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Optoelectronic systems can exert precise control over targeted neurons and pathways throughout the brain in untethered animals, but similar technologies for the spinal cord are not well established. In the present study, we describe a system for ultrafast, wireless, closed-loop manipulation of targeted neurons and pathways across the entire dorsoventral spinal cord in untethered mice. We developed a soft stretchable carrier, integrating microscale light-emitting diodes (micro-LEDs), that conforms to the dura mater of the spinal cord. A coating of silicone-phosphor matrix over the micro-LEDs provides mechanical protection and light conversion for compatibility with a large library of opsins. A lightweight, head-mounted, wireless platform powers the micro-LEDs and performs low-latency, on-chip processing of sensed physiological signals to control photostimulation in a closed loop. We use the device to reveal the role of various neuronal subtypes, sensory pathways and supraspinal projections in the control of locomotion in healthy and spinal-cord injured mice., Optogenetics is applied to the entire mouse spinal cord.

The main objective of this study is to empirically investigate whether the audit committee (AC) attributes and the quality of external auditor are associated with financial reporting quality (FRQ) of companies listed on the gulf cooperation council (GCC) countries’ stock markets. To achieve the study’s objectives, data was collected from a sample of 115 companies from four GCC countries during the period from 2017-2019 that represents 345 firm-year observations. Five hypotheses were tested, FRQ as dependent variable was regressed with five independent variables. For measuring the FRQ, the author adopted the qualitative approach using checklist developed by Beest, et al. 2009 sponsored by Nijmegen Center for Economics (NiCE) with limited modification based on the new amendments of IASB conceptual framework in 2018. The study findings reveal that the level of FRQ on the study sample averaged 63% while the minimum and the maximum valued 40% and 86% respectively. The findings indicate that FRQ are positively and significantly associated with the four AC attributes and quality of external auditor so, all hypotheses are accepted, which infer that FRQ will be enhanced if a company formed AC having, bigger size, more independence, financial experience, meetings frequently, and hiring high quality external auditor. The findings of this study have wide implications to all stakeholders especially, investors, creditors, auditors, management, in addition to stock markets regulators and standard-sitting bodies for the role of AC attributes and external auditor on improving FRQ

Background: Lumbopelvic pain is a substantial problem and can have a significanteffect on the pregnant women's daily activities. Aim: Evaluate the effect of an educationalsession regarding sitting pelvic tilt exercise on pregnant women's knowledge and intensityof lumbopelvic pain. Subjects and Method: A quasi-experimental research designconducted on 70 pregnant women with lumbopelvic pain who chosen by a purposivesample. Setting: Antenatal Clinics at Obstetrics and Gynecology Center in MansouraUniversity Hospital in Egypt. Tools of data collection: There were three tools for datacollection: Tool I: Structured Interview Schedule. Tool II: Structured KnowledgeQuestionnaire. Tool III: Numeric Rating Scale. Results: There were highly statisticallysignificant differences between the pregnant women's knowledge pre, immediate and after 2weeks of intervention (P< 0.001). Also, there were highly statistically significantdifferences between the intensity of lumbopelvic pain pre and post intervention (P< 0.001).Conclusion: The study hypotheses were accepted which indicated that the educationalsession had significant effects in improving the pregnant women's knowledge regardingsitting pelvic tilt exercise and reducing the intensity of lumbopelvic pain.Recommendation: The present study findings recommended that, distribution of a designedbrochure about the sitting pelvic tilt exercise for all pregnant women who attended theantenatal clinics as a part of the routine antenatal care.

This study investigates the impact of firm characteristics on the financial performance of companies listed on the Egyptian stock market. Regression model was performed to regress six firm characteristics variables, namely firm size, foreign listing, age, leverage, liquidity, and assets tangibility. The study controlled for five more variables related to corporate governance including board size, board independence, CEO role duality, audit committee, and the quality of external auditor to avert their effect on financial performance. The study used both accounting measures such as return on assets (ROA) and return on equity (ROE) and market-based Tobin's Q Ratio for measuring financial performance. The findings generally indicate that firm characteristics have an impact on both accounting financial performance as measured by ROA or ROE and market-based financial performance as measured by Tobin's Q, with little difference in the level of such impact. These findings revealed that firm characteristics affect corporate financial performance as evaluated by the company or the market.

Introduction Antimicrobial stewardship (ASP) is of the utmost importance as a way to optimize the use of antimicrobials to prevent the development of resistance and improve patient outcomes. So, it is worthwhile to assess the knowledge, attitude and awareness regarding antimicrobial stewardship in hospitals. Objective The aim of this study is to assess knowledge, attitudes and practices (KAP) of prescribers towards antimicrobial stewardship at hospitals in Khartoum state and to identify the associations between prescriber’s demographic information and their knowledge. Methodology This descriptive cross-sectional study multi-centered study conducted in 10 hospitals at Khartoum state -Sudan, during period from November to December 2018. Study population included all prescribers who is available at study’s hospitals during study period and willing to participate in the study. A self-administered questionnaire addressing participants’ knowledge, attitudes, and practice (KAP) regarding antibiotic resistance and ASP distributed in the selected hospitals among attending house-officers, registrars and consultants completed then analyzed. Results Of the 294 medical staff targeted, 287 responded to the survey (response rate 97.6%). Only (26.4%) were familiar with the term ASP and (31.5%) claimed that it is effective in reducing resistance. (43.0%) of respondents believe that ASP play vital role on antibiotic prescribing. Only (9.5%) had ASP in their hospital and (13.5%) having policy and team. (45.3%) of participants had good level of knowledge about antimicrobial stewardship, but majority show negative attitude (63.1%), and poor practices (92.0%) regarding ASP. There was no observed correlation between knowledge and attitude, knowledge with practice (p-value ≥ 0.05). Only attitude with practice shows significance correlation (P=0.0001), which means that prescribers with positive attitude had the better practices towards antimicrobial stewardship. Age, occupation and experience are the only significant predictors of prescriber's knowledge and attitude towards antibiotic stewardship, while no association between these factors and practice. Conclusion The present study concludes that the knowledge of prescribers regarding ASP is moderate and their attitude is negative. Unfortunately, practices regarding ASP were poor, despite, the good knowledge regarding the effects of ASP on antimicrobial resistance.

Purpose: The manufacturing sector with Lean Six Sigma is constantly improving (CI). CI is helping the organization to achieve and develop its efficiency and operational excellence. Synergizing all methods thus, helps to achieve better efficiency than using one method alone. This results in better quality. Thus, many companies have taken LSS for CI. Yet, inside LSS areas, there are clear restrictions. Very few think about the LSS cap. Design/Methodology/Approach: Data were gathered by questionnaires from 264 managers. The comparison analysis was performed and then a multiple regression model was used to test the hypotheses following confirmation of normality, validity and reliability. Findings: The results indicate that the Jordanian manufacturing organizations rely on high adoption of Lean Six Sigma variables; the lean six sigma variables, with absence of unused expertise and transport, have good relationships with business efficiency. All the reasons Lean Six Sigma affect business performance, except for industry in Jordan, which has expanded results from one industry and/or country to other industry and/or nations. Manufacturing companies can improve their business performance, other manufacturing industries can also be introduced. Practical Implications: All organizations aim to reduce the amount of waste that contributes to the protection of natural resources and to social responsibility of companies. Originality Value: The research helps experts and judges to recognize new processes and methods of development that add value and promote competitive advantages., peer-reviewed

The main objective of the study is to present and analyze efforts to develop an expected credit loss model (ECl), and compare that to the subject (ASC 326) issued by the Financial Accounting Standards Board (FASB), and International Standard (IFRS 9) issued by the International Accounting Standards Board (IASB), and assessing the impact of the implications of Covid-19 on practical practice when applying (ECL), This topic acquires its importance through the continuous attention of accounting standards setters and stakeholders, The study used a method that combines extrapolation and deduction in addition to the descriptive approach in order to study the problematic topic and answer questions, and is represented , the most important results of the study are that the historical background associated with practical practices and the variation in interpretation and understanding of terms upon application have caused differences in the methodology for measuring credit losses between the international and American approaches, the study also found the occurrence of expected effects on the recognition and accounting measurement in general due to the repercussions of 19-Covid, and ECL methodologies in particular, the magnitude of this effect varies, depending on the efforts made by countries to control the epidemic.

Progressive cytopenia is a serious complication among paediatric patients with inherited bone marrow failure syndromes (IBMFS). Androgens have been used to improve blood counts in different bone marrow failure conditions. Little is known about efficacy and toxicity with new androgens (i.e., danazol) in different types of IBMFS. We identified 29 patients from the Canadian Inherited Marrow Failure Registry, who received oxymetholone or danazol. Sixteen (55%) had haematological response including patients with unclassified IBMFS (45%). Danazol showed a better toxicity profile and similar efficacy compared to oxymetholone. Androgens are an effective and safe option to ameliorate bone marrow failure in IBMFS.

This study explores the extent to which institutional pressures influence the adoption of environmental management accounting (EMA) within the Egyptian manufacturing companies through an institutional perspective that relies on the new institutional sociology theory. The study has conducted interviews with staff members in 18 Egyptian manufacturing companies (organizational level), and with other different actors (organizational-field level), influencing the adoption of EMA in Egyptian companies. The study finds that there is some influence of institutional pressures on EMA's adoption in Egyptian manufacturing companies. The study finds that coercive pressure has more influence on companies to adopt EMA than normative and mimetic pressures. The poor influence of Egyptian accounting professional associations and environmental institutions has weakened the impact of normative pressures. More investigation is needed regarding the political and socio-economic factors surrounding the adoption of EMA in Egyptian context through the multi-levels institutional perspective.

Background: Quality of life (QOL) assessment after radical cystectomy (RC) and urinary diversion (UD) is a crucial element of a fully evaluated patient-reported outcomes and gauging the impact and success of the diversion surgery. There has been long-standing interest in health-related quality of life (HRQOL) evaluation and research among patients who receive UD. Objective: To compare ureterocolic versus orthotopic neobladder (ONB) urinary diversions in terms of their QOL. Patient and method: This retrospective, multicenter study included 128 patients with muscle invasive bladder cancer (MIBC) who underwent RC and UD through the period from January 2011 to June 2016. The patients were divided into two groups: (ONB) 78 patients and uretrosigmoidostomy group 50 patients. HRQOL was evaluated with Functional Assessment of Cancer Therapy–Bladder Cancer (FACT-BL) Questionnaire, while Sexual Health Inventory for Men (SHIM) Questionnaire was used to assess the erectile function of males. Results: The mean patients’ age was 54.0 ± 7.9 years old in the ONB group and 57 ± 8.5 years old in ureterosigmoidostomy group. Patients in the ONB group were younger than those in the ureterosigmoidostomy group. There were diff erences in the physical, social and functional well-being that were significantly higher in patients in the ONB. Regarding the sexual function, there were significant differences between patients who underwent nerve sparing RC and non-nerve sparing RC. Conclusions: Findings suggest that patients with an ONB have marginal QOL advantages over ureterosigmoidostomy.

BACKGROUND Peripheral hematopoietic stem cell (HSC) collections are needed for autologous hematopoietic stem cell transplantation (HSCT). Since 2015, our institution has utilized a secondary chamber mononuclear cell (MNC) protocol on the Spectra Optia apheresis system. Recently, a new continuous mononuclear collection protocol (CMNC) was developed for the same device. As there is limited data available regarding the use of the CMNC protocol in children, we compared collection efficiency (CE2), side effects, and clinical feasibility between the two protocols in patients

The primary purpose of this study was to examine the relationship between oil revenues and government budget in Iraq for 2006-2016. The study found that, Iraq’s oil production curve in recent years has remarkably specified the positions, even if not mainly at the levels estimated earlier, as more positive forecasts. Iraq has developed to be the world’s fourth-largest oil exporter. This study confirmed that, the critical element for Iraq’s economy is that, the country depends on oil and 97% of the government revenues are from its oil exports. While challenges continue to achieve the aims of increased oil production, opportunity for Iraq’s resources to produce revenue and pay for broad-based economic development still exists.

Objective: to determine : The different types of gynecologic pelvic or pelvic abdominal masses necessitating surgical intervention associated with increased CA125 levels. The relation between initial level of CA125 and histopathological nature of the mass. In malignant cases: relation between preoperative CA125 level and stage of the tumor. After surgery: whether decline in increased CA125 level occurs 6 months after surgery or not. Methods: The study was conducted during a period from April 2017 to April 2018. . IBM-SPSS ( version 24) was used for statistical data analysis. Results: The mean age of the study group was 44±11 years, with a range of 17-67 years.The most common surgical problem of our study group was myoma, present in 22 cases (37.3%). This was followed by simple serous cyst and endometrial carcinoma (8 cases each, 13.6%), then endometriotic cyst and mature cystic teratoma (6 cases each, 10.2%), then ovarian fibroma, ovarian cancer and endometrial hyperplasia (5 cases each, 8.5%), adenomyosis (3 cases, 5.1%) and lastly mucinous cystadenoma (one case, 1.7%).The mean CA125 of our study group had a mean of 38.6 U/ml, with a very high standard deviation of over 59 U/ml; reflected in the very wide range from 4.5 up to 446 U/ml.The highest mean level of CA125 was seen among patients with ovarian cancer (160.6 U/ml). This was followed by ovarian fibroma (57.5 U/ml), then adenomyosis (42.7 U/ml), endometriotic cyst (42.6 U/ml), simple serous cyst (22.2 U/ml), mucinous cystadenoma (22 U/ml), myoma (21.9 U/ml), endometrial carcinoma (20.2 U/ml) and lastly endometrial hyperplasia (17.6 U/ml).CA 125 level was normal in all cases of myoma, dermoid cyst, simple serous cyst, mucinous cystadenoma, endometrial hyperplasia, and endometrial carcinoma.CA125 elevated in all cases of ovarian cancer, endometriotic cyst, adenomyosis and elevated in 60% in cases of ovarian fibroma. Most cases of ovarian cancer (80%) had marked elevation in CA125 level (level >100 U/ml ) and the increase in CA125 level was more marked with increase staging of the cancer , all cases of endometriotic cyst had mild to moderate elevation in CA125 level which were > 100 U/ml , all cases of adenomyosis had mild elevation in CA125level which not more than 50 U/ ml, in cases of ovarian fibroma CA125 level were normal in about 40% of the cases and elevated in about 60% of the cases (40% had moderate elevation in CA125 level which was> 100 U/ml and 20% had marked elevation with CA125 level 100 U/ml). It helps in the differential diagnosis between endometriotic cysts (elevated CA125 level ) and hemorrhagic ovarian and dermoid cysts (normal CA125 level ).It also helps in the differential diagnosis between uterine fibroids and adenomyosis being elevated in the latter.CA125 serum level can suggest the stage of ovarian cancer. In cases with elevated preoperative CA125 levels, it is expected that this level will normalize within 6 months postoperatively.

BACKGROUND Despite the wide therapeutic options available for the treatment of melasma, including many active topical medications, technologies with lights and peelings, clinical control of this disorder is extremely challenging. OBJECTIVES To evaluate the effect of microneedling with topical vitamin C in the treatment of melasma. METHODS Thirty female patients with melasma received six sessions of microneedling with addition of topical vitamin C every two weeks. At each session, photos were taken and Melasma Area and Severity Index (MASI) score was calculated to assess the clinical improvement. RESULTS Mean age of the eligible patients was 33.2 ± 5.77 years. About 50% of cases were of Fitzpatrick skin type III. All patients showed improvement at the end of the sessions. Mean MASI score in the first session was 8.61 ± 4.45 and there was a gradual decline in its value till it reached a mean of 5.75 ± 4.16 in the last session (P

Rectovaginal colonization with group B streptococcus (GBS) is commonly encountered in pregnancy. GBS is the most common cause of early onset neonatal sepsis, which is associated with 12% case-fatality rate. Although screening protocols and prophylactic treatment are readily available worldwide, practice in low-resource countries is challenged by lack of awareness and limited implementation of these protocols. In addition, antibiotic susceptibility pattern may vary globally owing to different regulations of antibiotic prescription or prevalence of certain bacterial serotypes. This guideline appraises current evidence on screening and management of GBS colonization in pregnancy particularly in low-resource settings.

The current study aims to determine the critical success factors CSFs that support the sustainability of higher education institutions in the Kingdom of Bahrain, by attempting to identify a number of these factors that fit the environmental context in the Bahraini society. Consequently, critical success factors were addressed in higher education institutions in several environmental contexts, and the study ended up with identifying the critical factors that support the academic institutions effectiveness and success sustainability. Through reviewing project management literature, we concluded that there is no fixed CSF prescription that is valid, and suitable for all academic institutions in all times. The reason for this argument is that contextual and situational ramifications are the determinants of validity and suitability of CFSs. Finally, through the self-experience of the authors as they are currently active members in three different academic settings in the Bahraini context (i.e. Public, Private and foreign universities), the general situation of CSFs and the degree of availability for of them were diagnosed. From this investigation we suggest that some of the CSFs are currently found in the Bahraini academic institutions and some sub-factors of CSFs need more improvements to support and maintain the sustainability of these academic institution’s success.

The concern of this paper is exploratory. It investigates how the emergence of COVID-19 pandemic raise many risks in the global supply chain resilience and viability. Through archival research we were able to depict how COVID-19 impacted the global supply chain in general and kingdom of Bahrain in specific. We concluded that kingdom of Bahrain was successful in terms of agility and resilience of its supply chain. However, there is a need for more case studies that concentrate on the real mundane practices related to this resilience, and more research is needed to sustain this viability in the Bahraini supply chain. The novelty of this research is the creation of a holistic review of the impact of COVID-19 on supply chain management. Through explaining the resilience, agility, sustainability and viability of supply chains and the questions raised in this emerging market this paper could be a valuable resource for future researchers to seek solutions to supply chain management in pandemic and epidemic times. This work would also be on interest to practitioners from the GCC and other less developed countries in their thinking about facing the pandemic risks and building viable sustainable supply chains.

Health informatics has led to many changes in the health service delivery system. Awareness of health informatics is important and crucial to modern physicians. In general today there is a lack of awareness and understanding of health informatics among officials. Most of the institutions in the current environment have no idea about health informatics and its development. The objective of this study is to measure the health informatics awareness of healthcare providers (Staff) in Benghazi Medical Center. The study was an exploratory descriptive cross-sectional study targeted health care providers. The sample size distributed was one hundred forty. The tool was a questionnaire, and analytical (Frequency tables were used to summarize data. Mean and Standard Deviation. Custom Tables) statistics with the help of SPSS 2.7 software. The mean of awareness level was 12.9 (SD=3.1) and 72% did not receive training in health informatics. The majority of respondents from healthcare Providers between the age of 30-39 (53%, n=70) years with a mean of 34.5 years. Besides that, the average awareness among females was higher than that of males by 35%. The rate of awareness based on the type of profession was also at the level of the average among doctors by 22.7% and 12.2% for nurses and much less number for other categories. In conclusion, the study showed that health care providers' awareness of health informatics was not satisfactory and more than half of respondents had an average awareness. A large proportion of health service providers did not receive training on health informatics.

Background Hemophagocytic lymphohistiocytosis (HLH), a rare hyperinflammatory immuneregulatory disorder, is a challenge in hematopoietic stem cell transplantation (HSCT) because of the high rate of mixed chimerism, relapse, and graft failure (GF) unless intensive myeloablative regimens are used. However, historically conventional myeloablative regimens (conv MA) are associated with high toxicity and mortality. Procedure We retrospectively compared transplant outcomes between three preparative regimens of varying intensities: Conv MA (n = 15), reduced-intensity conditioning (RIC, n = 12), and a treosulfan-based reduced-toxicity conditioning (RTC, n = 9). Results Patients in the RIC cohort had a higher incidence of mixed donor chimerism and five patients (42%) developed secondary GF (P = .002) compared to the other two regimens. There was a higher incidence of veno-occlusive disease and intensive care unit (ICU) admissions in the Conv MA cohort. With the RTC regimen, there was a similar 2-year overall survival (89, 73, and 83%; P = .87), but improved compound EFS (lack of relapse, GF, second transplant or additional donor cell infusions, or death; 89, 73, and 42%, P = .041) in RTC, Conv MA, and RIC regimen, respectively. Conclusions The intensity of the preparative regimen has a significant impact on outcome of HSCT for HLH. The newly described treosulfan-based RTC provides for a stable graft with a reasonable toxicity profile.

Isolated neuroinflammatory disease has been described in case reports of familial hemophagocytic lymphohistiocytosis (FHL), but the clinical spectrum of disease manifestations, response to therapy and prognosis remain poorly defined. We combined an international survey with a literature search to identify FHL patients with (i) initial presentation with isolated neurological symptoms; (ii) absence of cytopenia and splenomegaly at presentation; and (iii) systemic HLH features no earlier than 3 months after neurological presentation. Thirty-eight (20 unreported) patients were identified with initial diagnoses including acute demyelinating encephalopathy, leukoencephalopathy, CNS vasculitis, multiple sclerosis, and encephalitis. Median age at presentation was 6.5 years, most commonly with ataxia/gait disturbance (75%) and seizures (53%). Diffuse multifocal white matter changes (79%) and cerebellar involvement (61%) were common MRI findings. CSF cell count and protein were increased in 22/29 and 15/29 patients, respectively. Fourteen patients progressed to systemic inflammatory disease fulfilling HLH-2004 criteria at a mean of 36.9 months after initial neurological presentation. Mutations were detected in PRF1 in 23 patients (61%), RAB27A in 10 (26%), UNC13D in 3 (8%), LYST in 1 (3%), and STXBP2 in 1 (3%) with a mean interval to diagnosis of 28.3 months. Among 19 patients who underwent HSCT, 11 neurologically improved, 4 were stable, one relapsed, and 3 died. Among 14 non-transplanted patients, only 3 improved or had stable disease, one relapsed, and 10 died. Isolated CNS-HLH is a rare and often overlooked cause of inflammatory brain disease. HLH-directed therapy followed by HSCT seems to improve survival and outcome.

The New Valley Governorate is one of the largest governorates in Egypt with an area of about 4400 km2, equivalent to 44% of the total area of the Arab Republic of Egypt and 66% of the Western Sahara. The groundwater is the only available water resource for all purposes (drinking, industry, agriculture). The agricultural sector is considered to be the most important productive sector in the economic structure of the governorate. Due to the importance of the wheat crop as a strategic crop used in human food, it is considered a source of animal nutrition. It is one of the most important field crops cultivated in the governorate. The area is about 158.8 thousand feddans in the 2015/2016 season. Of the total area cultivated with winter field crops. The problem of research was that although the New Valley Governorate is characterized by the availability of arable land of about 3.3 million feddans, of which about 158.8 thousand feddans are actually cultivated, In addition to the use of traditional irrigation methods and the consequent depletion of this resource. In addition, the main factor in agricultural exploitation was the water and not the land, which led to a decrease in the quantity of irrigated crops for arable crops. The research aimed at shedding light on the economics of wheat production in the New Valley governorate as one of the most important for field crops and maintain that using deep groundwater and surface using modern and traditional irrigation methods, and by studying the effect of different groundwater source and method of irrigation on the efficiency of the use of indicators alone water for the cultivation of this crop. The results of the research showed that the quantity of the main output of the wheat crop reached a maximum of 16.77 ardab. Irrigation in surface wells (spraying) while the irrigation system in the two wells together(irrigation by flooding) reached 12.15 ardab. The secondary yield of the wheat crop was the lowest in the Irrigation in surface wells (spraying irrigation) 9.88 load, while the surface irrigation system (Irrigation by flooding) was about 5.65 load. As a result, there were statistically significant differences in irrigation water unit productivity, net revenue from water unit, irrigation unit cost, To produce the output unit, the ratio of irrigation costs to total costs, where a Wheat cultivation using surface wells (spraying irrigation) came first in terms of productivity of the water unit, while wheat cultivation using deep wells (irrigation by flooding) came in first place in terms of net revenue from the water unit, and wheat cultivation using the two wells together (Irrigation by flooding) was ranked first in terms of the cost of irrigating the production unit. In terms of quantity of water needed to produce the output unit, wheat cultivation using both wells (irrigation by flooding) came first, while wheat cultivation using both wells the first place in terms of proportion of the cost in irrigation for total costs.

Background and study aim: Egypt is one of the highest prevalence of antibodies to hepatitis C virus (HCV) in the world, estimated nationally at 6.3%. Applying best treatment protocol has a great impact on the national disease burden. DAAs open the door to decrease HCV prevalence as well as to treat infected subjects. Patients and Methods: In this study 1000 patients treated by Pegylated interferon, Sofosbuvir and weight adjusted Ribavirin. Another group of 1000 patients treated by Sofosbuvir and weight adjusted Ribavirin. Results: Two groups showed sustained virological response : 90.1% and 72.3% respectively. Both groups approved that previous treatment status and viral load has no impact on response prediction. Both showed that males are more likely to respond than females. Conclusion: Addition of Direct Acting Antivirals (DAAs), like sofosbovir, to the standard treatment with interferon and ribavirin improved the duration of the treatment and the sustained virological response (SVR). Treating of cirrhotics byPEGINF+SOF+RBV and SOF+RBV leads to decrease success rates. Validation of SVR once will be a golden rule.

Background: Inflammatory bowel diseases (IBD) including ulcerative colitis (UC) and Crohn's disease (CD) are organic inflammatory diseases, caused by chronic mucosal inflammation of the gasrtointetinal tract. As the presenting manifestations of IBD and other diseases are similar, obtaining a clinical diagnosis can be difficult, and further invasive diagnostic procedures may be required in order to obtain a confirmed diagnosis. The aim of this study is to evaluate the diagnostic utility of measuring fecal concentrations of lactoferrin as a simple and noninvasive indicator of disease activity in patients IBD and to be correlated with endoscopic findings and disease activity index and acute inflammatory response including leucocytic count, high sensitive CRP, ESR. Methods: This study was carried on 40 patients with IBD; 24 patients with active IBD (16 UC patients and8 CD patients) and 16 patients with inactive IBD (10 UC patients and 6 CD patients) versus 40 healthy controls. All patients underwent blood and stool sampling as well as an interview to assess the disease severity utilizing UC activity measured by the Truelove and Witts Severity Index and Crohn's Disease Activity Index. Measurement of FLA levels at different stages of inflammatory bowel disease activity to detect its role in assessment of disease severity. Results: This study showed that FLA levels were highest in patients with IBD in comparison with healthy group. FLA levels also correlated significantly with disease severity in patients with IBD where higher levels of FLA were found in patients with severe UC or Crohn`s disease. At cutoff value 9.68 ug/ml FLA showed 100% sensitivity and specificity in identification of patients with IBD from healthy subjects. Conclusions: FLA is a sensitive and specific biochemical marker of inflammation for use in the diagnosis of suspected IBD cases, and its level correlates well with both clinical disease activity indices.

Children with acute myeloid leukemia (AML) are at high risk of life-threatening bacterial and fungal infection. However, little is known about the prevalence or severity of adenovirus infection in this population. Objective was to describe the characteristics, treatments and outcomes of adenovirus infection in children with newly diagnosed AML.We performed a retrospective chart review based upon 2 multicenter cohort studies that focused on identifying risk factors for infection in children with AML. Inclusion criteria were patients with de novo AML who were ≤18 years of age at diagnosis with a clinical specimen positive for adenovirus.Among the 235 patients with AML, 12 (5.1%) had positive adenovirus testing. The most common site of isolation was stool (n = 11, 91.6 %), and the most frequent symptom was diarrhea (n = 11, 91.6 %). Two patients received specific treatment for adenovirus, namely intravenous immunoglobulin only in 1 patient and both intravenous immunoglobulin and inhaled ribavirin in a second patient. In 11 patients, adenovirus resolved uneventfully without recurrence, including 10 that received no adenovirus-specific therapy. However, 1 patient developed sepsis syndrome in the setting of disseminated adenoviral infection and died from multiorgan failure.In children with AML, adenovirus infection was rare and typically not associated with severe disease, even without specific treatment. However, disseminated and fatal disease can occur in this population. Further investigations are needed to identify pediatric AML patients at particular risk for severe adenovirus infection and to determine optimal treatment approaches in these patients.

Primary immunodeficiency disorders represent a heterogeneous spectrum of diseases, predisposing to recurrent infections, allergy, and autoimmunity. While an association between primary immunodeficiency disorders and increased risk of cancer has been suggested since the 1970s, renewed attention has been given to this topic in the last decade, largely in light of the availability of large registries as well as advances in next generation sequencing. In this narrative review, we will give an insight of the primary immunodeficiencies that are commonly responsible for the greater number of cancers in the primary immunodeficiency disorders population. We will describe clinical presentations, underlying genetic lesions (if known), molecular mechanisms for carcinogenesis, as well as some management considerations. We will also comment on the future directions and challenges related to this topic.Conclusion: The awareness of the association between several primary immunodeficiencies and cancer is crucial to provide the best care for these patients.What is Known: • Patients with primary immunodeficiency have an increased risk of malignancy. The type of malignancy is highly dependent on the specific primary immunodeficiency disorder.What is New: • Survival in patients with primary immunodeficiency disorders has been improving, and conversely also their lifetime risk of malignancy. • International collaboration and multinational registries are needed to improve our knowledge and therapeutic strategies.

EBV-associated PTLD following allogeneic HSCT is a serious complication associated with significant mortality. In this retrospective study, we evaluated whether lymphocyte subset numbers and CD8:CD20 ratio at time of EBV viremia in children undergoing allogeneic HSCT could predict development of PTLD. Absolute lymphocyte count, lymphocyte subsets, and CD8:CD20 ratio at the time of EBV viremia were analyzed. Patients who were treated preemptively with rituximab for high blood EBV viral load were excluded. Out of 266 patients transplanted during the study period, 26 patients were included in the analysis. Patients were divided into two cohorts; cohort 1 included patients with EBV-associated PTLD (n = 5; four with proven, one with probable PTLD). Cohort 2 included patients with EBV viremia without PTLD (n = 21). Lymphocyte recovery was slower in the PTLD group. CD8:CD20 ratio was significantly lower in the PTLD group (median 0.15) compared to the non-PTLD group (median 2.4, P = .012). Using the ROC curve and 1 as the cutoff value, CD8:CD20 ratios were analyzed. In the PTLD group, 4/5 patients (80%) had a ratio1 whereas in the non-PTLD group, all 21 patients had a ratio1. Sensitivity and specificity were 80% and 100%, respectively. Negative and PPVs were 95% and 100%, respectively. Profoundly low T-cell count and CD8:CD20 ratio may be used to predict development of PTLD in the context of EBV viremia in children post-allogeneic HSCT. Further studies are needed to validate this finding.

Osteoarthritis (OA) is a multifactorial and progressive disease affecting whole synovial joint. The extract pathogenic mechanisms and diagnostic biomarkers of OA remain unclear. In this article, we review the studies related to metabolomics of OA, discuss the biomarkers as a tool for early OA diagnosis. Furthermore, we examine the major studies on the application of metabolomics methodology in the complex context of OA and create a bridge from findings in basic science to their clinical utility. Recently, the tissue metabolomics signature permits a view into transitional phases between the healthy and OA joint. Both nuclear magnetic resonance spectroscopy (NMR) and mass spectrometry-based metabolomics approaches have been used to interrogate the metabolic alterations that may indicate the complex progression of OA. Specifically, studies on alterations pertaining to lipids, glucose, and amino acid metabolism have aided in the understanding of the complex pathogenesis of OA. The discovery of identified metabolites could be important for diagnosis and staging of OA, as well as for the assessment of efficacy of new drugs.

Human adenovirus (HAdV) is recognized as a serious pathogen after allogeneic hematopoietic stem cell transplantation (HSCT), causing morbidity and mortality. Currently, there is no universal agreement regarding routine HAdV surveillance after HSCT. We assessed the impact of HAdV weekly monitoring by polymerase chain reaction (PCR) on HAdV viremia rates and the risk factors that influence survival. Three-hundred and fifty-six pediatric allogeneic HSCT were done between 2007 and 2015. Until July 2011, HAdV testing was performed based on clinical suspicion (cohort 1, n = 175) and from August 2011, weekly blood-HAdV monitoring was done (cohort 2, n = 181) until day +100. Twenty-three patients (4 [2.3%] from cohort 1 and 19 [10.5%] from cohort 2, p = .001) were found with HAdV viremia and seven of them died. Both cohorts had a similar incidence of HAdV-associated mortality (3/175; 1.7% in cohort 1 and 4/181; 2.2% in cohort 2). Respiratory failure was the cause of death in all patients. Clinical symptoms appeared prior to or within 5 days of HAdV detection in cohort 2. In summary, weekly monitoring was associated with higher detection of HAdV. The study could not assess survival benefit due to small numbers of HAdV-positive cases. In many instances, symptoms occurred with the development of positive HAdV blood PCR results and hence, symptomatology could have triggered the test. Future studies are needed to provide data that help establishing a uniform approach for regular monitoring of HAdV post-transplant.

Advanced myelodysplastic syndrome harbors a high risk of progression to acute myeloid leukemia and poor prognosis. In children, there is no established treatment to prevent or delay progression to leukemia prior to hematopoietic stem cell transplantation. Azacitidine is a hypomethylating agent, which was shown to slow progression to leukemia in adults with myelodysplastic syndrome. There is little data on the efficacy of azacitidine in children. We reviewed 22 pediatric patients with advanced myelodysplastic syndrome from a single center, diagnosed between January 2000 and December 2015. Of those, eight patients received off-label azacitidine before hematopoietic stem cell transplantation. A total of 31 cycles were administered and modification or delay occurred in four of them due to cytopenias, infection, nausea/vomiting, and transient renal impairment. Bone marrow blast percentages in azacitidine-treated patients decreased significantly from a median of 15% (range 9–31%) at the start of treatment to 5.5% (0–12%, P=0.02) before hematopoietic stem cell transplantation. Following azacitidine treatment, four patients (50%) achieved marrow remission, and none progressed. In contrast, three untreated patients (21.4%) had progressive disease characterized by >50% increase in blast counts or progression to leukemia. Azacitidine-treated patients had significantly increased 4-year event-free survival (P=0.04); predicted 4-year overall survival was 100% versus 69.3% in untreated patients (P=0.1). In summary, azacitidine treatment prior to hematopoietic stem cell transplantation was well tolerated in pediatric patients with advanced myelodysplastic syndrome, led to partial or complete bone marrow response in seven of eight patients (87.5%), and correlated with superior event-free survival in this cohort.

This article is a review, from a Saudi Arabian perspective, of selected historical Arabic books and recent medicolegal journal articles on 4 current controversial issues: medical ethics, forensic autopsies, end-of-life decisions, and genetic profiling. This article demonstrates the flexibility of the Islamic medical jurisprudence to accommodate medicolegal issues.

Doxorubicin is a commonly used anticancer agent, which may cause cardiac toxicity. The present study designed to evaluate Phoenix dactylofera (dates) in doxorubicin (DXR) induced cardiac toxicity and cardiac remodeling in Wistar albino rats. The experimental rats procured, acclimatized and finally divided into five groups (n = 6). Group I served as normal controls, group II served as disease controls and groups 3, 4 & 5 served as therapeutic groups (Phoenix dactylofera 5%, 10%, and 15% respectively). Cardiac remodeling and toxicity in the rats were induced by administration of DXR (1.25 mg/kg i.p. in 16 divided doses/month). At the end of protocol, effect of Phoenix dactylofera on cardiac remodeling was evaluated by measuring parameters like haemodynamics, heart weight, anatomy, Troponin T, creatine phosphokinase (CPK), creatine phosphokinase-MB (CPK-MB), Lactate dehydrogenase (LDH), serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), calcium ion Ca2+, sodium ion Na+, potassium ion K+, intracellular enzymes like Malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT). The disease control groups showed significantly elevated (p dactylofera significantly (p 2+, Na+, K+ levels to a normal value. Further, the histological studies of the cardiac tissues demonstrated that the normal architecture of the cardiac cells was restored in the animals fed with dietary Phoenix dactylofera as compared to disease controls. The findings show that the administration of Phoenix dactylofera has the potential to prevent the toxicity induced by doxorubicin in the experimental rats.

Context: Clinicians face one of the most common bacterial infections in developing countries that is urinary tract infection (UTI). Current knowledge on antimicrobial susceptibility pattern is essential for selecting appropriate therapy. Aims: In this study, we investigated the various bacteria causing UTI and determined the sensitivity and resistance of antibiotics pattern against most prevalent uropathogens isolated from patients at tertiary hospital, Al-Baha, Saudi Arabia. Settings and Design: This was a retrospective study of urine culture conducted in King Fahad Hospital at Al-Baha in Saudi Arabia. Materials and Methods: Laboratory reports and patient medical files of both inpatient and outpatient were collected between June 2017 and May 2018, targeting both male and female of age above 18 years of age, who had been treated for UTI. Results: A total of 349 patients’ urine report was studied to identify the uropathogens. Escherichia coli was the main etiologic agent in community and hospital-acquired infections. The majority of the bacteria was isolated from female (60%), whereas the remaining (40%) was from male. The most common isolates were E. coli, Klebsiella pneumoniae, Enterococcus faecalis, E. coli Extended spectrum beta-lactamases, Pseudomonas, and K. pneumoniae ESBL (these represented 37.82%, 19.20%, 10.89%, 10.32%, 6.59%, and 3.72%, of isolate, respectively). UTI due to E. coli was at a higher rate during summer than during winter. This study showed that ciprofloxacin (20.29%) and cefuroxime (16.14%) are most prescribed medications, followed by ceftriaxone (12.96%) and then tazocin (8.80%). Imipenem, meropenem, amikacin, vancomycin, tigecycline, linezolid, and colistin were highly sensitive for most types of bacteria, but gram-negative bacteria were highly resistant to ampicillin. Gram-positive bacteria showed highly resistance to cefoxitin. Conclusion: The microbial culture and sensitivity of the isolates from urine samples should be carried out as a routine before starting the antimicrobial therapy. Current knowledge of the antibiotic sensitivity/resistance patterns of uropathogens at a particular geographical region is a guiding factor for choosing an appropriate empirical antimicrobial treatment rather than following universal guidelines.

Radionuclide imaging is an integral part of functional evaluation of thyroid diseases. This study aimed to study thyroid abnormalities using scintigraphy, The study population consisted of 173(149 female and 24 male) patients with thyroid abnormalities, and referred to Nuclear Medicine, Fujairah hospital for thyroid scintigraphy during the period from Jan 10, 2016 to June 30 , 2018 . All patients Thyroid function test were done before coming to radiology department. The mean age of patients was 38 years. The results of this study revealed that thyroid nuclear medicine scan findings as normal in 6.4 % (16 patients) and abnormal in 91% (157 patients) , Autonomous Nodule 2 (1.1),nodular goiter- NTG , TNG 30 (17.3%),Goiter11(6.4%),Grave disease13(7.5%), Multinodular goiter 43(24.8%), Thyroiditis 20 (11), Thyroid nodule 2 (1.1), Toxic multinodular goiter 21 ,Toxic goiter 15 (8.7%), Normal 16 (9.2%). This study concluded that radionuclide methods are complementary and provide information that can help in the appropriate management of various thyroid diseases.

The current research deals with the specificity of the interior design of the classes of art education in the schools of excellence for the province of Muthanna and its center of the city of Samawah. In the first chapter، the problem of research was determined by the lack of internal spaces of the classes of art education to designs that meet the requirements and needs of students in these educational stages. The importance of the research in being an addition to knowledge in the field of interior design and engineering department of the general directorates of the Ministry of Education. The objectives of the research were determined through. Identifying the reality of the halls of art education for schools of excellence. Detecting design privacy in the classes of art education for the schools of excellence. The second chapter included the theoretical framework of the research by shedding light on the theoretical aspects that are directly related to the subject of the research. The first topic dealt with the concept of privacy، while the second topic dealt with internal space، elements، color، light، furniture، decorative elements، and indicators. The research and its procedures by defining the descriptive approach in the analysis of the samples and the research community. The sample of the research was for two schools in the city of Samawah for distinguished persons in order to arrive at the research objectives clearly. The most important results were reached: The nature of the interior space of the spaces The aesthetic design is not achieved due to its lack of bright colors that suit the age of the students and the extent of their interest، as well as the lack of safety and safety due to the lack of ground floor or other material which also helps to absorb noise، The conclusions are summarized as follows: The development of the construction technology in the materials has contributed to the effective realization of the privacy of the design of educational spaces through new forms different from the previous space.

Purpose To calculate the frequencies of incidental extraspinal findings and incidentally detected congenital anomalies or anatomical differences in the lumbar spine on magnetic resonance imaging (MRI) scans of intervertebral discs. Materials and methods A total of 379 lumbar spine MRI cases were prospectively investigated in the period spanning from August 2016 to January 2018. Both 1.5 and 0.35 Tesla MRI units (Toshiba and Siemens Medical Systems) were used to examine patients with clinically suspected intervertebral disc abnormalities at three MRI diagnostic centers in Khartoum State, Sudan. Results Of the 379(100%) patients, 90(23.7%) patients were presented with incidental findings. Among the incidental findings, 39(10.3%) were renal cysts, 10(2.6%) were retroverted uteri, 5(1.3%) were Nabothian cysts, 4(1.1%) were ovarian cysts, 10(2.6%) were uterine fibroids, 3(0.8%) were endometrial thickening, 11(2.9%) were indicative of hydronephrosis, 4(1.1%) were uncovered prostatic enlargement, 2(0.5%) were atrophic kidney, and 1(0.3%) each was of an ectopic kidney and bladder wall thickening, respectively. Conclusions A high percentage of extraspinal pathological findings were detected during MRI lumbar spine scans of intervertebral discs. Thus, it is important to be aware of the high percentage of patients who undergo further evaluation given the presence of unexpected findings, but for whom clinical confirmation of these abnormalities is not obtained.

Among 235 children with acute myeloid leukemia, 17 experienced 19 perianal infections. Among 12 episodes with definite abscess, 75% were severely neutropenic. Sixteen diagnostic imaging evaluations were performed; diagnostic yield was similar between computerized tomography of pelvis (5 of 10) and ultrasound (3 of 5). Consistent management approaches to perianal infection should be developed.

The objective of this study was to analyze the anticipated effects of the application of the International Financial Reporting Standard (IFRS9), which replaced the International Standard ( IAS 39), on the Arab banks. The obligatory application of the new standard will take place on the beginning of 2018. The application requirements of this standard constitute a great challenge to the Arab banks, in the fields of credits, finance and the banking and accounting systems. The study represented the International Financial Reporting Standard (IFRS 9) and the requirements of classification and measurement of the obligations, with special focus on the differences between the two standards. The study as well, focused on the challenges which face the standard application and the effect of this application on the banking system, with special focus on the expected credits loss (ECL). The study represented examples of some Arab banks experiences and evaluated these experiences. The study has come out with some results, including that the change of the (ECL) model will create some impediments on the credit and finance policies of the Arab banks, whereas the standard (IFRS9) will strengthen the shareholders and depositors trust, because it adopts a perceptional policy which avoids the expected loss which, in turn, reduces the liquidity risk and the failure of the obligations payment. The study also proposed some recommendations.

Identifying children's risk exposure is the first step toward mortality prevention. This retrospective study determined the causes of child fatalities in Dammam, Saudi Arabia. Death reports of children and adolescents from 1999 to 2015 (N = 157) were analyzed. Boys represented most cases (69%) and there were two age peaks (1–5 years and 16–18 years). Accidents (typically immersion) defined the main death circumstance (51%) followed by homicide (25%). Only 33% of cases underwent autopsy, and the most common cause of death was head injury (27%) followed by firearm injury. Only one immersion death underwent autopsy. This study revealed important data about the risk exposure of children in Dammam and emphasizes deficient investigative procedures. Child fatality reviews comprise systematic data collection by multidisciplinary teams to determine the true risks toward children in a community. Such teams do not exist in Arab countries; therefore, strategies should be implemented to initiate them.

Wiskott-Aldrich syndrome (WAS) is an X-linked disease characterized by microthrombocytopenia, eczema, immune deficiency, and autoimmune phenomena. Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative treatment. Myeloablative conditioning is the most common regimen used for HSCT in patients with WAS to avoid the risk of mixed donor chimerism and autoimmunity post-HSCT. There is limited data on the use of reduced intensity conditioning for HSCT in patients with WAS. Here, we report a case with severe phenotype of WAS transplanted successfully with reduced intensity conditioning, which is an acceptable conditioning regimen and can be considered in patients with WAS with significantly impaired organ functions.

Background: Psoriasis affects 0.5-0.7% of Iraqi people making it one of the significant dermatological problems. Despite the extent of this problem, little information regarding its epidemiology is available in this country. Objectives: To define the socio-demographic and clinical characteristics of psoriatic patients attended dermatology clinics in the four major governmental hospitals in Mosul city. Patients and methods: Study setting: Dermatology clinics in the 4 major governmental hospitals (Al- Jamhouri, Ibn Sina, Al-Salam, and Al- Mosul) in Mosul. Study design: Cross-sectional study. Study period: 1 st October 2101 to 25 th of February 2011. Participants: Patients with psoriasis of both sexes, and all ages, who attended the dermatological clinics. Each patient was subjected to detailed history and clinical examination. Data collection form included various demographic and clinical characteristics. Results: The sample of the study included 154 patients with psoriasis, comprising 50.6% males ranging in age from 3-62 years. The mean age±SD at presentation was 30.2±15.1 years; the mean age±SD at onset was 22.8±12.0 years. The mean duration of the illness was 7.4 years. A unimodal distribution curve of age at onset was noticed with a peak at the third decade. Early onset of psoriasis before 30 years was significantly associated with family history. Severity of psoriasis was mild in 74 (48.1%) of cases and it was more severe in elderly with longstanding disease. Itching and disfigurement were the main complaints especially the young and female patients. Plaque type (64.9%) was the most common variant, arms (52.6%) were the most commonly affected body site, and the scalp (27.9%) was the most common initial site affected by psoriasis. Nail involvement was seen in 30 (19.5%) patients especially fingernails. Conclusions and recommendation: The study revealed that psoriasis is a heterogeneous disease affecting all ages, genders and socio-economic strata. Further researches to study the relationship and the impact of these characteristics on the life of sufferers is recommended.

In this paper, novel virtual instrumentation based systems for real-time collision-free path planning and tracking control of mobile robots are proposed. The developed virtual instruments are computationally simple and efficient in comparison to other approaches, which act as a new soft-computing platform to implement a biologically-inspired neural network. This neural network is topologically arranged with only local lateral connections among neurons. The dynamics of each neuron is described by a shunting equation with both excitatory and inhibitory connections. The neural network requires no off-line training or on-line learning, which is capable of planning a comfortable trajectory to the target without suffering from neither the too close nor the too far problems. LabVIEW is chosen as the software platform to build the proposed virtual instrumentation systems, as it is one of the most important industrial platforms. We take the initiative to develop the first neuro-dynamic application in LabVIEW. The developed virtual instruments could be easily used as educational and research tools for studying various robot path planning and tracking situations that could be easily understood and analyzed step by step. The effectiveness and efficiency of the developed virtual instruments are demonstrated through simulation and comparison studies.

EBV-related PTLD developing after HSCT is a potentially life-threatening disease. HLH is uncommon after allogeneic HSCT. Data on outcome of patients with PTLD and concomitant HLH after allogeneic HSCT are limited. In this retrospective study, we collected demographic, clinical, laboratory, and outcome data for 408 patients who underwent allogeneic HSCT from 2006 to 2015. Graft source included CB (n = 135; 33.1%), PBSCs (n = 34; 8.3%), and BM (n = 239; 58.6%). Eight out of 408 patients (2%) developed EBV-PTLD with a median age at HSCT of 5.9 years (range: 2.3-17.3). All eight patients received ATG as part of the conditioning regimen. Graft source was PBSC in three patients (37.5%), BM in four patients (50%), and CB in one patient (12.5%). Donors were matched unrelated in five patients (62.5%) and matched sibling in three patients (37.5%). Seven out of eight patients developed EBV-PTLD within the first 100-day post-HSCT. Lymph node biopsy revealed early lesions in three patients, polymorphic in three patients, and monomorphic PTLD in two patients. Three patients (37.5%) died within 1 month of EBV-PTLD diagnosis. All deceased patients developed HLH manifestations with two of them meeting HLH diagnostic criteria and one having an incomplete workup. PTLD after allogeneic HSCT with manifestations of HLH is associated with high mortality. Early identification and treatment of EBV-PTLD seems imperative to control the disease, especially if signs of HLH are evolving.