Background: Guillain-Barré Syndrome (GBS) is one of the most severe neurological diseases that causes marked disability and even death. Aim: The aim of this study is to investigate the role of the neutrophil-lymphocyte ratio (NLR) as a prognostic marker for GBS and response to treatment with plasmapheresis. Methods: Seventy-five subjects (35 GBS patients and 40 healthy controls) were recruited. Complete general and neurological examinations were performed and Hughes disability scale score was evaluated for assessing functional motor deficits in GBS patients. In addition, NLR, erythrocyte sedimentation rate, and C-reactive protein level were calculated. Results: NLR was significantly higher in GBS patients than in controls (p < 0.001) and was significantly higher in axonal form than other demyelinating and mixed subtypes (p < 0.02). Patients with a poor outcome had a significantly high NLR than patients with a good outcome (p = 0.006). NLR was also positively correlated with Hughes disability scale score (p < 0.001). The cut-off value for NLR to predict a good response of patients to plasmapheresis was ≤ 4.4. Interpretation: NLR may be a rapid, simple, inexpensive biomarker for predicting the severity of GBS, outcome of patients, and their response to plasmapheresis.

Background: Common peroneal mononeuropathy at the fibular neck (CPN) is one of the most frequent neuropathies of the lower extremities. Nerve conduction studies (NCS) have been used to confirm the diagnosis of CPN and localize common peroneal nerve abnormalities. High-resolution ultrasonography (HRUS) can aid in assessing the size of the common peroneal nerve. Aim: Was to evaluate the superficial peroneal sensory potential (SPSP) and HRUS role in the confirmation of CPN. Methods: This study was conducted on 70 patients presented with clinical and motor electrophysiological evidence of common peroneal neuropathy at the fibular neck and 70 controls. Clinical assessment, electrophysiological evaluations, and HRUS at the fibular neck were done. Results: All the patients were electrophysiologically proven to have common peroneal motor neuropathy at the fibular neck, and seven of them showed abnormalities in nerve conduction studies only. The patients showed smaller common peroneal nerve motor and sensory responses and much larger cross-sectional area (CSA) of the common peroneal nerve at the fibular neck when compared with the controls. NCS and EMG positive findings are the most significant factor related to the increased HRUS CSA. Affected SPSP is significantly detected in patients with axonal affection. CSA of common peroneal nerve at the fibular neck showed a significant positive correlation with body mass index, motor, and sensory latencies. Also, it showed a significant negative correlation with motor and sensory amplitudes. HRUS CSA localized the lesion at the fibular neck with sensitivity and specificity 83% and 53% respectively. CSA plus SPSP affection sensitivity and specificity in confirming CPN were 91.9% and 89%. Conclusion: HRUS CSA plus affected SPSP improve the diagnosis of CPN compared to standard electrophysiological criteria. Recommendation: Further studies on a wider scale for detection of their role in the prediction of prognosis in CPN.

Background Stroke represents the second leading cause of death in the world after myocardial infarction. Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (alteplase, rt-PA) is the only pharmacological therapy that was approved for treatment within 4.5 h of acute ischemic stroke (AIS) onset. We aimed to predict the 3-month outcome of AIS patients who received alteplase regarding mortality, spontaneous intra-cerebral hemorrhage (sICH), and functional outcome in comparison with non-thrombolyzed patients and to evaluate the predictors of the outcome after 3 months. Methods All the clinical, National Institute of Health Stroke Scale (NIHSS) scores, radiological, and laboratory data of 40 AIS patients and received rt-PA during the period from 2016 to 2018 were collected and analyzed retrospectively. For comparison, 40 patients, as a control group, were selected to match the alteplase group as regards the baseline data and received regular treatment, rather than rt-PA within the first 24 h, that were obtained. The outcome of the thrombolyzed patients after 3 months was evaluated in comparison with controls by using a modified ranking scale. Results After a 90-day follow-up period, the death rate was slightly higher among the rt-PA group (7.5%) in comparison with the control group (5%). sICH occurred in 7.5% of the patients in the alteplase group and in 5% of the non-thrombolyzed patients; however, this difference was not significant. More patients had a favorable outcome (mRS = 0–2) in the rt-PA group than in the control group (65% vs 60%, OR 1.38, 95% CI 0.50–3.6, P = 0.51). NIHSS score on admission, body mass index (BMI) (≥ 30), and previous transient ischemic attacks (TIA)/previous ischemic stroke were significant predictors of outcome after IV thrombolysis. Age, sex, hypertension (HTN), diabetes mellitus (DM), dyslipidemia, smoking, atrial fibrillation (AF), stroke subtype, size of infarction, and hyperdense middle cerebral artery had a non-significant effect. Conclusion After 3 months of follow-up, rt-PA had a non-significant more increase of favorable outcome with increased risk of sICH and death than controls. Baseline NIHSS, BMI, and history of TIA or previous ischemic stroke were significant predictors of outcome after thrombolysis.

Background: The brain is a productive source of a variety of enzymes and any brain injury like a stroke to brain tissue could similarly result in an increase in these enzymes in cerebrospinal fluid and serum. Evaluation of these enzymes represents a simple method for the ischemic stroke subtype diagnosis and prognosis. Objective: This study aimed to determine the role of brain natriuretic peptide (BNP), D-dimer, creatine-kinase-MB (CK-MB), C-reactive protein (CRP) serum levels, and globulin/albumin ratio in the diagnosis of CES stroke and its ability to predict short-term outcome. Methods: This study was conducted on 96 patients with acute ischemic stroke, subdivided into two groups: group Ι was 48 patients with cardio-embolic stroke and group ΙΙ was 48 patients with non-cardio-embolic. All patients were subjected to the assessment of serum BNP, D-dimer and CK-MB, and CRP and globulin/albumin ratio within the first 24 h of stroke. In the third week, they were assessed by mRS. Results: The mean levels of BNP, D-dimer level, and CK-MB were significantly higher in patients with cardio-embolic stroke than in patients with non-cardio-embolic stroke (P < 0.001) and also were associated with poor short-term outcome. Conclusion: Elevated plasma levels of BNP, D-dimer levels, and CK-MB can be used as surrogate biomarkers for the diagnosis of cardio-embolic stroke and prediction of poor short-term outcomes.

Background: Several neuropeptides have concerned with epilepsy pathogenesis; ghrelin showed an anticonvulsant effect. There is a potential relation between its level and antiepileptic drug (AEDs) response.Objective: To evaluate ghrelin effect in adult epileptic patients and in response to AEDs. Materials and methods: This case control study included 40 adult epileptic patients and 40 healthy controls. Participants were subjected to history taking of seizure semiology, full general and neurological examination, electroencephalography, and cranial imaging. Fasting serum acylated ghrelin (AG), unacylated ghrelin (UAG), and urine AG levels were estimated to all participants by enzyme-linked immunosorbent assay (ELIZA).Results: Serum AG, UAG, and urine AG levels were statistically higher in epileptic patients than controls (p = 0.005, 0.003, and 0.018 respectively). A significant higher level of serum AG was found among generalized epileptic patients (p = 0.038). There was higher statistically significant levels of all measured parameters among poly therapy patients (p = 0.003, 0.013, and 0.001 respectively). Also, a higher statistical significant level of serum AG and UAG in AEDs-responsive patients was found (p < 0.001). Our results demonstrated significant positive correlation between all measured parameters (serum AG, UAG, and urine AG) and epilepsy duration (p = 0.001, 0.002, and 0.009 respectively). High serum AG and UAG levels were independently associated with longer epilepsy duration (p = 0.00 and 0.008) and better response to AEDs (p < 0.001). Conclusion: These results indicated that serum AG and UAG levels were significantly high in epileptic patients especially with prolonged epilepsy duration and good AEDs response.Trial registration: ClinicalTrials.gov NCT03926273 (22-04-2019) "retrospectively registered."

Background: Antiepileptic drugs are responsible for reproductive dysfunction in male epileptic patients. Objectives: To evaluate the effect of valproate (VPA) versus levetiracetam (LEV) as a monotherapy on males' sex hormones and sperm parameters in newly diagnosed epileptic patients. Materials and methods: This comparative study included 50 newly diagnosed epileptic male patients. All patients were subjected to complete general and neurological examination, Doppler ultrasonography of the testis, pre-and post-treatment serum sex hormone assay, and semen analysis. Post-treatment re-evaluation checkpoint was determined if 8 weeks have passed after the last seizures. This study included two groups, group I (25 patients were treated by VPA) and group II (25 patients were treated by LEV). Results: There was no statistical difference between groups regarding their baseline characteristics. In group I, at post-treatment checkpoint, we found significant decrease in luteinizing hormone and follicle-stimulating hormones and highly significant increase of prolactin serum level. In sperm parameters, there was significant decrease of all measured items. In group II, serum sex hormone was not significantly changed at post-treatment checkpoint but semen analysis parameters were significantly decreased regarding all items. In comparison between the two groups, there was significant decrease of sperm concentration among group II with highly significant decrease of normal morphology of sperm among group I. Conclusion: Both VPA and LEV had adverse effects on the semen of male epileptic patients while VPA had also an adverse effect on sex hormones.

The bacteriological examination of 200 meat samples obtained from diarrheic buffalo calves revealed that Salmonella isolates could be recovered with an incidence 2 %. Serological identification of Salmonella species by using O and H antisera revealed that the most common Salmonella serovars were Salmonella typhimurium followed by Salmonella dublin and Salmonella anatum with an incidence 1 %, 0.5% and 0.5 % respectively. Salmonella typhimurium is inactivated by 3 KGy dose of irradiation of meat and also the isolated organism for preparation of the vaccine. The result of vaccination inoculation challenge studies revealed that the prepared Salmonella typhimurium vaccine was effective in protecting rabbits from salmonellosis.

Background Epilepsy is one of the most frequent and serious brain disorders. The nature of the disorder and the unpredictability of seizures usually puts patients in a state of apprehension and anticipation, which creates a continuous condition of anxiety. COVID-19 pandemic has created a state of generalized anxiety all over the world. It is expected that patients with epilepsy (PWE) will suffer from more anxiety during the pandemic. This cross-sectional study was applied on 290 PWE. Data were collected by personal interview with each patient using GAD-7 scale for diagnosing anxiety and assessing its severity. We aimed to assess the prevalence of anxiety and to assess its risk factors in PWE during COVID-19 pandemic. Results We found that 52.4% of PWE suffered from anxiety. Not working, low financial status, fear of infection and death by COVID-19, fear of job loss, had job changes during pandemic, increased seizures rate during pandemic, increased ER visits, and lack of drug adherence during the pandemic, are significantly associated with increased risk of anxiety. Conclusions COVID-19 pandemic has a serious effect on the psychological and the physical wellbeing of PWE. There was an increased rate of anxiety during COVID-19 pandemic in PWE with its subsequent burden on those patients. So, these patients are in a high need of care and support during the pandemic.