Objective Previous reports show conflicting results regarding hepatitis B virus (HBV) vaccine efficacy in Hepatitis C virus (HCV) infected individuals and in those with isolated hepatitis B core antibodies (HBcAb). We aimed to evaluate the effectiveness of HBV vaccine and identify possible factors that may contribute to hyporesponsivness in HCV‐treated patients, including those with isolated HBcAb. Methods We conducted a prospective study with 118 enrolled chronic HCV patients who followed a 12‐week regimen of direct acting antivirals (DAAs) and were evaluated for HBV serological markers. Eventually, 98 received appropriate HBV vaccination and were assessed for response. Results A total of 57.1% were vaccine responders although only 5.1% achieved a seroprotective level of HBsAb titre. The response rate was significantly lower among treated HCV patients with isolated HBcAb [2 (5.6%) vs. 40 (64.5%) respectively]. On multivariate analysis, advanced age [OR (95% CI) = 1.09 (1.02–1.17)] and presence of isolated HbcAb [OR (95% CI) = 39.59 (7.98–196.63)] were predictors of vaccine non‐response. In our cost‐effectiveness models, the cost of HBV serological screening was less than the nationally adopted non‐screening approach. A model ratifying reinforced vaccination in non‐responder HBcAb seropositive HCV patients would incur extra cost. Conclusion Hyporesponsiveness to the HBV vaccination is frequent in chronic HCV patients even after achieving SVR following DAAs. Although there is no consensus on the clinical management of patients with isolated HBcAb, our cost‐effectiveness options may support decision‐making for better clinical benefit and proper health investments.

Purpose Civil registration and vital statistics (CRVS) systems should be the primary source of routine mortality data. However, there is lack of information about the completeness of death registration at the sub-national level of Egypt. The current study was conducted to estimate the completeness of death registration at the national and sub-national levels of Egypt, to investigate the spatial patterns of the completeness, and to examine the factors that influence it. Methods Data from the Central Agency for Public Mobilization and Statistics (CAPMAS, 2018) and Egypt Demographic and Health Survey (EDHS 2008, 2014) were used to estimate the completeness of death registration using an empirical method (random-effects models); hot spot analysis was conducted using Moran’s I and Getis-Ord Gi*; and the geographically weighted regression (GWR) model has been also carried out. Results The study estimates show that Egypt has 96% completeness of death registration, and all governorates have completeness of more than 90% except for Beni-Suef, Menia, Aswan, Suhag, Luxor, ELWadi ELGidid, and South Sinai. According to sex, the death registration of females is slightly better than that of males (96.8% compared to 95.4%). Concerning residence, urban area has almost complete death registration compared to rural area (99.5% and 85.4%, respectively). Hot spot analysis shows that all hot spots are centered on the north of Egypt, while all cold spots are focused on the south. However, according to the geographically weighted regression (GWR) model, poverty, illiteracy, and health office density are considered major factors for the completeness of death registration. Conclusion Although the completeness in Egypt is almost 100%, this analysis suggests that it may not be, and that it could be somewhat lower in some rural areas. However, there is uncertainty in the sub-national estimates because deaths are only reported by place of occurrence and not place of usual residence. Thus, efforts should focus on improving the quality of data of the vital registration system in some rural areas and in lower Egyptian governorates.

INTRODUCTION Topiramate is an antiepileptic drug that has been used for many labeled and off-labeled indications. It may be useful in reducing withdrawal symptoms of various addictive agents such as alcohol, cocaine, cannabis and smoking. To date, some studies have examined the effectiveness of topiramate for smoking cessation. The present review aims to synthesize the results from those studies and determine topiramate effectiveness in smoking cessation. METHODS A comprehensive search was conducted in the databases: PubMed/ Medline, Cochrane, Egyptian Knowledge Bank, and Google Scholar. All clinical trials that examined the effect of topiramate, compared with the placebo, on smoking cessation rate were included. Statistical analysis using fixed effect models, heterogeneity and sensitivity analysis were conducted using RevMan 5.3. RESULTS Five trials met the inclusion criteria and were included in the metaanalysis. Topiramate non-significantly increased prolonged smoking abstinence rate (OR=1.19, 95% CI: 0.57-2.5) compared with the placebo. On the other hand, topiramate significantly increased the abstinence rate at weeks 4

Background: The Personal Wellbeing Index-Adults (PWI-A) is the most widely used instrument for measuring subjective-quality of life (QoL). The current study seeks to investigate the construct validity and reliability of the Arabic version of the PWI-A on adults with bilateral hearing impairment by comparing the single-factor solution with the two-factor solution. Methods: A cross-sectional study was conducted at the Audio-Vestibular Medicine Unit of Alexandria University from July-2017 to January-2018. A total of 205 adults were interviewed to measure the subjective-QoL using the PWI-A instrument. Internal consistency was determined using both Cronbach’s alpha and composite reliability (CR). Validity was assessed by construct validity, including ordinal regression, ordinal exploratory factor analysis (OEFA), and ordinal confirmatory factor analysis (OCFA). Results: The first four items of the PWI-A which are: satisfaction with living standard, health, achievements, and relationships were the most important indicators of subjective-wellbeing (Part r2 0.0547, 0.0324, 0.0361, and 0.0225, respectively). OEFA suggested that the two-factor model contributes better than the single-factor model. OCFA validated this suggested solution; (two-factor: RMSEA=0.084 (90% CI=0.01-0.14); CFI=0.964; AIC=52.64; single-factor: RMSEA=0.119 (90% CI=0.07-0.17); CFI=0.922; AIC=62.77). Good internal consistency was also presented (two-factor: Cronbach’s alpha=0.719, 0.693; single-factor: Cronbach’s alpha = 0.750). Conclusion: The Arabic version of the PWI-A is a multidimensional scale that consists of two dimensions: the first is related to subjective-QoL, and the second is related to satisfaction with the community. Thus, it is recommended to use the short version of the PWI-A with only four items to measure subjective-QoL, as it achieved sufficient reliability and construct validity.

Objective: We aimed to ascertain survival rates of TNF-inhibitors and IL17-inhibitors therapy, as well as the reasons and potential predictors for drug discontinuation and switching in patients with axSpA. Methods: A longitudinal observational retrospective study was carried out on 148 patients with a clinical diagnosis of axSpA and were on TNF or IL-17 inhibitors recruited from June 2021 to September 2022. Drug survival was recorded as well as the frequency of and reasons for switching biological therapy were reported. Two types of models were used to investigate factors associated with recurrence of switching treatment: Poisson regression (for number of times patients switched treatment) and Cox model for recurrent event (for time to recurrence of switching to another treatment). Results: The initial biologic taken was IL17-i in 103 patients, and TNF-i in the remaining 45. Disease duration (P=0.01), BMI (P=0.021) and elevated faecal calprotectin (P=0.000), appeared to significantly increase the number of switching with a rate ratio of 1.05, 1.01 and 3.64 respectively. Median drug survival time for the initial, second, and third biologic lines showed no significant difference (P= 0.136) between the three. Elevated faecal calprotectin level was significantly associated with lower survival of IL17-i, (HR: 3.5; P: 0.000). For TNF-i, elevated faecal calprotectin level and higher BMI were significantly associated with lower survival (HR= 4.36 and 1.04 respectively). Conclusions: IL17-i has proved to have comparable survival to TNF-i in the management of a real-life heterogeneous cohort of axSpA patients irrespective of line of treatment. Increased BMI and faecal calprotectin were predictors of decreased TNF-i survival. Whereas only faecal calprotectin predicted decreased IL17-i survival.