This article discusses the relationship between depression, anxiety, and migraine. Several studies have reported that the interrelationships between these disorders are bidirectional (e.g., depression can lead to migraine, and vice versa). However, the physiological mechanism underlying the association between migraine, anxiety and depression is not well understood. Understanding the relationship between depression, anxiety, and migraine may better enhance treatment plans for patients with these disorders. This article suggests a number of possible mediating factors that may predict the comorbidity of migraine and anxiety and/or depression, including substance abuse, cigarette smoking, obesity, adverse childhood experiences, and iron deficiency. Further, in this article, we explore the efficacy of two treatments—onabotulinumtoxinA and Erenumab—which have been shown to manage migraine, anxiety and depression. Our review suggests that it is important to understand the association between migraine, anxiety and depression as these disorders can lead to severe personal and economic negative outcomes, including pain medication dependency, reduced quality of life, reduced career success, and suicidal ideation.

This chapter assessed the prevalence of religious delusions among a group of inpatients from an Egyptian mental health hospital (El-Abbassyia, Cairo). The main purpose was to investigate the frequency of religious delusions in psychotic patients, and how this affected their prognosis. Specifically, this study was carried out because there is insufficient research within Arabic-speaking cultures on the role religion plays in mental health illnesses. To achieve this goal, we investigated whether self-reported religious orientation, as well as the degree of insight patients had concerning their beliefs was related to the frequency of religious delusions. It is important to ascertain what social and interpersonal factors increase the chances of suffering delusions with religious content as it will affect the individual’s health belief model, and therefore, its adherence to treatment. The results indicate that 38% of patients suffered religious delusions, and it was found that higher religious orientation and higher conviction in their beliefs was associated with increased chances of experiencing religious delusions. This growing body of knowledge underscores the need to attend more fully to the potentially destructive (and constructive) roles of religion in psychiatric diagnosis, assessment, and treatment.

Glass is one of the oldest man-made material that is widely used in architecture. As it is a translucent material, it permits a full penetration of direct sunlight but may also increase the internal space temperature and then increasing cooling loads and energy consumption. As the need for energy optimization is very important and glazing is considered a weak point in any building, the selection of glazing assumes tremendous significance. This paper reviews the different types of glazing which can be categorized into conventional and advanced to optimize the thermal and the lighting performance according to their properties and insulation values. Conventional glazing includes the clear glazing whether it is single double or triple, the tinted glazing, the reflective glazing, and the low-E glazing. Advanced glazing which is mainly the insulated glazing unit such as the gas filled glazing, the vacuum glazing, the aerogel glazing and the phase change material glazing.

Background: Drug abuse is considered one of the most serious public health problems, especially among young people at working ages. In this study, we assessed clinical characteristics of patients presenting with drug abuse who were referred to the addiction treatment clinics of Al-Mamoura mental hospital (Alexandria, Egypt), including sociodemographic variables, clinical symptoms, physical complications and psychiatric co-morbidities in comparison to other substance abuse. Methods: A descriptive cross sectional and comparative study was conducted on 516 patients attending outpatient addiction treatment clinics in 2013–14 on the Structured Clinical Interview for DSM-IV (SCID-I and SCID-II) as well as social and addiction scales. Results: in our sample, drug addiction was more common in males than females. Importantly, among many potential factors, it was found that peer pressure (friends) was the most common cause for drug abuse. Second, it was also found that psychiatric symptoms were more common among patients with substance abuse than legal or financial problems. Conclusions: Future behavioral treatments should take into account the role played by friends that lead to drug abuse and the maintenance of such habits. Further, pharmacological and behavioral therapies should consider psychiatric aspects of drug abuse as these are very common and may impact effective recovery.

Background Stigma is a basic component of the negative discrimination that people with mental illness experience every day. It blocks access to facilities that have been created to help people with mental illness. Furthermore, the attitudes held by people with authority (including clinical staff and officers) towards people with mental illness are likely to influence their attitude towards them and hence the experience and treatment outcome of the patients. The aim of this work is to study and compare the attitudes of Egyptian residents of different clinical specialties and house officers towards patients with mental illness. The current study aimed to study the attitudes of Egyptian medical residents and house officers towards patients with mental illness and compare between both groups. This cross-sectional comparative study was designed to assess 150 residents and 201 house officers at Ain Shams University Hospitals by using the Mental Illness Clinician Attitude Scale version 4 (MICA-4) and newly designed questions related to stigma. Results The study revealed that the scores of MICA questionnaire were significantly lower than the cut point for negative attitude in both residents and house officers ( P < 0.0001). In addition, there was a trend of an increase in MICA scores throughout the three levels of seniority but with no statistically significant difference. Furthermore, there was no statistical significant finding regarding the majority of MICA items or stigma sheet questions across the different specialties. Conclusion Stigma is one of the most disabling factors that prevent people with mental illness to live a normal social and occupational life and thus receive a good quality of life and equal chance of medical health care as other non-psychiatric patients.

Background: Accumulating evidence suggests that neuro-inflammation has a crucial role in the pathogenesis of late onset depression. Tumor Necrosis Factors-alpha (TNF-alpha) is one of many pro-inflammatory cytokines associated with depression. Based on this, this proof-of-concept clinical trial, was conducted so as to study the effect of pentoxifylline, an anti TNF-alpha as an add on to increase the effectiveness of Selective Serotonin Reuptake Inhibitors in elderly depressed patients.

Type 2 diabetes mellitus and diabetic nephrophathy considered to be an inflammatory process in which immune cells involved in its development and progression apart from traditional metabolic and hemodynamic risk factors. This study was designed to determine the balance between T helper 17 and regulatory T cells in Type 2 diabetic patients having diabetic nephropathy in relation to type 2 diabetic patients without renal involvement and healthy individuals. This study included 3 groups; diabetic2 nephrophathy patients (on basis of proteinuria and reduced GFR), diabetic patients (ADA, 2015) and healthy controls of the same age and sex Detection of T regs and Th 17 cell were evaluated; T regs expressing CD4 & CD 25 while Th 17 cells expressing CD4 and CD161 was done by standard 2-color flow cytometry and Th17/Treg cells ratio was calculated. The results revealed that there was higher mean Th17 and Th17/Treg cells ratio among type 2 diabetic nephropathy patients compared to other two groups. There was lower mean Treg cells among type 2 diabetic nephropathy patients compared to other two groups with very high statistically significant differences. Also, there was higher mean Th17 and Th17/Treg cells ratio among type 2 diabetic patients compared to healthy individuals with very statistically significant differences that there was a strong positive correlation between BUN, serum creatinine, proteinuria and the grade of nephrropathic affection by the ultrasound from one side and Th17 and Th17/T reg cells ratio on the other side. But this correlation was strongly negative with T reg cells.

Background: Breast cancer (BC) is the most common cancer among women. In Egypt, BC accounts for 38% of all types of cancer in females with the majority often present at advanced stages. This might be attributed to defective health education programs and poor awareness. The aim of this study is to evaluate the knowledge, attitude and practice of Egyptian nurses at Tanta university hospitals towards BC. Methods: 421 female nurses from Tanta university hospitals completed a questionnaire that administred through face-to-face interviews by medical students and interns. The questionnaire included five sections: sociodemographic data, knowledge about BC symptoms, risk factors, screenings methods and treatment of BC. Results: Mean knowledge score was 18.75 ± 5.76 with 57.2% of participants knew the right answers of more than 50% of the questions. The least level of knowledge was in questions related to BC symptoms and risk factors with 60.3% and 52.2% , respectively, of participants had scores of < 50% of the total score. The knowledge for nurses aged 30-39 years-old, those from urban areas and those who have years of work experience ranged between 16 and 25 years had statistically lower levels of knowledge compared to other groups (p value, 0.035, 0.048, 0.005, respectively). Conclusions: The level of BC knowledge among Tanta university hospitals nursing staff is fair. The Knowledge about BC symptoms and risk factors needs more attention from health care authorities to specifically design educational programs focusing on these areas. Legal entity responsible for the study: Tanta Faculty of Medicine, Egypt. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

1. Kücüksezer UC, Palomares O, Rückert B, Jartti T, Puhakka T, Nandy A, et al. Triggering of specific toll-like receptors and proinflammatory cytokines breaks allergen-specific T-cell tolerance in human tonsils and peripheral blood. J Allergy Clin Immunol. 2013;131:875--85. 2. Palomares O, Rückert B, Jartti T, Kücüksezer UC, Puhakka T, Gomez E, et al. Induction and maintenance of allergen-specific FOXP3+ Treg cells in human tonsils as potential first-line organs of oral tolerance. J Allergy Clin Immunol. 2012;129:510--20, 520.e19. 3. Ikincioğullari A, Doğu F, ikincioğullari A, Eğin Y, Babacan E. Is immune system influenced by adenotonsillectomy in children? Int J Pediatr Otorhinolaryngol. 2002;66:251--7. 4. Amorós Sebastiá LI, Ferrer Ramírez MJ, López Mollá C, Carrasco Llatas M, Plá Mochilí A, Díaz Ruiz M, et al. Changes in immunoglobulin levels following adenoidectomy and tonsillectomy. Acta Otorrinolaringol Esp. 2004;55:404--8. 5. Kaygusuz I, Alpay HC, Gödekmerdan A, Karlidag T, Keles E, Yalcin S, et al. Evaluation of long-term impacts of tonsillectomy on immune functions of children: a follow-up study. Int J Pediatr Otorhinolaryngol. 2009;73:445--9. 6. van den Akker EH, Sanders EA, van Staaij BK, Rijkers GT, Rovers MM, Hoes AW, et al. Long-term effects of pediatric adenotonsillectomy on serum immunoglobulin levels: results of a randomized controlled trial. Ann Allergy Asthma Immunol. 2006;97: 251--6. 7. Akdis CA, Akdis M. Mechanisms of allergen-specific immunotherapy. J Allergy Clin Immunol. 2011;127:18--27. 8. Calderón MA, Simons FE, Malling HJ, Lockey RF, Moingeon P, Demoly P. Sublingual allergen immunotherapy: mode of action and its relationship with the safety profile. Allergy. 2012;67:302--11. 9. Dehlink E, Eiwegger T, Gerstmayr M, Kampl E, Bohle B, Chen KW, et al. Absence of systemic immunologic changes during dose build-up phase and early maintenance period in effective specific sublingual immunotherapy in children. Clin Exp Allergy. 2006;36:32--9.

Egypt has the highest worldwide prevalence of hepatitis C virus (HCV) infection, caused in part by nosocomial transmission. Patients on hemodialysis (HD) are at especially high risk of infection. We aimed to estimate the incidence of seroconversion among HCV-negative patients undergoing regular HD at a unit in a large public hospital in the Nile Delta of Egypt, which implements the Egyptian Ministry of Health guidelines for infection control, and an isolation policy for hepatitis-positive patients. We also assessed the adherence to infection control practices and evaluated nurses and physicians' knowledge and attitude toward infection control procedures. Records of HCV-negative patients undergoing regular HD at the unit from August 2008 to August 2010 were reviewed retrospectively for data on HCV status. Patients were then followed up until September 2011, when polymerase chain reaction was performed for all patients. Infection control practices were evaluated by four checklists applied monthly and analyzed by control charts. Nurses and physicians' knowledge and attitudes toward infection control were assessed by interview questionnaires. Of 60 patients followed up, there was one case of HCV seroconversion giving an incidence rate of 0.676/100 person-years of follow-up (95% confidence interval: 0.017-3.76). There were no cases of hepatitis B virus seroconversion. The mean scores of all the infection control practices' checklists were very high and generally remained above the lower control limit over the 12-month period. Physicians and nurses achieved very high scores on knowledge and attitude on infection control (mean score >95%). This public facility had a low seroconversion rate and high adherence to infection control guidelines.

Given that achievement in learning mathematics at school correlates with work and social achievements, it is important to understand the cognitive processes underlying abilities to learn mathematics efficiently as well as reasons underlying the occurrence of mathematics anxiety (i.e. feelings of tension and fear upon facing mathematical problems or numbers) among certain individuals. Over the last two decades, many studies have shown that learning mathematical and numerical concepts relies on many cognitive processes, including working memory, spatial skills, and linguistic abilities. In this review, we discuss the relationship between mathematical learning and cognitive processes as well as the neural substrates underlying successful mathematical learning and problem solving. More importantly, we also discuss the relationship between these cognitive processes, mathematics anxiety, and mathematics learning disabilities (dyscalculia). Our review shows that mathematical cognition relies on a complex brain network, and dysfunction to different segments of this network leads to varying manifestations of mathematical learning disabilities.

Parkinson's disease (PD) is primarily a motor disorder that involves the gradual loss of motor function. Symptoms are observed initially in the extremities, such as hands and arms, while advanced stages of the disease can effect blinking, swallowing, speaking, and breathing. PD is a neurodegenerative disease, with dopaminergic neuronal loss occurring in the substantia nigra pars compacta, thus disrupting basal ganglia functions. This leads to downstream effects on other neurotransmitter systems such as glutamate, γ-aminobutyric acid, and serotonin. To date, one of the main treatments for PD is levodopa. While it is generally very effective, prolonged treatments lead to levodopa-induced dyskinesia (LID). LID encompasses a family of symptoms ranging from uncontrolled repetitive movements to sustained muscle contractions. In many cases, the symptoms of LID can cause more grief than PD itself. The purpose of this review is to discuss the possible clinical features, cognitive correlates, neural substrates, as well as potential psychopharmacological and surgical (including nondopaminergic and deep brain stimulation) treatments of LID.

The chapter reviews prior data on the relationship between homocysteine (Hcy) levels and cognitive function (such as learning, memory, and attentional processes) in various neurological disorders, including (but not limited to) mild cognitive impairment (MCI), vascular dementia, Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), as well as fibromyalgia and chronic fatigue syndrome. Specifically, we will review data showing how hyperhomocysteinemia (i.e., abnormal increase in Hcy levels) contributes to various neurological disorders. We also review prior studies showing the relationship between Hcy levels and different symptoms of MCI and AD. Further, we will discuss the neural substrates underlying the effects of Hcy levels on the brain, behavior, and cognition. Some of these brain structures include the hippocampus, cortex, as well as neurotransmitters (including acetylcholine and dopamine).

Allergic conjunctival disease (ACD) is a type of ocular allergy, which includes seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), and vernal keratoconjunctivitis (VKC). Little is known about the pattern of sensitization or prevalent aeroallergens among patients with isolated ACD in Egypt We aimed to evaluate the prevalence of skin prick test positivity to common aeroallergens among Egyptian patients with isolated allergic conjunctival disease. The study included 75 patients with isolated ACD recruited from a tertiary Egyptian outpatient clinic. Skin prick test (SPT) was performed for all patients with common aeroallergens. Total serum immunoglobulin E (IgE) was measured by ELISA. A positive SPT reaction was present among 32 patients (42.7%). The most prevalent aeroallergens among all patients were mites and pollens (12% respectively), followed by grass (8%) and hay dust (6.7%). Eight patients (10.7%) had SAC, 19 patients (25.3%) had PAC, and 48 patients (64%) had VKC. Prevalence of SPT positivity to indoor allergens was significantly more common among PAC (52.6%) than among SAC (25%) and VKC (16.7%), P= 0.011. Outdoor allergen sensitization did not differ significantly between the 3 subgroups, P= 0.614. Elevated IgE levels were observed among 62.5%, 73.7% and 66.7% of patients with SAC, PAC and VKC, respectively, with no statistically significant difference between them, P= 0.806. In conclusion aeroallergen sensitization is common among Egyptian patients with isolated ACD. Accordingly, SPT should be included in the diagnostic workup of these patients.

Although homocysteine (Hcy) has been widely implicated in the etiology of various physical health impairments, especially cardiovascular diseases, overwhelming evidence indicates that Hcy is also involved in the pathophysiology of schizophrenia and affective disorders. There are several mechanisms linking Hcy to biological underpinnings of psychiatric disorders. It has been found that Hcy interacts with NMDA receptors, initiates oxidative stress, induces apoptosis, triggers mitochondrial dysfunction and leads to vascular damage. Elevated Hcy levels might also contribute to cognitive impairment that is widely observed among patients with affective disorders and schizophrenia. Supplementation of vitamins B and folic acid has been proved to be effective in lowering Hcy levels. There are also studies showing that this supplementation strategy might be beneficial for schizophrenia patients with respect to alleviating negative symptoms. However, there are no studies addressing the influence of add-on therapies with folate and vitamins B on cognitive performance of patients with schizophrenia and affective disorders. In this article, we provide an overview of Hcy metabolism in psychiatric disorders focusing on cognitive correlates and indicating future directions and perspectives.

The cerebellum has been considered for a long time to play a role solely in motor coordination. However, studies over the past two decades have shown that the cerebellum also plays a key role in many motor, cognitive, and emotional processes. In addition, studies have also shown that the cerebellum is implicated in many psychiatric disorders including attention deficit hyperactivity disorder, autism spectrum disorders, schizophrenia, bipolar disorder, major depressive disorder, and anxiety disorders. In this review, we discuss existing studies reporting cerebellar dysfunction in various psychiatric disorders. We will also discuss future directions for studies linking the cerebellum to psychiatric disorders.

Introduction. Psychosis and hallucinations occur in 20-30% of patients with Parkinson's disease (PD). In the current study, we investigate cognitive functions in relation to the occurrence of psychosis in PD patients.Methods. We tested three groups of subjects - PD with psychosis, PD without psychosis and healthy controls - on working memory, learning and transitive inference tasks, which are known to assess prefrontal, basal ganglia and hippocampal functions.Results. In the working memory task, results show that patients with and without psychosis were more impaired than the healthy control group. In the transitive inference task, we did not find any difference among the groups in the learning phase performance. Importantly, PD patients with psychosis were more impaired than both PD patients without psychosis and controls at transitive inference. We also found that the severity of psychotic symptoms in PD patients [as measured by the Unified Parkinson Disease Rating Scale Thought Disorder (UPDRS TD) item] is directly associated with the severity of cognitive impairment [as measured by the mini-mental status exam (MMSE)], sleep disturbance [as measured by the Scales for Outcome in Parkinson Disease (SCOPA) sleep scale] and transitive inference (although the latter did not reach significance).Conclusions. Although hypothetical, our data may suggest that the hippocampus is a neural substrate underlying the occurrence of psychosis, sleep disturbance and cognitive impairment in PD patients.