Promotion of sexual and reproductive health in Pakistan-The role of technology and online awareness

Digital health innovations such as online webinars,websites,blogs,and health apps have been associated with increased sexual and reproductive health(SRH)among the general population.Many studies have been conducted in developed countries in the West;however,little research has been conducted in low-income countries,especially in Pakistan.The socioeconomic instability and the government's lack of awareness and knowledge have resulted in no regulations being placed to incorporate telehealth in medicine.The healthcare departments must take into consideration the lifechanging impact of telehealth and the barriers that prevent it in becoming known,to reduce the incidence of unsafe abortions and sexual health practices that prove to be a stigma in society.

Effect of nutrition-related infodemics and social media on maternal experience: A nationwide survey in a low/middle income country

BACKGROUND Undernutrition is a crucial cause of morbidity and mortality among children in low-or middle-income countries(LMICs).A better understanding of maternal general healthy nutrition knowledge,as well as misbeliefs,is highly essential,especially in such settings.In the current era of infodemics,it is very strenuous for mothers to select not only the right source for maternal nutrition information but the correct information as well.AIM To assess maternal healthy nutritional knowledge and nutrition-related misbeliefs and misinformation in an LMIC,and to determine the sources of such information and their assessment methods.METHODS This cross-sectional analytical observational study enrolled 5148 randomly selected Egyptian mothers who had one or more children less than 15 years old.The data were collected through online questionnaire forms:One was for the general nutrition knowledge assessment,and the other was for the nutritional myth score.Sources of information and ways of evaluating internet sources using the Currency,Relevance,Authority,Accuracy,and Purpose test were additionally analyzed.RESULTS The mean general nutrition knowledge score was 29±9,with a percent score of 70.8%±12.1%(total score:41).The median myth score was 9(interquartile range:6,12;total score:18).The primary sources of nutrition knowledge for the enrolled mothers were social media platforms(55%).Half of the mothers managed information for currency and authority,except for considering the author's contact information.More than 60%regularly checked information for accuracy and purpose.The mothers with significant nutrition knowledge checked periodically for the author's contact information(P=0.012).The nutrition myth score was significantly lower among mothers who periodically checked the evidence of the information(P=0.016).Mothers dependent on their healthcare providers as the primary source of their general nutritional knowledge were less likely to hold myths by 13%(P=0.044).However,using social media increased the likelihood of having myths among mothers by approximately 1.2(P=0.001).CONCLUSION Social media platforms were found to be the primary source of maternal nutrition information in the current era of infodemics.However,healthcare providers were the only source for decreasing the incidence of maternal myths among the surveyed mothers.

Adherence in Patients with Type 2 Diabetes and Depression and the Role of Physician-Patient Relationship: A Cross-Sectional Study

Background: Diabetes mellitus (DM) challenges health and quality of life of patients, families, and communities. Patients with comorbid depression are more likely to develop macrovascular and microvascular complications. The aim was to assess glycemic control and adherence in diabetic patients with comorbid depression. Further, the study evaluated the relationship between adherence and the physician-patient relationship. Methods: The study was conducted at Al-Agouza Family Medicine Center (AFMC) between February 2018 and March 2020. The included patients were between 35 - 80 years of age;had type 2 diabetes with hemoglobin A1c (HbA1c) ≥ 6.5%, fasting plasma glucose ≥ 126 mg/dl, and scored between 11 - 30 on the Beck Depression Inventory (BDI). Logistic regression, chi-square, and analysis of variance (ANOVA) were used to assess the relationship between depression, adherence, physician-patient relationship, and other variables. Results: The study included 100 eligible patients with a median BDI score of 20 (10 - 30). The median diabetic panel for patients was FBS 188 (126 - 348) mg/dl, PPS 282.50 (162 - 448) mg/dl, and HbA1c 9.5 (6.6 - 14.0)%. Depression and regular follow-up visits were statistically associated with improvement of diabetes symptoms (p = 0.019). There was a significant relationship (p 0.001) between adherence, regular follow-up visits, and knowledge of DM. Further, there was a significant relationship between the physician-patient relationship and DM improvement (p = 0.047). Conclusion: Physician-patient relationship was paramount to improving adherence and positive diabetes care. Our findings suggest a shift to a physician-patient relationship model with mutual agreement on medical decisions is highly recommended.

Effectiveness of health coaching on diabetic patients: A systematic review and meta-analysis

、Background:Using health coaching to improve the quality of life and health outcomes of the patients with diabetes mellitus,has emerged as a possible intervention.However,the few published randomized controlled trials using health coaching for patients with diabetes mellitus have reported mixed results.The present meta-analysis aimed to determine the effectiveness of health coaching on modifying health status and quality of life among diabetic patients and to clarify the characteristics of coaching delivery that make it most effective.Methods:This study searched for articles on randomized controlled trials of health coaching interventions targeting type 2 diabetic patients that were published in the English language from January 2005 through December 2018 in the Cochrane,Medline,PubMed,Trip,and Embase databases.Patients in the control group received usual diabetes mellitus care,and those in the experimental group received health coaching based on usual diabetes mellitus care.The primary outcomes included Hemoglobin A1c(HbA1c)and cardiovascular disease risk factors,including systolic blood pressure,diastolic blood pressure,triglyceride,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol,total cholesterol,and body weight.The secondary outcomes included quality of life,self-efficacy,self-care skills,and psychological outcomes.Results:Health coaching intervention has a significant effect on HbA1c[mean difference(MD)=-0.35,confidence interval(CI)=-0.47,-0.22,I2=83%,P<0.001]and HDL-C(MD=-0.50,CI=-0.93,-0.07,I2=10%,P=0.02).The most effective strategy for health coaching delivery associated with improvement of HbA1c was decreasing the number of sessions and increasing the duration of each session.However,no significant difference was found for weight,SBP,diastolic blood pressure,triglyceride,low-density lipoprotein cholesterol,or total cholesterol.Mixed results were reported for the effect of health coaching on quality of life,self-efficacy,self-care skills,and depressive symptoms outcome.Conclusion:Health coaching intervention has a significant effect on HbA1c and HDL-C,and the most effective strategy is decreasing the number of sessions while increasing session duration.However,these results should be interpreted with caution as the evidence comes from studies at some risk of bias with considerable heterogeneity and imprecision.

Comparison of imaging-based and pathological dimensions in pancreatic neuroendocrine tumors

AIM To establish the ability of magnetic resonance(MR) and computer tomography(CT) to predict pathologic dimensions of pancreatic neuroendocrine tumors(Pan NET) in a caseload of a tertiary referral center.METHODS Patients submitted to surgery for Pan NET at the Surgical Unit of the Pancreas Institute with at least 1 preoperative imaging examination(MR or CT scan) from January 2005 to December 2015 were included and data retrospectively collected. Exclusion criteria were: multifocal lesions, genetic syndromes, microadenomas or mixed tumors, metastatic disease and neoadjuvant therapy. Bland-Altman(BA) and Mountain-Plot(MP) statistics were used to compare size measured by each modality with the pathology size. Passing-Bablok(PB) regression analysis was used to check the agreement between MR and CT.RESULTS Our study population consisted of 292 patients. Seventy-nine(27.1%) were functioning Pan NET. The mean biases were 0.17 ± 7.99 mm, 1 ± 8.51 mm and 0.23 ± 9 mm, 1.2 ± 9.8 mm for MR and CT, considering the overall population and the subgroup of non-functioning-Pan NET, respectively. Limits of agreement(LOA) included the vast majority of observations, indicating a good agreement between imaging and pathology. The MP further confirmed this finding and showed that the two methods are unbiased with respect to each other. Considering ≤ 2 cm non-functioning-Pan NET, no statistical significance was found in the size estimation rate of MR and CT(P = 0.433). PBR analysis did not reveal significant differences between MR, CT and pathology.CONCLUSION MR and CT scan are accurate and interchangeable imaging techniques in predicting pathologic dimensions of Pan NET.

Development of Health Literacy for Regular Hemodialysis Patients in Menoufia Governorate: A Cross-Sectional Study

Health literacy (HL) is essential to access, comprehend, assess and use health data allowing patients to make better health and quality of life decisions. To assess the health literacy level of hemodialysis Egyptian patients, a cross-sectional study from March to September 2020 was conducted at 4 hemodialysis (HD) units on 439 patients. A translated questionnaire including demographic characteristics and health literacy components was conducted. This study adapted Nutbeam’s model incorporating critical health literacy, interactive health literacy, and functional health literacy. Health literacy of hemodialysis patients was satisfactory among 35.5% of the studied patients. The average total score of health literacy questionnaire was (15.53 ± 4.32) distributed as (2.90 ± 1.26) for functional literacy, (3.10 ± 1.26) for basic health knowledge, (1.65 ± 1.21) for communicative literacy, (2.53 ± 0.70) for interactive literacy, (1.75 ± 1.30) for advanced health knowledge, (1.74 ± 0.48) for critical literacy, and (1.83 ± 0.93) for patient safety. It was found that poor health literacy was associated with low income (OR = 2.54, CI 95%: 1.66_3.89, p < 0.001), of increasing age (OR = 0.12 CI 95%: 0.07_0.19, p < 0.001), low education (OR = 1.08, CI 95%: 1.04_1.11, p < 0.001) and the patient did not undergo kidney transplant (OR = 4.19 CI 95%: 1.12_15.62, p = 0.033). There was a prevalent low health literacy among the studied regular hemodialysis patients which was affected by education, age and income and in turn it affected the adherence to treatment. Understanding the linkage between HL and self-care attitudes should enhance efforts to improve hemodialysis outcomes.

Assessment of Standard Criteria Implementation in Heamodialysis Water Treatment Units in Sharkia Governorate

Introduction: Haemodialysis is the most well-established form of treatment for ESRD. Method: To evaluate the implementation of standard criteria in heamodialysis water treatment units in Sharkia governorate and to determine the weak points in application of standard criteria, and reach the optimal standards to improve pt. outcomes, across the sectional study was conducted at 30 heamodialysis units of Sharkia governorate, using a modified questionnaire was developed based on MOH protocol and international guidelines such as CARI guidelines, AAMI guidelines and others by the researchers. All data were collected, tabulated and statistically analyzed using SPSS 22.0 for windows (SPSS Inc., Chicago, IL, USA). Results: Of the 30 units, the majority more than 80% of the units achieved the infrastructure and schematic structure, contain water purification devices, good infection control policies, proper chemical disinfection, good monitoring and quality control, accepted maintenance technician evaluation and collected processed water samples results matched decree of 63 for 1996. Conclusion: Most of the studied units nearly fulfilled the standard specifications of both MOH and AAMI. Ensuring that water quality meets AAMI standards and recommendations will minimize patient exposure to potential contaminants such as chemical hazards and endotoxemia associated with the use of the treated water for HD.

Relation between the Severity of Obstructive Sleep Apnea and the Severity of Type 2 Diabetes Mellitus and Hypertension

Background: Obstructive sleep apnea syndrome (OSAS) may promote hyperglycemia, insulin resistance, and hypertension (HTN). Purpose: To evaluate if there is a relationship between the severity of OSA and the severity of type 2 diabetes mellitus (T2DM) and HTN in our patients, aiming to understand and optimize the control for comorbidities. Materials and Methods: Patients referred for polysomnography (PSG) were retrospectively recruited during the period from October 2017 to August 2020. A STOP-BANG questionnaire formed eight questions was used to assess the risk of OSAS. We divided the patients into two groups;group 1, who have snoring without T2DM, and group 2, who have snoring with T2DM. PSG was completed for all subjects and data were collected for each patient including apnoea hypopnea index (AHI), mean arterial oxygen saturation (SaO2), and Nadir SaO2 recorded during PSG. Anthropometric data, medical history, and medications for T2DM (for group 2) and HTN and HbA1c were collected (for group 2). AHI was used to evaluate the severity of OSA and its relation to T2DM and HTN. Results: The study included 300 patients who met the inclusion criteria with mean age of 49.9 ± 13.6 years. The majority of subjects (56.3%) were males and the mean body mass index (BMI) was 38.0 ± 8.4 kg/m2. Forty-two percent had HTN and 32.7% had T2DM. OSA was diagnosed in 209 patients (69.7%). OSA was more detected among those with increased age, increased BMI, and those with HTN and T2DM. The severity of both HTN and T2DM was significantly higher among patients with OSA. Conclusions: There is a relation between OSA and T2DM and HTN. The risk of OSA is higher among patients with uncontrolled T2DM and HTN. OSA should be suspected in subjects with obesity, especially with uncontrolled HTN and T2DM.

Problems faced by evidence-based medicine in evaluating lymphadenectomy for gastric cancer

Gastric cancer surgical management differs between Eastern Asia and Western countries. Extended lymphadenectomy(D2) is the standard of care in Japan and South Korea since decades, while the majority of United States patients receive at most a limited lymphadenectomy(D1). United States and Northern Europe are considered the scientific leaders in medicine and evidencebased procedures are the cornerstone of their clinical practice. However, surgeons in Eastern Asia are more experienced, as there are more new cases of gastric cancer in Japan(107898 in 2012) than in the entire European Union(81592), or in South Korea(31269) than in the entire United States(21155). For quite a long time evidence-based medicine(EBM) did not solve the question whether D2 improves long-term prognosis with respect to D1. Indeed, eastern surgeons were reluctant to perform D1 even in the frame of a clinical trial, as their patients had a very good prognosis after D2. Evidence-based surgical indications provided by Western trials were questioned, as surgical procedures could not be properly standardized. In the present study we analyzed indications about the optimal extension of lymphadenectomy in gastric cancer according to current scientific literature(2008-2012) and surgical guidelines. We searched PubMed for papers using the key words "lymphadenectomy or D1 or D2" AND "gastric cancer" from 2008 to 2012. Moreover, we reviewed national guidelines for gastric cancer management. The support to D2 lymphadenectomy increased progressively from 2008 to 2012: since 2010 papers supporting D2 have achieved a higher overall impact factor than the other papers. Till 2011, D2 was the procedure of choice according to experts' opinion, while three meta-analyses found no survival advantage after D2 with respect to D1. In 2012-2013, however, two meta-analyses reported that D2 improves prognosis with respect to D1. D2 lymphadenectomy was proposed as the standard of care for advanced gastric cancer by Japanese National Guidelines since 1981 and was adopted as the standard procedure by the Italian Research Group for Gastric Cancer since the Nineties. D2 is now indicated as the standard of surgical treatment with curative intent by the German, British and ESMO-ESSO-ESTRO guidelines. At variance American NCCN guidelines recommend a D1+ or a modified D2 lymph node dissection. In conclusion, D2 lymphadenectomy, originally developed by Eastern surgeons, is now becoming the procedure of choice also in the West. In gastric cancer surgery EBM is lagging behind national guidelines, rather than preceding and orienting them. To eliminate this lag, EBM should value to a larger extent Eastern Asian literature and should evaluate not only the quality of the study design but also the quality of surgical procedures.

The future of COVID-19 vaccination rates for children

The COVID-19 pandemic has been ongoing for over two years since the first case was reported in the end of January 2020.Vietnam has successfully controlled the pandemic through its vaccination campaign,targeted messages and applications of various public health interventions including social distancing,quarantining,masking,and hand washing,which have made some significant achievements in reducing hospitalizations and deaths[1].

The Prevalence and Risk Factors of Elder Abuse during the COVID-19 Pandemic in the Fayoum Governorate,Egypt

Background: Elder abuse has evolved into a global public health and human rights issue. COVID-19 had a significant impact on Egypt’s economic development and style of life. Aim: This research aimed to estimate the prevalence of elder abuse in the Fayoum Governorate of Egypt during the COVID-19 pandemic and assess the prevalence of different elder abuse subtypes and study the effect of different demographic characteristics on these abuse subtypes. Methods: This study was a cross-sectional, descriptive survey among 201 older adults aged 60 and above in the Fayoum Governorate. The structured questionnaire used in the study had three sections: demographic characteristics, the Hwalek- Sengstock elder abuse screening test, and the Questions to Elicit Elder Abuse screening tool. Results: This research documented that the prevalence of elder abuse was (72.6%) and the most prevalent types were emotional and neglect abuse (71.1% and 64.7%, respectively). In our study, 22.9% of older adults were exposed to a single type of abuse, 29.9% to two types, 26.9% to three types, and 10.4% to four types. Female is significantly higher than male abuse exposure (66.7% vs. 33.3%). 52.4% versus 7.1% were more likely to be abused than elderly persons who earn enough income. Conclusion: According to this study, emotional and neglect abuse were the most common types of elder abuse. Risk factors for elder abuse included being between the ages of 60 and 70 years, being a woman, residing in a rural location, being illiterate, jobless, married, earning little money, and belonging to a middle-class socioeconomic group. For the general public to better comprehend the consequences of elder abuse on their health and human rights, awareness and education must be increased.

Matrix Metalloproteinase-9 in the Etiopathogenesis of Placenta Accreta Spectrum:A Literature Review

The recent increase in placenta accreta spectrum has been correlated with a rise in the rate of cesarean sections.A recent study provides evidence that hampered wound healing results in cesarean scar defects that lead to a failure in the normal process of decidualization and deeper adherence of trophoblasts.Matrix metalloproteinase(MMP)is crucial in every step of wound healing as it alters the wound matrix,facilitating cell migration,as well as tissue remodeling.MMP-9 expression is higher in placental and decidual tissue in cases of placenta accreta.Based on these findings,assessment of MMP-9 expression can shed new light on the etiopathology of placenta accreta spectrum disorder and can be a potential diagnostic marker.

约旦卫生护理工作者自诉对乳胶手套过敏

The objective of this study is to determine the prevalence of natural rubber latex allergy and its associated factors among health care workers in Jordan based on a self-administered questionnaire. In this cross-sectional study, the data were obtained through a self-reported hand-delivered questionnaire that was distributed to 500 health care workers who use natural rubber latex gloves. A total of 420 (84% ) health care workers responded by filling the questionnaire. Of the total number of 420 health care workers who filled the questionnaire, 57 (13.6% ) reported allergy to latex gloves. The prevalence of allergy to latex gloves was significantly higher for those who had allergy to some foodstuffs (especially avocado, kiwifruits and chestnuts) or with history of eczema and hay fever. However, allergy to latex gloves was independent of gender, age, job, family history, type of gloves, hours of use/day and number of years of use. It is concluded that a high rate of allergy to latex gloves was reported among health care workers in Jordan.

When important steps for a reliable Meta-analysis are missing: the bevacizumab versus ranibizumab case

【正】Dear Sir,W e have read with attention and interest the systematic review on the effectiveness and safety of bevacizumab and ranibizumab in the treatment of age-related macular degeneration(AMD)written by Zhang et al[1]and published on number of April 2014 of International Journal of Ophthalmology.The authors,who collected data from 4randomized clinical trials(RCTs)and 11 observational

Prevalence and Associated Factors of Eating Disorders in Weight Management Centers in Tanta, Egypt

Background： Eating disorders （EDs） are serious illnesses associated with medical complications and have been increased, especially among societies with an excessive concern about weight, shape, or appearance. This study aimed to investigate the prevalence of EDs among the individuals attending weight management centers and its associated factors. Methods： A cross-sectional study was carried out among individuals attending four weight management centers in Tanta, Gharbia Governorate, Egypt during the period from July to December 2016. Precoded interview questionnaires were used to identify the following data： sociodemographic characteristics and medical history of depression or psychological disorders and the Eating Attitude Test （EAT-40） was used to assess the attitudes, behavior, and traits associated with the EDs. Results： A total of 400 participants （I 12 males and 288 females） were included in the study. According to EAT-40 questionnaires, the prevalence of positive and negative EDs was 65.0% （n = 260） and 35.0% （n = 140）, respectively. EDs were more likely reported by females, married singles, rural residents, those with higher education, and nonworking or part-time working patients, those who were overweight or obese, and who were suffering from depression or any psychological problems. Logistic regression analysis revealed that the independent predictors of EDs were age （adjusted odds ratio [OR]： 1.06）, nonworking （adjusted OR： 2.32） or part-time working （adjusted OR： 2,18）, increased body weight （adjusted OR： 2.66 for overweight and adjusted OR： 1.24 for obese）, and having a history of depression or any psychological problem （adjusted OR： 2.76）. Factor analysis of EAT-40 revealed four factors （eating behavior, diet-related lifestyle, weight concern, and food preoccupation） that were responsible for 33.2% of the total variance. Conclusions： EDs are prevalent among individuals attending the weight management centers in a northern city in Egypt. Specific management strategies are warranted to address this commonly prevalent disease.