Consensus recommendations for diagnosis and treatment of Multiple Sclerosis: 2023 revision of the MENACTRIMS guidelines.

With evolving diagnostic criteria and the advent of new oral and parenteral therapies for Multiple Sclerosis (MS), most current diagnostic and treatment algorithms need revision and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and time and exclude alternative diseases that can explain the findings at hand. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. Appropriate selection of MS therapies is critical to maximize patient benefit. The current guidelines review the current diagnostic criteria for MS and the scientific evidence supporting treatment of acute relapses, radiologically isolated syndrome, clinically isolated syndrome, relapsing remitting MS, progressive MS, pediatric cases and pregnant women. The purpose of these guidelines is to provide practical recommendations and algorithms for the diagnosis and treatment of MS based on current scientific evidence and clinical experience.

Pooled-Testing for SARS-CoV-2 Reverse Transcription Polymerase Chain Reaction (RT-PCR) in asymptomatic healthcare workers in EL-Raghy isolation COVID-19 hospital, Assiut University.

COVID-19 pandemic is a substantial challenge for healthcare systems. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) tests are considered the gold standard technique for diagnosis of symptomatic and asymptomatic infectious viral carriers and for screening special or at-risk populations. The pooled testing procedure is commonly used to reduce the cost of screening a large number of individuals for infectious diseases. This work was conducted to verify the accuracy of the standard SARS COV-2 RT- real-time PCR kit for detecting a single positive sample in a pool of negative samples. Kit verification using negative and positive samples was performed for the selection of the target pool sizes. RNA extracts from 443 healthcare workers, after 15 days' rotation in EL-Raghy Isolation COVID-19 Hospital, Assiut University during the first outbreak of COVID-19 pandemic (the period from June to September 2020) were obtained and tested. Sixty-three different pool sizes (2, 3, 4, 5, 6, 7, 8, 9, and 10) were tested for the presence of SARS-CoV-2 using RT-qPCR. Of these, 53 pools (84.1%) were negatives and 10 pools (15.9 %) tested positive. The individual number of SARS- COV 2 RT-PCR tests used in different pool sizes was 40 tests. The total number of SARS- COV 2 RT-PCR test used in this study was 110 tests instead of 443 tests which reflect a decrease in cost up to 75.16%. In conclusion, the suggested pooling strategy can reduce testing loads which enable substantial savings in reagent costs, technical burden, and time to generate laboratory results.

Tuning of bandgaps and emission properties of light-emitting diode materials through homogeneous alloying in molecular crystals.

Alloy formation is ubiquitous in inorganic materials science, and it strongly depends on the similarity between the alloyed atoms. Since molecules have widely different shapes, sizes and bonding properties, it is highly challenging to make alloyed molecular crystals. Here we report the generation of homogenous molecular alloys of organic light emitting diode materials that leads to tuning in their bandgaps and fluorescence emission. Tris(8-hydroxyquinolinato)aluminium (Alq3) and its Ga, In and Cr analogues (Gaq3, Inq3, and Crq3) form homogeneous mixed crystal phases thereby resulting in binary, ternary and even quaternary molecular alloys. The M x M'(1-x)q3 alloy crystals are investigated using X-ray diffraction, energy dispersive X-ray spectroscopy and Raman spectroscopy on single crystal samples, and photoluminescence properties are measured on the exact same single crystal specimens. The different series of alloys exhibit distinct trends in their optical bandgaps compared with their parent crystals. In the Al x Ga(1-x)q3 alloys the emission wavelengths lie in between those of the parent crystals, while the Al x In(1-x)q3 and Ga x In(1-x)q3 alloys have red shifts. Intriguingly, efficient fluorescence quenching is observed for the M x Cr(1-x)q3 alloys (M = Al, Ga) revealing the effect of paramagnetic molecular doping, and corroborating the molecular scale phase homogeneity.

Bandgap Tuning in Molecular Alloy Crystals Formed by Weak Chalcogen Interactions.

We demonstrate systematic tuning in the optical bandgaps of molecular crystals achieved by the generation of molecular alloys/solid solutions of a series of diphenyl dichalcogenides-characterized by weak chalcogen bonding interactions involving S, Se, and Te atoms. Despite the variety in chalcogen bonding interactions found in this series of dichalcogenide crystals, they show isostructural interaction topologies, enabling the formation of solid solutions. The alloy crystals exhibit Vegard's law-like trends of variation in their unit cell dimensions and a nonlinear trend for the variation in optical bandgaps with respect to their compositions. Energy-dispersive X-ray and spatially resolved Raman spectroscopic studies indicate significant homogeneity in the domain structure of the solid solutions. Quantum periodic calculations of the projected density of states provide insights into the bandgap tuning in terms of the mixing of states in the alloy crystal phases.

Stroke in the Middle-East and North Africa: A 2-year prospective observational study of intravenous thrombolysis treatment in the region. Results from the SITS-MENA Registry.

BACKGROUND AND METHODS: Intravenous thrombolysis for acute ischemic stroke in the Middle-East and North African (MENA) countries is still confined to the main urban and university hospitals. This was a prospective observational study to examine outcomes of intravenous thrombolysis-treated stroke patients in the MENA region compared to the non-MENA stroke cohort in the SITS International Registry. RESULTS: Of 32,160 patients with ischemic stroke registered using the SITS intravenous thrombolysis protocol between June 2014 and May 2016, 500 (1.6%) were recruited in MENA. Compared to non-MENA (all p < 0.001), median age in MENA was 55 versus 73 years, NIH Stroke Scale score 12 versus 9, onset-to-treatment time 138 versus 155 min and door-to-needle time 54 min versus 64 min. Hypertension was the most reported risk factor, but lower in MENA (51.7 vs. 69.7%). Diabetes was more frequent in MENA (28.5 vs. 20.8%) as well as smoking (20.8 vs. 15.9%). Hyperlipidemia was less observed in MENA (17.6 vs. 29.3%). Functional independence (mRS 0-2) at seven days or discharge was similar (53% vs. 52% in non-MENA), with mortality slightly lower in MENA (2.3% vs. 4.8%). SICH rates by SITS-MOST definition were low (<1.4%) in both groups. CONCLUSIONS: Intravenous thrombolysis patients in MENA were younger, had more severe strokes and more often diabetes. Although stroke severity was higher in MENA, short-term functional independency and mortality were not worse compared to non-MENA, which could partly be explained by younger age and shorter OTT in MENA. Decreasing the burden of stroke in this young population should be prioritized.

Electron Density Analysis of the "O-O" Charge-Shift Bonding in Rubrene Endoperoxide.

Rubrene endoperoxide p-xylene (1) has been obtained in crystalline form from recrystallization and purification of the organic semiconductor, rubrene, and for the first time characterized by single-crystal X-ray diffraction methods. 1 is produced by reaction of rubrene with molecular oxygen to create rubrene endoperoxide, C42H28O2, in which an O2-bridge is joining the two phenyl-substituted C atoms opposite each other in the second of the four aromatic rings in tetracene thereby breaking the resonance along the tetracene moiety. The electron density distribution of 1 reveals that the intramolecular O-O bond is best characterized as charge-shift bonding with loss of electronic concentration in the interatomic region evidenced by the Laplacian. Likewise the ELI-D indicates little electron localization in this region. Furthermore, source function and ELI-D analysis of 1 clearly quantifies the lack of electronic delocalization across the six-membered ring that carries the peroxide-bridge.

Quantitative analysis of intermolecular interactions in orthorhombic rubrene.

Rubrene is one of the most studied organic semiconductors to date due to its high charge carrier mobility which makes it a potentially applicable compound in modern electronic devices. Previous electronic device characterizations and first principles theoretical calculations assigned the semiconducting properties of rubrene to the presence of a large overlap of the extended π-conjugated core between molecules. We present here the electron density distribution in rubrene at 20 K and at 100 K obtained using a combination of high-resolution X-ray and neutron diffraction data. The topology of the electron density and energies of intermolecular interactions are studied quantitatively. Specifically, the presence of Cπ⋯Cπ interactions between neighbouring tetracene backbones of the rubrene molecules is experimentally confirmed from a topological analysis of the electron density, Non-Covalent Interaction (NCI) analysis and the calculated interaction energy of molecular dimers. A significant contribution to the lattice energy of the crystal is provided by H-H interactions. The electron density features of H-H bonding, and the interaction energy of molecular dimers connected by H-H interaction clearly demonstrate an importance of these weak interactions in the stabilization of the crystal structure. The quantitative nature of the intermolecular interactions is virtually unchanged between 20 K and 100 K suggesting that any changes in carrier transport at these low temperatures would have a different origin. The obtained experimental results are further supported by theoretical calculations.

Post-chemotherapy arthralgia and arthritis in lung cancer.

OBJECTIVE: Evaluate the characteristics of arthritis, arthralgia and musculoskeletal pain after chemotherapy in patients with lung cancer. MATERIALS AND METHODS: In this study, we evaluate the characteristics of 17 patients with joint symptoms following receiving chemotherapy for lung cancer. Demographic information of patients including sex, age, time of rheumatologic findings after starting of chemotherapy, time of improvement after starting of medication, and relevant laboratory findings for each patient. RESULTS: A total of seventeen patients (six women with mean age 41.2 ± 5.2 years and 11 men with mean age 42.5 ± 8.2) that received standard chemotherapy for lung cancer according to stage of disease. Joint symptoms usually began about seven months after the first session of chemotherapy. Patients had an average of two tender joints and 1 hr of morning stiffness. Four patients were positive for anti-nuclear antibody, and none of patient was positive for rheumatoid factor. Non-steroidal anti-inflammatory drugs, disease modifying anti-rheumatic drugs (DMARD), corticosteroids, and venlafaxine were prescribed. Four patients did not show an improvement. Follow-up was available for all patients. 11 patients showed favorable responses, characterized by a significant decrease (more than 50%) in morning stiffness, pain, and tender joint counts after a mean of three months' treatment. Two patients had complete resolution of symptoms and did not required further medications for arthritis, arthralgia or musculoskeletal pain. CONCLUSION: Chemotherapy-related arthropathy in lung cancer is not uncommon. Early treatment with NSAID, DMARD, and corticosteroids is effective in the majority of patients.

Hepatic microsomal enzyme induction and thyroid function in rats treated with high doses of phenobarbital or chlorpromazine.

Rats were treated daily with high doses of phenobarbital or chlorpromazine for 6 weeks. The animals were sacrificed after 1, 2, 4 and 6 weeks of treatment. At each occasion, plasma levels of ASAT, ALAT, LDH, AP, total T4 and T3, free T4 and T3, and TSH were determined. The thyroids and liver weights were recorded, and the microscopical examination was performed on the liver, thyroids and pituitary gland. The results showed hepatic morphological changes indicative of enzyme induction on weeks 1, 2 and 4. During the first 4 weeks, plasma T4 and T3 were decreased in many individuals and increased in few others, and after 6 weeks of treatment the values for T4 and T3 returned to near normal. An increase in ASAT and ALAT was found at the same occasions. Follicular cell hypertrophy in the thyroids was observed during the first 4 weeks of treatment, in both treated groups, and after 6 weeks the thyroid glands returned to normal, except for a few individuals from the phenobarbital group. The present study has shown that the effect of phenobarbital and chlorpromazine on the thyroid gland function is predominantly due to their effect on the peripheral hormone disposition, as a result of the hepatic microsomal enzyme induction.