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Being the basis on which several languages of the world are built, the historical relevance of the basic Arabic characters cannot be overemphasized. Unique in its many similar characters which are only distinguishable by dots, Arabic character recognition and classification has witnessed notable increase in research in recent times, particularly using machine learning-based approaches. However, little or no research exists on automatic generation of handwritten Arabic characters. Besides, the available databases of labeled handwritten Arabic characters are limited. Motivated by this open area of research, we propose a Conditional Deep Convolutional Generative Adversarial Networks (CDCGAN) for a guided generation of isolated handwritten Arabic characters. Experimental findings based on qualitative and quantitative results show that CDCGAN produce synthetic handwritten Arabic characters that are comparable to the ground truth, given a mean multiscale structural similarity (MS-SSIM) score of 0.635 as against 0.614 in the real samples. Comparison with handwritten English alphabets generation task further shows the capability of CDCGAN in generating diverse yet high-quality images of handwritten Arabic characters despite their inherent complexity. Additionally, machine learning efficacy test using CDCGAN-generated samples shows impressive performance with about 10% performance gap between real and generated handwritten Arabic characters.

Background Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS). Aberrant expression of transcription factor forkhead box P3 (FoxP3) has been suggested to underlie different immunological disorders as FOXP3 expression is essential for T regulatory cells (Tregs) to maintain their suppressive and anti-inflammatory functions and exert immunologic self-tolerance. Interleukin-35 (IL-35) is an important immunosuppressive cytokine that is produced mainly by CD4+ FOXP3+ Tregs. Objectives To assess the possible role of the FOXP3 rs3761548 (C/A) single-nucleotide variation (SNV) in relapsing-remitting multiple sclerosis (RRMS). Also, measurement of the serum IL-35 concentration and study its relation to different genotypes and the degree of disease-related disability. Methods A total of 100 RRMS patients and 90 healthy control subjects were subjected to genotyping for the FOXP3 (rs3761548) variant by TaqMan real-time PCR, and measurement of the IL-35 level in their sera by Elisa. Results The frequencies of the AA genotype and A allele were significantly higher in the MS patients than in the healthy controls (P = 0.008, OR = 2.53, 95% CI = 1.27–5.04; P = 0.001, OR = 1.98, 95% CI = 1.31–3.00, respectively). There was a significant association between FOXP3 rs3761548 variant and female MS patients. The serum IL-35 level was significantly higher in MS patients (1372 [575–2192] pg/mL) compared to healthy controls (604 [454–696] pg/mL) (P 0.0001). No significant differences were found between the different FOXP3 genotypes and EDSS score ( P = 0.730). Conclusion The FOXP3 rs3761548 gene variant may influence the genetic susceptibility to MS rather than affecting its course, severity or progression. The serum IL-35 level might have a role in the development of the disease, however its role in disease-related disability is questionable.

BackgroundMultiple sclerosis (MS) is a major cause of neurological disability in adults. Depression is one of the most common psychiatric comorbidities in MS patients with negative impact on patients’ quality of life. The aim of the study is to evaluate the role of diffusion tensor imaging (DTI) in monitoring the therapeutic response after high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) versus selective serotonin reuptake inhibitor (SSRI) therapy for relapsing remitting multiple sclerosis (RRMS) patients presenting with depression by measuring the factional anisotropy of the dorsolateral prefrontal cortex (DLPFC) before and after treatment and also to assess the treatments’ impact on patients’ cognitive functions and depression.ResultsFractional anisotropy (FA) only increased in rTMS group (0.44 ± 0.03 pre-rTMS vs 0.53 ± 0.05 post-rTMS,P< 0.001), but there were no significant changes in the SSRI group (0.44 ± 0.04 pre-SSRIs vs 0.45 ± .37 post-SSRIs,P= 0.072). Both rTMS and SSRI groups showed significant clinical improvement in Beck Depression Inventory (BDI) and Paced Auditory Serial Addition Test (PASAT) after either intervention (17.6 ± 3.25 pre-rTMS vs 10.6 ± 1.89 post-rTMS and 23 ± 6.36 pre-rTMS vs 24.87 ± 6.6 post-rTMS, respectively,P< 0.001; 17.67 ± 3.15 pre-SSRIs vs 0.6 ± 1.84 post-SSRIs and 23.8 ± 6.45 pre-SSRIs vs 25.07 ± 7.02 post-SSRIs, respectively,P< 0.001).ConclusionDTI is an ideal non-invasive tool for examining white matter integrity and can detect microstructural changes in the dorsolateral prefrontal cortex after rTMS and SSRI therapies for patients with MS and depression. FA increased only with rTMS denoting positive alteration in white matter microstructure. Both rTMS and SSRIs were equally effective in improving depression and cognition.

The ongoing coronavirus (COVID-19) pandemic is a global health emergency of international concern and has affected management plans of many autoimmune disorders. Immunosuppressive and immunomodulatory therapies are pivotal in the management of neuromyelitis optica spectrum disorder (NMOSD), potentially placing patients at an increased risk of contracting infections such as COVID-19. The optimal management strategy of NMOSD during the COVID-19 era remains unclear. Here, however, we examined the evidence of NMOSD disease-modifying therapies (DMTs) use during the present period and highlighted different scenarios including treatment of relapses as well as initiation and maintenance of DMTs in order to optimize care of NMOSD patients in the COVID-19 era.

Background Studies have shown that interferon-beta (IFN-β) treatment is associated with headaches in patients with multiple sclerosis (MS). Headaches can affect quality of life and overall function of patients with MS. We examined the frequency, relationships, patterns, and characteristics of headaches in response to IFN-β in patients with relapsing-remitting multiple sclerosis (RRMS). Patients and Methods This study was a prospective, longitudinal analysis with 1-year follow-up. The study comprised 796 patients with RRMS treated with IFN-β (mean age 30.84±8.98 years) at 5 tertiary referral center outpatient clinics in Egypt between January 2015 and December 2017. Headaches were diagnosed according to the International Classification of Headache Disorders ICHD-3 (beta version), and data were collected through an interviewer-administered Arabic-language-validated questionnaire with an addendum specifically designed to investigate the temporal relationship between commencement of interferon treatment, and headache onset and characteristics. Results Two hundred seventy-six patients had pre-existing headaches, and 356 experienced de novo headaches. Of 122 patients who experienced headaches before IFN-β treatment, 55 reported headaches that worsened following onset of IFN-β treatment. In patients with post-IFN-β headaches, 329 had headaches that persisted for >3 months, 51 had chronic headaches, and 278 had episodic headaches, and 216 of these patients required preventive therapies. Univariate analysis showed a >6- and an approximately 5-fold increased risk of headache among those treated with intramuscular (IM) INF-β-1a (OR 6.51; 95% CI: 3.73-10.01; P-value

Background: Labor analgesia remains the center of interest for both obstetricians and women. The safety of the traditional pharmacologic analgesics remains questionable due to their potential fetal and maternal complications. Therefore, several non-pharmacological modalities were evaluated for their safety and efficacy to relieve labor pain. Among these methods, transcutaneous nerve stimulation (TENS) gained much concern due to ease of use, low cost and high capacity for women self-titration. The study aims to investigate the efficacy of TENS in reducing labor pain associated with vaginal deliveries, and to determine the factors controlling the response to TENS. Methods: The study was a randomized, controlled clinical trial. A total of 390 women candidates for vaginal delivery were randomly allocated to 3 groups of intervention: paracetamol infusion, TENS, and intramuscular pethidine (130 women per group). The primary endpoint was pain intensity assessed on 10-point VAS scale and women satisfaction. Secondary endpoints included maternal or fetal complications. Results: VAS scores recorded during vaginal deliveries demonstrated a statistically significant reduction in TENS group compared to paracetamol at 15, 30 minutes, 1 and 2 hours, while pethidine arm demonstrated lower scores than TENS group (p Conclusion: TENS is a reliable labor pain analgesic with comparable efficacy and superior safety relative to pethidine. Clinicians should personalize TENS therapy according to women’s BMI and education level for optimized pain control.

BACKGROUND The safety of Ramadan fasting for Muslim patients suffering from multiple sclerosis (MS) is still a matter of debate. This work aimed to study the clinical course of MS during Ramadan fasting and to clarify the predictors of relapses and symptoms exacerbation. METHODS This retrospective study included 153 Muslim patients with MS. Data related to the disease course before Ramadan were obtained from patients' files, whereas data related to the disease activity during Ramadan, were collected from patients over the two months following Ramadan. RESULTS Patients with MS who experienced relapses, exacerbation of symptoms and development of new symptoms during Ramadan had a statistically significant longer disease duration compared to those who did not experience (P < 0.001

Background Spinal anaesthesia (SA) is the preferred anaesthesia technique for Caesarean section. Hypotension and bradycardia are the most common side effects encountered and are more pronounced in pregnant patients, the incidence being as high as 52.6% and 2.5% in normal patients. The occurrence of hypotension can be dangerous as it compromises placental circulation and can have a detrimental effect on the foetus. Objectives The purpose of this study is to assess the efficacy of ondansetron versus dexamethasone in decreasing incidence of spinal induced hypotension in parturient undergoing cesarean surgery. Patients and Methods This study was conducted at Ain Shams University Hospitals between March 2019 till September 2019. After approval is obtained from the research ethics committee of faculty of medicine, Ain Shams University & patients’ informed consents consent from each patient after full explanation of the procedure possible side effects and complications., 75 healthy parturient, (ASA)physical status I and II undergoing elective cesarean delivery under spinal anesthesia. Results 8 mg ondansetron is more effective than 8 mg dexamethasone in the attenuation of post spinal hypotension. Also, that Dexamethasone 8 mg was as effective as ondansetron 8 mg in providing a simple, safe, cheap, and effective intra and postoperative nausea and emesis prevention method with the advantage of being cheaper decreasing the economic burden. Conclusion The present study demonstrated that, among patients who received spinal anesthesia with bupivacaine and fentanyl as adjuvant for elective for cesarean section, prophylactic intravenous 8 mg ondansetron compared to dexamethasone significantly decreases hypotension, HR fluctuation, yet the need for rescue doses for ephedrine were significantly higher in ondansetron.

OBJECTIVE To study Ramadan's effect on migraine from the start to the end of the month and the tolerability of patients with migraine to fasting. BACKGROUND Fasting is a well-known trigger for migraine. Whether this effect on migraine is the same throughout the whole month, or whether it varies from the first to the last days of the month, has not been studied yet. METHODS A prospective cohort observational study was carried out on persons with migraine who fasted from 24 April to 23 May during Ramadan 2020. Each patient was asked to fill out their headache diary starting from Shaaban (the month before Ramadan) to the end of Ramadan. The Ramadan diary was divided by 10 days each, by which the patient was asked to accurately describe their migraine attacks in terms of frequency, duration, and intensity by using the Visual Analog Scale. Migraine attacks during the first day of fasting were assessed separately. RESULTS A total of 292 known persons with migraine from Egypt completed the study. Their median age was 33 years; 72/292 (24.7%) were male, and 220/292 (75.3%) were female. About 126/236 (53.4%) of the patients had migraine attacks on Ramadan's first day, most of them during fasting. The frequency of migraine attacks was significantly increased in Ramadan (median 4, interquartile range [IQR] 2-7) compared with Shaaban (median 3, IQR 1-6), p = 0.009. The number of attacks was significantly reduced in both the second (median 1, IQR 0-2.25) and the third 10 days of Ramadan (median 1, IQR 1-3) compared with the first 10 days (median 3, IQR 1-5) (p

Background and purpose The development of new biomarkers for multiple sclerosis (MS) is of paramount importance to improve our ability to predict disease progression and disability. The aim of this study was to evaluate the potential role of the optic nerve diameter (OND) measured by ultrasonography as a biomarker of early disability in patients with relapsing-remitting multiple sclerosis (RRMS). Methods Forty-nine RRMS patients, 23 with a history of optic neuritis (MS-ON) and 26 without a history of optic neuritis (MS N-ON), and 50 age- and sex-matched healthy control subjects were included in the study. The OND and optic nerve sheath diameter (ONSD) were measured by transorbital sonography (TOS), and the retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) thicknesses were measured by optical coherence tomography (OCT) using the Optovue RTVue™ system (Optovue, Inc., Fremont, CA, USA). Results There was no significant difference between the patient (whether ON or N-ON eyes) and control groups in either the OND (p=0.979) or the ONSD (p=0.911). However, patients with an expanded disability status scale (EDSS) score >2 had a significantly lower OND and RNFL thicknesses (p=0.014, p=0.010 respectively) than patients with an EDSS score ≤2. Statistical logistic regression revealed that OND was an independent predictor of EDSS>2 (p=0.044, OR =0.000, 95% CI=0.000-0.589). Conclusion The OND, as measured by ultrasonography, could be potentially used as a biomarker for the detection of early disability in RRMS patients.

Avian influenza viruses became widely distributed in most Middle Eastern countries, causing high mortality rate and severe economic losses in poultry industry especially when complicated with other pathogens. The continuous evolution of highly pathogenic H5N1 avian influenza viruses (HPAI- H5N1) has resulted in multiple diverse groups based on their haemagglutinin (HA) sequences. In this study, samples from 40 broiler chicken farms during 2014 - 2017 were screened for HPAI- H5N1 Results showed that 15 flocks (37.5%) were positive for HPAI-H5 all of them non vaccinated . Furthermore, full sequencing of HA and NA gene for 3 isolates isolated during 2017 showed that the viruses were clustered with Egyptian viruses from clade 2.2.1.2 and closely related to viruses from neighboring countries.

Background Micro-RNAs (miRNAs) are evolving as biological markers for multiple sclerosis (MS) both in activity and remission. miR-96 is associated with remission, however, the exact mechanism through which it contributes to the anti-inflammatory pathway is not clear. Objective To study the expression of miR-96 and IL-10 (anti-inflammatory mediator) in relapsing remitting (RR) MS. Subjects and methods A case control study including 32 RRMS patients from Kasr Al-Ainy MS clinic, Cairo University, Egypt, and 26 healthy controls (HC). Assessment of serum IL-10 by ELISA, and miR-96 via real time PCR was done during relapse and remission in patients, and in HC. Results IL-10 was higher in RRMS patients during remission and in HC compared with relapse (P ˂ 0.001). miR-96 expression was higher in RRMS patients during remission compared with relapse and HC, and was higher in HC than in relapse (P ˂ 0.001). IL-10 level in remission correlated positively with disease duration (r = 0.41; P = 0.02). Otherwise, no correlation was found between IL-10 and relapse number or EDSS (P>0.05). miR-96 in relapse negatively correlated with EDSS in relapse (r=−0.47; P=0.007), but no correlation was found with disease duration or relapse number, whereas, miR-96 in remission did not correlate with any clinical parameters (P>0.05). No correlation was found between IL-10 and miR-96 either in relapse or remission (P>0.05). Conclusion IL-10 and miR-96 are associated with MS quiescence, however, the lack of a significant correlation between them implicates that the influence of miR-96 may be exhibited through some pathway other than IL-10.

Background: Spinal anesthesia is recommended for elective cesarean sections, but maternal hypotension by may occur, resulting in severe maternal complications. To avoid spinal hypotension, many methods were attempted; fluid loading, vasopressors, or combination of both. Objectives: Our study aimed to compare administration of intermittent i.v. boluses of norepinephrine and ephedrine to guard against hypotensive effect of spinal anesthesia during delivery. Methods: This study was conducted at Qena University Hospitals, sixty cases undergoing elective ceserian section under spinal anaesthesia were enrolled. They were randomly allocated to two equal groups, group N received prophylactic i.v.bolus of norepinephrine 5 μg,group E received prophylactic bolus of i.v. ephedrine 10mg immediately after intrathecal block. Incidence of hypotension and the numbers of the boluses of vasopressors used were recorded and considered as primary outcomes, maternal complication during the surgery as secondary outcomes. Results: According to SBP, DBP, MAP there was significant lower values in groupE compared with group N. The mean number of boluses of vasopressors used during spinal anesthesia was significantly lower in Group N (2.2 vs. 5.8, P = 0.001). the mean number of hypotension episodes was also significantly lower in Group N (2.5 vs. 5.33, P = 0.001). Regarding operative maternal complications, Group N had a significantly lower nausea(16.7% vs. 66.7%, p=.001) vomiting (60% vs. 16.7%, p=0.001). shivering (23.3% vs. 0%, p=0.001). Conclusion: Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with lower incidence of maternal complication.

Avian Pathogenic Escherichia coli (APEC) infections concern economically the poultry industry inducing different disease syndromes leading to high mortality and condemnations. There is tremendous diversity in O serotypes within even a limited geographic region. It has been reported previously on a live E. coli vaccine’s ability to protect against different O78 APEC in commercial broilers. Due to the diversity of APEC serotypes in the field, this study was conducted to measure that live attenuated E. coli (Poulvac® E. coli) vaccine’s ability to cross-protect against three of the heterologous (non-O78) APEC isolates; O27, O8, and O115 compared to cefotaxime treatment through experimental infections in commercial broiler chickens. While the vaccination gave significant protection against the three serotypes tested there were at least subtle differences between them based on clinical signs, post-mortem lesions and mortality rate for 14 days post-challenge (dpc), E. coli re-isolation and histopathological examination at 4, 10 and 14 dpc., final body weight and feed conversion ratio at 35 days of age.

During the current COVID-19 pandemic, many queries are raised regarding its nature, outcome, and sequelae. This letter raises the concern of potential impact on increasing the incidence of multiple sclerosis whose pathology involves a possible viral etiology. Besides, the potential neurotropism of the acute respiratory distress syndrome corona virus-2 (SARS-CoV-2), which is still not established, may raise concerns about the use of certain disease modifying therapies namely natalizumab.

Background In Egypt, the characterization of Neuromyelitis Optica Spectrum Disorder (NMOSD) is lacking. Objectives To determine the demographics, clinical features, aquaporin4 antibodies (AQP4-IgG) status, and neuroimaging of Egyptian NMOSD patients. Methods Retrospective analysis of 70 NMOSD patients’ records from the MS clinic, Kasr Alainy hospital, between January 2013 and June 2018. Results Patients’ mean age was 34.9 ± 9.2 years, and the mean at disease onset was 28.9 ± 10.5 years. Fifty-nine patients had an initial monosymptomatic presentation. AQP4-IgG was measured using either enzyme-linked immunosorbent assay (ELISA) (22 patients) or cell-based assay (CBA) (34 patients). Six and 29 patients had positive results, respectively (p < 0.001). 84% had typical NMOSD brain lesions. Longitudinally extensive myelitis was detected in 49 patients, and 9 had either short segments or normal cords. Treatment failure was higher in seropositive patients. Rituximab significantly reduced the annualized relapse rate (ARR) compared to Azathioprine with a percentage reduction of (76.47 ± 13.28) and (10.21 ± 96.07), respectively (p = 0.04). Age at disease onset was the only independent predictor for disability (p < 0.01). Conclusion Treatment failure was higher in seropositive patients. However, there was no difference in clinical or radiological parameters between seropositive and seronegative patients. Patients, who are polysymptomatic or with older age of onset, are predicted to have higher future disability regardless of the AQP4-IgG status.

Objective: Severe Acute Respiratory Syndrome Coronavirus 2 causes both health and economic crises and up till now no drug or vaccine has yet been approved. There is an increased demand to explore other complementary methods to protect the world. Eucalyptus essential oil; a popular off-label drug used to relieve nasal congestion via inhalation with promising effects on the upper respiratory diseases including viral infections. Methods: In order to provide review-based hypotheses demonstrating eucalyptus essential oil beneficial role; several published studies were retrieved from different databases and websites till June 2020. The retrieved data declared the antiviral potentials against viruses of same subgenus or with same pattern and the beneficial effects on respiratory system, immunity and overall health improvement, along with declaring the application methods and safety. Results: Off-label use of Eucalyptus essential oil by inhaling 12drops /150mL or 1.5% v/v solution boiling water may relief COVID-19 mild and moderate symptoms as pain, cough, respiratory inflammation, cytokine storm and dyspnea. Conclusions: Experimental and clinical data proved that inhalation of eucalyptus essential oil may provide the ability to reduce COVID-19 patients symptoms and morbidity risk factors and may play a role as a preventative technique complementary to WHO guidance for beating COVID-19 virulence and transmission spread. Peer Review History: Received 28 June 2020; Revised 20 July; Accepted 10 August, Available online 15 September 2020 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file Average Peer review marks at initial stage: 6.5/10 Average Peer review marks at publication stage: 8.5/10 Reviewer(s) detail: Name: Dr. Dalia Kamal Zaffar Ali Affiliation: Modern University for technology and information, Egypt E-mail: dr.moda88@gmail.com Name: Prof. Dr. Mahadeva Rao US Affiliation: Universiti Sultan Zainal Abidin, Malaysia E-mail: raousm@gmail.com Name: Francesco Ferrara Affiliation: USL Umbria 1, Perugia, Italy E-mail: francesco.ferrara@uslumbria1.it Comments of reviewer(s): Similar Articles: THE RISKS AND ADVANTAGES OF ANTI-DIABETES THERAPY IN THE POSITIVE COVID-19 PATIENT

The emergence of the novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health challenge of global concern since December 2019, when the virus was recognized in Wuhan, the capital city of Hubei province in China and epicenter of the COVID-19 epidemic. Given the novelty of COVID-19 and the lack of specific anti-virus therapies, the current management is essentially supportive. There is an absence of consensus on guidelines or treatment strategies for complex disorders such as multiple sclerosis (MS), in which the risk of infections is higher than in the general population. This is due to the overall impairment of the immune system typical of autoimmune diseases, in addition to accumulation of disabilities, and the iatrogenic effect generated by corticosteroids and the recommended disease-modifying therapies (DMTs). DMTs have different modes of action, but all modulate and interfere with the patient’s immune response, thereby raising concerns about adverse effects, such as an increased susceptibility to infections. In this review, we analyze the evidence for use of DMTs during the current critical period and ratify an algorithmic approach for management to optimize care between keeping DMTs, with their infection hazards, or coming off them, with the risk of disease activation. We also provide an algorithmic approach to the management of breakthrough activity during the COVID-19 pandemic.

Background: Hepatitis C virus infects about 185 million people equating 2.8% of worldwide population. Management of chronic HCV patients traditionally depended on combination of peg-interferon (IFN) with ribavirin but this regimen showed many serious side effects beside its non-satisfactory efficacy. In 2013, a second generation of direct acting antiviral agents (DAAs) gave a promising efficacy and safety. Although many IFN free regimens were approved, further evaluations are needed for these regimens.Aim of Study: To compare safety and efficacy of Sofosbuvir in combination with Daclatasvir (DCV) or Ledipasvir (LDV) or Simeprevir (SIM) in treatment of chronic HCV patients.Patients and Methods: This is a prospective study con-ducted on 150 patients of chronic HCV who visited Al-Ahrar Educational Hospital in Zagazig National Committee for the Control of Viral Hepatitis (NCCVH) from January to Septem-ber of 2017 and were selected according to the inclusion and exclusion criteria set by the (NCCVH).Patients were assigned into three groups: 50 patients received (SOF/DCV ± RBV), 50 patients received (SOF/LDV ± RBV) and 50 patients received (SOF/SIM ± RBV). Three regimens were given for 12 weeks.Results: In this study, the mean age of the 50 patients of each group was (52.6±9 years) in SOF/DCV group, (48.2±13.5 years) in SOF/LDV group and (50.26±10.6 years) in SOF/SIM. A total of 150 patients including 93 (62%) males & 57 (38%) females.Adverse events occurred in (18%) of SOF/DCV group, (18%) of SOF/LDV group and (40%) of SOF/SIM group. The most common adverse events occurred in three groups were; hyperbilirubinemia (20%) in SOF/SIM group, (8%) in SOF/ DCV group and (4%) in SOF/LDV group (Table 2), thus SOF/SIM group showed a higher incidence of adverse events occurrence but adverse events in three groups were mild (not sever enough to cause treatment discontinuation).Sustained Virological Response (SVR) rate was nearly similar in three groups: (100%) of SOF/LDV group, while it was achieved (98%) of SOF/SIM group and (98%) of SOF/DAC group. This results showed no statistically signif-icant difference.Conclusions: Sofosbuvir based antiviral regimen in com-bination with (DCV, LDV and SIM) were tolerable with no obvious side effect and showed high efficacy in management of chronic HCV with nearly similar SVR.

Background: Hepatitis C Virus infects about 185 million people equating 2.8% of worldwide population and about 500,000 people die annually from hepatitis C related liver diseases. The most common clinical presentation of the disease is the chronic hepatitis and its complications such as: Com-pensated cirrhosis, portal hypertension, decompensated cir-rhosis and Hepatocellular Carcinoma (HCC). Therapeutic management of chronic HCV patients traditionally depended on combination of peg-interferon (IFN) with ribavirin but this regimen showed many serious side effects beside its non-satisfactory efficacy. In 2013, a second generation of Direct Acting Antiviral Agents (DAAs) gave a promising efficacy and safety. Although many IFN free regimens were approved, further evaluations are needed for these regimens.Aim: To compare sofosbuvir in combination with Da-clatasvir, Ledipasvir and Simeprevir in patients with chronic hepatitis C infection according to safety, efficacy, relapse and patient outcomes.Patients and Methods: This is a prospective study con-ducted on 150 patients of chronic HCV who were admitted to the Viral Hepatitis Center in Al-Ahrar Educational Hospital in Zagazig {National Committee for the Control of Viral Hepatitis (NCCVH) during the first 9 months of 2017 and were selected according to the inclusion and exclusion criteria set by the (NCCVH). 58% of overall participants had cirrhosis and 2.7% were treatment-experienced. Patients were assigned into three groups: 50 patients received Sofosbuvir + Daclatasvir ± Ribavirin (SOF/DCV ± RBV) therapy, 50 patients received Sofosbuvir + Ledipasvir ± Ribavirin (SOF/LDV ± RBV) therapy and 50 patients received Sofosbuvir + Simeprevir ± Ribavirin (SOF/SIM±RBV) therapy. Three regimens were given for 12 weeks. Primary end point was the rate of achieving SVR12 by HCV RNA PCR, while secondary end point was the occurrence of virologic relapse.Results: The SVR rate of three groups was 98%, 100% and 100% for SOF/DCV, SOF/LDV and SOF/SIM groups respectively. Only one patient had a virological failure and he was in SOF/DCV group but these results showed no statistical significance. Virological relapse occurred in only 1 patients (.67%) of the 149 patients. The patient who showed virological failure wasn't included, while the only one patient relapsed (2%) was in SOF/SIM therapy group. Results of virological relapse were statistically not significant. RVR showed a predictive value in SVR achievement and relapse occurrence was also confirmed in our study, in SVR (p=>.05) and in relapse (p=.9). Adverse events occurred in (22%) of SOF/DCV group, (26%) of SOF/LDV group and (40%) of SOF/SIM group (p=.153), thus SOF/SIM therapy showed a higher incidence of adverse events occurrence.Conclusions: Sofosbuvir based antiviral combination therapy with (DCV, LDV and SIM) showed a highly safety, tolerability and efficacy for treatment of chronic Hepatitis C Virus.

Background: Sedation in the intensive care unit Patients is assumed to reduce discomfort from care interventions, increase tolerance of mechanical ventilation, prevent accidental removal of instrumentation, and reduce metabolic demands during cardiovascular and respiratory instability. Aim of the Work: The aim of the work was to evaluate the use of dexmedetomedine as a sedative to facilitate weaning from mechanical ventilation and extubation, so decrease the incidence of reintubation, ventilator complications and decrease the ICU cost and stay. Patients and Methods: This was a controlled randomized prospective clinical trial carried out at Ain-Shams University Hospitals. After approval of institutional ethical committee, the study included 90 adult postoperative patients and requiring postoperative mechanical ventilation in the surgical ICU for maximum duration of 48 hours postoperatively. Results: As regard to time to extubation, results of the current study showed a highly statistically significant difference between three groups regarding time to extubation (hr) when p-value was < 0.001. Conclusion: dexmedetomidine has clinically relevant benefits compared to midazolam and propofol in facilitating extubation because of its shorter time to extubation, more hemodynamic stability, easy arousability and lack of respiratory depression; hence, it can be used as an effective, and safe sedative agent to facilitate extubation in ICUs and decreasing ICU length of stay.

Background: childbirth is one of the most painful events of a woman's life. The experience of labor pain is a complex, multidimensional response to sensory stimuli generated during parturition and its intensity can vary greatly. Unlike other acute and chronic pain experiences, labor pain is not associated with pathology, but with the most basic and fundamental of life’s experiences Aim of the work: this work aimed to study the efficacy of intravenous tenoxicam for labor analgesia. Patient and methods: this was two-arm, randomized controlled trial. The first arm (Group T) represented subjects who received tenoxicam. The second arm (Group R) represented subjects who received routine analgesic pethidine and it is given at a dose of 50 mg diluted over 10 ml of normal saline. The parturient woman was given 3-4 cm of diluted pethidine whenever she has intolerable pain. Results: this study included 260 subjects that were allocated into two arms: tenoxicam arm (n=118) and pethidine arm (n=142) as the control group. Tenoxicam group included 118 subjects and the pethidine group included 142 subjects. Maternal age was 23.74 ± 3.76 in tenoxicam group vs 23.99 ± 3.5 in pethidine group. Gestational age was 39.04 ± 1.42 in tenoxicam group vs 38.93 ± 1.5 in pethidine group. Birth weight was 3.43 ± 0.26 in tenoxicam arm vs 3.41 ± 0.26 in pethidine arm, average fetal heart rate was 140.1 ± 17.12 in tenoxicam arm vs 138.1 ± 16.39 pethidine arm, cervical dilatation was 4.19 ± 0.77 in tenoxicam arm vs 4.25 ± 0.7 and interval to delivery was 5.89 ± 1.29 in tenoxicam arm vs 6.2 ± 1.62 in pethidine arm. Conclusion: tenoxicam (40 mg iv), a long acting NSAID that induces analgesia by inhibiting peripheral prostaglandin synthesis, reduced postpartum uterine contraction pain without apparent maternal or neonatal adverse effects. Furthermore, tenoxicam exhibits superior analgesic properties over the routinely used pethidine as labor analgesic. Further studies should evaluate analgesic effects vs side effects of iv tenoxicam as a function of dosage or as part of combination therapy with different opioid analgesics.

Background and study aim: Egypt has the highest prevalence of hepatitis C virus (HCV) infection in the world and is facing an epidemic of type 2 diabetes mellitus. The objective of this study was to assess the frequency of prediabetes in patients with chronic HCV infection. Subjects and Methods: A cross- sectional study was performed on Session [CurrentTestPartID] HCV patients. Twenty healthy persons were taken as controls. Full history taking, clinical examination, routine laboratory and radiological investigations were done Body mass index (BMI), Waist Hip ratio, serum fasting glucose and fasting insulin were determined. IR was calculated by the Homeostasis Model for Assessment of Insulin Resistance (HOMA-IR), where values less than 2 has been considered completely normal and higher than 2 as a prediabetic state. Results: Serum fasting glucose, fasting insulin and HOMA-IR levels were significantly higher among HCV group compared with control group. The frequency of prediabetic (HOMA-IR values >2) among non-diabetic chronic HCV patients is 63.33%. Conclusion: Chronic HCV patients should be screened regularly for insulin resistance to avoid the double burden of diabetes mellitus and HCV.

One-year surveillance of HPAI (H5N1) virus infection in different chicken flocks (141 flock) from different Governorates in Upper Egypt was carried out, during the period from January 2015 to January 2016. The detection rate of highly pathogenic avian influenza (HPAI) H5N1 virus was 21.3% (30/141) which was highest during the winter season compared with the other seasons. The investigated flocks suffered from respiratory and nervous signs and cyanosis of the comb and wattles was observed in some birds as well as subcutaneous hemorrhages in shanks. The thirty positive H5N1 samples were tested for the existence of other respiratory viruses. The results were as follows: single H5N1 virus infection was only detected in 5 flocks (16.6%). The mixed H5N1 with H9N2 in 2 flocks (6.6%); H5N1with NDV in 12 farms (40%); H5N1 with IBV in 7 farms (23.3%) while H5N1, H9N2 and NDV were detected together in 4 flocks (13.3 %). The sequence analysis of the HA gene from five selected H5N1 isolates revealed that these strains were clustered with Egyptian classical H5N1 viruses (sub-clade 2.2.1.2) of the Eurasian origin. It is concluded that, the five H5N1 subtype isolates of HPAI are clustered with classical H5N1 viruses to subclade 2.2.1.2 of Eurasian origin. Therefore, vaccination of the backyard chicken as well as chicken farms with suitable homologues vaccine to eliminate HPAI virus from Egypt is recommended.

Objective : This study aimed to report the severity of COVID-19 in a cohort of Egyptian patients with multiple sclerosis (MS) with particular attention on the impact of disease modifying drugs (DMDs). Methods and study population : We included 119 MS patients recruited from two centers, Ain-Shams university and Cairo university with confirmed or suspected COVID-19 during the period from May to September 2020 as a part of the MuSC-19 project. Univariate logistic regression was fitted to assess risk factors for severe COVID-19 (at least one outcome among hospitalization, ICU admission and death). Results : Females were 77%, mean age was 34 years, mean duration of MS was 5.28 years, median EDSS was 3, most of the patients (83%) had RRMS, while 15% and 2% had respectively SPMS and PPMS. Only eleven patients (9% of study population) had a severe outcome and 3 patients (3%) died. Headache was the only symptom significantly associated with the severity of COVID-19 (OR=10.85, P = 0.001). There was no association between any of the DMDs and severe COVID-19 outcome. Conclusion : This study showed an acceptable safety profile of DMDs in Egyptian MS patients who developed COVID-19, as 91% of the cohort had a favorable outcome. Headache as a symptom associated with severe outcome in Egyptian patients’ needs further validation.

Hatem S Shehata,1 Hadeer Mahmoud AbdelGhaffar,2 Mohammed Nasreldin,3 Alaa Elmazny,1 Ahmed Abdelalim,1 Asmaa Sabbah,1 Nevin M Shalaby1 1Department of Neurology, Cairo University, Giza, 2Department of Paediatrics, Fayoum University, Fayoum, 3Department of Psychiatrics, Cairo University, Giza, Egypt Introduction: Refractory epilepsy is a common clinical manifestation in patients with tuberous sclerosis complex (TSC), which can be complicated by many life-threatening conditions, such as status epilepticus (SE). However, very few reports mention the patterns and semiology of SE in those patients.Objective: To study the clinical characteristics and outcomes of SE in TSC patients.Materials and methods: This observational, prospective study was carried out on 36Egyptian children with definite TSC. Clinical history, general and neurological examination and psychometric evaluation by standard questionnaires were used to explore characteristics of epileptic manifestations and clinical patterns of SE. All included patients were required to have long-term video electroencephalograms (EEGs) and brain MRI performed.Results: A total of 32 attacks of SE were recorded in 21 patients (58.3%) in our cohort during a follow-up period of 2.8±1.1 years; of those patients, 15 had convulsive status, 7 had non-convulsive SE, 6 had refractory/super-refractory SE and 14 patients had a history of infantile spasms (epileptic spasms). The duration of status ranged from 40 to 150 min (mean ± standard deviation: 90±15). Fourteen patients with SE had severe mental retardation, 9 had autistic spectrum disorder and 22 had severe epileptogenic EEG findings. Patients with SE had higher tuber numbers (mean: 9.6), 5patients had subependymal giant cell astrocytomas and 2 patients had their SE after receiving everolimus.Conclusions: The incidence of SE in our patient sample is high (>50%); severe mental retardation, autistic features, history of infantile spasm (epileptic spasms) and high tuber burden are risk factors for developing SE. Keywords:Egyptian children, tuberous sclerosis, status epilepticus, infantile spasms, autistic spectrum

Naglaa A El-Sherbiny,1 Hatem Samir Shehata,2 Hanan Amer,2 Alaa Elmazny,2 Mohamed Masoud,1 Hanan Helmy,2 Nevin M Shalaby2 1Faculty of Medicine, Fayoum University, Faiyum, Egypt; 2Faculty of Medicine, Cairo University, Cairo, Egypt Background: The reported prevalence of headache disorders in Arab regions varies considerably between countries. This may be due to a lack of standardized survey instruments that capture the prevalence. Purpose of the study: Our goal was to construct and validate a structured headache questionnaire for Arabic-speaking headache patients to be used as an epidemiological survey instrument. Methods: We developed a culturally adapted interviewer-administered questionnaire in Arabic language comprising two sets of questions. The first set included personal and sociodemographic data together with a screening question regarding the presence of headaches over the last year. The second set was designed to define the type and pattern of headaches according to the International Classification of Headache Disorders criteria (for subjects with “yes” answers on the screening question). Validation process took place in two phases through probability random sampling selected from 1,221 headache subjects collected in an epidemiological survey 3 (n=70) and 6 months (n=232) later. A detailed assessment of patients’ headaches was performed by neurologists (blinded from the questionnaire diagnosis) who clinically assessed the patients’ headache. Results: The validity of the questionnaire was tested in 232 subjects with a mean age of 41.2±10.9 years, 72.8% of whom were females. The mean time to complete the questionnaire was 8.4±1.7 minutes. The intraclass correlation coefficient was 0.903 (95% confidence interval: 0.875–0.925), the Cronbach κ coefficient was 0.775 (95% confidence interval: 0.682–0.837), and the percentage of agreement was 84.5%.Conclusion: Our results support the use of this comprehensive questionnaire as a valid tool for headache assessment among Arabic-speaking patients. Keywords: Arabic, Egypt, headache, questionnaire, validation&nbsp

Background Chronic migraine is a prevalent disabling disease, with major health-related burden and poor quality of life. Long-term use of preventive medications carries risk of side effects. Objectives The aim of this study was to compare repetitive transcranial magnetic stimulation (rTMS) to botulinum toxin-A (BTX-A) injection as preventive therapies for chronic migraine. Methods A pilot, randomized study was conducted on a small-scale sample of 29 Egyptian patients with chronic migraine, recruited from Kasr Al-Aini teaching hospital outpatient clinic and diagnosed according to ICHD-III (beta version). Patients were randomly assigned into two groups; 15 patients received BTX-A injection following the Phase III Research Evaluating Migraine Prophylaxis Therapy injection paradigm and 14 patients were subjected to 12 rTMS sessions delivered at high frequency (10 Hz) over the left motor cortex (MC, M1). All the patients were requested to have their 1-month headache calendar, and they were subjected to a baseline 25-item (beta version) Henry Ford Hospital Headache Disability Inventory (HDI), Headache Impact Test (HIT-6), and visual analogue scale assessment of headache intensity. The primary efficacy measures were headache frequency and severity; secondary measures were 25-item HDI, HIT-6, and number of acute medications. Follow-up visits were scheduled at weeks 4, 6, 8, 10, and 12 after baseline visit. Results A reduction in all outcome measures was achieved in both the groups. However, this improvement was more sustained in the BTX-A group, and both the therapies were well tolerated. Conclusion BTX-A injection and rTMS have favorable efficacy and safety profiles in chronic migraineurs. rTMS is of comparable efficacy to BTX-A injection in chronic migraine therapy, but with less sustained effect.

Wireless Mobile Ad-Hoc Networks is one of the attractive research field that growing exponentially in the last decade. it surrounded by much challenges that should be solved the improve establishment of such networks. Failure of wireless link is considered as one of popular challenges faced by Mobile Ad-Hoc Networks (MANETs) . As this type of networks does not require any pre-exist hardware. As well as, every node have the ability of roaming where it can be connected to other nodes dynamically. Therefore, the network internal structure will be unpredictably changed frequently according to continuous activities between nodes that simultaneously update network topology in the basis of active ad-hoc nature. This model puts the functionality of routing operation in crucial angle in the area of research under mobile adhoc network field due to highly dynamic nature. Adapting such kernel makes MANET indigence new routing techniques to settle these challenges. Thereafter, tremendous amount of routing protocols proposed to argue with ad-hoc nature. Thus, it is quite difficult to specify which protocols operate efficiently under different mobile ad-hoc scenarios. This paper examines some of the prominent routing protocols that are designed for mobile ad-hoc networks by describing their structures, operations, features and then comparing their various characteristics.

Background and study aim : Hepatitis B is a serious and common infectious disease of the liver, affecting millions of peoplethroughout the world. In this regard, Egypt has an intermediate HBV seroprevalence. Quantitation of hepatitis B surface antigen (HBsAg) by automated chemiluminescent micro-particle immunoassay has been proposed to be a surrogate marker. The aim of this study was to evaluate correlation between HBsAg quantitation assay, histo-pathology and viral-DNA level in chronic hepatitis BeAg negative patients. Patients and methods: This study carried on 50 HBV-DNA positive naive CHB patients. All the studied patients wereHBeAg negative. HBV DNA was measured by real-time polymerase chain reaction, and serum HBsAg was quantified by electrochemiluminescence assay (Roche Diagnostic). Liver biopsy done to all patients in this study for histopathological grading and staging of hepatic fibrosis by experienced pathologist using METAVER scoring. Results: A significant correlation between serum HBsAg quantitation level and HBV DNA levels was revealed in all studied HBeAg negative patients (r =0.748, P= 0.05). Conclusion: All the studied patients were tested for assess correlation between HBsAg quantitation, HBV-DNA level and histo-pathology grading and staging. There is strong positive correlation between HBsAg quantation level and HBV-DNA and between HBsAg quantation level and stages of fibrosis. No correlation between HBV DNA levels and histopathology.

Sherif M Hamdy,1 Maged Abdel-Naseer,1 Nevin M Shalaby,1 Alaa Elmazny,1 Marian Girgis,2 Mona A Nada,1 Amr Hassan,1 Husam S Mourad,1 Mohamed I Hegazy,1 Ahmed Abdelalim,1 Nirmeen A Kishk,1 Noha T Abokrysha,1 Shaimaa A Genedy,1 Ehab A Essawy,3 Hatem S Shehata1 1Neurology Department, Cairo University, Cairo, Egypt; 2Pediatric Department, Cairo University, Cairo, Egypt; 3Division of Biochemistry, Chemistry Department, Faculty of Science, Helwan University, Helwan, Egypt Introduction: Although the frequency of pediatric-onset multiple sclerosis (POMS) has increased in recent decades, it is still highly uncommon, which creates a need for the involvement of more registries from various clinical centers.Objective: To characterize the demographic, clinical, and paraclinical features of Egyptian patients with POMS.Patients and methods: A retrospective chart review study was undertaken on 237 Egyptian patients with demyelinating events which started before the age of 18 years who attended one of five tertiary referral centers in Cairo, Egypt.Results: Multiple sclerosis was diagnosed in 186 patients, 47 (25.27%) patients had disease onset before the age of 12 years; “early-onset pediatric multiple sclerosis (EOPMS)”. The mean age of disease onset was (14.13±2.49years), with a female:male ratio of 1.62:1, none of the enrolled patients had a primary progressive course (PPMS), whereas 10 patients (5.38%) had a secondary progressive form. Approximately two-thirds of the patients had monofocal disease onset, and less than 10% presented with encephalopathy; most of them had EOPMS. Motor weakness was the presenting symptom in half of the patients, whereas cerebellar presentation was detected in 34.95%, mainly in EOPMS. Seizures (not related to encephalopathy) were more frequent in those with EOPMS. Initial brain magnetic resonance images were positive in all patients, with detected atypical lesions in 29.03%, enhanced lesions in 35.48%, black holes in 13.98%, and infratentorial in 34.41%. Cervical cord involvement was found in 68.28%. More than two-thirds of the patients received either immunomodulatory or immunosuppressant (IS) treatment throughout their disease course, and about half of them received their treatment within the first year from symptoms onset, with a more favorable outcome, and patients with highly active disease received natalizumab, fingolimod, or other IS.Conclusion: The results from this registry – the largest for MS in the Arab region to date – are comparable to other registries. Immunomodulatory therapies in POMS are well tolerated and efficacious and they can improve the long-term outcome in children. Keywords: multiple sclerosis, pediatric onset, early onset, registry, Egypt&nbsp

Diminishing the cost of broiler chicken diet is a critical issue in the poultry industry. Numerous studies were performed to achieve this pivotal objective by diet supplementation with alternative feed additives. In the current study, low-energy broiler rations were supplemented with different commercial multienzyme formulations to minimize the cost, and increase the digestibility and absorption of the digested macronutrients. Cobb Avian 48 broiler chicks (mixed sex, 1-d-old, n = 3120) were randomly allocated into six groups, and each group was subdivided into four replicates (130 birds per replicate). The birds were randomly allocated into a control group fed basal diet (CB); control group fed low-energy diet (CL); and birds fed low-energy diets supplemented with different enzyme formulations. The enzyme formulations used were Xylam 500® (CLX group), Hemicell® (CLH group), Avizyme® (CLA group), and Megazyme® (CLM group,) following the doses recommended by the manufacturers. The growth performance of CLA and CLH group birds was significantly improved when compared with CL. In comparison with CB, Avizyme® significantly (p < 0.001) increased the intestinal PEPT1, GLUT2, ACC, and IL-2 expression; PEPT1 facilitates the absorption of micronutrients. In conclusion, exogenous multienzyme complexes may be included in the low-energy diet to enhance the performance of broiler chickens (Avizyme® ˃ Hemicell® ˃ Megazyme®), and reduce the diet cost by up-regulating the expression of intestinal nutrient transporter genes, and improving the immunity and serum biochemical parameters of broiler chickens.

The paper is made for a partial fulfillment of a Ph.D. research made by the above mentioned authors to present a proposed national sustainable rating & certification system for new construction to promote the benefits of sustainable building practices, and embrace the potential of green buildings in Egypt, while the paper is describing one main category of the proposed system which is the Integration and Management category. Both terms of "Integration" and "Management" are usually listed separately in the main categories of different international sustainable rating and certification systems for new construction, while in this paper both terms are combined together in one category named as "Integration and Management" category which is mainly focusing to insure that the sustainable accreditation targeted level is given to the project under uniform and consistent Total Quality Assessment (TQA) procedures and project management conditions for the proposed national sustainable rating and certification system for new construction in Egypt. Integration and Management Category, as described below, is having a new assembly of mandatory and scoring credits complying with the sustainability three bottom lines; ecological/environmental, equity/social, and economical aspects to rectify the lack of integration & management issues in new construction including achievement & appraisal of technical quality from all project disciplines for design documents, construction activities, sustainable planning, project time, modular & standardized design, adaptability & deconstruction, and building re-use.

Background and study aim :Portal hypertension is one of the most important complications of liver cirrhosis. Endoscopic screening of all patients with liver cirrhosis would result in a large number of unnecessary additional burden to endoscopic units. This study is designed to assess insulin resistance in cirrhotic patients due to hepatitis C infection as non invasive parameter for esophageal varices. . Patients and Methods: This study was conducted on 50 cirrhotic patients (Child A) post hepatitis C who attended the Hepatology Department and outpatient clinic at Shebein El Kom Teaching Hospital. All the patients were evaluated by thorough history ,clinical examination, biochemical parameters ,metabolic features, including insulin resistance by the homeostasis model assessment (HOMA), ultrasonongraphy , liver biopsy and upper gastrointestinal endoscopy to search for esophageal varices. Results: EVs (esophageal varices) were detected in 18 of 50 patients. By multivariate analysis ,the presence of EVs was independently associated with a low platelet count/spleen diameter ratio (562.75 + 99.16) , a high HOMA-IR score (5.49 + 0.754), high body mass index , low hemoglobin, low albumin, high alanine aminotransferase and high aspartate aminotransferase. Conclusion: Insulin resistance in patients with Hepatitis C virus cirrhosis (Child A ) measured by HOMA-IR score significantly predicts the presence esophageal varices in this patients and can be used as non-invasive parameter for predicting esophageal varices.

Aim of the workTo measure the extent of subclinical atherosclerosis in patients with systemic sclerosis, and to evaluate any potential vascular risk factors in these patients.Patients and methodsThis study included 30 patients with systemic sclerosis diagnosed according to the American college of rheumatology criteria and 20 healthy individuals were also included as a control group. Non-invasive vascular tests including; carotid duplex scanning measuring common carotid arteries (CCA) intima-media thickness (IMT), and ankle brachial pressure index (ABPI) were performed. Traditional vascular risk factors such as blood pressure, blood sugar, lipid profiles, steroid usage and other immunosuppressive medications were assessed.ResultsThe mean IMT of CCA was higher in systemic sclerosis patients (right 0.67±0.11mm, left 0.67±0.12mm) when compared with the control group (right 0.48±0.2mm, left 0.54±0.13mm) (p

Sherif M Hamdy,1 Maged Abdel-Naseer,1 Nevin M Shalaby,1 Alaa N Elmazny,1 Ahmed A Nemr,2 Amr Hassan,1 Mohamed I Hegazy,1 Husam S Mourad,1 Nirmeen A Kishk,1 Mona A Nada,1 Ahmed Abdelalim,1 Amr M Fouad,1 Hatem S Shehata1 1Neurology Department, Cairo University, 2Neurology Department, Maadi Military Hospital, Cairo, Egypt Background: Multiple sclerosis (MS) is a complex autoimmune disease with a heterogeneous presentation and diverse disease course. Recent studies indicate a rising prevalence of MS in the Middle East.Objective: To characterize the demographics and disease features of Egyptian patients attending four tertiary referral MS centers in Cairo.Materials and methods: This was a retrospective, observational study on 1,581 patients between 2001 and 2015. Medical records were reviewed and data were identified and extracted in a standardized electronic registry.Results: The mean age of disease onset was 26.6±7.8 years, with the majority being female (2.11:1). Relapsing–remitting MS was the most common type (75.1%). The main presenting symptom was motor weakness (43.9%), which was also the most frequent symptom during the disease course. Family history of MS was found in 2.28%. Higher initial Expanded Disability Status Scale score, black holes, and infratentorial lesions on initial magnetic resonance imaging were independent factors for disease progression by univariate analysis (OR 3.87 [95% CI 1.84–6.51], 4.14 [95% CI 3.08–5.58], 4.07 [95% CI 3.21–4.99], respectively); however, in multivariate analysis, only infratentorial lesions were an independent risk for disease progression (OR 6, 95% CI 2.99–12.02; P=0.0005).Conclusion: The results from this registry – the largest for MS in the Arab region to date – are comparable to other registries with slight differences. Keywords: multiple sclerosis, MS registry, epidemiology, Middle East, North Africa, Egypt&nbsp

The main aim of this study is to develop a spell-checker system for Arabic language. This is done by investigating the viability of applying the radix search tree approach. Through this scientific research several shrubs that represent Arabic characters will be built through serialized tracking of characters word where it can be added to the dictionary and with a special mark in the node that contains the last characters from each word; on other side during searching process, every word can be tracked character by character according suitable path inside its shrub, Accordingly, correct word can be recognized if and only if searching process locates some leaves during the traverse of the shrub. Otherwise, the word will be considered incorrect. General Terms Your general terms must be any term which can be used for general classification of the submitted material such as Pattern Recognition, Security, Algorithms et. al.

This paper discusses about the significance of selecting right requirements management tools. It's no secret that poorly understood user requirements and uncontrolled scope creep to many software project failures. Many of the application development professionals buy wrong tools for the wrong reasons. To avoid purchasing the more complex and expensive tool, the organization needs to be realistic about the particular problem for which they opt. Software development organizations are improving the methods, they use to gather, analyze, trace, document, prioritize and manage their requirements. This paper considers four leading Requirements Management tools; Analyst Pro, CORE, Cradle and Caliber RM, the focus is to select the appropriate tool according to their capabilities and customers need.

Simple Summary The present study aimed to investigate the influences of muscle type and postmortem storage period on meat chemical composition and quality attributes of three breeds of camels, including Baladi Saudi, Pakistani, and Somali. Baladi Saudi and Pakistani had better carcass characteristics than Somali. In addition, the longissimus lumborum muscle had better meat quality and the storage process can enhance quality features of meats that have relatively small amounts of connective tissue and that have not cold-shortened. Abstract The influence of muscle type and postmortem storage period on meat chemical composition and quality attributes of three breeds of camels (Baladi Saudi, Pakistani, and Somali) were investigated in this study. Crude fat and ash content were significantly higher in the Pakistani than in the Baladi Saudi and Somali breeds, except for higher moisture content observed in the Somali breed. The longissimus lumborum (LL) and semimembranosus (SM) muscles had a greater crude protein than the biceps femoris (BF) muscle. Storage period exhibited a significant reduction in pH values and improvement in color components of meat. The Somali breed produced higher cooking loss % and shear force, with a lower water holding capacity than the Baladi Saudi and Pakistani breeds. The LL muscle had better cooking loss %, water holding capacity, and shear force, whereas storage period (7 days) exhibited a significant reduction in the myofibrillar fragmentation index. Baladi Saudi and Pakistani breeds and LL muscle samples presented better meat sensory attributes, while storage period had no significant influence on the overall sensory characters of meat. In conclusion, there were significant differences between the chemical and structural characteristics of the LL, BF, and SM muscle samples among the three breeds of camel. Baladi Saudi and Pakistani had better meat quality traits than the Somali breed. In addition, LL muscles had better nutritional values and meat quality parameters than BF and SM muscles. Improvement in meat quality attributes were achieved with the storage process of 7 days. It is observed that, the Saudi Baladi camels have a merit of low fat content over both Somali and Pakistani camel breeds. It is also concluded that no significant effects were observed between the treatments as a result of storage when sensory attributes were considered. Moreover, breed, muscle and storage period were interacted significantly only with regard to lightness color space and shear force. This is useful knowledge for the meat industry for optimizing processing and storage procedures for various camel muscles.

In this work, we investigate the performance of dye-sensitized solar cells (DSSCs) based on natural dyes extracted from ten different plant seeds. The extracts were characterized by UV-VIS absorption spectra. The solar cells were assembled using a TiO2 mesoporous film on FTO-coated glass. The photovoltaic properties of the DSSCs were studied under an incident irradiation of 100 mW/cm2. The best performance was for the DSSC sensitized with Eruca sativa with a solar energy conversion efficiency of 0.725%. Moreover, the validity of these extracts was compared using two types of semiconductor layers (TiO2 and ZnO), and finally the photovoltaic properties of one of these dyes were studied using different types of electrolytes.

We describe the use of controlled diffusion treatments to arrange the distribution of alloying elements within a material. The Fe–C system is particularly interesting because of the strong effect of carbon on the mechanical properties and phase stability of steel. We demonstrate, through multi-step treatments, both one-dimensional and two-dimensional distributions of carbon within steel. A sample two-dimensional architecture is prepared and characterized to demonstrate feasibility. We briefly introduce a global optimization algorithm as a method for computationally optimizing treatment schedules.

Background Cytokines are major contributors in the immune disruption in multiple sclerosis (MS). Objective Evaluating the proinflammatory (IL-17A) and anti-inflammatory (IL-10) cytokines in relapsing-remitting (RR) MS patients at time of relapse and during remission. Subjects and method A case-control study including 30 RRMS patients and 15 controls. Patients were recruited from the Kasr Al-Ainy MS research unit (KAMSU), Cairo University, Egypt. Levels of IL-17A and IL-10 were assessed in patients' sera, during relapse and 30 days after IV methylprednisolone, and in control subjects using enzyme linked immunosorbent assays (ELISA). Results IL-17 was higher in patients during relapse and remission phases when compared with controls (P = 0.001), whereas, IL-10 was higher in patients during remission but normal during relapse (P = 0.01; 0.86 respectively). IL-17 increased during relapses (P = 0.001) while IL-10 increased during remissions (P = 0.028). No significant correlations were found between both interleukins and age at onset; disease duration, number of relapses; or EDSS. Conclusion RRMS patients can have a regulatory imbalance between both pro-and antiinflammatory cytokines, which could be a target for treatment strategies rather than focusing on a single cytokine.