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Introduction COVID-19 is characterized by a procoagulant state that increases the risk of venous and arterial thrombosis. The dose of anticoagulants in patients with severe COVID-19 pneumonia without suspected or confirmed thrombosis has been debated. Aim of the study We evaluated the prevalence, predictors, and outcomes of venous thromboembolism (VTE) in critically ill COVID-19 patients and assessed the association between the dose of anticoagulants and outcomes. Materials and methods This retrospective cohort included patients with COVID-19 who were admitted to the ICU between March and July 2020. Patients with clinically suspected and confirmed VTE were compared to those not diagnosed to have VTE. Results The study enrolled 310 consecutive patients with severe COVID-19 pneumonia: age 60.0±15.1 years, 67.1% required mechanical ventilation and 44.7% vasopressors. Most (97.1%) patients received anticoagulants during ICU stay: prophylactic unfractionated heparin (N=106), standard-dose enoxaparin (N=104) and intermediate-dose enoxaparin (N=57). Limb Doppler ultrasound was performed for 49 (15.8%) patients and chest computed tomographic angiography for 62 (20%). VTE was diagnosed in 41 (13.2%) patients; 20 patients had deep vein thrombosis and 23 had acute pulmonary embolism. Patients with VTE had significantly higher D-dimer on ICU admission. On multivariable Cox regression analysis, intermediate-dose enoxaparin versus standard-dose unfractionated heparin or enoxaparin was associated with lower VTE risk (hazard ratio, 0.06; 95% confidence interval, 0.01-0.74) and lower risk of the composite outcome of VTE or hospital mortality (hazard ratio, 0.42; 95% confidence interval, 0.23-0.78; p=0.006). Major bleeding was not different between the intermediate- and prophylactic-dose heparin groups. Conclusions In our study, clinically suspected and confirmed VTE was diagnosed in 13.2% of critically ill patients with COVID-19. Intermediate-dose enoxaparin versus standard-dose unfractionated heparin or enoxaparin was associated with decreased risk of VTE or hospital mortality.

Hend Abdel Ghany,1 Ahmed Karam-Allah,1 Ramy Edward,2 Maged Abdel Naseer,1 Mohamed I Hegazy1 1Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Radiology Department, Faculty of Medicine, Cairo University, Cairo, EgyptCorrespondence: Mohamed I Hegazy, Neurology Department, Cairo University, 108 Al Manial street, Degla, Maadi, Cairo, 11435, Egypt, Tel +20 1223130686, Email mhegazy@kasralainy.edu.egPurpose: Magnetic resonance imaging (MRI) findings in multiple sclerosis (MS) overlap with numerous MS mimics. The central vein sign (CVS) can help to differentiate MS from other mimics. This study aimed to determine the value of CVS as a diagnostic biomarker for distinguishing MS from its mimics.Patients and Methods: Patients were prospectively recruited into two groups: a typical clinical (TC) MS presentation with an atypical MRI for MS and an atypical clinical (ATC) MS presentation with a typical MRI for MS. Patients underwent a 1.5T MRI brain scan with a T2&ast;-weighted gradient-echo sequence. The presence of the central vein was assessed by a radiologist blinded to patients’ clinical presentation. The MS consultant made the final diagnosis without reviewing the T2&ast;-weighted gradient-echo sequence or the CVS analysis results.Results: Forty-two patients were included. Ten (40%) out of 25 TC patients were diagnosed with clinically definite MS (CDMS), with a mean percentage of CV-positive lesions of 65.5% among CDMS patients. Four (23.5%) out of 17 ATC patients were diagnosed with CDMS with a mean CV-positive lesions percentage of 68.25% among CDMS patients. TC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 10.13%, while ATC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 16.38%. The CVS showed 85.7% sensitivity and 100% specificity (95% confidence interval: 0.919– 1.018) for diagnosis of MS at a cut off value of 45% (p < 0.001). The percentage of CV-positive lesions was significantly higher in oligoclonal bands (OCBs) positive patients compared to OCBs negative patients (p < 0.001) and those with spinal cord lesions compared to patients with no spinal cord lesions (p = 0.017).Conclusion: The CVS has 85.7% sensitivity and 100% specificity for the diagnosis of MS at a cutoff value of 45%.Keywords: multiple sclerosis, central vein, mimics, cutoff, gradient-echo

The kidney represents an important target of systemic inflammation. Its involvement in monogenic and multifactorial autoinflammatory diseases (AIDs) vary from peculiar and relatively frequent manifestations to some rare but severe features that may end up requiring transplantation. The pathogenetic background is also very heterogeneous ranging from amyloidosis to non-amyloid related damage rooted in inflammasome activation. Kidney involvement in monogenic and polygenic AIDs may present as renal amyloidosis, IgA nephropathy, and more rarely as various forms of glomerulonephritis (GN), namely segmental glomerulosclerosis, collapsing glomerulopathy, fibrillar, or membranoproliferative GN. Vascular disorders such as thrombosis or renal aneurysms and pseudoaneurysms may be encountered in patients with Behcet’s disease. Patients with AIDs should be routinely assessed for renal involvement. Screening with urinalysis, serum creatinine, 24-h urinary protein, microhematuria, and imaging studies should be carried out for early diagnosis. Awareness of drug-induced nephrotoxicity, drug-drug interactions as well as addressing the issue of proper renal adjustment of drug doses deserve a special mention and should always be considered when dealing with patients affected by AIDs. Finally, we will explore the role of IL-1 inhibitors in AIDs patients with renal involvement. Targeting IL-1 may indeed have the potential to successfully manage kidney disease and improve long-term prognosis of AIDs patients.

Early diagnosis of cancer remains a great challenge in the field of laboratory medicine. We investigated the ability of ccf DNA and DNA integrity index (DNA II) in differentiating benign from malignant breast diseases.Serum samples were collected from 50 patients with benign breast disease (BBD) and 50 newly diagnosed breast cancer (BC) patients, in addition to 50 control women. VEGF was measured by ELISA, while Real-time q-PCR was used to measure ccf DNA concentrations and to assess the concentrations of ALU repeats, both short fragments (115 bp) and long fragments (247 bp), then DNA II was calculated (all were done before and after radical mastectomy).BC group showed significantly higher ccf DNA concentrations and DNA II compared to BBD and control groups, meanwhile, no statistically significant differences were found between BBD and control groups. Ccf DNA concentrations decreased significantly after surgery (P0.001). Good AUC was found for ccf DNA (AUC=0.860), fair AUC was found for DNA II (AUC=0.727), while VEGF AUC failed to discriminate between BBD and BC cases.ccf DNA and DNA II could be used as excellent molecular biomarkers for early diagnosis of BC and for monitoring the efficiency of therapy in such patients. Utilizing these molecular markers would improve both the healthcare and economic burden of malignancy.

The aim of this paper is to point out the design, development and deployment of the AutoInflammatory Disease Alliance (AIDA) International Registry for paediatric and adult patients with non-infectious uveitis (NIU).This is a physician-driven, population- and electronic-based registry implemented for both retrospective and prospective collection of real-world demographics, clinical, laboratory, instrumental and socioeconomic data of patients with uveitis and other non-infectious inflammatory ocular diseases recruited through the AIDA Network. Data recruitment, based on the Research Electronic Data Capture (REDCap) tool, is thought to collect standardised information for real-life research and has been developed to change over time according to future scientific acquisitions and potentially communicate with other similar instruments. Security, data quality and data governance are cornerstones of this platform.Ninety-five centres have been involved from 19 countries and four continents from 24 March to 16 November 2021. Forty-eight out of 95 have already obtained the approval from their local ethics committees. At present, the platform counts 259 users (95 principal investigators, 160 site investigators, 2 lead investigators, and 2 data managers). The AIDA Registry collects baseline and follow-up data using 3943 fields organised into 13 instruments, including patient's demographics, history, symptoms, trigger/risk factors, therapies and healthcare utilization for patients with NIU.The development of the AIDA Registry for patients with NIU will facilitate the collection of standardised data leading to real-world evidence and enabling international multicentre collaborative research through inclusion of patients and their families worldwide.

Familial Mediterranean fever (FMF) is the most prevalent monogenic autoinflammatory disease, caused by recessively inherited MEFV gene mutations. The most frequent MEFV mutations differ in penetrance and disease severity. We investigated the genotype-phenotype associations of the three most frequent MEFV gene mutations (M680I, M694V, and V726A) in Egyptian FMF children, regarding clinical features, severity, and colchicine response.We conducted a retrospective analysis of the medical registries of 500 FMF pediatric patients from Metropolitan Cairo between 2010 and 2015. The diagnosis was based on the Tel-Hashomer clinical diagnostic criteria. Clinical data and baseline investigations were collected. Mutation analysis was performed by the amplification-refractory mutation system (ARMS)-PCR method.Males represented 54% and ages ranged from 2 to 18 years. The most frequent symptoms were abdominal pain, fever, and arthralgia. Clinical features mostly associated with M694V mutation either homozygous or heterozygous whether simple, double, or triple. Of the patients, 94.6% completely responded to colchicine. Among patients benefiting from colchicine, 42.5% had M694V/V726A, 21.6% had M694V/V726A/M680I, and 21.1% had M694V genotype. Simple heterozygous M694V or V726A mutations conveyed a moderate phenotype in 57.1% and 50% of cases, respectively. Homozygous M694V mutation showed moderate and severe phenotypes in 21.7% and 65.2% of cases, respectively. Compound M694V/V726A mutation associated with moderate or severe disease in 48.3% and 33.8% of cases, respectively.This study encompasses the largest group of Egyptian pediatric FMF up to date to explore their genotype-phenotype associations. Our results support the notion that the genotype influences the phenotype as regards clinical manifestations, disease severity, and colchicine response.• This study encompasses the largest group of Egyptian pediatric patients affected by FMF up to date to explore their genotype-phenotype associations. • Our results support the notion that the genotype influences the phenotype as regards the clinical manifestations, the disease severity, and the response to colchicine treatment.

Background Cervical incompetence is a failure of the cervix to retain the products of conception throughout pregnancy, which results into cervical dilatation and preterm delivery. Many methods are conducted for early detection of cervical shortening, ripening and eventually dilatation to lessen the incidence of the preterm delivery, which is responsible for about 75% of neonatal comorbidities. Ultrasound plays an important role in the diagnosis and early detection of cervical incompetence. Elastography is a relatively new technique, which investigates into another important factor for cervical insufficiency which is “tissue stiffness”. The process of early cervical ripening, which is an important and main step in spontaneous preterm delivery, precedes cervical shortening and renders the human cervix soft which can be diagnosed through the color-coding method of the sonoelastography technique. The aim of this study is to determine the value of cervical elastography as a predictor of spontaneous preterm labor and validate the role of strain ratio in such technique. Results In our study, we examined the pregnant females by transvaginal conventional B-mode ultrasound and complementary elastography technique and recorded the elastography index of their cervix, internal os and external os together with measuring the amount of strain and strain ratio at internal and external os. Conclusions We concluded that women who had preterm delivery did have higher strain and elastography index as their cervices were softer than those who had full-term deliveries. Elastography therefore can be a reliable method for the prediction of preterm delivery.

Aim of the study: Compare the results of Latarjet operation and Arthroscopic Bankart repair in high demand patients including heavy labour and contact athletes with traumatic anterior shoulder instability. Methodology: Design: This is a prospective study of high demand patients with traumatic anterior shoulder instability selected during the period between February 2019 and July 2020. Thirty patients met the inclusion criteria, half of them underwent arthroscopic bankart repair, while the other half had an open Latarjet surgery. All patients were followed up for at least 6 months. Methods of treatment: A) Arthroscopic Bankart repair procedure & B) Open Latarjet Procedure: Result: The main finding of our study was the time to return to work/sports which was significantly lower in the Latarjet group (5.2 months) compared to the Bankart group (7 months). On the other hand, there was no statistical significance between the rates of return to sports/work in both groups. All patients in our study were assessed according to the Rowe scoring system as regards stability, ROM and function of the shoulder. There was a statistically significant increase in the Rowe score postoperatively with mean score of 84.0 ± 15.83 compared to 27.17± 12.15 preoperatively. However, there was no statistical significant difference in the postoperative ROM and Rowe score between Bankart and Latarjet groups. Conclusion: Both the Latarjet procedure and the arthroscopic Bankart repair revealed satisfactory clinical outcomes with nearly similar rate of return to sports/work in high demand patients with recurrent anterior glenohumeral dislocation. Latarjet procedure is considered more invasive and non-anatomical procedure, however it is less costly with shorter time to return to sports/work compared to Bankart. Evidence-based data support both procedures, thus the personal preference of the surgeon will always play a paramount role in choosing one of these procedures over the other. Keywords: Bankart repair, Latarjet procedure, shoulders instability. Title: Comparing Arthroscopic Bankart repair and Latarjet procedure in treating anterior shoulder instability in high demand patients Author: Ahmed Mohamed Hany Mohamed Farid Genena, Mohammed Hassan Aly Hashem, Ahmed Hassan Waly, Mohamed Osama Hegazy International Journal of Novel Research in Life Sciences ISSN 2394-966X Vol. 10, Issue 1, January 2023 - February 2023 Page No: 1-22 Novelty Journals Website: www.noveltyjournals.com Published Date: 09-January-2023 DOI: https://doi.org/10.5281/zenodo.7515368 Paper Download Link (Source) https://www.noveltyjournals.com/upload/paper/Comparing%20Arthroscopic%20Bankart%20repair-09012023-1.pdf, International Journal of Novel Research in Life Sciences, ISSN 2394-966X, Novelty Journals, Website: www.noveltyjournals.com

© 2022 Elsevier Inc.Background/objectives: Long-term efficacy and safety of tocilizumab (TCZ) in adult-onset Still's disease (AOSD) mostly derive from small case series. Herein we report a registry-based study investigating TCZ efficacy and safety in a cohort of patients with AOSD evaluated by clinical and serum inflammatory markers as well as drug retention rate analysis. Methods: This is an international multicentre study analyzing data from patients with AOSD regularly enrolled in the AIDA registry. TCZ efficacy was evaluated between baseline and last follow-up assessment in terms of changes in the Pouchot score and laboratory findings. Drug-retention rate was estimated by the Kaplan-Meier method, while Cox-regression analysis was employed to detect potential predictive factors of treatment withdrawal. Results: Data from 31 patients (15 men, 16 women) refractory to the conventional therapies and treated with TCZ were extracted from the AIDA registry. Mean ± SD time of treatment duration with TCZ was 24.32 ± 20.57 months. Median (IRQ) Pouchot score significantly decreased throughout the study period (p=0.001) with a significant difference between baseline [2.00 (4.00)] and 6 month-follow-up [0.00 (0.00)] (p=0.003) and between baseline and last follow-up assessment [0.00 (0.00)] (p=0.032), while no differences were observed between 6 month-evaluation and last follow-up assessment (p=0.823). Similarly, laboratory parameters significantly decreased from baseline to the last follow-up visit. With regard to drug survival, cumulative TCZ retention rate at 12-, 24-, and 36-month follow-up visit were 83.1%, 71.7% and 63.7%, respectively, without significant differences between biologic naïve patients and those previously treated with other biologics (p=0.329). Likewise, no significant differences were observed between chronic articular course of AOSD and other types of disease course (p=0.938) or between patients co-administered with conventional immunosuppressants and patients receiving TCZ as monotherapy (p=0.778). Cox-regression analysis identified no variable associated with a higher hazard of treatment withdrawal. Treatment was discontinued in 9 patients due to long-term remission (n=4), adverse events (n=2), loss of efficacy (n=1), non-medical reason (n=1) and unspecified cause (n=1). Mean glucocorticosteroids daily dose significantly decreased from baseline (18.36 ± 24.72 mg) to the last follow-up assessment (4.02 ± 4.99 mg, p=0.003). Conclusions: TCZ allows control of disease activity as well as normalization of serum inflammatory markers in both systemic and chronic articular form of AOSD. Additionally, TCZ displays an excellent drug retention rate while minimizing the risk of long-term exposure to corticosteroids.

Systemic lupus erythematosus (SLE) susceptibility has a strong genetic component. Genome-wide association studies (GWAS) across trans-ancestral populations show both common and distinct genetic variants of susceptibility across European and Asian ancestries, while many other ethnic populations remain underexplored. We conducted the first SLE GWAS on Egyptians–an admixed North African/Middle Eastern population–using 537 patients and 883 controls. To identify novel susceptibility loci and replicate previously known loci, we performed imputation-based association analysis with 6,382,276 SNPs while accounting for individual admixture. We validated the association analysis using adaptive permutation tests (n = 109). We identified a novel genome-wide significant locus near IRS1/miR-5702 (Pcorrected = 1.98 × 10−8) and eight novel suggestive loci (Pcorrected < 1.0 × 10−5). We also replicated (Pperm < 0.01) 97 previously known loci with at least one associated nearby SNP, with ITGAM, DEF6-PPARD and IRF5 the top three replicated loci. SNPs correlated (r2 > 0.8) with lead SNPs from four suggestive loci (ARMC9, DIAPH3, IFLDT1, and ENTPD3) were associated with differential gene expression (3.5 × 10−95 < p < 1.0 × 10−2) across diverse tissues. These loci are involved in cellular proliferation and invasion—pathways prominent in lupus and nephritis. Our study highlights the utility of GWAS in an admixed Egyptian population for delineating new genetic associations and for understanding SLE pathogenesis.

COVID-19 pandemic continues to be a global health crisis. The gut microbiome critically affects the immune system, and some respiratory infections are associated with changes in the gut microbiome; here, we evaluated the role of nutritional and lifestyle habits that modulate gut microbiota on COVID-19 outcomes in a longitudinal cohort study that included 200 patients infected with COVID-19. Of these, 122 cases were mild and seventy-eight were moderate, according to WHO classification. After detailed explanation by a consultant in clinical nutrition, participants responded to a written questionnaire on daily sugar, prebiotic intake in food, sleeping hours, exercise duration and antibiotic prescription, during the past 1 year before infection. Daily consumption of prebiotic-containing foods, less sugar, regular exercise, adequate sleep and fewer antibiotic prescriptions led to a milder disease and rapid virus clearance. Additionally, data on these factors were compiled into a single score, the ESSAP score (Exercise, Sugar consumption, Sleeping hours, Antibiotics taken, and Prebiotics consumption; 0–11 points), median ESSAP score was 5 for both mild and moderate cases; however, the range was 4–8 in mild cases, but 1–6 in moderate (P = 0·001, OR: 4·2, 95 % CI 1·9, 9·1); our results showed a negative correlation between regular consumption of yogurt containing probiotics and disease severity (P = 0·007, OR: 1·6, 95 % CI 1·1, 2·1). Mild COVID-19 disease was associated with 10–20 min of daily exercise (P = 0·016), sleeping at least 8 h daily, prescribed antibiotics less than 5 times per year (P = 0·077) and ate plenty of prebiotic-containing food.

Background The prevalence of cognitive impairment (CI) can reach up to 65% among multiple sclerosis (MS) patients. Self-administered screening questionnaires can offer a valuable solution for screening MS patients for cognitive complaints. The cognitive screening questionnaire for neurological disorders (CSQND) is an Arabic self-administered questionnaire that has been developed to screen patients with various neurological disorders attending neurology clinics. The aim of this study was to assess cognitive complaints and to validate the CSQND as a screening tool among Egyptian MS patients. Results Four-hundred MS patients and 400 controls were included in this study. All 400 patients and 400 controls were subjected to the CSQND, only 50 out of the 400 patients and 50 out of the 400 controls retook the CSQND 1 week later to establish test–retest reliability. Fifty patients and 50 controls were assessed by the symbol digit modalities test (SDMT) to establish concurrent validity. Thirty-four percent of patients complained of memory problems, 51% complained of concentration difficulties, 34% complained of language difficulties and 22.5% complained of space and time disorientation. Multiple sclerosis patients had significantly more cognitive complaints (12.4 ± 12.6) compared to controls (6.2 ± 6.8) when screened using the CSQND (P r = 0.14; 0.275; 0.3; 0.167, respectively), P R = 0.9, P = 0.0001) and controls (R = 0.85, P = 0.0001). Conclusions The CSQND was found to be a simple, valid, and reliable self-administered questionnaire to screen for cognitive complaints in MS patients.

Mona A Hegazy,1 Rania Mohamed Lithy,2 Hoda M Abdel-Hamid,3 Mahmoud Wahba,1 Omar Ahmed Ashoush,1 Mohamed Tharwat Hegazy,1 Maha Hossam El-Din Ibrahim,1 Dalia Abdelfatah,4 Ahmed Abdelghani1 1Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Chest Diseases Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 4Biostatistics and Cancer Epidemiology Department, National Cancer Institute, Cairo University, Cairo, EgyptCorrespondence: Mona A HegazyInternal Medicine Department, Faculty of Medicine, Cairo University, P.O. Box Number: 12566, 6th October City, Giza, EgyptTel +201001421551Email monahegazy@cu.edu.egBackground: The novel coronavirus disease 2019 presents an urgent threat to global health. As the epidemic grows, prognosis prediction is essential for monitoring risky patient. It is thus important to consider gastrointestinal manifestations and the duration of symptoms as predictors of prognosis. Our aim was to determine the correlation of gastrointestinal symptoms and laboratory markers with disease outcomes and whether symptom duration varies substantially between patients. We also undertook this study to determine the optimal time to predict COVID-19 outcome.Patients and Methods: A total of 190 patients with polymerase chain reaction-confirmed COVID-19 were followed up until recovery. We proposed a correlation between gastrointestinal symptoms and disease severity (based on clinical data, and diagnostic investigations) to estimate the duration of symptoms as a predictor of COVID-19 prognosis.Results: The prevalence of gastrointestinal symptoms was 49.5%, consisting mainly of diarrhea in 27.9% of patients. In addition, a longer disease duration and higher temperature were observed in patients with diarrhea. Symptom duration was variable, with a median of 12 days and a range of 1– 55 days. Statistical analysis indicated that patients with a duration of symptoms ≥ 12 day had more severe symptoms and a worse prognosis. Patients who complained of diarrhea had 2.7 times the odds of a longer duration of symptoms, and those with a history of chronic lung disease have 7.2 times the odds of a longer duration of symptoms.Conclusion: GIT manifestations (mainly diarrhea) and the duration of symptoms of COVID-19 provide prognostic evidence of COVID-19 outcomes, irrespective of earlier categorization by the World Health Organization. Thus, patients with mild symptoms who present with diarrhea and a duration of symptoms longer than 12 days are expected to have a worse prognosis.Keywords: COVID-19, GIT manifestations, symptoms duration, prognosis

Acne is a chronic inflammatory disease known to occur in adolescent age group. There are many myths and misconceptions in patients as well as health care providers regarding the causes and treatment of acne Aim: The present study was aimed to evaluate the Effect of Educational Guideline on performance and attitude of blind adolescent students’ regarding Acne Vulgaris. Subjects and Method: A quasi-experimental research design was utilized in this study that was conducted at Al-Nour and Al –aml School for the blind, preparatory and secondary of Beni-Suef and El Noor schools of visual handicapped at Tanta city. Convenience sampling of 100 blind adolescent students of the previously mentioned settings. The following study tools were used (pre/posttests): 1) Students’ interviewing to assess their knowledge as regards acne vulgaris. 2) An observational checklist to evaluate studied students’ practices such as skin care and face massage. 3) Attitude scale to assess adolescent students’ attitude regarding acne vulgaris. Results: There were significant differences regarding knowledge, practices (face and skin care, skin massage, methods of drying, hand wash, drinking water, and changing diet, applying topical medications, warm compress and exercises) and attitude about acne vulgaris between pre, post and follow up educational guideline. Conclusion: The present study concluded that, the educational guideline had a positive effect on performance and attitude of blind adolescent girl students regarding acne vulgaris. Recommendations: An orientation program should be prepared for such group of students regarding acne vulgaris. Increasing awareness of blind adolescent students about physical and physiological changes and needs during this stage.

Background Given the diversity of multiple sclerosis (MS) symptoms including cognitive impairment in certain domains, the need to develop a rapid and at the same time thorough tool for cognitive assessment is mandatory and represents an unmet need in the clinical and research fields of MS. The Brief International Cognitive Assessment for MS (BICAMS) is a good and practical tool to achieve this mission but is not present in the Arabic language for Arabic speaking countries yet. Objectives To assess the reliability and validity of Arabic version of the BICAMS (Egyptian dialect). Methods Ninety Egyptian MS patients and 85 matched healthy controls underwent neuropsychological testing using the BICAMS Arabic version (Egyptian dialect) battery including the Symbol Digit Modality Test (SDMT), California Verbal Learning Test 2nd edition (CVLT-II), and revised Brief Visuospatial Retention Test- (BVRT-R). Test–retest data were obtained from MS patients 2 weeks after the initial assessment. Mean differences between both groups were assessed controlling for age, gender, and educational level. Results The MS patients scored significantly lower on the SDMT, CVLT-II, and BVMT-R tests compared to healthy controls (pr values of 0.85, 0.61, and 0.68, respectively. Conclusion BICAMS Arabic version is a reliable and valid tool for cognitive assessment of Arabic speaking MS patients in different clinical and research settings.

Background: Children undergoing treatment with hemodialysis are exposed frequently to pain and anxiety which are caused by the insertion of large-gauge needles into an arteriovenous fistula. Non pharmacological pain management methods such as virtual reality and guided visualization are used to manage pain and pain related anxiety. Aim: to evaluate the effect of virtual reality compared to guided visualization on arteriovenous fistula cannulation pain and pain anxiety among hemodialysis children. Setting: the study was carried out at the Tanta Main University Hospital, Pediatric Medical Department, Dialysis Unit, Tanta City, Egypt. Sample: a convenience sampling of thirty children undergoing hemodialysis with arteriovenous fistula were included from the previously mentioned setting. Tools: there were three tools used: Tool I: Structured interview schedule, consisting of three components: sociodemographic characteristics of the children, data about the caregiver of the child and data related to the disease and fistula. Tool II: Wong–Baker faces pain rating scale for children. Tool III: Pain Anxiety Symptom Scale Short Form which was developed by McCracken (2002). Results: 53.33% and 33.33% of the studied children had moderate and severe pain anxiety symptoms pre-intervention respectively while 73.33%and 46.67%of them had mild pain anxiety symptoms during application of virtual reality and guided visualization respectively. Conclusion: visual reality was the preferred method which given the greater relief of pain and pain anxiety than guided visualization. Recommendations: visual reality should be used and disseminated to other hemodialysis centers as a strategy to reduce pain and pain anxiety among those children undergoing hemodialysis.

Down Syndrome is a lifelong chromosomal disorder caused by an extra copy of chromosome number 21 inside each of the body’s cells. This genetic disorder, causes mental retardation and developmental delays. Aim of this study was to determine the effect of promoting mothers’ caring practices regarding their children with Down Syndrome on the family coping. Subjects and Method: A quasi-experimental research design used for sixty mothers and their children with Down Syndrome at Pediatric Outpatient Genetic Clinic of Tanta University Hospital. Three tools were used for data collection: Structured Interview Schedule to assess socio-demographic and mothers, knowledge about Down Syndrome, Mothers, Care Reporting Sheet and Family Crisis Oriented Personal Scales. Results: The total scores of knowledge for more than three quarters of mothers were low before educational program while, more than half of them had moderate level of knowledge and less than half of them had high level immediately after program. The total scores of most mothers, reported care were unsatisfactory before educational program while, the majority of them had satisfactory care immediately and one month after program. Family adaptation for nearly two thirds of caregivers was fair before program while, all of them had good adaptation immediately after program. Conclusion: There was a significant improvement of mothers, knowledge, reported care and family adaptation towards crises. Recommendations: Continuous health education program should be applied to mothers of children with Down Syndrome in health care facilities to improve their knowledge and practice that affect family adaptation.