Doaa Ghaith

Background Some anthropometric, laboratory, and genetic variations, such as patatin-like phospholipase domain-containing protein 3 ({PNPLA}3) genetic variants, have been associated with nonalcoholic fatty liver disease ({NAFLD}). Liver biopsy is the most accurate {NAFLD} diagnostic method, but it is invasive; hence, noninvasive diagnostics are required for the early diagnosis and assessment of {NAFLD}. Patient and methods This prospective case-control study included 107 {NAFLD} patients and 107 healthy controls. All individuals underwent anthropometric measurements, abdominal ultrasonography, laboratory tests, and evaluation for {PNPLA}3 polymorphisms. Results Patients with {NAFLD} had higher levels of C-reactive protein ({CRP}), tumor necrosis factor-alpha ({TNF}-α), and interleukin-6 ({IL}-6) than healthy individuals (p = 0.03, p {\textless} 0.0001). Additionally, patients with {NAFLD} had substantially lower albumin (P = 0.01) and leptin (P {\textless} 0.0001) levels than healthy individuals. {BMI} leptin and {CRP} levels were independent indicators of {NAFLD} severity (p = 0.05–0.004). {GG} is the most prevalent genotype in patients with moderate to severe {NAFLD}. A novel model based on four markers (leptin, {CRP}, {BMI}, and {PNPLA}3 polymorphism) was developed. The {AUC} values for distinguishing between the healthy subjects and those with varying degrees of {NAFLD} severity (mild, moderate, and severe) were 0.99, 0.99, and 1.0, respectively. Conclusion Anthropometric measurements, such as {BMI} and laboratory results, including liver enzymes, {CRP}, inflammatory markers, lipid parameters, and genetic markers, especially {PNPLA}3 polymorphisms, can provide an accurate, sensitive, and specific noninvasive approach for the early identification and assessment of {NAFLD} and can guide its management. This may minimize the need for liver biopsy to assess {NAFLD}. Further large-scale studies are needed to confirm these findings and verify the model in larger studies.

Abstract Background and Aim: Helicobacter pylori {CagA} gene is a major virulence factor that undergoes tyrosine phosphorylation in a region holding differing numbers of repeat sequences ({EPIYAs}) resulting in modulation of the inflammatory response. The aim of this cross-sectional study is to determine the correlation between {CagA} {EPIYA} motifs with diverse gastroduodenal outcomes. Methods: Gastric biopsies were collected from 54 Egyptian patients (11 patients with {PUD} and 43 chronic non atrophic gastritis). Molecular detection of H. pylori, {CagA} gene with determination of the {EPIYA} motifs in {CagA} positive cases were done. Results: Out of the 54 H. pylori positive cases, {CagA} gene was detected in 31 patients. {EPIYA}-{ABC} was the most presented pattern in 22 cases (71 %) and the least common pattern was {EPIYA}-{ABCCC}, which was positive only in one case (3.2%). Both {EPIYA}-{AB} and {EPIYA}-{ABCC} were presented in 4 cases for each (12.9% for each). Conclusion: There was a significant statistical correlation between the presence of {CagA} gene and both {PUD} and {GU}. Furthermore, the structure of the variable region of the {CagA} gene in Egyptian strains was Western type with a variable number of {EPIYA}‑C.

Device-associated infections ({DAIs}) are a significant cause of morbidity following living donor liver transplantation ({LDLT}). We aimed to assess the impact of bundled care on reducing rates of device-associated infections.

{\textless}sec{\textgreater}{\textless}title{\textgreater}Introduction{\textless}/title{\textgreater}{\textless}p{\textgreater}The colonization of patients by carbapenemase-producing {\textless}italic{\textgreater}Enterobacterales{\textless}/italic{\textgreater} ({CPE}) has been associated with heightened mortality, especially in vulnerable individuals within intensive care units ({ICUs}). Our study aimed to comprehensively assess {CPE} prevalence among {ICU} patients across the Mediterranean region pre-{COVID}-19, conducting a multicenter prevalence study in the first quarter of 2019.{\textless}/p{\textgreater}{\textless}/sec{\textgreater}{\textless}sec{\textgreater}{\textless}title{\textgreater}Methods{\textless}/title{\textgreater}{\textless}p{\textgreater}We collected clinical data and rectal or fecal samples from 256 {ICU} patients for {CPE} testing. Additionally, we performed whole-genome sequencing on 40 representative {CPE} strains to document their molecular characteristics.{\textless}/p{\textgreater}{\textless}/sec{\textgreater}{\textless}sec{\textgreater}{\textless}title{\textgreater}Results{\textless}/title{\textgreater}{\textless}p{\textgreater}Among the 256 patients, {CPE} was detected in 73 samples (28.5%), with prevalence varying from 3.3 to 69.0% across participating centers. We observed 13 colistin-resistant {CPE} strains, affecting three {ICUs}. Genetic analysis revealed highly diverse {\textless}italic{\textgreater}E. coli{\textless}/italic{\textgreater} and {\textless}italic{\textgreater}K. pneumoniae{\textless}/italic{\textgreater} strains, predominantly from international high-risk clones. Notably, {\textless}italic{\textgreater}bla{\textless}/italic{\textgreater}$_{\textrm{{OXA}-48}}$ and {\textless}italic{\textgreater}bla{\textless}/italic{\textgreater}$_{\textrm{{NDM}-1}}$ were the most prevalent carbapenemase genes. Molecular typing uncovered potential patient clusters in six centers. Significantly, longer hospital stays were associated with increased {CPE} carriage ({\textless}italic{\textgreater}p{\textless}/italic{\textgreater} < 0.001). Nine centers across Morocco, Tunisia, Egypt, and Lebanon voluntarily participated.{\textless}/p{\textgreater}{\textless}/sec{\textgreater}{\textless}sec{\textgreater}{\textless}title{\textgreater}Discussion{\textless}/title{\textgreater}{\textless}p{\textgreater}Our study provides {CPE} prevalence in Mediterranean {ICUs} and reaffirms established {CPE} presence in this setting but also provides updates on the molecular diversity of {CPE} strains. These findings highlight the imperative of reinforcing infection control measures in the participating {ICUs} to curtail escalated mortality rates, and of strictly applying isolation measures around patients originating from the Mediterranean region when transferred to other healthcare institutions.{\textless}/p{\textgreater}{\textless}/sec{\textgreater}

(1) Background: Type 2 diabetes mellitus (T2DM) is one of the rapidly growing healthcare problems, and several vitamin D receptor ({VDR}) polymorphisms seem to modulate the risk of T2DM. Our research was designed to investigate the allelic discrimination of {VDR} polymorphisms and T2DM occurrence risk. (2) Methods: This case-control research included 156 patients with T2DM and 145 healthy control subjects. Most of the study population were males 56.6% vs. 62.8% in the case and control groups, respectively. Genotyping for {VDR} single nucleotide polymorphisms ({SNPs}), rs228570 (Fok1), rs7975232 (Apa1), and rs1544410 (Bsm1) was compared between both groups. (3) Results: There was a negative link between vitamin D levels and insulin sensitivity. A significant difference was noted in the allelic discrimination of {VDR} polymorphism rs228570 and rs1544410 between the study groups (p {\textless} 0.001). No difference was observed in the allelic discrimination of {VDR} polymorphism rs7975232 between the groups (p = 0.063). Moreover, T2DM patients had significantly higher levels of fasting blood sugar ({FBS}), glycated hemoglobin {HbA}1c, 2-h post-prandial blood sugar ({PP}), serum glutamic oxaloacetic transaminase ({SGOT}), serum glutamic-pyruvic transaminase ({SGPT}), total cholesterol, and triglycerides (p {\textless} 0.001), while High-Density Lipoprotein ({HDL}) Cholesterol ({HDL}-C) was significantly decreased (p = 0.006). (4) Conclusions: {VDR} polymorphisms had a positive association with T2DM risk among the Egyptian population. Further large-scale research using deep sequencing of samples is strongly urged to investigate different vitamin D gene variants and interactions, as well as the influence of vitamin D on T2DM.

Antibiotics are used to both prevent and treat bacterial infections. When bacteria adapt to the use of antibiotics, antibiotic resistance develops. Antibiotic resistance develops in bacteria, not in people or other animals. Both people and animals are susceptible to infection from these germs, and their illnesses are more difficult to treat than those caused by non-resistant bacteria. Antibiotic resistance causes greater mortality, longer hospital stays and higher medical expenses. The way antibiotics are prescribed and used worldwide has to alter immediately. Antibiotic resistance will continue to pose a serious hazard even if new medications are created. Additionally, behavioral changes must focus on improving food cleanliness, hand washing, practicing safer sex and being vaccinated in order to stop the spread of diseases. This chapter discusses the history, evolution and epidemiology of antibiotic resistance, antibiotic resistance mechanisms and their methods of detection, prevention of antibiotic-resistant organisms in healthcare settings and the role of artificial intelligence in prevention of antimicrobial resistance and drug discovery.

(1) Background: Type 2 diabetes mellitus (T2DM) and metabolic syndrome are associated with decreased vitamin D. In contrast, high pro-neurotensin (pro-{NT}) levels are linked with an increased risk of T2DM and cardiovascular disease. We aimed to determine the validity of pro-{NT} and 25-dihydroxy vitamin D3 levels as predictors for T2DM complications; (2) Methods: One hundred T2DM, and one hundred healthy volunteers participated in this case-control study. Their Pro-{NT} and 25-hydroxyvitamin D3 levels were evaluated using the {ELISA} technique; (3) Results: Pro-{NT} and 25 ({OH}) vitamin D3 have significant validity and accuracy in T2DM prediction, 84.5%, and 90.5%, respectively (p = 0.001). At a value of {\textless}29.5, 25-Hydroxy vitamin D3 showed 88% sensitivity and 93% specificity in predicting T2DM. At a value of {\textgreater}124 Pmol/L, Pro-{NT} showed 81% sensitivity and 88% specificity in predicting T2DM. At a value of 16.5, 25-Hydroxy vitamin D3 had 78.4% sensitivity and 68.3% specificity in predicting T2DM complications. At a value of {\textgreater}158 pmol/L, Pro-{NT} predicted T2DM complications with 67.6% sensitivity and 56.0% specificity; (4) Conclusions: 25 ({OH}) Vit D3 and Pro-{NT} could identify T2DM patients and predict T2DM complications. More extensive research is required to adequately validate this novel perspective with a large population study.

Background & Aims: Coronavirus disease - 2019 ({COVID}-19) is a major pandemic that causes high morbidity and mortality rates. Aim of this study: to detect the relations between many risk factors, {ACE}-2, {MCP}-1, Micro {RNA} 146 gene expression, and {COVID}-19 infection and disease severity. Methods: This study was carried out on 165 cases of {COVID}-19 and 138 controls. {ACE}2 and {MCP}1 levels were measured in {COVID}-19 cases and control by {ELISA} and micro-{RNA}-146 expression by {PCR}. Results: We found an increased blood level of {ACE}2 and {MCP}1 in {COVID}- 19 patients than in healthy persons and a significant down-regulation of micro-{RNA} 146 gene expression in cases than in controls. There was a significant correlation between increased blood level of {ACE}2, regulation of micro-{RNA} 146 gene expression and severity of lung affection, a significant correlation was found between increased blood level of {MCP}1 and thrombosis in {COVID}-19 patients. Neurological complications were significantly correlated with more viral load, more {ACE}2 blood level, and down regulation of micro {RNA}146 expression. Conclusion: High viral load, increased blood level of {ACE}2, and down-regulation of micro-{RNA} 146 expression are associated with more severe lung injury and the presence of neurologic complications like convulsions and coma in {COVID}-19 Egyptian patients.

Carbapenem-resistant Gram-negative organisms ({CRGNO}) are a growing threat. We aimed in our study to determine the genotype of carbapenemases at Beni-Suef University Hospital by using newly introduced lateral flow assays in comparison with molecular techniques and test the effectiveness of ceftazidime/avibactam against them.

Antibiotic resistance is a global health concern. Strains of pathogenic microorganisms that have developed resistance to multiple antibiotics, such as {MRSA}, are extremely difficult to treat, and alternative methods for tackling pathogenic microorganisms are in demand. One potential target for new therapeutics is inhibition of quorum sensing: how microorganisms communicate and form biofilms in a density-dependent manner. Inhibiting this system via ‘quorum quenching’ ({QQ}) is a promising route to new pharmaceuticals and for controlling biofilm formation and growth. Quorum sensing also provides interesting possibilities in synthetic biology for producing novel products, biosensors, bioactive molecules, and so on. This book covers the biology of quorum sensing and quenching, and potential sources of {QQ} enzymes and other inhibitors, as well as an overview of their mechanism and potential biotech applications. The book also covers the potential for new drug development from {QQ}, covering a range of related topics including protein engineering, imaging and computational studies, and integrated systems. This book is an ideal companion to researchers in chemical biology and medicinal chemistry, particularly those interested in biofilm formation, quorum sensing, novel antimicrobial development, synthetic biology and enzymology.

Immune paralysis can be defined as a hypoinflammatory state associated with the incapacity of the immune system to release proinflammatory mediators despite the clearance of pathogens by antimicrobials. Persistent immune paralysis leads to failure to eradicate primary infections with a substantial increase in the risk of multiorgan dysfunction and mortality. The state of immune paralysis is caused mainly by the diminished ability of monocytes to release proinflammatory cytokines in response to endotoxin. This phenomenon is known as endotoxin tolerance. This study aimed to assess the role of dexmedetomidine in modifying immune paralysis in septic shock patients.

Portal hypertension and esophageal varices complicating hepatitis C virus ({HCV})-related chronic liver diseases are some of the most devastating sequelae. Angiogenesis is the hallmark of their pathogenesis. Apelin is one of the recently identified angiogenic and fibrogenic peptides. We studied apelin gene expression, apelin (rs3761581) single-nucleotide polymorphism ({SNP}), and serum apelin level in patients with chronic {HCV}, and their association with liver fibrosis and esophageal varices in 112 patients with {HCV}-related chronic liver disease (40 with liver cirrhosis [{LC}]/low-grade varices, 33 with {LC}/high-grade varices, and 39 with fibrotic non-cirrhotic liver/no varices) and 80 healthy control subjects. Real-time polymerase chain reaction was used for apelin gene expression assay and apelin rs3761581 {SNP} analysis in peripheral blood samples. The serum apelin level was measured by {ELISA}. Apelin gene expression was undetectable in the studied samples. The {SNP} analysis revealed a greater frequency of the C (mutant) allele among patients compared with control subjects (P = 0.012; odds ratio, 3.67). The serum apelin level was significantly greater in patients with {LC}/varices (median, 31.6 ng/L) compared with patients without {LC}/varices (median, 2.9 ng/L; P {\textless} 0.001). A serum apelin level cutoff value of 16.55 ng/L predicted the presence of varices, with an area under the receiver operating characteristic curve value of 0.786. A positive correlation was found between serum apelin level and grade of liver fibrosis (r = 0.346, P {\textless} 0.001) and portal hypertension (r = 0.438, P {\textless} 0.001). In conclusion, the apelin rs3761581-C allele may be associated with the progression of {HCV}-related chronic liver disease and varices formation, and can be considered a potential therapeutic target to control fibrosis progression. The serum apelin level provided an accurate prediction of the presence of esophageal varices.

{\textless}p{\textgreater}Methicillin-resistant {\textless}italic{\textgreater}Staphylococcus aureus{\textless}/italic{\textgreater} ({MRSA}) is a major pathogen associated with severe morbidity and mortality and poses a significant threat to public health worldwide. The genetic diversity based on sequence types of {MRSA} strains was illustrated in previous studies; meanwhile, the diversity along with the predominant sequence type, especially in Egypt, remains unknown. The purpose of the current study was to determine the diversity of the predominant {MRSA} clone {ST}239-{MRSA} (n = 50) isolated from different hosts and clinical samples and to illustrate the correlation between the resistance patterns, toxin genes, and the genetic background in Port-said and El-Sharkia Governorates, Egypt. The {ST}239-{MRSA} clone was analyzed by phenotypic antibiotyping and various genotypic assays comprising {SCC}{\textless}italic{\textgreater}mec{\textless}/italic{\textgreater}, {\textless}italic{\textgreater}agr{\textless}/italic{\textgreater}, {\textless}italic{\textgreater}spa{\textless}/italic{\textgreater}, {\textless}italic{\textgreater}coa{\textless}/italic{\textgreater}, and {\textless}italic{\textgreater}coa{\textless}/italic{\textgreater}-{RFLP} in addition to toxin gene profiles. Most of the analyzed strains (40/50, 80%) were multidrug resistant ({MDR}), belonged to {SCC}{\textless}italic{\textgreater}mec{\textless}/italic{\textgreater}-{III}, {\textless}italic{\textgreater}agr{\textless}/italic{\textgreater}-I, and {\textless}italic{\textgreater}coa{\textless}/italic{\textgreater} genotype I, and harbored {\textless}italic{\textgreater}sea{\textless}/italic{\textgreater} and {\textless}italic{\textgreater}pvl{\textless}/italic{\textgreater} genes. A negative correlation between the toxin gene profiles and antimicrobial resistance was recorded. Meanwhile, the correlation between the toxin gene profiles and the genetic background was not observed in this study. Although {ST}239-{MRSA} strains belonged to a single sequence type, they exhibited a high degree of phenotypic and genotypic diversity, indicating weak clonality and adaptability. With such diversity, it is assumed that these strains may have undergone different evolutionary processes during transmission events among and/or within a single host or tissue niche.{\textless}/p{\textgreater}

Chronic spontaneous urticaria ({CSU}) is a common skin disorder affecting negatively patients’ lives. Vitamin D deficiency has been reported to be associated to many allergic skin disorders. This study aimed to evaluate the association between the serum level of 25 hydroxy vitamin D and {CSU} and to assess the efficacy and safety of active vitamin D in management of {CSU}. The study was conducted on 77 patients with {CSU} and 67 healthy controls, then the 77 {CSU} patients were randomized to either the study group that received 0.25 µg alfacalcidol daily or the placebo group that received oral placebo for 12 weeks. Serum 25({OH}) D was significantly lower in {CSU} as compared to healthy controls and was negatively correlated to the urticarial severity. After alfacalcidol administration, the study group showed significant higher level of 25({OH}) D compared to the placebo group. In addition, the mean serum level of {IL}6, {hsCRP} and {TNFα} significantly decreased in the study group in comparison to the placebo group and as compared to their baseline results. Vitamin D deficiency is more common in {CSU} patients as compared to healthy people and hence, alfacalcidol might have a beneficial role as add on therapy in {CSU} management with no reported side effects.

Searching for a non-antibiotic therapeutic option such as probiotics is gaining momentum nowadays. We aimed to evaluate the in vitro antibacterial ability of cell-free supernatant ({CFS}) of selected Lactobacillus strains (with probiotic properties) against clinical isolates of {OXA}-48-producing multidrug-resistant ({MDR}) Klebsiella pneumoniae separately and in combination with cefoperazone antibiotic.

The coronavirus disease 2019 ({COVID}-19) poses a significant threat to achieving the Sustainable Development Goals ({SDGs}). To address this challenge, a thorough examination of the pandemic’s influence on four {SDGs} in Egypt is presented in a system dynamic model. The addressed goals are related to no poverty ({SDG} 1), zero hunger ({SDG} 2), decent work and economic growth ({SDG} 8), and climate action ({SDG} 13). The model is simulated over 35 years extending from 2015 to 2050. Furthermore, a web-based interactive learning environment is developed to analyze the interdependencies among public health activities and study the impacts of possible intervention countermeasures or prevention policies. Indicators including poverty line, food insecurity, gross domestic product ({GDP}) growth rate, and greenhouse gas ({GHG}) emissions are evaluated to track Egypt’s performance in relation to {SDGs} 1, 2, 8, and 13. According to the simulation model, the poverty line will continue to decline until it reaches around 16% by 2050. According to the significant governmental efforts to follow its vision of 2030, Egypt can achieve a decreasing percentage of food insecurity, reaching 3% in 2030, and this percentage will continue to decrease until it reaches full sufficiency by 2050. The {GDP} growth rate will rise every year until it reaches 13.71% in 2050. With respect to climate, {GHG} emissions are predicted to fall to roughly 97 Mt {CO}2-equivalents by 2050. This approach revitalizes debates about the achievement of {SDGs} amid the crisis and acts as a powerful tool that aids decision-makers in identifying leverage points to avoid the long-term negative repercussions of the crisis on the economy, people, and environment.

Background and Aim: Although implantation of a care bundle approach is well established in intensive care units ({ICUs}), yet its impact on reducing surgical site infections ({SSI}) among post living-donor-liver transplantation ({LDLT}) patients has not been established. Our aim is to evaluate the impact of a care bundle in reducing {SSI} and to detect the pattern of antibiotic resistance in {LDLT}. Materials and Methods: This before and after comparative study was conducted at Elmanial specialized tertiary hospital, Cairo University over a period of 3 years (January 2016 - December 2018) including 57 {LDLT} patients. We introduced a care bundle comprised of a group of evidence-based practices implemented together. The study was divided into three phases. All bacterial identification and antibiotic sensitivity testing were done by a Vitek 2 compact system. Results: {SSIs} rates were reduced significantly by 30.4% from the pre-implementation to the post implementation phase (from 13/24, 54.2% to 5/21, 23.8%, {OR} 0.21, {CI} 95%: 1.137- 0.039). This reduction went hand in hand with increase in the hand hygiene compliance from 57.3 % to 78 %, then remained sustained with a median rate of 78% in the last 6 months. Klebsiella pneumoniae 11{\textbackslash}25 (44% of {SSIs}), Acinetobacter baumannii 8{\textbackslash}25 (32% of {SSIs}), Escherichia coli 5{\textbackslash}25 (20%), Pseudomonas aeruginosa 5{\textbackslash}25 (20%) and {MRSA} 4{\textbackslash}25 (16%). With predominance of {XDR} phenotype 14/25 (56%), followed by {ESBL} of gram-negative bacteria 6/25 (24%), then {MRSA} 4/25 (16%). Conclusion: {SSIs} in {LDLT} mandates strict implementation of comprehensive evidence-based care bundles for better patent outcome.

Epidermal Growth Factor rs4444903 A{\textgreater}G Gene Polymorphism Association with Chronic Hepatitis B Liver Disease Progression among Egyptian Children: A Multicenter Study

BACKGROUND: Serum 1, 3-β-D-glucan (BDG) assay was recommended for diagnosing fungal infections. AIM: We aimed to assess 1, 3-β-D-glucan in bronchoalveolar lavage (BAL) fluid in invasive pulmonary aspergillosis (IPA). METHODS: Out of 104 patients clinically suspected fungal, 45 were probable, 18 possible, and 41 unlikely according to EORTC/MSG 2008 criteria. Measuring BAL BDG and galactomannan were done. RESULTS: The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for BDG were 44%, 71%, 62%, and 54%; for galactomannan 84%, 83%, 84%, and 83%; and 93%, 66%, 75%, and 90%, respectively, when combining both tests. A significant different performance of GM; p = 0.0008 was detected in patients with malignant disorders when compared to non-malignant; but not for BDG; p = 0.121. CONCLUSION: We can conclude that BAL-BDG is helpful if positive in a clinically suspected IFI case, but if negative cannot rule out fungal infection. Thus, combining results of BAL-GM and BAL-BDG are recommended.

Candida famata has been associated with the identifiable Candida infections that takes place in human and the identification error of this species possibly will result in misinterpretation of antifungal susceptibility and improper diagnosis; which will have a major effect on the prognosis and therapy of patients. Our objective is to correctly identify Candida spp. collected from patients at the intensive care units, New Cairo University teaching hospital in Cairo-Egypt using matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). Hundred clinically isolated yeast strains were identified using API 20C AUX obtained from patients receiving care at intensive care units. ATB FUNGUS 3 strips were used to detect the minimum inhibitory concentration. Thirty-three non duplicate strains identified as C. famata were subjected to re-identification by MALDI-TOF MS. Our results revealed that isolates were initially identified as C. famata 33%, C. tropicalis 15%, C. albicans 12% and C. parapsillosis 10% using the phenotypic techniques. MALDI-TOF MS analyses results showed that the 33 C. famata isolates are C. tropicalis (n = 29), Trichosporon asahii (n = 2), C. parapsilosis (n = 1), and Aeromonas sobria (n = 1). Antifungal resistance was low in the Candida species, except for reduced susceptibility to itraconazole among C. krusei strains. This report shows that misidentification of C. famata is frequent when using conventional phenotypic methods of identification which result in challenges in treating fungal infections. MALDI-TOF MS is an accurate convenient substitute to classical approaches for fungal identification. In general, antifungal multidrug resistance is uncommon in our studied Candida species and yeast isolates.

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Background: Chronic spontaneous urticaria ({CSU}) is a common skin disorder affecting negatively patients’ lives. Vitamin D deficiency has been reported to be associated to many allergic skin disorders.Objective: This study aimed to evaluate the association between the serum level of 25 hydroxy vitamin D and {CSU} and to assess the efficacy and safety of active vitamin D in management of {CSU}.Methods: The study was conducted on 77 patients with {CSU} and 67 healthy controls, then the 77 {CSU} patients were randomized to either the study group that received 0.25 µg alfacalcidol daily or the placebo group that received oral placebo for 12 weeks.Results: Serum 25({OH}) D was significantly lower in {CSU} as compared to healthy controls and was negatively correlated to the urticarial severity. After alfacalcidol administration, the study group showed significant higher level of 25({OH}) D compared to the placebo group. In addition, the mean serum level of {IL}6, {hsCRP} and {TNFα} significantly decreased in the study group in comparison to the placebo group and as compared to their baseline results.Conclusion: Vitamin D deficiency is more common in {CSU} patients as compared to healthy people and hence, alfacalcidol might have a beneficial role as add on therapy in {CSU} management with no reported side effects.