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COVID-19 is a pandemic disease which predominantly affects the respiratory system with high critical care mortality and morbidity; however, it also causes multi-organ dysfunction in a subset of patients. Although causality between COVID-19 and mucormycosis remains unclear, many factors including glucocorticoids, worsening of blood glucose control, and viral-induced lymphopenia have been attributed to cause mucormycosis in patients with COVID-19. In COVID-19 patients, especially those who need oxygen support, inflammatory and cytokine storm or usage of steroids make the immune system weak. This may pave the way for opportunistic infections including mucormycosis. We report fourteen cases of COVID-19 infection, who developed rhino-orbito-cerebral mucormycosis, during treatment. Early recognition of this life-threatening infection is the key to allow for optimal treatment and improved outcomes.

The combination of big data and artificial intelligence (AI) is having an increasing impact on the field of electrophysiology. Algorithms are created to improve the automated diagnosis of clinical ECGs or ambulatory rhythm devices. Furthermore, the use of AI during invasive electrophysiological studies or combining several diagnostic modalities into AI algorithms to aid diagnostics are being investigated. However, the clinical performance and applicability of created algorithms are yet unknown. In this narrative review, opportunities and threats of AI in the field of electrophysiology are described, mainly focusing on ECGs. Current opportunities are discussed with their potential clinical benefits as well as the challenges. Challenges in data acquisition, model performance, (external) validity, clinical implementation, algorithm interpretation as well as the ethical aspects of AI research are discussed. This article aims to guide clinicians in the evaluation of new AI applications for electrophysiology before their clinical implementation.

Introduction: The neutrophil to lymphocyte ratio (NLR) can be used as a marker of subclinical inflammation, and may have a predictive power in prognosis and severity of atherosclerosis-related diseases. This study aimed to assess an association between the NLR, and clinical characteristics and one-month outcome in acute ischemic stroke (AIS). Subjects and Methods: This case-control observational prospective study included 75 patients admitted to stroke unit of Ain Shams University hospitals with AIS, sub grouped into 3 equal groups according to subtype of AIS, in addition to 25 healthy individuals. The demographic characteristics of the patients, complete blood picture test results at presentation, National Institutes of Health Stroke Scale (NIHSS) scores and modified Rankin Scale (mRS) scores were recorded. The clinical outcome was assessed by the NIHSS and mRS scores after one month. Results: The total leucocyte count was significantly higher in large artery atherosclerosis (P = 0.004) and cardioembolic (P = 0.020) stroke groups, unlike lacunar stroke group (P = 0.082), when compared to controls. The neutrophils count was higher (P < 0.001) and the lymphocyte count was lower (P < 0.001) among all the stroke groups compared to the control group. The NLR was higher among all the stroke groups compared to the control group (P < 0.001). The NLR at cutoff value more than 1.34 had predicted stroke with a sensitivity of 89.33% and specificity of 72% and accuracy reached 88.6%. There was non-significant association between NLR and each of NIHSS and mRS after one month from onset of AIS. Conclusion: NLR was significantly higher among AIS subtypes compared to controls, but not a good predictor for one month outcome.

IntroductionAfter the results of phase III vaccine studies became available, the leading oncology societies recommended two doses of COVID-19 vaccination to all patients with cancer with no specific recommendation for tumor type and active treatments. However, the data on the COVID-19 vaccine efficacy in cancer patients is limited due to exclusion of cancer patients from most vaccine clinical trials. Therefore, we systemically reviewed the available evidence evaluating the antibody responses in cancer patients.MethodsWe conducted a systematic search from the Pubmed database and calculated risk differences (RD) and 95% confidence intervals (CI) to compare seroconversion rates between cancer patients and controls using the Review Manager software, version 5.3.ResultsOur systematic search retrieved a total 27 studies and we included 17 studies with control arms in the analyses. Cancer patients had significantly lower seroconversion rates (37.3%) than controls (74.1%) (RD: -0.44, 95% CI: -0.52, -0.35, pConclusionIn conclusion, COVID-19 vaccine seroconversion rates were significantly lower in patients with hematological malignancies and patients under active treatment. Further research focusing on the approaches to improve vaccine efficacy and exploration of novel treatment options is urgently needed for these patients.

Study Objectives: About a quarter of strokes and transient ischemic attacks occur in the vertebrobasilar distribution. Vertebrobasilar stroke is particularly prone to devastating consequences especially brain stem infarctions due to damage of the regional brain tissues that contain vital centers, and is associated with high rates of death and disability. Study Design: This was across sectional observational prospective hospital-based study conducted on 60 patients with first-ever acute posterior circulation ischemic stroke. The aim of the current study was to determine the relationship between different risk factors and different infarction patterns in posterior circulation; single small lacunar lesion, single large lesion, or multiple scattered lesions. Diagnosis of ischemic stroke and stroke subtypes were defined using the Trial of ORG 10,172 in Acute Stroke Treatment (TOAST) criteria as well as clinical and brain imaging features. Stroke severity using National Institutes of Health Stroke Scale (NIHSS) score was done on admission, after 24 hours from admission, and at 7 days from onset of symptoms. The patients functional status was assessed by modified Rankin scale (mRS) done on admission and on discharge from hospital and at 7-day follow up from onset of symptoms. Patients were classified according to infarction patterns into a single small lacunar lesion (group I), a single large lesion (group II), and multiple scattered lesions (group III) 20 patients in each group. Results: There was no significant difference between the three groups as regard the presence of vascular risk factors and the only significant difference as regard vascular risk factors was atrial fibrillation (AF). There was significant difference between the three groups as regard the occurrence of previous transient ischemic attacks (TIA). There was significant difference between the three groups as regard NIHSS score on admission, after 24 hours, and at 7 days from admission. There were significant differences between the three groups as regard mRS score at discharge and at 7-day follow up from the onset of symptoms and the degree of improvement from admission to discharge. There was significant difference between the three groups as regard volume of infarction in Brain magnetic resonance imaging (MRI). Group II and group III patients had larger volumes of infarction when compared to group I patients. There was no significant difference between the three groups as regard presence of significant intracranial stenosis in magnetic resonance angiography (MRA). There was significant difference between the three groups as regard stroke etiology. It was found that largeartery atherosclerosis (LAA) was the most common stroke etiology in posterior circulation being present in (53.3%) of the patient group and was common in group II and III in contrast to group I patients. Conclusions: Different vascular risk factors such as hypertension, diabetes, dyslipidemia, and smoking are present in all infarction patterns of posterior circulation ischemic stroke either single or multiple infarctions. However, AF and significant vertebrobasilar stenosis were mostly associated with large and multiple infarct lesion patterns. Small vessel disease was the most common stroke etiology for single small lacunar lesion while large artery atherosclerosis was associated with single large lesion and multiple lesions in the posterior circulation. Early MRI and MRA help in define type and prognosis of posterior circulation infarcts. Early diagnosis and control of potentially modifiable risk factors and comorbid conditions are an important aspect in the early management of patients with infarction in the posterior circulation.

Background: Antioxidants such as vitamin C can eliminate free radicles responsible for oxidative stress. Objective: To assess the serum level of vitamin C in a sample of multiple sclerosis (MS) patients to investigate a possible role of vitamin C in the pathogenesis of MS. Subjects and Methods: Forty patients with MS and twenty healthy controls were included in this study. Vitamin C level was estimated for each participant. Results: Serum vitamin C levels were significantly lower among the patients (ranging from 0.28 mg/dL to 0.75 mg/dL with mean 0.47 ± 0.14 mg/dL and median of 0.46 mg/dL) compared to controls (ranging from 0.60 mg/dL to 2.90 mg/dL with mean 1.87 ± 0.61 mg/dL and median of 1.90 mg/dL) (P < 0.001). A positive correlation was detected between age and serum vitamin C (r = 0.312, P = 0.049). Patients with infratentorial lesions had significantly lower levels of serum vitamin C compared to those who did not have infratentorial lesions (P = 0.017). Conclusion: Patients with MS tended to have low serum vitamin C levels, and younger patients had lower serum levels.

Post-tensioned method is a technique commonly used all over the world to prevent cracks and minimize deflections produced by externally applied loads. In post-tensioned, stress is added after concrete placement and appropriate hardness and strength are achieved. By a post-tensioned method greater loads, greater spans, control the cracks and smaller size of members can be achieved. This paper reviews some previous research studies on post-tensioned concrete beams. From this literature; it was concluded that the ultimate load capacity for a beam with a bonded tendon is higher if compared to the same beam with the unbonded tendon. The higher ultimate capacity for the bonded beam is due to the additive stiffness obtained by tendon-concrete bond. For external prestressed beam, the results showed that using draped tendon profile increases the flexural resistance as compared to straight tendon profile.

Introduction Stroke is a leading cause of disability worldwide with grave morbidity and mortality. Sleep and stroke have a definite intermingling neuropathological relationship, so along with expeditious acute management, efficient secondary prevention and consistent rehabilitation, sleep disorders’ management has a hand in offering a medical service up to the mark. Objective Screening of sleep disorders’ prevalence in patients who survived a previous stroke by applying simple questionnaires and to determine the correlation between these disorders and stroke’s demographic, clinical, and risk factor variables. Methods Cross-sectional prospective study on 75 stroke patients from stroke outpatient clinic and all patients were subjected to answer a sheet of sleep questionnaire, Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Apnea/Hypopnea Index (AHI), Arabic versions. Results A total of 70.6 % were found to have sleep disorders, 61.6% had poor sleep quality, 20% had a severe degree of excessive day time sleepiness (EDS). Sleep disorders were more prevalent in the moderate severity of stroke by NIHSS and in the first 1–4 weeks. There was no correlation between the occurrence of sleep disorders and the site of the lesion. Conclusion Sleep disorders are broadly prevalent after a stroke. Resulting damage impedes the functional outcome. Simple questionnaires are easy applicable methods for screening of such disorders in post-stroke patients. Guidelines needed regarding screening and management of sleep disorders after a stroke.

There have been great developments in the area of civil engineering in the recent few decades and among these, construction and material innovation are quite prominent. Steel-concrete composite construction has emerged as one of the fastest methods of construction. Even though considerable research efforts on conventional reinforced concrete columns have been executed prior to now, concrete filled steel tube (CFST) composite columns however have received limited attention. This work aims to study the experimental behavior of steel tubular specimens. Plastic and steel specimens are considered with circular and square sections filled with the concrete with the steel fiber and as well, plain concrete. Four parameters are considered in this study which are sectional designs (circular and square), tube thickness (2 and 5 mm), tube material (plastic and steel) and content of steel fiber (0 and 5%). Ten concrete filled steel tubular columns were cast and tested. Two circular columns were made from plastic and the other made from steel. The main purpose of this work are study the effect of steel fiber and cross section on the ultimate load capacity of columns. It was discovered the utilization of steel fiber reinforced concrete filled steel tubular columns have comparatively substantial stiffness in comparison with plain concrete filled columns.

Background: The anatomical location of white matter hyperintense lesions in small vessel disease are apparently similar to those of borderzone infarction. The objective of this study is to find clinical and radiological points of differentiation between the two vascular disorders in a sample of Egyptian patients which might have an impact on primary and secondary prevention. Methods: Ischemic stroke patients with white matter lesions were categorized into two groups: small vessel disease and borderzone infarctions. NIHSS was done on admission. Risk factor profile was reported, and investigations done including: HbA1C, lipid profile, CRP, ECG, echocardiography, carotid duplex, brain MRI, MRA and MR perfusion study. Results: 46 patients completed the study, 29 with SVD and 17 with BZI. Smoking, hypertension and recurrent stroke were more common in borderzone infarctions, but only diabetes was significantly higher (p = 0.047). Limb shaking was more observed in borderzone infarctions (p = 0.049). Radiologically: lacunar pattern was observed more in small vessel disease, while rosary pattern was more in borderzone infarctions (p = 0.04). FLAIR symmetrical lesions and microbleeds were more significant in small vessel disease (p =

Background: Dysphagia following acute stroke can be a serious threat to one's health because of the risk of aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. There is an evidence that early enteral feeding via percutaneous endoscopic gastrostomy (PEG) is both beneficial and safe. Objectives: To predict risk factors ofprolonged dysphagia following acute stroke and proper management of similar cases. Subjects and Methods: This study was a prospective cohort study conducted on 113 patients with acute stroke admitted within 24 hours. Clinical findings and imaging results were prospectively collected, and subsequent progress was recorded. Subjects were divided into 3 groups for analysis: no dysphagia; transient dysphagia (≥14 days); or prolonged dysphagia (>14 days). Particular attention was paid to bulbar function. Stroke severity was assessed using the National Institutes of Health Stroke Scale on admission and on discharge. The water swallow test was performed to all patients who were able to attend sufficiently to follow the instructions. Modified Barium Swallow or Video-fluoroscopy test was done for some patients to detect the oropharyngeal dysphagia. Results: Significant associations for prolonged dysphagia were seen with large stroke, increased stroke severity, dysphasia and lesions of the frontal and insular cortex and presence of old vascular insult on brain imaging. Conclusion: These results indicated that it is potentially possible to identify those patients who have prolonged significant dysphagia following acute stroke at an early time point. This would allow the judicious use of early PEG to avoid aspiration pneumonia and for better nutrition.

Background: There is growing recognition of the clinical and public health importance of stroke in women. Moreover, stroke-related outcomes, including disability and quality of life are consistently poorer in women than in men. Yet the reasons for this are not well understood. Objectives: The aim of this study was to identify risk factors, clinical severity, type, site and size of stroke among sample of Egyptian women patients with acute stroke. Subjects and Methods: The study evaluated 103 female patients with acute stroke admitted within 48 hours of stroke onset. All patients were subjected to full history and neurological examination. The stroke severity was assessed on presentation using National Institutes of Health Stroke Scale (NIHSS). Also, computer topography and magnetic resonance imaging brain, bilateral carotid duplex study and trans-thoracic echocardiography study were done to all patients. Results:The mean age of the patients was 62.16 ± 13.5 years. Hypertension was the highest family (48.5%) and past history (78.6%) among the study patients. The mean of NIHSS score of our study patients on admission was 6.5 ± 3.76. The past history of previous cerebral stroke insult, high erythrocyte sedimentation rate and abnormal glycosylated hemoglobin were significantly associated with more severe stroke. Large artery atherosclerosis was the most common ischemic etiology in our sample (38.3%). Parietal lesions was the most common stroke site affected in our study patients (26 patients = 25.2%) followed by frontal lesions (18 patients =17.5%). Conclusion: Understanding acute stroke among females will help neurologist to develop sex-specific interventions that improve post-stroke recovery for women and reduce their excess burden of disability.

In the original article entitled “Prognostic Value of P-POSSUM and Osteopenia for Predicting Mortality After Emergency Laparotomy in Geriatric Patients”[1] which was published in July 2019 issue of the journal, there was an error in the specified mortality outcome in the manuscript. The published version describes 30-day mortality, however, the correct outcome measure should be 90-day mortality throughout the article. The article has been corrected accordingly online.

Eosinophils and their granules were shown to be significant participants in the inflammatory processes of various helminthic infections. So far, only few reports have dealt with ECP level in parasitic diseases. So, this study aimed at evaluating the serum ECP in fascioliasis and hydatis disease and to compare the ECP level with the blood eosinophil count and serum lgE antibody levels in both diseases. Material and methods: this work included 90 individuals [30 patients with fascioliasis [group I], 30 patients with hydatid disease [group II], and 30 normal persons as control group]. All patients were free from concomitant parasitic infections, viral hepatitis B or C, allergic and autoimmune disorders. ECP was estimated in all patients and controls by radioimmuno assay. Moreover, peripheral blood eosinophil count and serum lgE were also estimated. Results: the mean serum level of ECP was significantly higher in patients with fascioliasis and hydatid disease [31.1±21.4, 20.3±11.6 µg/L, respectively] than the control group [7.1±4.0 µg/L], P=0.001 in each case. Moreover, ECP was significantly higher in fascioliasis group than in hydatid group [P=0.001]. The mean eosinophil count was 3.1x109/L ±2.2 in patients with fasciola infection, 1.4x109/L ±1.0 in patients with hydatid disease, and 0.2x109/L ±0.1 in the control group. Serum level of lgE antibody was found to have a mean value of 178.9±66.7 IU/ml in patients with fascioliasis, 157.9±54.1 IU/ml in patients with hydatid disease, and 90.9±35.5 IU/ml in the control group. ECP was shown to have significant positive correlations with the peripheral blood eosinophil count in both groups of patients. However, it was more significant with fascioliasis, a disease with more degree of eosinophilia. In contrast, no significant correlations existed between ECP and lgE antibody in either the groups. Conclusion: The data indicate a generally greater activity of the eosinophil cell system in fascioliasis and hydatid disease. So, ECP appears to be a useful clinical parameter in parasitic infections with eosinophilia to assess disease activity, inflammatory process, or may serve as a new tool for monitoring therapy.

There is no clear consensus about the pattern of cytokine production and regulation that causes patients with chronic schistosomiasis to develop severe hepatosplenic disease, which is characterized by peri-portal fibrosis and portal hypertension. Circulating immune complexes [CICs], play an important role in the pathogenesis of many clinical syndromes during the course of hepatic schistosomiasis. Therefore, the aim of this study was to estimate interleukin-6 [IL-6] and tumor necrosis factor-α] levels in serum and ascetic fluid [AF] of schistosomal patients and to evaluate these cytokines response in relation to circulating immune complexes. Material and methods: The study enrolled 40 patients with hepatic schistosomiasis forming two groups; 20 patients with ascites [group I] and the other 20 patients without ascites [group II]. Apart from complete history taking, clinical examination, and routine laboratory work, blood and ascetic fluid [AF] samples were collected from the patients after hospital admission. Estimation of IL-6 and TNF-α in serum and AF according to the manufacturer instructions. Moreover, serum circulating immune complexes [CICs] were assayed as well. Results: The mean serum level of IL-6 was 156.9±150.82 pg/ml in schistosomal ascetic patients and 121.63±68.47 pg/ml in non-ascetic cases. The mean serum concentration of TNF-α was 88.5±70.59 pg/ml in group I and 66±46.76 pg/ml in group II patients. IL-6 concentration in the ascetic fluid of schistosomal patients had a mean of 284.4±280.08 pg/ml while ascetic fluid TNF-α had a mean of 113.25±58.97 pg/ml. Schistosomal patients with ascites were shown to have significantly higher levels of IL-6 and TNF-α in their ascetic fluid than in serum. A significant positive correlation was detected between the serum and AF concentrations of IL-6 [r-=0.559], and TNF-α [r-=0.556*], P

Background Type 2 diabetes mellitus (T2DM) has various effects on the vascular tree, both macrovascular and microvascular and both intracranial and extracranial circulation. Metabolic syndrome is a combination of medical disorders that, when occurring together, increases the risk of developing cardiovascular diseases including stroke. Objectives In this study, we aimed to estimate the site and degree of intracranial arterial stenosis among patients clinically diagnosed as acute ischemic stroke patients with metabolic syndrome with or without T2DM. Patients and methods This cross-sectional study included 100 patients admitted in Ain Shams University Specialized Hospital-Stroke Unit with the diagnosis of clinically first-ever cerebral infarction and metabolic syndrome with or without T2DM. All patients were subjected to detailed medical history, thorough general and neurological examination, full laboratory investigations, computerized tomography, MRI, and magnetic resonance angiography of the brain, carotid duplex, ECG, and echocardiography. Results Small vessel disease (lacune) was present more frequently in patients with T2DM than in those without T2DM, and this showed a statistically significant difference ( P = 0.008). It was found that intracranial stenosis was statistically significantly higher compared with extracranial carotid stenosis in patients with T2DM with total or near-total occlusion, with P values less than 0.05. These stenoses or occlusions also tend to be multiple in the same group of patients with T2DM ( P = 0.033). Conclusion Diabetic patients with acute ischemic stroke have a higher severity of intracranial arterial stenosis, higher incidence of multiple intracranial arterial stenoses, and lastly higher tendency to have obstructive intracranial arterial lesions.

Intractable temporal lobe epilepsy (TLE) is associated with alterations in expression of apoptosis-associated signaling molecules in the temporal lobe. Bcl-2 is an anti-apoptotic molecule which has previously been reported to be raised in patient's brain and serum. In the present study we examined serum Bcl-2 protein levels as a surrogate marker of apoptosis-associated signaling in children with non lesional TLE. Serum Bcl-2 levels were found to be higher in patients with TLE than controls. The serum level correlated to seizure variables including, duration of disease, frequency of seizures, and disease severity. The impact of epilepsy on cognition was assessed using total score intelligence quotient (IQ). IQ was found to be lower than controls and negatively correlated to serum Bcl-2. These findings support serum Bcl-2 levels as a marker of seizure burden and cognition in children with epilepsy.

Background Sophisticated analysis of seizure semiology and electroencephalography (EEG) has a significant role in lateralizing and localizing the epileptogenic zone. Hence, understanding the pathophysiology of epileptogenic dysrhythmia requires thorough knowledge of how to put the very different pieces of the puzzle together. Objective The aim of the study was to investigate the concordance between seizure semiology, electrophysiological generator, anatomical lesions, and neuropsychological evaluation in patients with partial epilepsy, and to identify the importance of ictal EEG recording and the diagnostic yield of other electrophysiological techniques. Patients and methods Thirty patients with a diagnosis of intractable partial epilepsy and lesional MRI were prospectively included. All of them were clinically evaluated and identified according to semiological seizure classification. Long-term video digital EEG with ictal recording was done, along with a source analysis (SA) study. Results Clinical evaluation by seizure semiology lateralized 73% of the cases and localized 80%. Ictal EEG lateralized 80% of cases and localized 66.9%. SA revealed a much superior power to lateralize and localize (96.7%) the epileptogenic zone, but what is more important is the added value of SA, as it lateralized and localized 96-100% of the cases that failed on semiology. SA has the highest expected value for additional lateralizing and localizing information ( ±7.73 and ±7.30, respectively). Conclusion Seizure semiology and ictal EEG recording with SA are the most accurate ways to lateralize and localize the epileptogenic zone in intractable partial epileptic cases, giving the patient a respectable chance to avoid other invasive diagnostic techniques.

Numerous examples exist of the benefits of the timely access to information in emergencies and disasters. Information technology (IT) is playing an increasingly important role in information-sharing during emergencies and disasters.The effective use of IT in out-of-hospital (OOH) disaster response is accompanied by numerous challenges at the human, applications, communication, and security levels.Most reports of IT applications to emergencies or disasters to date, concern applications that are hospital-based or occur during non-response phases of events (i.e., mitigation, planning and preparedness, or recovery phases). Few reports address the application of IT to OOH disaster response.Wireless peer networks that involve ad hoc wireless routing networks and peer-to-peer application architectures offer a promising solution to the many challenges of information-sharing in OOH disaster response. These networks offer several services that are likely to improve information-sharing in OOH emergency response, including needs and capacity assessment databases, victim tracking, event logging, information retrieval, and overall incident management system support.