cities for low income. The paper therefore aims to identify the way in directing the investments projects to meet the requirements of future urban development of these cities. The study makes a critical analysis for the growth of real sate development at the different eras of GCR development. Then it reviews the case of New Cairo city as a recent example representing the supply –demand forces in the western of Cairo. Through these studies it can be recommended some tips to direct the investment projects at the regional and national levels.

Background: In recent years laparoscopic splenectomy (LS) has gained acceptance as a viable alternative to open splenectomy. Laparoscopic splenectomy is evolving and may become the standard operative method for the treatment of the problem spleen. Patients and methods: From July 2012 till December 2013, 20 patients with clinical immune thrombocytopenic purpura (ITP) were referred as surgical candidates. Two ofthem (10%) were converted to open, and the other 18 underwent successful LS. The operative approach was performed with the patient in the right lateral decubitus position, with extensive use of the ultrasonic dissecting shears. Results: There were 20 patients in the study, twelve women and eight men with a mean age of28 years (18-38). Immune thrombocytopenic purpura (ITP) was the indication for surgery. Laparoscopic splenectomy was intended in all patients and successfully completed in 18 patients (90%). Two cases (10%) required conversion to open splenectomy, due to intraoperative hemorrhage which could not be controlled laparoscopically. Length of hospital stay (LOS) was 2.3 ± 0.8 days. The two major complications (10%) were intraoperative hemorrhage which required conversion to open splenectomy The two minor complications were trocar site infection and hernia. The average operative times (150 ± 48 min) improved as the study progressed. This improvement was believed to be due to the learning curve. Conclusion: Laparoscopic splenectomy (LS) may be considered the standard of care for patients who require splenectomy for ITP Laparoscopic splenectomy results in less patient disability, shorter hospitalization, and probably less perioperative morbidity