Cellulose paper remains the dominant solid insulation in oil-immersed power transformers due to its costeffectiveness and excellent dielectric and mechanical behavior. However, during the manufacturing of insulation assemblies, a significant amount of cellulose paper is discarded as waste due to its small, unused size, despite being unused factory remnants. Reclaiming and reusing these remnants presents an opportunity to reduce: material waste, production costs, raw material consumption, and support sustainable manufacturing. The present work provides a systematic evaluation of recycled cellulose insulation, a topic with limited prior investigation. This study provides a systematic evaluation of recycled cellulose insulation, a topic with limited prior investigation. Both recycled and standard cellulose papers were impregnated in two commonly used mineral oils, Shell DIALA S2 and Shell DIALA S4, and tested for dielectric constant, dissipation factor, and AC breakdown strength. Measurements were performed using precision LCR techniques and an IEC 60156-compliant breakdown tester. The recycled cellulose paper exhibited closely comparable results, with a difference of approximately $6 \%$ in dielectric constant and less than $1 \%$ in AC breakdown strength, confirming consistent dielectric performance and insulation reliability. These results demonstrate the recycled paper’s viability as a sustainable insulation material for high-voltage applications.

Background While a connection has been established between serum interleukin-6 ( IL-6 ) levels and the IL-6 gene (− 174G/C) polymorphism in allergic diseases such as asthma, its specific association with severe asthma remains unexplored. This study examined the relationship between the IL-6 (− 174G/C) gene polymorphism and mild and severe asthma, focusing on its influence on type 2 inflammation. Methods Our study comprised 98 patients with mild asthma and 116 with severe asthma. Additionally, we recruited 121 healthy participants to serve as controls for comparative analyses. The IL-6 gene (− 174G/C) polymorphism was assessed utilizing the polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) method. Results In our study, the risk of mild asthma exhibited a significant fourfold increase in individuals with the GG genotype pattern compared to healthy controls, yielding an odds ratio (OR) of 4.4 ( p < 0.001). Conversely, we found no significant correlation between the IL-6 − 174G/C gene polymorphism and severe asthma when compared to the healthy control group. However, a noteworthy pattern emerged when we compared subgroups of mild and severe asthma. The risk of severe asthma increased fivefold in individuals with the GC polymorphism pattern, with an OR of 4.99 ( p < 0.001), while the likelihood of mild asthma showed a similar fourfold increase with the GG polymorphism pattern, OR = 4.4 ( p < 0.001). Consequently, we observed a significantly higher frequency of the C allele in patients with severe asthma, whereas the G allele was more prevalent in individuals with mild asthma ( p = 0.05). Additionally, the correlation between markers of type 2 inflammation and the dominant model of the IL-6 gene -174G/C polymorphism (CC + CG vs GG) revealed a significant increase in total serum immunoglobulin E (IgE), Blood Eosinophil Counts (BEC), and Fractional Exhaled Nitric Oxide (FeNO) levels in asthmatic patients with the CC + CG gene pattern compared to those with GG, with p-values of 0.04, 0.03, and 0.04, respectively. Furthermore, after adjusting for other risk factors, the likelihood of developing severe asthma increased from fourfold to eightfold, with an OR of 8.12 ( p = 0.01) with (CC + CG) gene pattern. Other predictors for severe asthma included older age and childhood-onset disease (OR = 1.13 and 19.19, p < 0.001). Allergic rhinitis (AR) and nasal polyps (NP) also demonstrated a substantial association with an increased risk of severe asthma, with odds ratios of 5 and 32.29 ( p = 0.01 and < 0.001), respectively. Additionally, elevated Body Mass Index (BMI), BEC, and FeNO were linked to severe asthma, with ORs of 1.11, 1.00, and 1.04, respectively ( p = 0.04, 0.05, and 0.001). Conclusion This study illuminated the intricate relationship between the IL-6 gene polymorphism, type 2 inflammation markers, and diverse risk factors in shaping asthma severity. As a significant association between the GG polymorphism of the IL-6 gene (− 174G/C) and mild asthma was found, while possessing at least one C allele, whether in a homozygous (CC) or heterozygous (CG) combination, independently predicts the likelihood of severe asthma.

For many years, mineral oil-filled transformers have successfully used dissolved gas analysis (DGA) as a fault diagnosis and condition monitoring tool. Amid continuous technological advancements, and with the proposed use of alternative dielectric liquids, such as nanofluids, it is essential to assess whether and how this diagnostic technique can be effectively adapted and optimized for use with these advanced insulating systems. This study investigates the dissolved gas generation patterns of mineral oil and nanofluids under thermal and electrical fault conditions. These faults were conducted on oil samples using specialized test cells to simulate realistic fault scenarios. Subsequently, the traditional Duval (Triangle 1/Pentagon 1) methods were applied to assess their suitability for analyzing dielectric nanofluid oils. The high rate of total dissolved combustible gas production in nanofluids caused fault misclassifications with Duval Triangle 1, indicating a need for adjusted zone boundaries. Consequently, a proposed modified version of Duval Triangle that is suitable for use with dielectric nanofluids has been introduced.

Mineral oil is the most frequent insulating liquid used in oil-immersed transformers for electrical insulation and heat dissipation.However,oil-based nanofluids are becoming more popular in scientific research as they have proved to have better dielectric and thermal characteristics.When applying these nanofluids into actual transformers,they would be exposed to thermal and electrical stresses.Thus,The aim of the authors is to investigate the generation pattern of dissolved gases in nanofluids under thermal and electrical faults and to assess the applicability of traditional Dissolved Gas Analysis(DGA)techniques if oil-based nanofluids are used in transformers.Oil-based nanofluid samples were prepared using a magnetic stirrer and an ultrasonic homogeniser and then subjected to simulated thermal and electrical faults in the laboratory using properly sealed test cells.Three types of metal oxides,Silicon dioxide,Titanium dioxide,and Aluminium oxide nanoparticles,have been used to prepare nanofluids with 0.02 g/L and 0.04 g/L concentrations.The gases released and dissolved into oil due to the simulated faults were analysed and compared to traditional mineral oil as a benchmark.The dielectric dissi-pation factor was obtained and analysed for all samples.According to the findings,the presence and concentration of nanoparticles were shown to influence the amount of gases produced.As a result,this research is crucial in guaranteeing that traditional DGA techniques can be employed in transformers that use oil-based nanofluids.

Objective: The objective of this study was to assess the effectiveness of switching from omalizumab to another biologic therapy for patients with severe asthma and evaluate factors that influenced the decision to switch and determined the optimal time for a good biologic response. Subjects and Methods: A retrospective study of severe asthma patients was conducted at Al-Rashed Allergy Center, a tertiary center in Kuwait. After meeting the eligibility criteria, patients were divided into two comparative groups: those continuing with omalizumab and those who started with omalizumab but switched to another biologic. Results: One hundred sixteen patients with severe asthma were recruited, and only 33 had access to multiple biological treatments. Approximately 22.4% switched from omalizumab. Male patients with a history of ischemic heart disease, chronic rhinosinusitis, and nasal polyps were more likely to switch if they had higher levels of eosinophils in the sputum. This study showed that every 1% increase in sputum eosinophils doubled the likelihood of a switch. Patients with access to alternative biological options had a much shorter mean duration of omalizumab therapy before switching compared to those with only affordable omalizumab: 4.9 ± 1.5 years versus 8.9 ± 1.3 years (p < 0.001). The optimal time to predict the likelihood of a good response was less than 5.5 years, with an area under the curve of 0.91 and p = 0.003. This cutoff point provided a sensitivity and specificity of approximately 89% and 100%, respectively. Conclusion: An early transition from omalizumab, specifically within the first 5 years of treatment, in patients with severe asthma and higher sputum eosinophils may enhance the likelihood of a good response if other biological therapies were available.

Bovine viral diarrhea (BVD) is an economically significant diseases in the bovine industry causing severe economic losses and there is no specific treatment so the primary aim of control to detect and remove persistently infected cattle (PI carriers) which serve as a virus source by shedding the virus life along and responsible for the presence of the virus within herds. So early diagnosis of PI animal is the critical point. To our knowledge, there have been no reports about the disease’s situation in New valley province, Egypt. The goal of this study was to serodiagnosis of BVD infection by Serum Neutralization Test (SNT) and early diagnosis of PI animals using BVDV Ag (POC)Test and Double antibody Sandwich ELISA (DS. ELISA) .In this study a total of 320 cattle of different ages, sexes, and breeds (not previously vaccinated with BVD vaccines) were screened clinically for symptoms of BVD infection, 92 cattle out of the totally screened 320 cattle showed clinical signs arousing suspicion of BVD( respiratory manifestation, diarrhea, growth retardation, oral lesion, and abortion) and undergo SNT and the result shows the percent of infection was 31.5% (29/ 92) .20 animal out of 92 clinically diseased undergo BVDV Ag Point-of-Care Test for detection of PI animal, 11 out of 20 examined cattle (55 %) were positive. PI animal was found to be high in cattle aged>2 months – 6 months than in other age groups. Also, male cattle had a greater infection rate than female ones, and infection was high in Frisian than in native bread. For more accurate confirmation five positive PI animal undergo (DS. ELISA). All Five positive PI animal were positive in ELISA (100% compatibility).

Background A significant breakthrough has been made in treating severe asthma, with the recognition of various asthma phenotypes and an updated management guideline. Type 2 targeted therapies, such as benralizumab and omalizumab; have been identified as an effective treatment for severe asthma, improving patient response, lung function tests and asthma symptom control. This study aimed to evaluate factors contributing to poor response to therapy. Methods A retrospective single-center cohort study of 162 patients with severe asthma who started biologic therapy; their data were retrieved from medical records for further analysis. Poor responders were patients remained clinically and functionally uncontrolled despite even after augmenting all treatment options. Results Childhood-onset asthma, bronchiectasis, poor symptom control (ACT below 19), severe airway obstruction (< 60% predicted), and maintenance oral corticosteroid (mOCS) use were significantly associated with poor response to omalizumab and benralizumab; p = 0.0.4 and 0.01; 0.003 and 0.01; 0.01 and 0.001, 0.05 and 0.04; 0.006 and 0.02, respectively. However, chronic rhinosinusitis and IgE < 220kIU/L were associated with higher poor response rates to omalizumab ( p = 0.01 and 0.04, respectively). At the same time, female patients and those with blood eosinophils level < 500 cells/mm3 had a higher poor response rate to benralizumab ( p = 0.02 and 0.01, respectively). Ischemic heart disease (IHD), bronchiectasis, and continued use of OCS increased the likelihood of poor response to omalizumab by 21, 7, and 24 times ( p = 0.004, 0.008, and 0.004, respectively). In contrast, the female gender, childhood-onset asthma and higher BMI increased the likelihood of poor response to benralizumab by 7, 7 and 2 times more, p = 0.03, 0.02 and 0.05, respectively. Conclusion Poor response to omalizumab treatment was independently associated with ischemic heart disease (IHD), bronchiectasis, and a history of maintenance oral corticosteroid (mOCS) use. Conversely, poor response to benralizumab therapy was independently linked to female gender, childhood-onset asthma and higher body mass index (BMI).

PVNS or TGCT (Pigmented Villonodular Synovitis, or Tenosynovial Giant Cell tumour) is a benign tumour affecting the synovial lining of joints and tendon sheaths, historically treated with surgical excision or debridement. We have shown previously this management is fraught with high recurrence rates, especially in its diffuse form. We present the encouraging early results of medical management for this condition with use of a CSF1 inhibitor, in comparison to a cohort of 137 cases previously treated at our institution.

We present the indications and outcomes of a series of custom 3D printed titanium acetabular implants used over a 9 year period at our institution (Sydney, Australia), in the setting of revision total hip arthroplasty. Individualised image-based case planning with additive manufacturing of pelvic components was combined with screw fixation and off-the-shelf femoral components to treat patients presenting with failed hip arthroplasty involving acetabular bone loss. Retrospective chart review was performed on the practices of three contributing surgeons, with an initial search by item number of the Medicare Benefits Scheme linked to a case list maintained by the manufacturer. An analysis of indications, patient demographics and clinical outcome was performed. The cohort comprised 65.2% female with a median age of 70 years (interquartile range 61–77) and a median follow up of 32.9 months (IQR 13.1 - 49.7). The indications for surgery were infection (12.5%); aseptic loosening (78.1%) and fracture (9.4%), with 65.7% of cases undergoing previous revision hip arthroplasty. A tumour prosthesis was implanted into the proximal femur in 21.9% of cases. Complications were observed in 31.3% of cases, with four cases requiring revision procedures and no deaths reported in this series. Kaplan-Meier analysis of all-cause revision revealed an overall procedure survival of 88.7% at two years (95%confidence interval 69 - 96.2) and 83.8% (95%CI 62 - 93.7) at five years, with pelvic implant-specific survival of 98% (95%CI 86.6 - 99.7) at two and five year follow up. We conclude that an individualised planning approach for custom 3D printed titanium acetabular implants can provide high overall and implant-specific survival at up to five years follow up in complex cases of failed hip arthroplasty and acetabular bone loss.

Technology and teaching tools play a crucial role in enhancing the learning process, especially collaborative learning, in higher education institutions. This role has been supported by widely used online platforms and educational technology tools. These tools include Google Docs, a free cloud-based writing tool allowing teachers and students to create a virtual, interactive, and collaborative learning environment. The researchers in this article attempt to draw attention to the capabilities and uses of Google Docs and its role in enhancing blended learning in higher education institutions. Based on the review of the relevant literature on the effectiveness and usefulness of Google Docs integration, it was found that Google Docs was recognised as a valuable technical and collaborative tool to enhance collaborative writing in higher education institutions. Its features make it easier for users to work together on documents, resulting in more efficient and effective collaboration, improving the students' writing skills.

Giardia duodenalis (G. duodenalis) is an infectious protozoan that has a global distribution especially in the hot climate. Around 200 million people are infected worldwide annually by Giardia, but infection is not always accompanied by symptoms, especially in endemic countries. Using traditional microscopy techniques in diagnosis, both in stool and water samples were less sensitive when compared to immunological methods; and the need for new diagnostic methods was necessary. Also, protection from infection is required in endemic areas. Therefore, the study aimed to produce anti- G. duodenalis IgG polyclonal antibodies (pAbs) by immunizing rabbit by G. duodenalis cyst recombinant protein. The produced antibodies were evaluated in the detection of G. duodenalis antigens in patients' stool and water samples from endemic areas across River Nile; where pAbs were used as a coating and a peroxidase conjugate antibody in sandwich ELISA. Moreover, pAbs were tested for the protection of mice from giardiasis. Sandwich ELISA using pAb has succeeded in the detection of G. duodenalis coproantigens in stool samples by a sensitivity of 97% and a specificity of 92.72%. Moreover, G. duodenalis cyst was detected in only seven water samples by ordinary microscopy; while sandwich ELISA revealed nineteen positive results. IgG pAb (1/200 µg/ml) protected mice from giardiasis; which was evident from the reduction in cysts and trophozoites numbers. We recommended the use of sandwich ELISA to monitor water quality, investigate environmental contamination and diagnosis in patients' stools. The pAbs can be prepared in large amount and used in field diagnosis and protection. This will help in the early diagnosis of G. duodenalis in water, which in turn can control outbreaks in rural areas.

Background: There is increasing recognition of marked phenotypic heterogeneity within severe asthma patients. Methods: Severe asthma patients on GINA step 4 or 5 treatment, followed up at Al-Rashed Allergy center Kuwait, were evaluated for: demographics (gender, age, age of asthma onset), comorbidities (allergic rhinitis (AR), chronic rhinosinusitis (CRS), chronic rhinosinusitis with nasal polyposis (CRSwNP), obesity), blood biomarkers (total serum Immunoglobulin E (IgE), peripheral eosinophils), and sensitization to inhalants allergens. Results: A total of 169 patients were candidates for biological treatment. Patients were divided in two groups based on level of total IgE as a "low" group with IgE<160 IU/ml (n = 55) and "high" group with IgE >= 160 IU/ml (n = 114). Both groups were further divided in subgroups, "low" and "high", based on absolute number of eosinophils (Eos) in peripheral blood with <300 cells/mu l or >= 300 cells/mu l. Only 10% of patients were in low IgE/ low Eos while majority (46%) were in the high IgE/high Eos group. Mean age of patients was 44.1 year with domination of females (n = 123). Majority of patients were obese. AR, CRS and CRSwNP were more common in group with IgE >= 160 IU/ml, while CRS and CRSwNP in group with Eos >= 300 cells/mu l. Conclusion: The majority of severe asthma patients in Kuwait are obese females with adult-onset asthma (>18 years of age) who were allergic with comorbid conditions including AR, CRS and CRSwNP, which correlates well with the level of Eos.

Canvas is a software platform that belongs to the Learning Management System (LMS) and used to enable instructors, administrators and students to manage knowledge, share information and collaborate by implementing an appropriate pedagogical approach. Integrating online Learning LMS tools in the Libyan higher education institutions has been one of the concerns in past years, especially during the recent Coronavirus disease 2019 (COVID- 19 pandemic). Some studies were held in Libya recently to investigate the new means and strategies implemented by schools and higher education institutions of online education and e-learning resources. This study utilized qualitative methods to investigate the perceptions of Libyan instructors regarding integrating Canvas LMS in the higher education institutions, based on their own online learning experience from a professional development course on Canvas, to which they are all enrolled. Online questionnaire utilizing Google form Application was conducted with 82 Libyan instructors who responded for the study. The collected data was analyzed and the results of the study showed that ease of use and usefulness contribute to the instructors' intention and attitudes toward the use of Canvas LMS. The findings can be used by educational institutions to understand instructors' perceptions regarding Canvas LMS, and ultimately improve e-learning and instructional practices. The study recommended that the higher education institutions should use Canvas LMS being easy, and useful for both students and teachers.

Blended learning is widely adopted as an effective approach to develop the traditional teaching style, and to fulfill the satisfaction of learners, students, and institutions. Therefore, this paper discusses the effectiveness of blended learning with learning management systems (LMS) implications in higher engineering education. Blended learning concepts, components, and challenges are discussed, as well as strategies of implementation are introduced.

The correlation between quantities of pigeon paramyxovirus type 1 (PPMV1)-Haemagglutination Inhibition (HI) antibodies exhibited by sera of Specific Pathogen Free (SPF) chicks and susceptible pigeon squabs at 7, 14, 21 and 28 days after inoculation with one and two pigeon doses of three batches of commercial inactivated PPMV-1vaccine was assessed throughout the present study to declare the reasonability of using SPF-chicken for evaluating the immunogenicity of inactivated PPMV-1 vaccine instead of pigeon in case of difficulty to find susceptible pigeon squabs in the market. Three groups of each susceptible pigeon squabs and SPF-chicks were used for immunogenicity assay of each batch of the tested vaccine. Blood samples were collected weekly from ten individuals of each inoculated and control group, and PPMV-1 HI antibodies were measured in each individual serum sample by HI test using PPMV-1HA antigen containing 4 HA units, and geometric mean titer of each group was calculated. SPF-chickens were reacted serologically with the test vaccine batches; PPMV-1-HI antibody GMTs of range 6.0 log2 – 7.1 log2 and mean 6.4 log2, and 6.0 log2 – 7.4 log2 and 6.6 log2 were determined in sera of chickens by the third and fourth weeks after inoculation with the pigeon dose respectively, while PPMV-1-HI antibody GMTs of range 7.0 log2 – 8.8 log2 and mean 7.6 log2, and 7.1 log2 - 8.9 log2 and mean 7.8 log2 and 8.1 log2 - 9.5 log2 and mean 8.8 log2 were determined in sera of pigeons by the third and fourth weeks after inoculation respectively. The obtained Relative Potencies of the test vaccine batches in chickens were ranged between 0.84 and 0.86, and the minimum required Page 2 PPMV-1-HI antibody GMT in sera of SPF-chicks collected between the third and fourth weeks after inoculation with the pigeon dose should be equal or more than 6.0 log2 X 85/ 100 = 5.1 log2. In-conclusion, the present study data suggest that SPF-chickens represent the reasonable alternative host for immunogenicity assay with one recommended dose of pigeon by inactivated PPMV-1 vaccine instead of susceptible pigeon.

Background: Obesity and its related diseases are increasing worldwide to an alarming figure, and researches are conducted to control and understand this pandemic. Purpose: This study aims to determine the added value of adding gastrojejunostomy to sleeve gastrectomy regarding gastric emptying and percentage of excess weight loss (%EWL). Materials and Methods: This study included 40 morbidly obese patients and was divided into two groups, group 1 underwent sleeve gastrectomy and group 2 underwent hybrid technique (adding gastrojejunostomy to the sleeved stomach). Both groups had gastric emptying test after 1 month and were followed for 1 year for %EWL or body mass index (BMI) change. Results: Regarding %EWL, it reached after 1 year 73.4 +/- 7.63 (mean +/- SD) in group 2, which was higher than group 1, 69.33 +/- 3.79 with p value = 0.009. It has been shown that gastric emptying to solids was also faster in the group 2 with a mean solid emptying T 1/2 of 18.25 min compared with group 1 with a mean of 28.35 min with a statistically significant p value of <0.001. Conclusions: There is a significant difference of emptying through gastrojejunostomy, which clarifies the added value of creating gastrojejunostomy to sleeve gastrectomy and may explain the lower pouch pressure than sleeve and therefore less gastroesophageal reflux disease symptoms.

Background: Obesity is excessive fat accumulation. Now, laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a primary, staged and provisional operation for its proven safety and simplicity. Complete removal of the gastric fundus makes adequate weight loss and plays a key role in reducing co-morbidities, ghrelin production, and eliminate inlet of the stomach to become small enough so that the patient will feel full quickly. Objective: The aim of this study was to assess the results of resecting the stomach 6-cm versus 3-cm from the pylorus regarding weight loss, reflux development, nausea and vomiting Patients and Methods: This randomly selected prospective study included a total of 30 morbidly obese patients, attending at Department of General Surgery, Bab El-Shaaria, and Al-Azhar University Hospital for doing sleeve gastrectomy. According to the starting point of stomach resection, the included subjects were randomly divided into two groups; each was 15 patients. Group (A) started 3 cm from the pylorus towards the gastro-esophageal junction and Group (B) started 6 cm from the pylorus. These patients followed up over a period of 2 years for postoperative nausea; vomiting and reflux symptoms and their weight loss. Results: group A patients (3 cm groups) were >14 times at a higher risk to have minor complications in the form of nausea; vomiting and reflux compared to group B patients (6 cm groups) without any difference between both groups regarding BMI changes over a period of six months. Conclusion: It could be concluded that leaving an antral pouch of 6 cm size while performing this procedure is recommended for better outcome with minor complications.

Angefangen von der kleinsten funktionellen Einheit, dem Bewegungssegment mit der zentral gelegenen Bandscheibe, sind Wirbelsäule und Becken mit den Iliosakral- und Hüftgelenken als funktionelle Einheit zu verstehen. Im komplexen Zusammenspiel der diskalen, ossären und ligamentären Strukturen sowie dem angrenzenden Muskelapparat spielen die Bandscheiben eine wichtige Rolle. Diskusveränderungen gehen häufig mit Veränderungen der Abschlussplatten einher und können bereits frühzeitig kernspintomographisch nachgewiesen werden. Der Fokus bei der Diagnostik und Beurteilung der Bandscheibendegeneration sollte auf die klinische Problematik zentriert sein. Grundlage dafür ist eine einheitliche Terminologie zwischen den beteiligten Fachdisziplinen.

In this study during one year 294 blood samples, collected from cattle showing clinical signs arousing suspicion of theileriosis and apparently healthy neighboring animal (related one) for diagnosis of theileriosis using stained blood film and molecular diagnosis (Semi nested PCR). the result of blood film revealed that 91 out of 294 examined cattle (30.95%) were positive for the piroplasmic form (intra erythrocytic stage) of T. annulate infection, the highest prevalence of infection by theileriosis was (39.50 %) in Summer, and the lowest rate was (13.95 %) in Winter. and the highest prevalence of infection was 39.30 %, in age group1(1day – 6months) and the lowest rate was 21.40%. in group 5 (> 4 Years). The Tbs-S/Tbs-A primer set was used for PCR amplification of Theileria sp. And the Ta-S/Tbs-A specific primer set was used in semi-nested PCR technique for detection of Theileria annulata. The semi-nested PCR accurately revealed (60%) positive samples The results indicated that Giemsa staining method, having 50% sensitivity, is not suitable for determination of Theileria annulata in carrier cattle, while semi-nested PCR technique can be used as a gold standard method for the mentioned aim and also can be used for screening of Theileria annulata carrier cattle in all regions. The phylogenic analysis of DNA of theileriosis revealed two sequences deposited in the GenBank database under accession numbers MK332380 and MK332382.

AimTo assess efficacy of omalizumab in moderate to severe asthma and notable factors affecting it, such as treatment compliance during the period of ten years.This retrospective, observational real life study is the first of this kind in the Gulf region and one of the worldwide rare long term omalizumab treatment studies. MethodsThe treatment for 35 patients started in 2008.Twenty patients (ongoing group) proceeded with treatment and were assessed annually until 2017.Reasons for treatment discontinuation in 15 patients (drop-out group) were also assessed. ResultsBefore starting omalizumab the ongoing group of patients had history of ≥2 asthma exacerbations per year, which significantly decreased during the first year of the treatment (p<0.001), and for 14 (70%) patients ≤1 exacerbation stayed during the next 10 years.Since 2014 six (30%) patients had had ≥2 annual asthma exacerbations (p<0.05 in 2013; p<0.05 in 2014; p<0.001 in 2015; p<0.01 in 2016; p<0.001 in 2017).At the same time there was a significant drop in compliance index (CI) (p<0.0001). ConclusionTo our knowledge this is the first 10-year study of compliance and effectiveness, which may help finalize some practical suggestions to improve CI in clinical practice and to note acceptable variation in CI.It is important to recognize factors that can possibly affect effectiveness of the treatment and identify the patients who will have the best benefit from a long term omalizumab treatment.