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We present a case of indolent neurolymphomatosis in a 55-year-old male patient with worsening pain and weakness in his right leg over the past few months. The patient has a past medical history of type II diabetes mellitus, four-year history of worsening left foot drop, left lower limb pain and weakness attributed to diabetic amyotrophy, and back pain. The new right-sided symptoms prompted further imaging which revealed a left sciatic nerve mass which was biopsied. Initial biopsy results were inconclusive. 18F-FDG PET/CT revealed the full extent of this patient's disease and helped plan for a more representative biopsy site, which finally established a diagnosis of diffuse large B-cell lymphoma involving the lumbosacral nerve roots. The patient underwent a course of chemotherapy. 18F-FDG PET/CT was ordered again at the end of treatment showing partial response to therapy. He underwent radiation therapy to the site of residual disease, with complete metabolic response of lesions on follow up PET CT.

Background and purpose The National Institutes of Health Stroke Scale (NIHSS) has been found to be biased toward the left hemispheric and motoric functions providing minimal assessment to the right hemispheric language and cognitive functions. The need to complement the role of the NIHSS is necessary in accurate and rapid assessment of AIS patients and better management. We hypothesized that combining the NIHSS with a quantitative analysis of Spoken Picture Description scale of Comprehensive Aphasia Test (SPD-CAT) could provide valuable data regarding side, site, and size of stroke. Subjects and methods Eighty-six AIS patients presented within 48 h of onset of stroke were enrolled from Stroke Units of Ain-Shams University Hospitals (ASUHS). Clinical Assessment with NIHSS and SPD-CAT were correlated with the radiological MRI Brain lesions of stroke regarding (site, side, size/volume and lesion volume percent to the whole brain volume “LV% WBV”). Results Total and subscale scores of NIHSS and SPD-CAT have a highly statistically significant correlation with the ischemic “LV% WBV.” Quantitative analysis (content units) of SPD-CAT may help in prediction of the lobar site of the stroke with higher significance in the tempro-parietal and brainstem regions. Right hemispheric strokes have clinically and statistically significant scores on SPD-CAT in comparison to NIHSS scores. Also, the left to right ratio of content units of information carrying words (ICWs) in SPD-CAT gives a significant difference between right and left hemispheric strokes. Recording and analysis time of SPD-CAT makes it easy and rapidly applicable in emergency room (ER) and stroke units. Conclusion Combining the quantitative analysis of NIHSS and SPD-CAT can better predict the side, size, and site of AIS within reasonable time table and without urgent MRI for AIS assessment and management.

Background New-onset seizure (NOS) is defined as the first seizure within a 24-h period ever experienced by the patient. A first-ever seizure can be the first manifestation of epilepsy. Or it may be a symptom of a brain tumor, a systemic disorder, an infection, or a syndrome that deserves special attention and treatment. This study aims to identify the etiology of NOS among different age and sex groups of adult Egyptian patients. A hundred and twenty adult Egyptian patients (> 18 years) presented with acute NOS were enrolled in a hospital-based cross-sectional observational study from the emergency room and neurology outpatient clinics of our hospitals within a time period of 6 months from March till September 2018. All patients were subjected to neurological examination, laboratory, neuroimaging, and electroencephalogram investigations. Results Among 120 adult patients presented with NOS, males were prevalent (63%). Older adults (age group > 55 years) were the most prevalent cohort (60%). Cerebrovascular diseases (CVDs) were the most common identified etiology of NOS (44.17%), followed by idiopathic epilepsy syndrome (18.33%), symptomatic mainly “metabolic” (11%), brain tumors (9.17%), post-traumatic epilepsy (6.67 %), encephalitis (5.83%), and cryptogenic (5%). Idiopathic epilepsy syndrome was the most common etiology (55.56%) of new-onset seizures among the young adult age group ( 55 years). Also, CVDs were the most common etiology among males (43.4%) as well as females (45.4%). However, male predominance was the highest among post-traumatic seizures (87.5%). And female predominance was the highest among brain tumors identified etiology of NOS (54.5%). Conclusion NOS among adults are prevalent in elder males. CVDs are the most commonly identified etiology of adult NOS across males and females. Idiopathic epilepsy syndromes are the predominant etiology among younger adults.

Background New onset seizure (NOS) is defined as the first seizure within a 24-h period ever experienced by the patient. Cluster seizures (CS) or status epilepticus (SE) can be the first manifestation of epilepsy or it may be a symptom of a brain tumor, a systemic disorder, an infection, or a syndrome. This study aims to determine the etiology of CS and SE in NOS among adult Egyptians. One hundred twenty adult Egyptian patients presented with NOS were enrolled in a hospital-based cross-sectional observational study within a time period of 6 months from March till September 2018. All patients were subjected to neurological examination including mini mental status examination, laboratory, neuroimaging, and electroencephalogram. Results Among 120 adult patients presented with NOS, males were prevalent (63%). Older adults (> 55 years) were prevalent (60%). Of the patients, 25% presented by CS, while 11% presented by SE. Post-stroke epilepsy (41%) was the predominant etiology of NOS. Cerebrovascular diseases (CVDs) were the prevalent etiology of SE in NOS (35%). NOS presented by CS were more prevalent among patients with brain tumors (29%) in comparison to CVDs (25%). Conclusion CS represented 25% of NOS in adult Egyptian patients. SE is prevalent among 11% of NOS. Despite CVDs being the most prevalent etiology of NOS in adult population (41%) including those presented with SE (35%), brain tumors are the most prevalent etiology of new onset CS (29%).

Background: multiple sclerosis (MS) is an inflammatory disorder of the brain, spinal cord, and optic nerves. MS affects more than two million people worldwide; sleep disorders are very common in the general population; their high prevalence rate suggests that MS patients will certainly be suffering from comorbid sleep disorders. Objective: study the prevalence of sleep disorders among MS patients by clinical and Polysomnography (PSG) studies. Patients and Methods: twenty-five MS patients and 12 healthy controls were examined by expanded disability status scale (EDSS) for functional disability, Pittsburg sleep quality index (PSQI) for sleep quality, Epworth sleepiness scale (ESS) for excessive daytime sleepiness, international restless leg syndrome scale (IRLSS) for restless led syndrome (RLS). PSG studies were done for all subjects for assessment of quality of sleep and sleep parameters. Magnetic Resonance Imaging (MRI) Brain was done for MS patients g to subtype it according to McDonald criteria 2010. Results: seventy six percent of MS patients had poor sleep quality according to PSQI (8.6 ±3.7). While 44% had excessive daytime sleepiness according to ESS (12.2±3.6) and 40% had RLS according to IRLSS. Patients with progressive MS (PMS) either primary (PPMS) or secondary (SPMS) subtypes had poorer sleep quality index and excessive daytime sleepiness compared to relapsing remitting MS (RRMS) subtype. PSG study showed decreased total sleep time (TST) and sleep efficiency index in MS patients with prolonged sleep latency and decreased rapid eye movement (REM) latency and higher total arousal index and periodic limb movement (PLM) index than control. EDSS of MS patients had positive correlation with PSQI and ESS. Also EDSS had inverse correlation with TST and sleep efficiency index on PSG. Conclusion: sleep disorders are prevalent among MS patients. PPMS and SPMS patients showed more prevalence of sleep disorder than RRMS with poorer sleep parameters on PSG.

To evaluate the efficacy of high-frequency repeated transcranial magnetic stimulation (rTMS) applied contralesionally versus transcutaneous neuromuscular electrical stimulation (TNES) in acute post-stroke dysphagic patients.A randomized, parallel, comparative, controlled trial was conducted on patients with acute ischemic stroke who were admitted to our department. Fifteen patients received rTMS, 15 patients received TNES, and 15 patients were recruited as a control group. Between the second and tenth days after a stroke, patients were enrolled. The study and follow-up periods were completed by all patients.Among the screened patients, 45 (31.47%) right-handed patients were diagnosed with post-stroke dysphagia with a mean age of 60.53 ± 8.23 years. Immediately after intervention both rTMS and TNES groups significantly improve the swallowing disturbance questionnaire (SDQ) and penetration aspiration scale (PAS), compared to the control (p 0.001 and p = 0.027), respectively. rTMS was more effective than TNES in reducing SDQ and PAS (p 0.05). rTMS and TNES improved the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) significantly (p = 0.002); however, their efficacy was comparable (p 0.05). A significant (p 0.001) strong negative correlation was observed between the grade of weakness and all scores.Our findings showed that high-frequency rTMS and TNES effectively improved the clinical condition of acute post-stroke dysphagic patients in terms of swallowing disturbance assessed by SDQ, pharyngeal residue assessed by YPRSRS, and the severity of penetration and aspiration events evaluated by PAS, compared to the controls. The outcomes of high-frequency rTMS were more favorable than those of TNES in terms of SDQ and PAS.

Background: chronic hepatitis C virus (HCV) is a major cause of liver-related morbidity and mortality. Successful antiviral therapy with sustained viral clearance is associated with improved quality of life, and reduced risk of liver complications such as cirrhosis and hepatocellular carcinoma. Aim of the Work: to evaluate the impact of HCV eradication using direct acting antiviral drugs (DAADs) on cognitive function among hepatitis c virus infected patients. Patients and Methods: this study was conducted at Viral Hepatitis Unit of Dar El Shefaa Hospital (one of the centers of national committee for control of viral hepatitis) and MASRI (Faculty of Medicine Ain-Shams Research institute) unit at El-Demerdash Hospital. Data were prospectively collected using MoCA, PHQ-9 and PSQI scales to assess the cognitive function of the treated patients with the newly used DAADs before the start of treatment, during treatment and at 12 weeks after the end of treatment, and the laboratory data were collected from the files of the patients in the previously mentioned centers. Results: results of the current study as regarding the analytical part of the study showed that: Pre treatment: slightly cognitive impairment was found with mild level of depression and sleep disturbance with MoCA test Mean ± SD 23.02 ± 4.96. At the end of treatment: there was no direct effect of the newly used drugs on the cognitive function. After 3 months of treatment (SVR): there was significant improvement of the cognitive function. Conclusion: HCV eradication had beneficial effect on cognitive function. Sofosbuvir based treatment had no effect on cognitive function.

The current work investigates the thermal conductivity and mechanical properties of Boron Nitride (BN)-Acrylonitrile Butadiene Styrene (ABS) composites prepared using both 3D printing and injection molding. The thermally conductive, yet electrically insulating composite material provides a unique combination of properties that make it desirable for heat dissipation and packaging applications in electronics. Materials were fabricated via melt mixing on a twin-screw compounder, then injection molded or extruded into filament for fused deposition modeling (FDM) 3D printing. Compositions of up to 35 wt.% BN in ABS were prepared, and the infill orientation of the 3D printed composites was varied to investigate the effect on properties. Injection molding produced a maximum in-plane conductivity of 1.45 W/m-K at 35 wt.% BN, whereas 3D printed samples of 35 wt.% BN showed a value of 0.93 W/m-K, over 5 times the conductivity of pure ABS. The resulting thermal conductivity is anisotropic; with the through-plane thermal conductivity lower by a factor of ~3 for injection molding and ~4 for 3D printing. Adding BN flakes caused a modest increase in the flexural modulus, but resulted in a large decrease in the flexural strength and impact toughness. It is shown that although injection molding produces parts with superior thermal and mechanical properties, BN shows much potential as a filler material for rapid prototyping of thermally conductive composites.

Abstract Background: Ceramic on ceramic total hip arthroplasty is now a standard procedure in the management of degenerative hip joint disorders. The new operative techniques has made the procedure an easy process to operate and with good results for young individuals. Patients and Methods: Our study was performed on 24 patients that were operated at Orthopedic department, Zagazig university and Ain-Shams university hospital in the period between August 2014 to August 2016. All cases were treated by CoC THA. 11 males and 13 females with mean age of 33 years (range: 18-63). The etiology was femoral head avascular necrosis in 16 hips, and posttraumatic hip arthritis in 6 patients and ankylosing spondylitis in 2 hips. Clinically, the indications of operation were intolerable pain, limitation of hip motions and flexion adduction deformity. Clinical evaluation by Harris Hip Score. preoperatively, postoperatively and at follow up visits was done. Results: The age of the patients was between 18 and 63 years with mean 33 years. Regarding sex distribution 54.2% were female. There were statistical significant increase in Harris score grading among the studied cases postoperative compared to pre. Excellent results were in 18 hips (75%), and good results in 2 (8.3%), fair in 3 hips (12.5%), and 1 hip (4.2%) had poor results. 33.3 % of the patients had complication, one case had linear breakage, 3 cases had head dislocation, two infected cases, one cases suffered from squeaking and one case revised.

The petroleum industry is faced with a number of enormous challenges resulting from the declining oil prices such as high abandonment and new wells construction costs, low sweep efficiency, harsh environments etc. These challenges can be met by designing a long term field development plan of a petroleum prospect, ensuring maximum recovery without sacrificing the safety standards. This work describes a multicomponent and strategic development plan designed for a tight gas reservoir, starting from formation evaluation to drilling-completion and economic analysis in addition to the environmental issues that must be considered in advance. The authors also acknowledge the support of: The field is principally a gas condensate field, where the reservoir is mainly Chalk with an average porosity of 27% and average permeability of 0.1mD with 65% water saturation. The reservoir pressure (5960 psia) and dew point (5940 psia) being very close, the reservoir is close to saturation pressure and gas condensate is expected to form immediately on commencing production. PVT studies indicated that the critical condensate saturation will not be reached which in turn means that it will never be mobile or recoverable with reservoir pressure decline. Given the fact that the water drive is rather weak, pressure maintenance methods will be needed to avoid the condensation of gas within the reservoir. Based on petro-physical evaluation, our team was able to construct a static reservoir model using Petrel Software and the team suggested three different development scenarios consisting of horizontal and multilateral wells of various configurations. Based on the development strategies, a dynamic model is constructed for each scenario to compare the techno-economic feasibility and selection of the most optimum strategy. It was found that the field would be economically viable to produce for a time period of 50 years and the simulation results indicate that an ultimate recovery of 69-76% was achieved if water injection is applied from year-1 onwards. Moreover, the highest recovery factor of 76% is achieved with scenario-B as it has a five spot pattern with 8 vertical injection and 3 multilateral production wells. In addition, the most delayed water breakthrough is achieved in this scenario that occurs after 2.5 years. Moreover, it was also observed that the pressure maintenance was 100% effective in scenario-C as the reservoir pressure increased as a result of increasing the water injection rate rather than increasing the sweep efficiency. However, for the other scenarios, the reservoir pressure drops but not below the critical value. Finally, a cumulative gas production of 389-424 MMMSCF was observed along with a gas production rate of 8.61-24.7MMSCF/day giving a cumulative net present value of $890,000 with a payback period of 5 years, indicating that the project is economically viable after 50 years.

Background Despite aggressive medical therapy, the risk of recurrent stroke in patients with symptomatic intracranial arterial (ICA) disease is as high as 15% per year. In patients with severe stenosis (>70%) and in certain high-risk groups, the risk of recurrent stroke has been reported to be as high as 25% per year. Objective Our study aimed to follow-up the patients after ICA stenting by using transcranial duplex (TCD). Patients and methods This is a retrospective single-center study carried out on data of patients recruited to Neurovascular Unit of El Mataria Teaching Hospital during the period from June 2015 to June 2016. A total of 25 patients were enrolled. TCD before and after stenting data were collected from the patients' files. Results Our study showed significant decreased in mean flow velocity and percent of stenosis after intracranial stenting. Conclusion Our study concluded that TCD is a good method for follow-up of patients after ICA stenting.