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Purpose This study aims to investigate the association between corporate governance and financial transparency, using the moderating role of an Egyptian currency devaluation decision as a policy shock. Design/methodology/approach Data was collected for a sample of companies listed on the Egyptian stock exchange from 2014 to 2019. To control for time-invariant unobserved heterogeneity, the authors analyse panel data using an estimated generalised least squares regression model. Findings The findings underline the pitfalls of assuming that corporate governance mechanisms are effective regardless of circumstances and support the complementary roles of a number of theories in interpreting the empirical findings. Research limitations/implications This study is limited to non-financial companies and includes only corporate board and audit committee governance mechanisms. The study results have important implications for policymakers, international lending institutions, investors and accounting standards setters. It is of particular importance to policymakers in other less-developed countries with similar economic conditions. Originality/value To the best of the authors’ knowledge, this study is the first empirical attempt to provide evidence of the impact of a currency devaluation shock on the relationship between corporate governance and financial transparency within the Egyptian context as an example of a transitional economy. Hence, it provides a significant theoretical and empirical contribution to the literature.

Introduction: Collagens are the most abundant proteins in the human body, accounting for one-third of total proteins. Over the last few years, accumulated evidence have indicated that some collagens are differentially expressed in cancer. The aim of the study was to assess COL1A1 gene expression as a novel marker for the progression of hepatitis B cirrhosis into hepatocellular carcinoma. Methods: This cohort study included 348 subjects and was conducted between May 2018 and June 2019. Subjects were divided into 4 groups: group1 included HBV positive hepatocellular carcinoma patients “HCC” (n= 87), group II included HBV positive patients with liver cirrhosis “LC” (n = 87), group III included chronic hepatitis B patients with neither HCC nor cirrhosis “ C-HBV” (n = 87) and group IV consisted of healthy volunteers as controls (n = 87). Fasting venous blood samples (10 ml) were collected from each participant in this study and were used for assessment of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, albumin and alfa-fetoprotein (AFP). Another portion of blood was collected in 2 vacutainer tubes containing EDTA, one for Complete blood count and the other for gene expression of COL1A1. Results: The gene expression of collagen was 6.9 ± 8.8 in group 1 (HBV positive hepatocellular carcinoma patients) and this was a significant increase in comparison with the other groups. In group 2 (HBV positive patients with liver cirrhosis), the gene expression (collagen) was 3.7±1.5 and it was significantly increased when compared with group 4 (healthy volunteers). Conclusion: COL1A1 gene expression can be used as an indicator of the progression of hepatitis B cirrhosis into hepatocellular carcinoma.

Background: When someone has herpes zoster and the rash goes away in spite of persistence of pain, they are defined to have post-herpetic neuralgia (PHN). Herpes zoster is frequently accompanied by post-herpetic neuralgia. Clostridium botulinum produces botulinum toxin (BTX-A), a neurotoxic protein that is used to treat various ailments. Objective: Intralesional botulinum toxin injections were tested for their efficacy in the treatment of post herpetic neuralgia. Patients and methods: An intralesional BTX-A injections pilot trial including 19 patients with PHN was carried out. Quality of life scale (QLS), neuropathy pains scale (NPS), and pain analyses by visual analogue scale (VAS) were used for all patients after comprehensive history-taking process. Results: After a six-months therapy follow-up period, we found significant differences comparing before and after treatment in the neuropathy pain scale, VAS score, and the QLS (SF-36). Pain at site of injection was found in all patients while redness or erythema was found in 13 patients. Conclusion: Treatment with botulinum toxin via local injection is beneficial for post-herpetic neuralgia (PHN). BTX could be alternative therapeutic modality in treating PHN in the future.

Background & Aims: The aim of the study was to evaluate serum c-reactive protein (CRP), ascitic procalcitonin (PCT) and monocyte chemotactic protein-1 (MCP-1) in the diagnosis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. Methods: A cross-sectional analytic study that included 199 patients with decompensated cirrhosis (101 with SBP and 98 without SBP). Patients were classified according to Child-Pugh criteria. Ascitic PCT and MCP-1 were measured by enzyme-linked immunosorbent assay. Serum CRP, liver and renal functions were assessed. Results: Three markers are significantly elevated in SBP patients than those without ascites. Using the ROC curve at AUC 0.883 and a cut-off value of >186 ng/ml, the diagnostic performance of ascitic MCP-1 level was higher than CRP (AUC 0.562) and ascitic fluid procalcitonin (AUC 0.751) in the diagnosis of SBP. The sensitivity and specificity were 86.15% and 79.59% at the cutoff of 186 ng/ml for MCP-1, 65.4 and 75.5 at ≥ 1 ng/ml for PCT, and 52.5 and 64.3, respectively for at 11.2 mg/dl CRP. Conclusion: Ascitic MCP-1 has a better diagnostic value with higher sensitivity and specificity in diagnosis SBP compared to CRP and procalcitonin which has higher diagnostic accuracy than CRP. Further studies with a large number will be necessary to evaluate the usefulness of these markers in diagnosis, follow-up and relation to morbidity and mortality of SBP patients.

Background: Diabetes mellitus is best described as a condition that is characterized by postprandial hyperglycemia that has two types; diabetes type 1 and type 2. Many patients with type 2 diabetes can be asymptomatic. There are many novel biomarkers for the detection of diabetes type 2, such as FABP1, which is investigated as a marker to detect patients with diabetes type 2. Aim: The aim of the study was to investigate FABP1 in Patients with diabetes type 2 and to find the correlations between FABP1 and fasting insulin in those patients. Methods: Samples were collected from 99 diabetic patients and 85 samples of healthy participants as the control group. All participants were subjected to liver enzymes (ALT and AST) lipid profile (triglycerides, HDL, LDL, and cholesterol), T-billirbun, Albumin, Alp, AFP, BMI, S-creatinine, Hb, Fatty acids, F. Insulin, CA19.9, HbA1c, and Fbs that were done by an autoanalyzer. The serum level of fatty acid-binding protein 1 was measured by SunRed human FABP1 Elisa kits. Results: Data was represented as mean ± standard deviation or median with statistically significant values of ALT, AST, ALP, PT, and INR (at P< 0.05). Findings revealed a significant positive correlation between our marker FABP1 and TG, cholesterol, LDL, Fasting insulin, and CA19.9, Conclusion: FABP1 can be used as a novel marker to detect patients with diabetes type 2.

Novel Corona Virus 2019 (COVID-19) is a new virus spread rapidly all over the world. It has specific respiratory or gastrointestinal tract symptoms. Its reported complications include respiratory distress, systemic inflammatory response syndrome, and septic shock. Due to heavy cytokines released by the virus; corticosteroids (40-120 mg / day) were given to severe cases to reduce pneumonia. It’s a difficult task to control the spread of SARS-CoV-2, and to invent proper vaccines and treatments. In this review, the existing understanding of fatal, pandemic human coronavirus SARS-Cov2 (COVID-19), with special reference to its diagnosis, origin, transmission, and different approaches to develop its therapeutics, will be discussed.

Background: Chronic lymphatic leukemia (CLL) is the most common hematological malignancy in adults presenting with varied clinical courses. There is an increased demand for establishing known prognostic factors for stratifying CLL patients. Aim of the work: To investigate the expression of soluble form of human leucocyte antigen-G (HLA-G) & CD 38 in CLL and to correlate our findings with a variety of clinical and laboratory variables. Patients and methods: The study included thirty newly diagnosed CLL patients. They were 18 males and 12 females with age ranged from 49–65 (a mean of 57.5 years old). Diagnosis of CLL was confirmed by flow cytometric immunophenotyping using standard lymphoma panel. CD38 expression was determined by flow cytometry. S. HLAG was measured by ELISA method. Results: Positive CD38 expression was significantly associated with lower Hb and platelets (p = 0.008 and 0.025 respectively) also with higher Beta2 microglobulin (p = 0.012). Soluble HLA G was positively correlated with the platelets count(r = 0.400, p = 0.02). Higher level of soluble form HLA-G was significantly more frequent in patients of 60 years or older (p = 0.001). The cumulative overall survival was 83.3%. Positive CD 38 expression was associated with significantly worse survival (p < 0.005). HB count < 10 gm/dl was associated with significantly worse survival (p < 0.001). Conclusion: CD38 expressions are considered powerful prognostic markers in predicting overall survival for Egyptian CLL patients and they should be assessed to decide the patient's therapy and to determine disease prognosis. Expression of soluble form of HLA-G in CLL patients by ELISA get no extra prognostic importance.

Background The incidence of end-stage renal disease (ESRD) has increased by 30-40% in the last decade. These patients have a higher mortality rate of 3-8 times compared to the general population. In the present study, we aimed to detect cardiovascular complications and their relation to the first-year mortality rate in patients on hemodialysis in Aswan University Hospital, upper Egypt. Patients and methods Our study was a cross-sectional study which was done at the hemodialysis unit in Aswan University Hospital from May 2016 to May 2018. The study included 100 patients with ESRD on regular hemodialysis (first year on programmed hemodialysis). All patients were subjected to full clinical examination and laboratory studies includngd complete blood count (CBC), kidney function tests, serum calcium and phosphorus level, parathormone (PTH) hormone, serum albumin level, C-reactive protein (CRP), echocardiography and electrocardiogram (ECG), and lateral abdominal x-ray for detection of aortic calcification. . Results The present study included 47 males and 53 females, with a mean age of 50.6 ±13.89 years. The main risk factors for patients with ESRD were hypertension (48%) followed by diabetic nephropathy (36%), glomerulonephritis (15%), idiopathic etiology (11%), obstructive uropathy (8%), lupus nephritis (6%), polycystic kidney disease (4%) and cardio renal syndrome (1%). Twenty-seven deaths have been noted during the first year of dialysis treatment. The leading causes of death were cardio-vascular events (66, 67%), infection (22, 22%) and malignancy (11, 11%), The most common cardiovascular events were myocardial infarction (27.8%), sudden cardiac death (SCD) (27.8%) and heart failure (22.2%). Conclusion In conclusion, our study showed that the main risk factors for ESRD patients in Aswan University Hospital are hypertensive nephrosclerosis, diabetic nephropathy, glomerulonephritis and idiopathic etiology, and the main causes of first-year mortality were cardiovascular events followed by infection and malignancy.

Background: Chronic lymphocytic leukemia (CLL) is the most common hematological malignancy in adults presenting with varied clinical course. There is a higher request for founding known prognostic factors for stratifying CLL patients. HLA-G is a non-classical major histocompatibility complex (MHC) molecule. It can be expressed in membrane bound (m.HLA-G) and soluble forms (s.HLA-G). Objective: The aim of work was to investigate the expression of membrane form of HLA-G in CLL and correlate findings and a variety of clinical and laboratory variables. Patients and methods: This prospective study included a total of thirty newly diagnosed B-CLL patients, attending at Hematology Unit, Medical Oncology Department, national Cancer institute, Cairo. This study was conducted between December 2017 to July 2019. Diagnosis of CLL was confirmed by flow cytometric immunophenenotyping using standard lymphoma panel, membrane HLA-G was determined by flow cytometry. Results: The expression of HLA-G by flowcytometry was negatively correlated with the platelet count (r = -0.516, p = 0.004) and Hb (r = -0.479, p = 0.007). The expression of HLA-G was significantly higher in CD38 positive cells (p = 0.006). The expression of HLA-G was significantly higher in Rai stage 4 compared to stage 1 & stage 2 (p = 0.001). Conclusion: It could be concluded that expression of HLA-G might represent signs of immunosuppression in CLL patients which contribute to the immune escape of tumor cells. In addition, HLA-G expression by B-CLL cells correlates significantly with the known prognostic markers of disease progression, mainly Rai clinical staging, CD38 expression and worse survival, making this parameter possibly an important prognostic factors of disease progression.

Background: The rate of suicidal attempts with paraphenylenediamine (PPD) poisoning has raised steadily in the past few decades. Recently, a growing body of evidence demonstrated that PPD can lead to acute kidney injury (AKI). Objectives: To assess the incidence of AKI among cases with suicidal attempts of PPD poisoning in Aswan University hospital. Patients and Methods: Our study was a cross-sectional study that included 94 patients presented with suicidal attempts of paraphenylenediamine (dark hair dye) at Aswan University Hospital during the period from January to December 2019. All of the participants were subjected to history taking as age, sex, route of administration, suicidal or accidental intake of dye, type and amount of dye used, and duration of intake. Examination and investigations were as follows, vital data: BP, temperature, pulse, respiratory rate, electrocardiogram (ECG ), urine analysis, blood urea, serum creatinine, serum sodium, serum potassium, creatine phosphokinase (CPK), alkaline phosphatase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum uric acid, arterial blood gases (ABG) and follow up for the development of any complications or any interventions as tracheostomy, intubation, and hemodialysis. Results: The mean age of the included patients was 26.1 ±12.9 years and the majority of them were females (66%). In terms of the primary outcome of the present study, we found that the incidence of AKI was 29.7%. There were statistically significant differences between AKI and non-AKI patients in terms of serum ALT (p =0.001), serum AST (p =0.001), serum urea (p =0.001), serum creatinine (p =0.001), and serum CPK (p =0.001). Additionally, patients with AKI had a significantly higher mortality rate than non-AKI patients (p =0.023). Serum CPK was a major predictor of AKI in the univariate analysis. Conclusion: In conclusion, AKI is considered one of the most common problems in patients with suicidal attempts of PDD ingestion. AKI is one of the leading causes of mortality in patients with PPD ingestion.

Background and Objectives: The main benefits of laparoscopic surgery in comparison to open surgery involve the rapid discharge from recovery room, decreased postoperative hospital stays, reduced postoperative discomfort, easier getting back to work and faster return to ordinary daily life as well as cosmetic surgical wounds. The anesthesia type has an essential role in attenuation of the surgical stress and achievement of these advantages. We aimed to determine the outcome of giving general anesthesia in conjunction with thoracic epidural analgesia (TEA) compared to general anesthesia alone on stress response to surgery and anesthesia by investigating cytokine reaction (interleukin 6 and 8 levels), hemodynamic changes (BP, HR, RR, SPO2), and Visual Analogue Scale (VAS) scores postoperatively in patients subjected for laparoscopic cholecystectomy. Methods: This study included 40 patients aged 20 - 60 years old with American Society of Anesthesiologists physical status (ASA) I and II. They were planned for laparoscopic cholecystectomy at Aswan University Hospital from April 2017 to March 2018. They were randomly allocated into two groups. Group A (n. 20) received general anesthesia only and Group B (n. 20) received general anesthesia in conjunction with thoracic epidural analgesia using fentanyl and bupivacaine in the epidural catheter. Chi-square was applied to differentiate categorical variables, whereas comparison between continuous variables was done by using t-test. Two-tailed p ficant. Results: As regards IL-6 and IL-8 post-operative there is significant difference (p nd and 4th hr and 24th hr postoperative, with significantly increased postoperative levels of IL-6 and IL-8 in comparison to their preoperative baseline values. The largest increase in IL6 & IL8 levels was in group A (GA group). VAS score showed significant lower values in TEA group in comparison to GA group. No significant difference between groups as regard intraoperative and postoperative hemodynamic changes. Conclusion: Regional techniques including TEA attenuate and decrease cytokine reaction secondary to surgery which decreases inflammatory process and improves patient outcome and reduces pain score postoperatively.

The objective of this study is to investigate the effect of deferred tax disclosed under the Egyptian Accounting Standard No. 24, income taxes and tax planning on earnings management. In addition, to investigate the role of net deferred tax liabilities as a mediator between tax planning and earnings management. This study employs a sample of 127 firms listed on the Egyptian stock exchange covering the period 2012 to 2018 ending up with 889 observations. Stratified simple random sampling technique was used to select the sample. Path analysis is employed to examine the framework of the study and analyses the indirect effect of tax planning on earnings management. In addition, Ordinary Least Square Regression is employed to calculate discretionary accrual, which is used as a proxy to earnings management. The results suggest that tax planning does not have a significant direct effect on earnings management. However, it has a significant indirect effect on earnings management through net deferred tax liabilities, which in turn has a significant direct effect on earnings management. Findings of this paper may be of interest to financial analysts and standard setters, as they highlight how tax planning and deferred tax liabilities affect the quality of accounting information.

Background:Diabetes mellitus is best described as a condition that is characterized by postprandial hyperglycemia that has two types; diabetes type 1 and type 2. Many patients with type 2 diabetes can be asymptomatic. There are many novel biomarkers for the detection of diabetes type 2, such as FABP1, which is investigated as a marker to detect patients with diabetes type 2. Aim:The aim of the study was to investigateFABP1in Patients with diabetes type 2 and to find the correlations between FABP1and fasting insulin in those patients. Methods:Samples were collected from 99 diabetic patients and 85 samples of healthy participants as the control group. All participants were subjected to liver enzymes (ALT and AST) lipid profile (triglycerides, HDL, LDL, and cholesterol), T-billirbun, Albumin, Alp, AFP, BMI, S-creatinine, Hb, Fatty acids, F. Insulin, CA19.9, HbA1c, and Fbs that were done by an autoanalyzer. The serum level of fatty acid-binding protein 1 was measured by SunRed human FABP1 Elisa kits. Results:Data was represented as mean ± standard deviation or median with statistically significant values of ALT, AST, ALP, PT, and INR (at P< 0.05). Findings revealed a significant positive correlation between our marker FABP1 and TG, cholesterol, LDL, Fasting insulin, and CA19.9, Conclusion:FABP1 can be used as a novel marker to detect patients with diabetes type 2. &nbsp

Objective: To predict pregnancy outcome by studying the relation between serum βHCG, progesterone and CA125 and the occurrence of miscarriage in the first trimester, in cases with history of recurrent pregnancy loss. Methods: Serum βHCG, progesterone and CA125 levels in fifty pregnant women with history of recurrent pregnancy loss were compared to 50 pregnant women with no history of abortion, and to another group of women (No=50) who failed to complete the 1st trimester of pregnancy during the study. Results: Serum B-hCG showed a sensitivity of 100%, a specificity of 50%, a PPV of 50% and a NPV of 100%. Serum progesterone showed a sensitivity of 24%, a specificity of 73%, a PPV of 55.07% and a NPV of 85.18%, while serum CA125 showed a sensitivity of 15.6%, a specificity of 58.59%, a PPV of 16.32% and a NPV of 57.42%. Conclusion: The value of CA125 in recurrent abortions is still unclear and cannot recommended on routine basis. On the other hand, β-HCG is highly sensitive as a single serum measurement for the prediction of pregnancy outcome.

Background/objectives The pathophysiology of obesity is multifactorial, including genetic and environmental factors. Previous studies had highlighted the association of the leptin gene/receptor with obesity. We aimed to study the leptin gene rs7799039 single nucleotide polymorphism (SNP) in children, and its association with the children’s characteristics. Methods A cross-sectional analytic study that included 143 children with obesity (cases) and a comparable group of 86 lean children as controls. The anthropometric measures, blood pressure, and biochemical testing were done for all participants. The real-time polymerase chain reaction was used to detect rs7799039 SNP variant alleles and ELISA for leptin level assessment. Results The distribution of rs7799039 SNPs genotypes GG/GA/AA was comparable between both groups. Testing children regardless of their body mass index showed that the abnormalities in blood pressure, lipids values, insulin resistance, and hepatic insulin sensitivity were significantly associated with increased leptin levels. Among cases, the abnormal metabolic status was associated with higher leptin levels. Conclusions The genotype’ distribution of leptin gene rs7799039 SNP was similar in both children with obesity and those with normal-weight. The high blood pressure, abnormal lipid profile, and metabolic disturbances, were significantly associated with higher leptin levels and not with leptin gene rs7799039 SNP.

Omaima Mohamed Ali,1 Aml Ahmed Sayed,1 Wafaa Salah Mohammed,2 Ragaa Ramadan Mohammed3 1Internal Medicine Department, Faculty of Medicine, Aswan University, Aswan, Egypt; 2Clinical Pathology Department, Faculty of Medicine, Aswan University, Aswan, Egypt; 3Internal Medicine Department, Faculty of Medicine, Al-Azhar University for Girls, Cairo, EgyptCorrespondence: Omaima Mohamed AliDepartment of Internal Medicine, Faculty of Medicine, Aswan University, Aswan 81528, EgyptTel +201005373193Fax +20973480449Email Omaimaaly3@gamil.comBackground: The incidence of end-stage renal disease (ESRD) has increased by 30– 40% in the last decade. These patients have a higher mortality rate of 3– 8 times compared to the general population. In the present study, we aimed to detect cardiovascular complications and their relation to the first-year mortality rate in patients on hemodialysis in Aswan University Hospital, upper Egypt.Patients and Methods: Our study was a cross-sectional study which was done at the hemodialysis unit in Aswan University Hospital from May 2016 to May 2018. The study included 100 patients with ESRD on regular hemodialysis (first year on programmed hemodialysis). All patients were subjected to full clinical examination and laboratory studies includngd complete blood count (CBC), kidney function tests, serum calcium and phosphorus level, parathormone (PTH) hormone, serum albumin level, C-reactive protein (CRP), echocardiography and electrocardiogram (ECG), and lateral abdominal x-ray for detection of aortic calcification. Results: The present study included 47 males and 53 females, with a mean age of 50.6 ± 13.89 years. The main risk factors for patients with ESRD were hypertension (48%) followed by diabetic nephropathy (36%), glomerulonephritis (15%), idiopathic etiology (11%), obstructive uropathy (8%), lupus nephritis (6%), polycystic kidney disease (4%) and cardio renal syndrome (1%). Twenty-seven deaths have been noted during the first year of dialysis treatment. The leading causes of death were cardio-vascular events (66, 67%), infection (22, 22%) and malignancy (11, 11%), The most common cardiovascular events were myocardial infarction (27.8%), sudden cardiac death (SCD) (27.8%) and heart failure (22.2%).Conclusion: In conclusion, our study showed that the main risk factors for ESRD patients in Aswan University Hospital are hypertensive nephrosclerosis, diabetic nephropathy, glomerulonephritis and idiopathic etiology, and the main causes of first-year mortality were cardiovascular events followed by infection and malignancy.Keywords: end-stage renal disease, cardiovascular complication, mortality rate

Background: bacteremia is the presence of bacteria in the blood stream that are alive and capable of reproducing. It is a type of blood stream infection Aim of the Work: was to identify bacteremia predictive factors among inpatients at Internal Medicine Department in Aswan University Hospital and to improve the management and decrease mortality among inpatients through clinical parameters. Patients and Methods: we estimated blood cultures of one hundred patients at our department from April 2017 to April 2018. Results: The final diagnosis and univariate analysis have shown use of central venous line (p 38OC, leucocytosis, neutrophillia >85%, tachycardia>90 and serum creatinine >1.3% were independent risk factors of bacteremia. Conclusion: The presence of bacteremia can be highly predicted by fundamental clinical information such as high pulse rate, leucocytosis, high grade temperature and neutrophilia.

Perceptions, attitudes and anticipated behavior represent very useful information for decision and policy makers before they implement proposed new policies. Road safety is one of the most critical fields in the built environment. In the Kingdom of Saudi Arabia, women started driving in 2019. There is a huge shortage of studies that investigate users’ attitudes and behavior, particularly women, in Saudi Arabia. It is very timely therefore, to assess their perceptions, attitudes and raise their awareness towards road safety. In this paper, the perceptions and attitudes towards road safety and relevant policies and programs were assessed and compared using two approaches: analytical and a fuzzy logic system. By means of a questionnaire, a total of 17 road safety policies, including engineering, enforcement programs, education programs and legislation programs, were presented to the participants and assessed. These policies were assessed from the viewpoint of Saudi women. The engineering policies included the use of road signs and marking, improving road network alignment, monitoring driver speed and engineering speed reduction measures. The assessment was in terms of the usefulness of the policies to reduce traffic accidents and improve road safety in Riyadh. A total of 375 participants were surveyed. Using a Likert scale response system to report the Saudi female participants’ opinions, two sets of indices were calibrated to evaluate the perceived usefulness and acceptability of the safety policies. A MATLAB simulation of a fuzzy logic system was utilized to assess, investigate and compare travel attitudes and perceptions of road safety. The results indicate overall encouragement for the safety programs and policies by the participants. Most of the support seems to be for the engineering program. The physical presence of traffic police was observed to have scored the highest. This is an interesting result that shows that enforcement policies are still perceived to be the most effective. In this category, the policy of enforcing speed limits showed high support, amongst the other policies. While a fuzzy logic analysis is typically used in hard engineering assessments and investigations, such as mechanical engineering and system design applications, the results obtained in this investigation show that the efficacy and adequacy of the proposed fuzzy logic control system in assessing attitudinal data was sufficiently good to be recommended for future research. The outcomes from both sets of approaches, the analytical and the fuzzy logic, showed comparable results, which also demonstrates the potential benefits of using the fuzzy system in many attitudinal and behavioral studies.

Background: Inflammation has been reported to constitute a major component of ischemic stroke pathology. Nevertheless, to the best of our knowledge, no previous studies have inves-tigated the NLR and MPV values in the cases of stroke stratified by subtype.Aim of Study: The aim of our study is to predict the role MPV and NLR in short-term outcome in patients with ischemic stroke and their association to stroke severity, stroke risk factors and functional outcome.Patients and Methods: This prospective cross sectional study directed on 125 patients with first time acute ischemic stroke. All members exposed to full history taking, detailed clinical examination and neurological checking. Brain imaging was performed after hospital admission. Blood tests were drawn for appraisal of the mean platelet volume (MPV) (in FL) and the neutrophil-lymphocyte ratio (NLR).Results: Our results revealed that the mean value for NLR was higher in dead patients with ischemic stroke. By ROC curve, higher NLR at admission predicted the mortality than MPV. We found higher NLR levels in patients with more severe stroke. However, We did not observe a significant correlation between the MPV, the stroke severity, and outcome.Conclusion: NLR was an independent risk factor and serves as a sensitive index for the prognosis of ACI patients. Further well-designed and large-scale prospective studies are necessary to evaluate platelet MPV and NLR for observing patients with cerebral infarction among different territories of Egypt and for stroke subtypes.

Background: Vitamin D deficiency has in like manner rose as a hazard factor for cerebrovascular stroke. It is ques-tionable if vitamin D status impacts the anticipation of patients who have created intracerebral hemorrhage. In Aswan gov-ernate, most of people had low vitamin D levels in spite of its sunny weather, as well as increased number of hemorrhagic stroke.Aim of Study: Consequently, our study planned to look at the connection between serum 25 (OH) D status and hem-orrhagic stroke, to clear up their relationship with stroke seriousness, and to evaluate its connection with functional outcome and mortality in our considered patients.Patients and Methods: This prospective cross sectional study directed on 125 patients with first time acute stroke with spontaneous intracerebral hemorrhage. All members exposed to full history taking, detailed clinical examination and neurological checking. Brain imaging was performed after hospital admission. Blood tests were drawn for appraisal of serum 25-hydroxyl vitamin D and parathyroid hormone on the first day of admission.Results: 44% and 40% of examined patients with intrac-erebral hemorrhage had lacking and inadequate vitamin D levels respectively. There was a relationship between intrac-erebral hemorrhage with vitamin D levels, and the severity of the stroke and functional outcome. In dead patients with intracerebral hemorrhage, a low vitamin D level was detectable.Conclusion: Vitamin D deficiency may have a relationship with acute intracerebral hemorrhage and its pervasive hazard factors among individuals in Upper Egypt (Aswan). Low levels of vitamin D are freely prescient for deadly strokes with more confirmation of negative result in acute intracerebral hemorrhage. Consequently, It may be a marker of more noteworthy comorbidity and a being causally identified with stroke proposing that vitamin D supplementation is a promising approach in the preventive action of strokes. Further studies are needed to investigate this relationship among different territories of Egypt and for stroke subtypes.

Background The incidence of end-stage renal disease (ESRD) has increased by 30–40% in the last decade. These patients have a higher mortality rate of 3–8 times compared to the general population. In the present study, we aimed to detect cardiovascular complications and their relation to the first-year mortality rate in patients on hemodialysis in Aswan University Hospital, upper Egypt. Patients and Methods Our study was a cross-sectional study which was done at the hemodialysis unit in Aswan University Hospital from May 2016 to May 2018. The study included 100 patients with ESRD on regular hemodialysis (first year on programmed hemodialysis). All patients were subjected to full clinical examination and laboratory studies includngd complete blood count (CBC), kidney function tests, serum calcium and phosphorus level, parathormone (PTH) hormone, serum albumin level, C-reactive protein (CRP), echocardiography and electrocardiogram (ECG), and lateral abdominal x-ray for detection of aortic calcification. Results The present study included 47 males and 53 females, with a mean age of 50.6 ±13.89 years. The main risk factors for patients with ESRD were hypertension (48%) followed by diabetic nephropathy (36%), glomerulonephritis (15%), idiopathic etiology (11%), obstructive uropathy (8%), lupus nephritis (6%), polycystic kidney disease (4%) and cardio renal syndrome (1%). Twenty-seven deaths have been noted during the first year of dialysis treatment. The leading causes of death were cardio-vascular events (66, 67%), infection (22, 22%) and malignancy (11, 11%), The most common cardiovascular events were myocardial infarction (27.8%), sudden cardiac death (SCD) (27.8%) and heart failure (22.2%). Conclusion In conclusion, our study showed that the main risk factors for ESRD patients in Aswan University Hospital are hypertensive nephrosclerosis, diabetic nephropathy, glomerulonephritis and idiopathic etiology, and the main causes of first-year mortality were cardiovascular events followed by infection and malignancy.

Abeer A Tony,1 Effat AE Tony,2 Wafaa Salah Mohammed,3 Emad F Kholef3 1Department of Neuropsychiatry, Faculty of Medicine, Aswan University, Aswan, Egypt; 2Department of Internal Medicine, Nephrology Unit, Faculty of Medicine, Assuit University, Assuit, Egypt; 3Department of Clinical Pathology, Faculty of Medicine, Aswan University, Aswan, Egypt Background: Inflammation constitutes a major component of ischemic stroke pathology. The prognostic value of “neopterin” and soluble CD40 ligand (sCD40L), as a potential biomarker of ischemic stroke, has been less extensively studied.Objectives of the study: This study aims at assessing the serum levels of neopterin and sCD40L in acute ischemic stroke (AIS), to clarify its association with the severity, etiology, and risk factors of stroke, and to evaluate their relationship with the stroke functional outcome in our study sample within 90 days of follow-up.Study sample: This case–control study was conducted on 100 patients with first-ever acute onset ischemic stroke and 25 control subjects.Methods: Participants were subjected to full history taking and detailed clinical and neurological examination. Brain imaging was performed after hospital admission. Blood tests were drawn for assessment of neopterin and sCD40L on the first day of admission.Results: High levels of neopterin and sCD40L was reported. Their levels were significantly higher in relation with survival status. There was a relationship between AIS and sCD40L levels and the severity of the stroke. Within 3 months of follow-up, these biomarkers were associated significantly with poor functional outcome, within a 90-day follow-up period, and mortality. These biomarkers were highly associated in patients with small vessel occlusion as an etiology for AIS.Conclusion: Neopterin and sCD40L levels increased after AIS. Both biomarkers were strong and independent predictors of 90-day unfavorable clinical outcome and death in patients after AIS. Keywords: acute ischemic stroke, soluble CD40 ligand, neopterin, stroke risk factors, functional outcome &nbsp