Risk factors for Autistic Spectrum Disorders at Assiut City

Autism is a neurological disorder characterized by qualitative impairments in social interaction, qualitative impairments in communication, and restricted repetitive, stereotyped patterns of behavior, interests, and activities. Autistic Spectrum Disorders are relatively common without known etiology can be found in 80-90% of cases. The aim of this study is to recognize the risk factors for Autistic Spectrum Disorders at Assiut City. The study was descriptive research design; it was conducted in all autism centers at Assiut city which includes 7 centers and included 47 parents who agree to participate in this study selected by convenient sample. The study included a structured interview sheet; this sheet divided into two parts Socio demographic characteristics, and parent’s knowledge about risk factors of Autism. The main findings of the study are: male represent a higher prevalence (72.3%) rate of autism than females (27.7%), and autistic children were more prevalent among families living in urban areas (80.9%) than rural (19.1%). The present study clears that (63.8%) of the fathers and 61.7% of the mothers had university level, the majority (85.1%) of autistic parents’ children hadn’t consanguinity degree while only (14.9%) from them had consanguinity from first degree (cousin), the vast majorities (97.9%) of studied children haven’t family history of autism; the present study found that all mothers of studied children hadn't any history of rubella, diabetes, thyroid and infectious diseases while only (4.3%) were exposed to eclampsia. The study recommended that, increase of public awareness about the risk factors of autism and its prevention by community leaders, mass media, and others especially at rural area. The curriculum of medicine and nursing faculties should include the Autistic Spectrum Disorder (risk factors, diagnosis and different treatment methods). Further studies should be conducted and gained a lot of attention for Autistic children and their parents. Key wards: Autism - Autism Spectrum Disorders – Risk factor

Vasoactive intestinal peptide (VIP) differentially affects inflammatory immune responses in human monocytes infected with viable Salmonella or stimulated with LPS

We compared the effect of VIP on human blood monocytes infected with Salmonella typhimurium 4/74 or stimulated with LPS. VIP (10−7 M) increased monocyte viability by 24% and 9% when cultured for 24 h with 4/74 or Salmonella LPS (100 ng/ml), respectively. Significantly increased (P < 0.05) numbers of 4/74 were also recovered from monocytes co-cultured with VIP after 6 h post-infection (pi) and this remained high after 24 h pi. Both 4/74 and LPS increased (P < 0.05) the concentration of TNF-α, IL-1β and IL-6 measured in monocyte supernatants. However, LPS induced this effect more rapidly while, with the exception of IL-6, 4/74 induced higher concentrations (P < 0.05). VIP significantly decreased (P < 0.05) TNF-α and IL-1β production by 4/74-infected monocytes after 6 pi, but only after 24 h in LPS-cultured monocytes. This trend was reversed for IL-6 production. However, TNF-α and IL-1β production by 4/74-infected monocytes, cultured with VIP, still remained higher (P < 0.05) than concentrations measured in supernatants cultured only with LPS. VIP also increased (P < 0.05) production of anti-inflammatory IL-10 in both 4/74 and LPS cultures after 24 h. We also show a differential effect of VIP on the expression of TNFα and IL-6 receptors, since VIP was only able to decreased expression in LPS-stimulated monocytes but not in 4/74-infected monocytes. In conclusion, we show a differential effect of VIP on human monocytes infected with virulent Salmonella or stimulated with LPS. Our study suggests that the use of VIP in bacteraemia and/or sepsis may be limited to an adjunctive therapy to antibiotic treatment

Risk Factors of Hypocalcemic Patients at Surgical Intensive Care Unit of Zagazig University Hospitals

Background: Hypocalcemia may be present as an asymptomatic laboratory finding or as a severe life-threatening condition. Objective: The study aimed to estimate incidence rate of hypocalcemia and to identify risk factors associated with hypocalcemia in patients of Surgical Intensive Care Unit of Zagazig University Hospitals. Patients and methods: This study involved 310 patients who enrolled to Surgical Intensive Care Unit, Zagazig University Hospitals over a period of six months. Total serum calcium concentration and ionized calcium concentration were measured. Results: The distribution of the studied cases according to admission diagnosis, 40% of the studied cases were admitted to ICU due to sepsis and septic shock, 16% polytrauma, 10% respiratory failure, 10% post-operative monitoring, 6% with ICH, 6% with uncontrolled HTN, 4% with ischemic stroke, 2% pancreatitis, 2% dehydration and electrolyte imbalance, 2% DKA and one case due to organophosphorus poisoning and 1% rhabdomyolysis. There was statistically significant negative correlation between GCS score and Ca total and ionized at 3rd day. However, a statistically significant positive correlation was detected between Ph and Ca total at 3rd day. Only sepsis, septic shock, hypertensive crisis, aminoglycosides, respiratory failure and APACHE score were significant risk factors for hypocalcemia. Conclusion: Hypocalcemia is more common in cases with sepsis and septic shock, hypertensive crisis, respiratory failure and cases with electrolyte disturbance

How does terrorism hollow out the sustainable economic growth in big ten countries?

PurposeThe main objective of this research is to investigate if there is a long-term relationship between "terrorism" and sustainable "economic growth" in Big Ten Countries.Design/methodology/approachThe data was tested via Panel ARDL Analysis. The growth rate (GR) is the dependent variable, and the "Global Terror Index (GTI)" is the independent variable as the terror indicator. The ratio of Foreign Direct Investment (FDI) to the Gross Domestic Product (GDP), and the ratio of External Balance (EB) to Gross Domestic Product (GDP) are included in the model as the control variables due to their effect on the growth rate. A Panel ARDL analysis is conducted to examine the existence of long-term co-integration between terror and the economy. The planning of the study, the formation of its theoretical and conceptual framework, and the literature research were carried out in 2 months, and the collection of data, the creation of the methodology and the analysis of the analyzes were carried out in 2 months, the interpretation of the findings and the development of policy recommendations were carried out within a period of 1 month. The entire study was completed in a total of 5 months.FindingsResults showed that "Terror" has a negative impact on "Growth Rate" in the long term while "External Balance" and "Foreign Direct Investment" positively affect the Growth Rate. The coefficients for the short term are not statistically significant.Research limitations/implicationsThe sample is only limited to Big Ten including China, India, Indonesia, South Korea, Argentina, Brazil, Mexico, Turkey, Poland and South Africa. The period for annual data collection covers the years between 2002 and 2019 and due to the unavailability of data.Practical implicationsConsidering the risks and the mutual negative effect that turns into a vicious circle between terrorism and the economy, it is necessary to eliminate the problems that cause terrorism in the mentioned countries, on the one hand, and to develop policies that will improve economic performance on the other.Social implicationsTrustful law enforcement bodies have to be established and supported by all technological means to prevent terror. The conditions causing terror have to be investigated carefully and the problems causing terror or internal conflict have to be solved. International cooperation against terrorism has to be strengthened and partnerships, information, experience sharing have to be supported at the maximum levels.Originality/valueIt is certain that terror might have a negative influence on the performance of economies. But the limited number of studies within this vein and the small size of their sample groups mostly including single-country case studies require conducting a study by using a larger sample group of countries. Big Ten here represents at least half of the population of the world and different regions of the Globe

GRFS and CRFS in alternative donor hematopoietic cell transplantation for pediatric patients with acute leukemia.

We report graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) (a composite end point of survival without grade III-IV acute GVHD [aGVHD], systemic therapy-requiring chronic GVHD [cGVHD], or relapse) and cGVHD-free relapse-free survival (CRFS) among pediatric patients with acute leukemia (n = 1613) who underwent transplantation with 1 antigen-mismatched (7/8) bone marrow (BM; n = 172) or umbilical cord blood (UCB; n = 1441). Multivariate analysis was performed using Cox proportional hazards models. To account for multiple testing, P \u3c .01 for the donor/graft variable was considered statistically significant. Clinical characteristics were similar between UCB and 7/8 BM recipients, because most had acute lymphoblastic leukemia (62%), 64% received total body irradiation-based conditioning, and 60% received anti-thymocyte globulin or alemtuzumab. Methotrexate-based GVHD prophylaxis was more common with 7/8 BM (79%) than with UCB (15%), in which mycophenolate mofetil was commonly used. The univariate estimates of GRFS and CRFS were 22% (95% confidence interval [CI], 16-29) and 27% (95% CI, 20-34), respectively, with 7/8 BM and 33% (95% CI, 31-36) and 38% (95% CI, 35-40), respectively, with UCB (P \u3c .001). In multivariate analysis, 7/8 BM vs UCB had similar GRFS (hazard ratio [HR], 1.12; 95% CI, 0.87-1.45; P = .39), CRFS (HR, 1.06; 95% CI, 0.82-1.38; P = .66), overall survival (HR, 1.07; 95% CI, 0.80-1.44; P = .66), and relapse (HR, 1.44; 95% CI, 1.03-2.02; P = .03). However, the 7/8 BM group had a significantly higher risk for grade III-IV aGVHD (HR, 1.70; 95% CI, 1.16-2.48; P = .006) compared with the UCB group. UCB and 7/8 BM groups had similar outcomes, as measured by GRFS and CRFS. However, given the higher risk for grade III-IV aGVHD, UCB might be preferred for patients lacking matched donors. © 2019 American Society of Hematology. All rights reserved

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Dynamics of a Heterogeneous Constraint Profit Maximization Duopoly Model Based on an Isoelastic Demand

A Cournot duopoly game is a two-firm market where the aim is to maximize profits. It is rational for every company to maximize its profits with minimal sales constraints. As a consequence, a model of constrained profit maximization (CPM) occurs when a business needs to be increased with profit minimal sales constraints. The CPM model, in which companies maximize profits under the minimum sales constraints, is an alternative to the profit maximization model. The current study constructs a duopoly game based on an isoelastic demand and homogeneous goods with heterogeneous strategies. In the event of sales constraint and no sales constraint, the local stability conditions of the Cournot equilibrium are derived. The initial results show that the duopoly model would be easier to stabilize if firms were to impose certain minimum sales constraints. Two routes to chaos are analyzed by numerical simulation using 2D bifurcation diagram, one of which is period doubling bifurcation and the other is Neimark–Sacker bifurcation. Four forms of coexistence of attractors are demonstrated by the basin of attraction, which is the coexistence of periodic attractors and chaotic attractors, the coexistence of periodic attractors and quasiperiodic attractors, and the coexistence of several chaotic attractors. Our findings show that the effect of game parameters on stability depends on the rules of expectations and restriction of sales by firms

Comparison of good clinical practice compliance and readability ease of the informed consents between observational and interventional clinical studies in the Emirates

Background: Expansion of clinical trials activity into emerging regions has raised concerns regarding participant rights and research ethics. Increasing numbers of observational studies are now conducted in developing economies, including the United Arab Emirates. Materials and Methods: This study compares the content of information provided, Good Clinical Practice (GCP) guideline compliance, and readability of informed consent forms (ICFs) for observational compared to interventional studies. Results: GCP compliance for observational studies averaged at 79.5% + 6.8%, significantly (P < 0.001) lower than 92.2 + 5.0 percent for interventional studies. Readability ease and readability-grade level were assessed with Flesch-Kincaid scales. Results indicated higher readability grade-level 12.4 + 0.4 (P < 0.001) and lower readability Flesch-Kincaid reading ease score 35.7 + 3.6 for observational studies, as compared to 10.3 + 1.6 and 47.8 + 7.4 for interventional studies. Conclusion: Mandatory training for investigators is essential to provide readability ease and GCP compliance for the ICFs for the local population

A comparative evaluation for Detection Brain Tumor in MRI Image using Machine learning algorithms

In medical imaging, automated defect identification of defects has taken on a prominent position. Unaided prediction of tumor (brain) recognition in magnetic resonance imaging process (MRI) is vital for patient preparation. With traditional methods of identifying z is designed to reduce the burden on radiologists. One of the problems with MRI brain tumor diagnosis is the size and variation of their molecular structures. This article uses deep learning techniques (Artificial neural network ANN, Naive Bayes NB, Multi-layer Perceptron MLP ) to discover brain tumors in the MRI scans. First, the brain MRI images are run through the preprocessing steps to remove texture features. Next, these features are used to train a machine learning algorithm