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BackgroundStroke is the most common acquired neurological disease in the adult population worldwide with an incidence of 16 million new cases every year responsible for about 6.1 million deaths and 130.6 million disability-adjusted life-years (DALYs). The objectives of this work were to study the level of stroke awareness and the proper response for suspected stroke patients in urban and rural areas of Tanta City, Egypt. The study was conducted on 1869 Egyptian Citizens; 908 and 961 reside in urban and rural areas, respectively, who were submitted to a face-to-face interview using the stroke awareness questionnaire (Arabic version).ResultsRural participants showed a significant reduction in acute cerebrovascular stroke (CVS) awareness and knowledge including the most affected organ by CVS, what are the risk factors, what are the early stroke symptoms, is there specific treatment for acute ischemic stroke, and what is the proper reaction when confronted with a case of acute CVS?ConclusionUrban populations have better recognition of stroke risk factors, early stroke symptoms, and the proper response when confronted with a case of acute CVS when compared with rural people possibly due to better socioeconomic status and higher educational levels.

Timely diagnosis is essential for managing feline panleukopenia (FPL), a devastating disease of cats caused by feline parvovirus (FPV) or canine parvovirus variants (CPV-2a, -2b, -2c). To support swift clinical decisions, point-of-care (PoC) antigen kits offer frontline tools. Given their cost and availability advantages, CPV-specific kits are often used off-label in cats; however, their interchangeability with manufacturer-matched FPV-specific kits remains unverified. This study assessed the diagnostic agreement between paired canine- and feline-specific PoC parvovirus antigen tests from two manufacturers. Fifty cats (30 with acute gastroenteritis, 20 healthy) were tested using all test formats. All cats underwent PCR and sequencing for parvovirus typing. Tests from the same manufacturer showed near-perfect or perfect agreement for result interpretation (Cohen's κ: 0.919 and 1.000). This strong inter-kit concordance also extended to test line intensity (  = 0.908 and 1.000). Antigen-positive results were limited to diseased cats, mirroring the distribution of PCR positives. The latter included all the 30 cases, and were typed by sequencing as follows: 28 FPV, 1 CPV-2a, and 1 CPV-2c. All kit types detected FPV and CPV variants, and agreement within each manufacturer's paired kits was consistent across detected viral types. This preliminary evidence suggests that for two manufacturers, CPV antigen tests were non-inferior to their FPV counterparts, supporting flexible, cost-effective FPL diagnosis in cats, regardless of implicated parvovirus types.

Does access to microfinance improve household welfare? We seek the answer to this question using data on 2,060 borrower and nonborrower households based in six major urban centers of Djibouti. We construct a composite index of multidimensional poverty that captures various aspects of household well-being, including ownership of agricultural and livestock assets, land, transportation, employment, quality of housing, and sanitation facilities. We carry out estimations using an instrumental variable–based empirical strategy and a number of econometric techniques. Our results show that neither access to microcredit nor its ostensibly productive use is significantly associated with poverty regardless of the duration of time since the loan was acquired. This holds for both access to and the amount of microcredit obtained. The results are robust across specifications and econometric techniques employed. The lack of significant beneficial effect of microfinance found in the study adds to the growing literature questioning the effectiveness of microfinance as a tool for poverty alleviation. The findings raise doubts on the usefulness of Djibouti's microfinance program.

Background and objectives: Oleanolic acid (OA) is a penta-cyclic triterpene with diverse bioactivities such as anticarcinogenic, antiviral, antimicrobial, hepatoprotective, anti-atherosclerotic, hypolipidemic, and gastroprotective. However, its effects on hepatorenal damage remain unclear. The protective activity of OA, separated from Viscum schimperi (Loranthaceae), against TAA (thioacetamide)-produced acute hepatic and renal damage was explored. Materials and Methods: Mice were treated with OA for 7 days before TAA (200 mg/kg, i.p.). Serum indices of hepatorenal injury, pathological lesions, molecular biological indexes, and inflammatory/apoptotic genes were estimated. Results: The tissues of both organs were greatly affected by the TAA injection. That was evident through increased serum markers of hepato-renal injury as well as remarkable histopathological lesions. TAA-induced injury was associated with oxidative and inflammatory responses in both organs as there was an elevation of oxidative stress parameters (4-HNE (4-hydroxy-nonenal), MDA (malondialdehyde), NOx (nitric oxide)), decline of antioxidants (reduced glutathione (GSH), superoxide dismutase (SOD), and total antioxidant capacity (TAC)), and an increase in the gene expression/level of inflammatory mediators (interleukins (1β&6)). The inflammatory response was linked to a significant activation of NF-κB (nuclear-factor kappa-B)/TNF-α (tumor-necrosis factor-alpha) signaling. The inflammatory response in both organs was accompanied by apoptotic changes, including a rise in the gene expression and level of apoptotic parameters (caspase-3 and Bax) along with a decline in Bcl-2 (anti-apoptotic parameter) gene expression and level. These pathogenic events were found to be closely related to the suppression of the antioxidant signaling pathway, Nrf2 (nuclear-factor erythroid 2–related factor-2)/SIRT1 (sirtuin-1)/HO-1 (heme-oxygenase 1). On the other hand, OA significantly ameliorated TAA-induced injury in both organs. On the other hand, OA counterpoised the inflammatory response as it ameliorated NF-κB/TNF-α signaling and cytokine release. OA enhanced Nrf2/SIRT1/HO-1 signaling and counteracted apoptotic damage. Conclusions: OA showed anti-inflammation and antiapoptotic capacities that effectively suppressed TAA-induced acute hepatorenal damage.

Pulsatile perfusion is a developing technique that attempts to mimic the natural pulsatile flow of blood during cardiopulmonary bypass (CBP). This systematic review and meta-analysis was conducted to show the effects of pulsatile perfusion in CPB compared to non-pulsatile. Randomized control trials that evaluated the implementation of pulsatile perfusion during cardiopulmonary bypass surgery were identified by a literature search in the following electronic databases (PubMed, Web of Science, Scopus, CENTRAL, and Embase) published from inception up to February 2024. The search yielded 33 trials of which three studies demonstrated a low risk of bias, 29 studies showed some concerns, and one study presented a high risk of bias overall. The total number of patients was 3174 patients. The analysis showed that pulsatile perfusion led to a significant decrease in creatinine level [MD = -0.14, 95% CI (-0.24, -.04), P < 0.004], lactate level [MD = -8.21, 95% CI (-13.16, -3.25), P < 0.001], hospital stay [MD = -1.38, 95% CI (-2.51, -0.25), P = 0.016], ICU stay [MD = -0.47, 95% CI (-0.82, -0.13), P = 0.007], intubation time [MD = -3.73, 95% CI (-5.42, -2.04), P < 0.001], and increase in creatinine clearance [MD = 10.08, 95% CI (3.36, 16.80), P < 0.003]. However, no significant difference between the two regimens was detected in estimated glomerular filtration rate (eGFR), alanine transferase (ALT) level, AST (aspartate transferase) level, Blood urea nitrogen (BUN) level, acute renal failure (ARF), and mortality rates. Pulsatile perfusion showed some positive effects on creatinine, creatinine clearance, lactate level, hospital stay, ICU stay, and intubation time. However, there was no difference between the two methods on BUN, ALT, AST, eGFR, ARF, and death. Most of the outcomes showed significant heterogeneity, which requires more robust RCTs to be conducted to increase the quality and the certainty of evidence.

Aim This study aimed to determine the prevalence of disability domains among Egyptian children in the age group of 6–12 years as well as assess their socio-demographic, epidemiological, and perinatal predictors. Methods A national population-based cross-sectional household survey targeting 20,324 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for the identification of disabilities. Results The prevalence of children with at least one type of disability was 9.2%. Learning/ comprehension was the most prevalent type (4.2%), followed by speech/communication (3.7%), physical/ mobility and seizures (2.2% for each), intellectual impairment (1.5%), visual (0.7%), and hearing (0.4%). The commonest predictors for disabilities were children who suffered from convulsions or cyanosis after birth and maternal history of any health problem during pregnancy. However, preterm and low birth weight (LBW) babies or being admitted to incubators for more than two days were strong predictors for all disabilities except hearing disability. A history of jaundice after birth significantly carried nearly twice the odds for seizures (AOR = 2.2, 95% CI:1.5–3.4). History of difficult labor was a predictor of intellectual impairment (AOR = 1.5, 95% CI:1.1–2.0). A disabled mother was a strong predictor for all disabilities except seizures, while a disabled father was a predictor for visual and learning/ comprehension disabilities (AOR = 3.9, 95% CI:2.2–7.1 & AOR = 1.6, 95% CI:1.1–2.4 respectively). Meanwhile, both higher maternal and paternal education decreased significantly the odds to have, physical/ mobility and Learning/ comprehension by at least 30%. Conclusion The study found a high prevalence of disability among Egyptian children aged 6–12 years. It spotted many modifiable determinants of disability domains. The practice of early screening for disability is encouraged to provide early interventions.

Background Early childhood life is critical for optimal development and is the foundation of future well-being. Genetic, sociocultural, and environmental factors are important determinants of child development. Aim The objectives were to screen for suspected developmental delays (DDs) among Egyptian preschool children, and to explore the determinants of these delays based on sociodemographic, epidemiological, maternal, and child perinatal risk factors. Methods A national Egyptian cross-sectional developmental screening of a representative sample of preschool children (21,316 children) aged 12 to 71 months. The Revised Denver Prescreening Developmental Questionnaire (R-PDQ) followed by the Denver Developmental Screening Test, 2 nd edition (DDST) was used. Results Each screened child manifested at least one of six developmental categories. Either typical development, gross motor delay (GM), fine motor adaptive delay (FMA), Language delay (L), Personal-social delay (PS), or multiple DDs. The prevalence of preschool children with at least one DD was 6.4%, while 4.5% had multiple DDs. Developmental language delay was the most prevalent, affecting 4.2% of children. The least affected domain was GM (1.9% of children). Boys were more likely to have DD than girls. Children in urban communities were more likely to have at least one DD than those in rural areas (OR = 1.28, 95%CI: 1.14–1.42), and children of middle social class than of low or high social class (OR = 1.49, 95%CI: 1.30–1.70 & OR = 1.40, 95%CI: 1.23–1.59 respectively). The strong perinatal predictors for at least one DD were children with a history of postnatal convulsions (OR = 2.68, 95%CI: 1.97–3.64), low birth weight (OR = 2.06, 95%CI: 1.69–2.52), or history of postnatal cyanosis (OR = 1.77, 95%CI: 1.26–2.49) and mothers had any health problem during pregnancy (OR = 1.73, 95%CI: 1.44–2.07). Higher paternal and maternal education decreased the odds of having any DD by 43% (OR = 0.57, 95% CI: 0.47–0.68) and 31% (OR = 0.69, 95%CI: 0.58–0.82) respectively. Conclusion This study demonstrates a considerable attempt to assess the types and the prevalence of DD among preschool children in Egypt. Perinatal factors are among the most common determinants of DD in preschool children and the majority could be preventable risk factors.

Due to great interest in the secure storage and transmission of color images, the necessity for an efficient and robust RGB image encryption technique has grown. RGB image encryption ensures the confidentiality of color images during storage and transmission. In the literature, a large number of chaotic-based image encryption techniques have been proposed, but there is still a need for a robust, efficient and secure technique against different kinds of attacks. In this paper, a novel RGB image encryption technique is proposed for encrypting individual pixels of RGB images using chaotic systems and 16 rounds of DNA encoding, transpositions and substitutions. First, round keys are generated randomly using a logistic chaotic function. Then, these keys are used across different rounds to alter individual pixels using a nonlinear randomly generated 16×16 DNA Playfair matrix. Experimental results show the robustness of the proposed technique against most attacks while reducing the consumed time for encryption and decryption. The quantitative metrics show the ability of the proposed technique to maintain reference evaluation values while resisting statistical and differential attacks. The obtained horizontal, vertical and diagonal correlation is less than 0.01, and the NPCR and UACI are larger than 0.99 and 0.33, respectively. Finally, NIST analysis is presented to evaluate the randomness of the proposed technique.

This study aimed to provide a national estimate of the prevalence of the high risk of autism spectrum disorder (ASD) and their determinants. A national screening survey was conducted for 41,640 Egyptian children aged 1 to 12 years in two phases. Tools used were Vineland's Adaptive Behavior Scales, Modified Checklist for Autism in Toddlers, Gilliam Autism Rating scale, and Denver II Developmental screening test. The overall prevalence of children at high risk of ASD was 3.3% (95% CI:3.1%–3.5%). Children living without mothers in homes, suffered from convulsions (AOR = 3.67; 95%CI:2.8–4.8), a history of cyanosis after birth (AOR = 1.87; 95% CI:1.35–2.59) or history of LBW babies (AOR = 1.53; 95% CI:1.23–1.89) carried higher odds of being at high risk of ASD.

Background Intra-abdominal hypertension (IAH) is prevalent among patients admitted to the intensive care unit (ICU). There is still a debate regarding the independent impact of IAH on patients’ outcomes. Aim To gain more insight about the prevalence and outcome of IAH in patients admitted to the ICU. Patients and methods A prospective study that was conducted on patients admitted to the ICU. The IAP was measured for all patients using the classic method of Harrahill four times daily. The patients were divided into 2 groups according to the intra-abdominal pressure. Results This study included 85 critically ill patients. It was found that 46 patients (54.1%) had IAH. Patients with IAH had significantly higher central venous pressure, greater clinical severity scores, a longer ICU stay, a higher percentage of mechanical ventilation (MV) requirements, a longer MV duration, and a higher incidence of acute kidney injury (AKI). Central venous pressure (CVP) and AKI were significant predictors of IAH. IAH was a significant predictor of the patients’ mortality. Conclusion This study adds new evidence regarding the higher prevalence of IAH in critically ill patients. The primary contributors to IAH were IV fluid administration and obesity. IAH was associated with longer ICU stays, worse clinical conditions, a requirement for MV, prolonged MV duration, and AKI. The mean intra-abdominal pressure (MIAP) and AKI emerged as significant predictors of mortality.