Methods: This study included 36 patients with FHP with a mean age of 27±2.63 years. These patients were randomly assigned to the two following groups: experimental group A (n=19), which received CSEs and postural correctional exercises (PCEs), , and control group B (n=17), which received only the PCE program. Randomization was performed using the computer-generated block randomization method. Training was applied 3 times per week and lasted for 6 weeks. Data were collected before and after training using lateral view cervical X-ray and NDI. Results: Two-way mixed-design multivariate analysis of variance revealed significant improvements in mean cSVA and NDI values after training (p <0.05) in experimental group (A) compared with pre-training values, whereas no significant differences in these values were observed after training in the control group. In contrast, no significant difference in the mean Cobb angle values after training was observed between the groups. Conclusions Adding CSEs to PCEs is more effective than performing PCEs alone for managing FHP. The trial was registered in the ClinicalTrials. gov registry under the registration number NCT06160245.

Methods: This study included 36 patients with FHP with a mean age of 27±2.63 years. These patients were randomly assigned to the two following groups: experimental group A (n=19), which received CSEs and postural correctional exercises (PCEs), , and control group B (n=17), which received only the PCE program. Randomization was performed using the computer-generated block randomization method. Training was applied 3 times per week and lasted for 6 weeks. Data were collected before and after training using lateral view cervical X-ray and NDI. Results: Two-way mixed-design multivariate analysis of variance revealed significant improvements in mean cSVA and NDI values after training (p <0.05) in experimental group (A) compared with pre-training values, whereas no significant differences in these values were observed after training in the control group. In contrast, no significant difference in the mean Cobb angle values after training was observed between the groups. Conclusions Adding CSEs to PCEs is more effective than performing PCEs alone for managing FHP. The trial was registered in the ClinicalTrials. gov registry under the registration number NCT06160245.

Methods: This study included 36 patients with FHP with a mean age of 27±2.63 years. These patients were randomly assigned to the two following groups: experimental group A (n=19), which received CSEs and postural correctional exercises (PCEs), , and control group B (n=17), which received only the PCE program. Randomization was performed using the computer-generated block randomization method. Training was applied 3 times per week and lasted for 6 weeks. Data were collected before and after training using lateral view cervical X-ray and NDI. Results: Two-way mixed-design multivariate analysis of variance revealed significant improvements in mean cSVA and NDI values after training (p <0.05) in experimental group (A) compared with pre-training values, whereas no significant differences in these values were observed after training in the control group. In contrast, no significant difference in the mean Cobb angle values after training was observed between the groups. Conclusions Adding CSEs to PCEs is more effective than performing PCEs alone for managing FHP. The trial was registered in the ClinicalTrials. gov registry under the registration number NCT06160245.

Background: and Purpose Repetitive transcranial magnetic stimulation (rTMS) of the cerebellar hemisphere represents a new option in treating essential tremor (ET) patients. We aimed to determine the efficacy of cerebellar rTMS in treating ET using different protocols regarding the number of sessions, exposure duration, and follow-up duration. Methods: A randomized sham-controlled trial was conducted, in which 45 recruit patients were randomly allocated to 2 groups. The first (active group) comprised 23 patients who were exposed to 12 sessions of active rTMS with 900 pulses of 1-Hz rTMS at 90% of the resting motor threshold daily on each side of the cerebellar hemispheres over 4 weeks. The second group (sham group) comprised 22 patients who were exposed to 12 sessions of sham rTMS. Both groups were reassessed at baseline and after 1 day, 1 month, 2 months, and 3 months using the Fahn-Tolosa-Marin tremor-rating scale (FTM). Results: Demographic characteristics did no differ between the two groups. There were significant reductions both in FTM subscores A and B and in the FTM total score in the active-rTMS group during the period of assessment and after 3 months (p=0.031 and 0.011, respectively).However, subscore C did not change significantly from baseline when assessed at 2 and 3 months (p=0.073 and 0.236, respectively). Furthermore, the global assessment score was significantly higher in the active-rTMS group (p>0.001). Conclusions Low-frequency rTMS over the cerebellar cortex for 1 month showed relative safety and long-lasting efficacy in patients with ET. Further large-sample clinical trials are needed that include different sites of stimulation and longer follow-ups.

?AIM:To compare the efficacy and safety of penetrating keratoplasty ( PK) and deep anterior lamellar keratoplasty ( DALK) in the treatment of stromal corneal dystrophy.?METHODS:A systematic review and Meta-analysis was conducted for studies comparing visual acuity [ best-corrected visual acuity ( BCVA ) ( LogMAR ) ] and corneal endothelial cell count ( ECC) as well as safety outcomes of DALK and PK surgeries, including graft-related outcomes and intraoperative and postoperative complications. Embase, PubMed, and Google Scholar were searched for eligible studies until June 2019. Continuous and dichotomous variables were expressed as weighted mean difference ( WMD ) and risk ratios ( RRs ) , respectively, along with their respective 95％confidence intervals ( CIs) .? RESULTS: Five comparative studies recruiting 350 patients with macular and/or lattice corneal dystrophy (59.71％ males) were eventually included. No significant differences were noted in the mean BCVA after both types of surgeries. However, following DALK procedures, corneal ECC was significantly higher two years postoperatively ( WMD=401.62 cell/mm2 , 95％CI:285.39-517.85, P< 0.001 ) , and graft and endothelial rejection rates were significantly lower ( RR=0.30, 95％ CI: 0.14-0.64, P=0.002;RR=0.09, 95％ CI: 0.02-0.46, P=0.004, respectively) when compared to patients undergoing PK procedures. However, DALK procedures were associated with increased risks of intraoperative Descemet' s membrane perforations and postoperative double anterior chamber ( All P<0.001) .?CONCLUSION: DALK procedures are relatively more efficacious over the follow up periods with better safety outcomes than PK in patients with stromal CDs, conerning rejection and better visual outcome.

Dengue fever (DF) is one of the common mosquito-borne viral diseases. It is transmitted by Aedes aegypti and Aedes albopictus.The aim to study the clinical and laboratory manifestations of serologically confirmed cases of DF in outpatient clinics.This cross-sectional study was carried out in outpatient setting. According to WHO criteria all patients above 14 years old who were suspected to have DF were tested by IgM dengue antibody test. Additionally all patients underwent history, clinical examination and investigation including complete blood count, liver function test and abdominal ultrasound. Data was analyzed using SPSS version 20.Out of 126 patients presented with acute febrile illness, 71 (56.3%) had seroreactivity for dengue IgM antibodies. Fever, headache and muscloskeletal pain were the most common clinical presentation (100%). Decreased appetite (92.9%) , retro-orbital pain (78.8%) and dizziness(64.7%) were the next common symptoms. 29(40.8%) had hepatomegally, 11 (15.4%) had splenomegally.Elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were observed in 58(81.6%) and 53(74.6%) respectively. Lastly; Fever associated with headache, retro-orbital pain, along with thrombocytopenia and elevated liver transaminases should prompt a clinician on the possibility of DF. Increased community awareness and vector control measures need to be strengthened to reduce the burden of dengue cases.

AIM: To compare the efficacy and safety of penetrating keratoplasty(PK)and deep anterior lamellar keratoplasty(DALK)in the treatment of stromal corneal dystrophy.

METHODS: A systematic review and Meta-analysis was conducted for studies comparing visual acuity \〖best-corrected visual acuity(BCVA)(LogMAR)\〗 and corneal endothelial cell count(ECC)as well as safety outcomes of DALK and PK surgeries, including graft-related outcomes and intraoperative and postoperative complications. Embase, PubMed, and Google Scholar were searched for eligible studies until June 2019. Continuous and dichotomous variables were expressed as weighted mean difference(WMD)and risk ratios(RRs), respectively, along with their respective 95% confidence intervals(CIs).

RESULTS: Five comparative studies recruiting 350 patients with macular and/or lattice corneal dystrophy(59.71% males)were eventually included. No significant differences were noted in the mean BCVA after both types of surgeries. However, following DALK procedures, corneal ECC was significantly higher two years postoperatively(WMD=401.62 cell/mm2, 95% CI: 285.39-517.85, P<0.001), and graft and endothelial rejection rates were significantly lower(RR=0.30, 95% CI: 0.14-0.64, P=0.002; RR=0.09, 95% CI: 0.02-0.46, P=0.004, respectively)when compared to patients undergoing PK procedures. However, DALK procedures were associated with increased risks of intraoperative Descemet's membrane perforations and postoperative double anterior chamber(All P<0.001).

CONCLUSION: DALK procedures are relatively more efficacious over the follow up periods with better safety outcomes than PK in patients with stromal CDs, conerning rejection and better visual outcome.