Purpose:To analyze the outcomes of screen-time reduction on the foveal responses that associates computer vision syndrome (CVS) using multifocal electroretinogram (mfERG) examination.Methods:This prospective multicenter cohort comparative study included 49 eyes of 49 medical students divided into two groups. Group A (control group) included 25 eyes with no CVS diagnosis while group B (CVS group) included 24 eyes with CVS diagnosis. All students responded to the valid and reliable CVS-Form 3 (CVS-F3) questionnaire and underwent complete ophthalmic and mfERG examinations twice at the time recruitment in the study and four weeks after strict reduction of the daily screen-hours to ≤1 screen-hour daily to document associated foveal responses.Results:We documented statistically significant reduction in foveal responses in CVS versus control groups in mean mfERG Rings 1, 2, and 5 with Quadrants 1, 2, and 4 (P=<0.0001, 0.0001, 0.0003, 0.001, 0.002, and 0.006, respectively). Following the screen-time reduction, the second mfERG examination revealed significant post-reduction improvements in foveal responses in CVS group particularly in mean mfERG Rings 1, 2, 3, and 5 with Quadrants 1 and 4 (P=<0.0001, <0.0001, 0.0005, 0.02, <0.0001, and 0.04, respectively).Conclusion:This study documented the screen-induced foveal dysfunction that associates CVS using mfERG examination, which revealed remarkable significant improvements in foveal responses in the 4 weeks following strict screen-time reduction. These improvements were also associated with corresponding improvements in the visual performances. We suggest that the potential screen-induced foveal dysfunction outcomes might be reversible with strict screen-time reduction. We also recommend that educational institutional policies should limit online education-hours and redesign the mandated computer system use program to guard against visual sequelae of CVS.Clinical Trials Registration:ClinicalTrials.gov (ID: NCT04405648).

Introduction: This study aimed to discover and document the potential of visual and ocular sequelae of computer vision syndrome (CVS) among medical students. Methods: This cross-sectional case-control study was conducted on medical students (n=4030) of five universities in Egypt. All students completed a specially designed and validated CVS questionnaire survey (CVS-F3). Students with ≥5 CVS symptoms constituted a risk group (n=352), while students with 1-4 CVS symptoms constituted a low-symptoms group (n=3067). Students from the control and risk groups were examined using objective methods, such as visual acuity, subjective refraction, dry eye disease tests, and anterior segment and fundus examinations. Students who complained of visual blur underwent multifocal electroretinography mfERG examinations (mfERG group). Results: The CVS-F3 indicated that 84.8% of students had complaints that might be related to CVS, however, our ophthalmic examination group revealed only a 56% CVS prevalence rate. The most common single screen type used by 70.4% of students was the smartphone, and the most common complaint was headache (50.2%). Multivariate logistic regression analysis revealed that CVS was significantly associated with increased screen-hours, including >2 screen-hours daily (odds ratio [OR], 2.48; P<0.0001), >2 screen-hours at night (OR, 1.79; P=0.003), and ≥3 screen-years (OR, 1.69; P=0.006). In the mfERG group, 37% demonstrated reduced amplitudes of mfERG rings and quadrants, indicating reduced foveal responses. Conclusion: CVS-questionnaires overestimate the true CVS prevalence and sequelae, which could be accurately detected by objective ophthalmic examination. Smartphones primarily caused CVS among students, with CVS severity increasing in correlation with shorter eye-to-screen distance and frequent use. Contact lens wearing doubled the risk of CVS development and augmented its severity. CVS might affect macular integrity with screen-induced foveal dysfunction. Clinical Trials Registration: PACTR201811618954630.

Purpose To assess the visual, ocular, extraocular, and multifocal electroretinography (mfERG) outcomes of computer vision syndrome (CVS) among medical students. Methods This study was designed as a cross-sectional case-control study that included 733 medical students. All students completed a specially designed and validated CVS questionnaire survey (CVS-F3). Students from the control (No-CVS) and CVS groups underwent comprehensive ophthalmic examinations including the mfERG examinations. Our main outcome measures included uncorrected and corrected distance visual acuity (UDVA and CDVA, resp.) measurements, subjective and cycloplegic refractions, slit-lamp examination, intraocular pressure measurement, pupillary reflexes tests, ocular movements' tests, dry eye disease tests, and fundus and mfERG examinations. Results The CVS-F3 identified that 87.9% of students had complaints that might be related to CVS. We documented a 76% prevalence rate in students undergoing an ophthalmologic exam. The most common ocular and extraocular complaints included visual blur and headache (40.9% and 46.8%, resp.). Statistical logistic and linear regression analyses showed that refractive errors, prolonged screen-hours, close eye-screen distance, improper gaze angle, poor screen-resolution, and screen-glare were risk factors for developing CVS and influencing its severity. In the mfERG subgroup, 42.5% demonstrated reduced amplitudes of mfERG rings and quadrants, indicating reduced foveal responses. Conclusion Surveys cannot yield an accurate CVS prevalence. However, they help to identify subjects at risk who should be comprehensively assessed to confirm or exclude CVS diagnosis. Smartphone misuse primarily caused CVS among users. Our mfERG findings might be a sign of potential CVS visual sequelae; however, future studies are warranted. Clinicians need to understand these sequelae to appropriately identify and treat CVS.

PURPOSE:To compare the efficacy of implanting a single Keraring segment according to a novel Q-value-based nomogram (QN) to that of segment implantation according to the manufacturer's standard nomogram (SN), for keratoconus treatment.METHODS:This was a prospective, randomized controlled trial of 104 patients (104 eyes) with Amsler-Krumeich grade 1 or 2 keratoconus, and type 1 or 2 cone asymmetry determined according to manufacturer's classification. They were randomly distributed into two groups: group A patients (n = 52) underwent Keraring implantation according to the SN, and group B patients (n = 52) underwent implantation of a single (210° arc-length) Keraring segment according to the QN. Both treatments were combined with accelerated transepithelial cross-linking, and follow-up was 6 months. Main outcome measures were preoperative and postoperative visual acuity, subjective refraction and corneal topography.RESULTS:At postoperative month 6, group B exhibited statistically significantly higher values of mean uncorrected distance visual acuity (UDVA), sphere, K2, K-average, K-max and Q-anterior (p = 0.02, 0.01, 0.002, 0.001, 0.0001 and 0.03, respectively) compared to that of group A. However, group A exhibited better refractive cylindrical improvements (p = 0.04). In group A, we documented spontaneous extrusion of one Keraring segment.CONCLUSION:Single 210° arc-length segment implantation using our objective QN was more efficacious for keratoconus treatment than using the subjective SN. The nomograms were comparable when the Q-anterior value was >-1.00; however, the QN was superior to the SN when the Q-anterior value was ≤-1.00. The QN yielded greater postoperative UDVA and smoother corneal remodelling than did the SN for treatment of grade 1 and 2 keratoconic eyes.

Background Autism Spectrum Disorders (ASD) are a group of neurodevelopmental disabilities with unknown etiology. Recent studies suggest the contribution of immune dysfunction and oxidative stress in its pathophysiology. The present study aimed to investigate the serum level of thioredoxin (Trx), as a marker of oxidative stress and some inflammatory cytokines, and to evaluate their role in children with ASD. Results Concentrations of Trx, IL-1β, IL-8, and TNF-α were significantly higher in children with ASD compared with matched controls. There were no association between cytokine levels and the severity of clinical manifestations, according to CARS classification of severity. Conclusion The present study provides support for the idea that physiological abnormalities, such as oxidative stress and immune dysfunction, may contribute in the pathophysiology of ASD.

Background: Asthma is a common and heterogeneous respiratory disease characterized by airway obstruction and chronic inflammation. Innate and adaptive immune system plays an important role in its pathogenesis. Vitamin D has regulatory effects on the immune system via gene expression. Its functions are mediated by the transcription factor vitamin D receptor (VDR). Our aim was to analyze VDR gene expression and vitamin D status in asthmatic children, and to evaluate the effect of vitamin D supplementation on asthma severity as well as VDR mRNA level. Methods: VDR mRNA expression was measured by real-time PCR in 50 patients and 20 healthy controls. Serum vitamin D, asthma exacerbations and spirometry level were evaluated. Patients with deficiency were supplemented for two months and the level of serum Vitamin D and VDR expression level were remeasured. Results: Results showed that Vitamin D level was low in all patients. VDR mRNA level significantly upregulated in patients than the control group (P = 0.01) and significantly down regulated in response to 2 months of Vit D supplementation (P < 0.01). Significant improvement of the level of asthma control and spirometry readings accompanied the elevation of vitamin D level. Conclusion: VDR expression level associated with bronchial asthma and may serve as a predictor. The present study provides some molecular evidences about vitamin D effectiveness in bronchial asthma treatment.

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Purpose To compare the efficacy, safety and stability of standard epithelium-off cross-linking (SCXL) versus accelerated epithelium-off cross-linking (ACXL) and transepithelial epithelium-on cross-linking (TCXL) in the treatment of progressive keratoconus (KC) in children. Methods This prospective multicentre controlled trial included 271 eyes (136 children) with grade 1-3 progressive KC who were randomized to undergo SCXL (n = 91, as a control group), ACXL (n = 92) or TCXL (n = 88). Uncorrected and corrected distance visual acuity, subjective refraction, pachymetry, keratometry and corneal topography measurements were recorded preoperatively and 6, 12 and 24 months postoperatively. Results At 1 year, there was no significant difference in uncorrected distance visual acuity, refractive sphere, cylinder, spherical equivalent or Kmax between the ACXL and SCXL groups; however, during year 2, ACXL regressed while SCXL continued to improve. After 2 years, there were significant differences in all visual, refractive and keratometric components between SCXL and both ACXL and TCXL (p < 0.0001) and between ACXL and TCXL (p < 0.0001). KC progressed in 5.4% of patients who had ACXL and 28.4% of those who had TCXL but in none of those who had SCXL. Vernal keratoconjunctivitis was documented in 43.3% of eyes that progressed postoperatively. Conclusion SCXL was more effective for paediatric KC and achieved greater stability than either ACXL or TCXL, and ACXL was superior to TCXL. SCXL also achieved marked improvement in both myopia and spherical equivalent; however, these refractive outcomes were unpredictable and uncontrollable. TCXL had a 28.4% failure rate within 2 years. SCXL is preferable for management of paediatric KC.

IntroductionSickle cell disease (SCD) is a chronic inflammatory disorder characterized by altered levels of several inflammatory cytokines, which may be regulated by genetic polymorphisms and could be associated with diverse clinical presentations. Interleukin 1β (IL-1) and interleukin 6 (IL-6) have a pivotal role in the pathogenesis of many acute and chronic diseases, and their genetic alterations have been considered as molecular contributors to several inflammatory disorders. The current study aimed to define the impact of IL-1β and IL-6 genetic polymorphisms on the clinical course of the disease in a cohort of pediatric SCD patients.Material and methodsGenotyping of IL-1β +3954 C/T and IL-6 –174 G/C polymorphisms was performed by the polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) technique for 84 SCD patients and 100 age- and gender-matched unrelated healthy controls.ResultsThe polymorphic genotypes of IL-6 –174 G/C were associated with patients suffering from repeated, severe attacks of vaso-occlusion (VOC) requiring hospitalization (p = 0.023 and p = 0.03 respectively), while no significant differences were noted between SCD patients harboring the wild or the polymorphic genotypes of IL-1β +3954 C/T and their demographic, clinical or laboratory characteristics.ConclusionsIL-6 –174 G/C polymorphism could be considered as a molecular predictor for recurrent, severe attacks of vascular occlusion in Egyptian SCD patients. Considering the important roles of cytokines in SCD pathophysiology, further investigations in larger cohorts are recommended for better characterization of individual variations in immune regulatory genes and identification of novel markers for disease complications and morbidity.

Background: Interleukin 17F (IL-17F) is a pro-inflammatory cytokine that is recently proved to have a crucial role in the emergence of autoimmune diseases; it induces the expression of various cytokines, chemokines, and adhesion molecules. IL-17F polymorphism is subsequently related to enhanced IL-17F expression and activity; which may result in susceptibility to many autoimmune diseases including primary immune thrombocytopenia (PIT). Aim of the study: This case-control study aimed to investigate the possible association between IL and 17F gene single nucleotide polymorphism (SNP) at rs 7488A/G and PIT susceptibility in Egyptian pediatric patients. Subjects and methods: A total of 50 children with PIT with a mean age of 7 years, together with 50 age and sexmatched healthy controls were enrolled in the study for evaluation. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used for detection of IL-17F polymorphism at rs7488A/G. Results: Regarding the genotypes distribution, the frequencies of the AA, AG and GG genotypes were 96, 2, and 2% in PIT patients and 90, 10 and 0% in the control group respectively. The A and G allele frequencies were 97 and 3% in the patients’ group versus 95 and 5% in the control group. There was no significant difference in either genotypes or allelic distribution between PIT patients and the controls. Conclusion: Our study suggests that IL17F gene polymorphism at rs7488A/G may not contribute to the susceptibility in development of primary immune thrombocytopenia in the Egyptian children. Keywords: Interleukin 17F (IL-17F), Primary immune thrombocytopenia (PIT), Single nucleotide polymorphism (SNP), Polymerase chain reaction-restriction fragment polymorphism (PCR-RFLP)

IntroductionObesity has become the most prevalent chronic disorder that affects large populations, particularly children, all over the world. Although the cause of obesity has largely been considered to be multifactorial, the concept of a viral origin has been relatively understudied, in comparison with genetic and behavioral causes. Emerging evidence supports adenovirus 36 (Ad 36) as a potential cause of human obesity. We aimed to examine whether Ad 36 infection is associated with obesity and lipid disorders in Egyptian children.Material and methodsOne hundred and thirty children and adolescents were included in this study; 80 of them were obese and 50 were controls. All participated in physical and clinical examination. Personal habits of nutrition, anthropometric measurements, and laboratory parameters including plasma glucose, insulin, HOMA-IR index, lipid profile and Ad 36-specific neutralizing antibodies were assessed.ResultsFood habit inquiries revealed that 70% of all children had snacks before lunch, which were significantly higher in carbohydrates and fats in obese subjects (p = 0.009). No significant difference in lipid profile was found between the 2 groups. Obese children had significantly higher levels of insulin and HOMA-IR index than the controls. Adenovirus 36 IgG was positive in only 2 of the obese children. Age was positively correlated with BAZ, insulin levels and HOMA index (r = 0.29, p < 0.001; r = 0.29, p = 0.001 and r = 0.22, p = 0.013, respectively). A positive correlation between insulin and BAZ (r = 0.24, p = 0.007) was found.ConclusionsNo association was found between obesity and infection with Ad 36 in Egyptian children, indicating that Ad 36 has a limited effect as a causative agent of obesity in the Egyptian community.

BACKGROUND: Obesity is a multi-factorial chronic disorder. A considerable number of studies have been performed to figure out whether there is an association between obesity and polymorphisms of gene IL-6 (174G/C), but the results are equivocal. AIM: This study aimed to find out whether the IL-6 (174G/C) gene was associated with the risk of developing obesity in Egyptian children. SUBJECTS AND METHODS: The study included 149 children and adolescents with age ranged between 9.5 – 18 years. Eighty-five of them were obese which BMIZ-score is > 2, and sixty-four children with BMIZ-score ≤ 2 served as control group. Serum level of IL-6 and genetic analysis for IL-6 (174G/C) gene polymorphism were done. RESULTS: Obese children had significantly higher serum levels of IL-6 as compared to those of control children (P = 0.003). A high percentage of IL-6 polymorphism GC was found in obese subjects (93.7%), while the control group had a higher percentage of IL-6 polymorphism GG (70.6 %). CONCLUSION: Our study showed that carriers of the C allele for the IL-6 (174G/C) polymorphism have higher BMI. As the G174C polymorphism is likely to affect IL-6 expression and its physiological regulation; consequently this polymorphism may affect adiposity.

BACKGROUND:Beta Thalassemia is the most common chronic hemolytic anemia in Egypt (85.1%) with an estimated carrier rate of 9-10.2%. Injury to the liver, whether acute or chronic, eventually results in an increase in serum concentrations of Alanine transaminase (ALT) and Aspartate transaminase (AST).AIM:Evaluating the potentiating effect of iron overload & viral hepatitis infection on the liver enzymes.PATIENTS AND METHODS:Eighty (80) thalassemia major patients were studied with respect to liver enzymes, ferritin, transferrin saturation, HBsAg, anti-HCV antibody and HCV-PCR for anti-HCV positive patients.RESULTS:Fifty % of the patients were anti-HCV positive and 55% of them were HCV-PCR positive. Patients with elevated ALT and AST levels had significantly higher mean serum ferritin than those with normal levels. Anti-HCV positive patients had higher mean serum ferritin, serum ALT, AST and GGT levels and higher age and duration of blood transfusion than the negative group. HCV-PCR positive patients had higher mean serum ferritin and serum ALT and also higher age and duration of blood transfusion than the negative group.CONCLUSION:Iron overload is a main leading cause of elevated liver enzymes, and presence of HCV infection is significantly related to the increased iron overload.

Aim The aim of the present study was to compare the differences in visual outcomes, higher-order aberrations and corneal asphericity, as measured by Q values, in patients undergoing laser in-situ keratomileusis using wavefront-guided variable-spot size VISX CustomVue and wavefront-optimized small-spot size WaveLight Allegretto platforms. Type of study This study was designed as a randomized, prospective, single-blinded, double-armed, fellow-eye comparative study. Patients and methods A total of 100 eyes of 50 patients undergoing customized laser in-situ keratomileusis for compound myopic astigmatism were enrolled and randomly divided into two groups. Each patient underwent full ophthalmological examination; aberrometry was performed on either eye by using VISX CustomVue aberrometer and Allegretto WaveLight aberrometer. Each patient had one eye examined using the Allegretto Wave eye Q system (small-spot scanning), and the fellow eye by using VISX Star CustomVue S4 system (variable-spot scanning). All patients were given postoperative steroids, antibiotic drops and artificial tears. First day postoperative visit was scheduled to check for flap stability, and to exclude complications. Clinical examination and best corrected visual acuity, corneal imaging and aberrometry were scheduled at 1 month and 1 year later. Results Final best corrected visual acuity showed insignificant difference between the two groups (P = 0.712). The final differences between the groups were insignificant in all other parameters. Conclusion The two ablation profiles are highly comparable in treating compound myopic astigmatism.

Exposure to various environmental toxins with a reduced ability to metabolize them may lead to acquired aplastic anemia (AA). Genetic polymorphism of the detoxifying enzymes, the glutathione-S-transferase (GST) and microsomal epoxide hydrolase (mEh), with alteration in their activities could explain the genetic interindividual risks for AA. We aimed to characterize the genetic polymorphisms of the GST and mEh and to test their impact on the susceptibility, disease severity, and prognosis in Egyptian patients with AA. The GST and mEh genotypes were determined by multiplex-polymerase chain reaction and polymerase chain reaction-restriction fragment length polymorphism analysis, respectively, in 21 patients with AA and 20 healthy control subjects. The mEh functional phenotypes were assessed. The frequency of GST θ1-null genotype was found significantly higher in AA patients compared with the controls (odds ratio=2.8, 95% confidence interval = 1.1-7.8; P = 0.001). The frequency of heterozygous 139A--G of the mEh gene was significantly higher in AA patients compared with the controls (odds ratio=3.07, 95% confidence interval = 1.23-7.7; P = 0.018). Moreover, the patients with normal functional phenotype of the mEh had significantly favorable prognosis than those with abnormal enzyme activity (P = 0.027). Thus, the GST θ1-null genotype and the 139A--G mEh gene polymorphism may enhance the susceptibility to AA and provide an evidence of gene-environmental interaction.

ObjectiveTo compare the effectiveness of oral montelukast and that of inhaled corticosteroid (ICS) for controlling mild-persistent asthma after 8 weeks of treatment. ParticipantsThe study included 50 children of both sexes, who suffered from mild-persistent asthma, with a mean age of 7.72±2.4 years. Randomly, 25 patients were chosen to receive oral montelukast for 8 weeks, whereas the other 25 patients received ICS for the same period. Fifty children, who were apparently healthy, and age-matched and sex-matched with the study population, served as a control group. MethodsAll children were subjected to full clinical evaluation, assessment of pulmonary function tests, and measurement of fractional exhaled nitric oxide (FENO) and percentage of eosinophilic count before and after treatment. ResultsAfter 8 weeks of treatment, both groups of asthmatic children showed significantly higher levels of all pulmonary function tests and significantly lower levels of both FENO and percentage of eosinophilic count as compared with those before treatment. However, the ICS-treated group showed significantly higher levels of forced expiratory volume at the first second and significantly lower levels of eosinophilic count percentage and FENO when compared with the oral montelukast-treated group. ConclusionICS are the preferable primary long-term treatment for mild-persistent asthma. However, the state of efficacy of montelukast in this study, besides its oral route, may make it an alternative controller therapy for these patients. In addition, FENO appeared as a good indicator for airway inflammation in asthmatic patients.