A Case of X-Linked Moesin-Associated Immune Deficiency in a Pediatric Patient

Background: X-Linked Moesin-Associated Immune Deficiency (X-MAID) is a rare severe combined immunodeficiency (SCID) subtype that can present at any age due to its variability. Depending on severity, patients demonstrate failure to thrive, recurrent bacterial and viral infections, and increased susceptibility to varicella zoster. It has been characterized by marked lymphopenia with hypogammaglobulinemia and impaired T-cell migration and proliferation. Case Presentation: This is a report of a Cuban 7-year-old male with poor weight gain and facial dysmorphia. He had a history of recurrent bacterial gastrointestinal infections and pneumonia beginning at 4 months of age. He additionally had 4-6 upper respiratory tract and ear infections annually. While still living in Cuba, he was admitted for a profound EBV infection in the setting of significant leukopenia. A bone marrow biopsy confirmed no malignancy. After he moved to the United States, his laboratory work-up revealed marked leukopenia with low absolute neutrophil and lymphocyte count with low T and B cells, very low immunoglobulin levels IgG, IgA, and IgM, and poor vaccination responses to streptococcus pneumonia, varicella zoster, and SARS-CoV-2. Genetic testing revealed a missense pathogenic variant c.511C>T (p.Arg171Trp) in the moesin (MSN) gene associated with X-MAID. He was managed with Bactrim and acyclovir prophylaxis, and immunoglobulin replacement therapy, and considered for hematopoietic stem cell transplantation. Discussion(s): Diagnosis of X-MAID should be considered in patients with recurrent infections and profound lymphopenia. As with SCID, early diagnosis and intervention is of utmost importance to prevent morbidity and mortality. This case demonstrates the importance of genetic testing in identifying this disease as it may prompt an immunologist to consider HSCT if conservative management is suboptimal. In the current literature, HSCT appears promising, but the long-term outcomes have yet to be described.Copyright © 2023 Elsevier Inc.

Impact of the new corona virus (SARS-CoV-2) pandemic on climateric women's health: websurvey

The COVID-19 pandemic has impacted society: causing the collapse of health systems around the world, and also had a significant impact on the economy, personal care, mental health and the quality of life of the population. Few studies have been done about pandemic and the climacteric population, and the impact on quality of life and health. Our objective was to Investigate changes in the health and health care of climacteric women residing in Brazil during the pandemic period. Cross-sectional study with climacteric women aged between 40 and 70 years, residing in Brazil. The evaluation was carried out using a Google Docs electronic form with questions related to sociodemographic, clinical, gynecological data, treatments, access to health services and consultations, as well as changes in behavior. The Menopause Rating Scale - MRS was applied to assess climacteric symptoms, validated for Portuguese. Result(s): 419 women answered the questionnaire. More than 45% were between 51 and 60 years of age, 56.6% being married and residing in Brazilian capitals. 60% of participants reported weight gain during the pandemic. 50.8% of participants reported a decrease in the weekly practice of physical activity More than 80% reported worsening mental health during this period, and 66.1% had a change in their sleep pattern. More than half reported having difficulty accessing gynecological consultations. Women living in capital cities reported a greater increase in alcohol consumption (p=0.002). Food intake increased for 54.9%;the category of civil servant was associated with a significant increase in consumption in relation to other professions (p=0.038). Women whose family incomes changed during the pandemic had a higher prevalence of weight gain (p=0.033) and also had a higher occurrence of changes in sleep quality (72.6% vs. 61.5%;p=0.018). Women with a high school education had a higher occurrence of alterations in personal and health care outcomes (p<0.001). Conclusion(s): We observed an important reduction in the health care of climacteric women during the pandemic period. Changes in life habits, such as increased food consumption and reduced physical activity, were quite prevalent. There was a deterioration in mental health, with a high prevalence of anxiety symptoms and changes in sleep quality. Despite the attenuation of the pandemic, attention should be given to the health care of this population, as the changes may have repercussions for many years.Copyright © 2023

Increased diagnosis of diabetes in secondary care: Is Covid-19 the only reason?

Aim: To evaluate the prevalence of new diabetes in secondary care during the second wave of the Covid-19 pandemic. Method(s): Data were collected prospectively for patients presenting to the hospital with new diagnosis of diabetes from December 2020 to May 2021. It included demographics, risk factors, presenting glucose, other investigations and treatment. Result(s): In the six-month study period, 31 patients were diagnosed with new diabetes. Thus far, approximately 13 patients have been identified to have type 1 diabetes and the average age was 37 years. Everyone was discharged with insulin except one patient. Prior to the pandemic in the year 2019, only 17 patients were diagnosed with diabetes in the hospital. Conclusion(s): The lockdown led to a reduction in physical activity and varied diet which may have contributed to weight gain;worsening insulin resistance. It is plausible that severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) could trigger autoimmune type 1 diabetes or accelerate its presentation. Together with a hesitancy for patients to seek medical attention and reduced access to face-to- face primary care consultations, this may have contributed to the increased presentation of diabetes-related emergencies and reduction in symptomatic hyperglycaemia. Various studies found patients with pre-existing diabetes have a worse outcome if they develop Covid-19. Overall, during the pandemic, physical and mental health worsened, pre-disposing to medical conditions and impacting self-management of health and disease. We predict the increase in new diagnoses of diabetes in secondary care is multifactorial due to the effects of the pandemic rather than Covid-19 infection solely.

Antenatal anaesthetic assessment of parturients with BMI > 40 kg/m2

Introduction: Frimley Park Hospital criteria for referral to High-Risk Obstetric Anaesthetic Clinic (HROAC) included all parturients with BMI > 40. The COVID-19 pandemic necessitated HROAC becoming virtual. It was still possible to discuss risk and assess patients' airways, but not to reliably assess the likely ease of neuraxial techniques or cannulation. Observationally, little useful clinical information was gained, and airway problems rarely noted. An audit was planned to assess how often clinically useful information about the women's airways was gained during appointments. Method(s): HROAC database search for women referred with BMI > 40 with estimated date of delivery 20/04/20-03/04/21 to see whether any airway difficulties were predicted (Mallampati 3 or 4;limited neck movement;jaw slide B or C;limited mouth opening). Result(s): 82 women had BMI > 40, of which 3 were assessed as having a potentially difficult airway: two had BMI > 50 and one had retrognathism causing difficult airway prediction unrelated to her BMI of 41.7. One woman, BMI 58.7, was assessed as having a straightforward airway but her notes revealed her airway had been challenging to intubate in the past. One was assessed in video consultation as straightforward but an airway assessment during admission at the end of her previous pregnancy was Mallampti 3. Five women declined a video consultation. Discussion(s): In view of the minimal gain of clinically useful information and the routine presence of difficult airway kit for the obstetric emergency theatre, it was deemed safe and more relevant to make airway and neuraxial assessments on admission to labour ward rather than in the antenatal clinic for women with BMI<50. The assessment would therefore be made by the duty trainee anaesthetist who would be responsible for managing the patient, thus facilitating appropriate planning and communication if a woman with a challenging airway was identified. It is therefore also made at the very end of pregnancy when weight gain and its impact on airway is likely to be at its maximum. This approach, in conjunction with an antenatal information leaflet, and the ability of any obstetrician to refer to the HROAC, complies with the need for timely assessment of women as required by GPAS [1]. By formalising the assessment of women with high BMI on the labour ward it is hoped that patient safety and planning can be maximised.Copyright © 2023 Elsevier Ltd

Development of warm autoimmune hemolytic anemia after initiation of Ruxolitinib in a patient with STAT1 gain-of-function mutation

Introduction: STAT1 gain-of-function (GOF) disease is associated with chronic mucocutaneous candidiasis (CMC) and a broad spectrum of infectious, inflammatory, and vascular manifestations. The Janus Kinase inhibitor ruxolitinib has been used successfully for CMC and autoimmune phenomena. We describe a case of warm autoimmune hemolytic anemia (WAIHA) in a patient with STAT1 GOF disease after initiating ruxolitinib. Case report: A 36-year-old man with STAT1 c.850G>A (p.Glu284Lys) mutation presented with CMC as well as recurrent viral and bacterial infections, lymphadenopathy, enteritis, nodular regenerative hyperplasia (NRH) and splenomegaly. Immune workup confirmed a combined immunodeficiency with hypogammaglobulinemia and T-cell lymphopenia. Ruxolitinib was initiated at 5 mg twice daily (due to pre-existing thrombocytopenia) with up titration over 3 months to 20 mg twice daily. He improved with weight gain, increased energy, resolution of chronic anemia, and improved lymphadenopathy and splenomegaly on imaging. Serum CXCL9 only minimally decreased from 4660 pg/ml to 3990 pg/ml. Soon after reaching ruxolitinib 20 mg twice daily, he developed JC viremia, prompting dose reduction to 15 mg BID. Within two weeks, he developed a non-COVID upper respiratory tract infection followed by fatigue, shortness of breath with ambulation, and dark urine. Emergency evaluation revealed warm antibody positive hemolytic anemia with a hemoglobin of 5 g/dL, and worsened thrombocytopenia. He was treated with blood transfusions, pulse steroids, and high-dose IVIG with stabilization but continued hemolysis. Due to the JC viremia, there was concern to give rituximab with increased PML risk. Bone marrow showed trilineage hematopoiesis, a mild increase in megakaryocytes and RBC precursors, and a loss of B-cell progenitors with retention of mature B cells. His B and T lymphocyte numbers had increased since prior to ruxolitinib, with a predominance of Tfh1-cells (58.7% of total Tfh-cells). He was started on sirolimus with a slow taper of prednisone with continued stable hemoglobin and platelets, and resolution of hemolysis after 3 months. Conclusion(s): To our knowledge, this is the first case of a STAT1 GOF patient developing WAIHA while receiving ruxolitinib therapy. Treatment choices were complicated by the risks of PML. Sirolimus combined with ruxolitinib allowed wean of corticosteroid and subsequent resolution of hemolysis.Copyright © 2023 Elsevier Inc.

Effect of the COVID-19 pandemic on obesity and it is risk factors: a systematic review.

BACKGROUND: Coronavirus disease (COVID-19) is a contagious disease caused by the severe acute new coronavirus called SARS-CoV-2. Devastating social, economic, and health service utilisation-related activities. Increased burden and lifestyle changes due to confinement. OBJECTIVE: This study aimed to investigate and determine the determinants of obesity during the coronavirus disease (COVID-19) pandemic from 2019 to 2023. METHODS: Observational studies published between December 2019 and January 2023 were thoroughly searched using a PRISMA flow chart. PubMed, Google Scholar, Web of Science, HINARI, Scopus, and Embase databases were used. Two reviewers independently identified and critically evaluated the relevant literature. Studies that reported weight gain or involved BMI measurements of 25 kg/m2 or BMI z-scores for children during the COVID-19 lockdown were selected for inclusion. The Newcastle-Ottawa Scale (NOS) was used as a quality assessment instrument in nonrandomised studies to evaluate study quality. All the contributing determinants of weight increase were identified, gathered, and synthesised. RESULTS: This systematic review identified 40 studies with a total population of 5,681,813 from 22 countries, of which 74.6% were male. The sample size from included articles ranged from 37 to 5,315,435. Of the 40 selected articles, 24 focused on adults, five on adolescents, three on children, and eight on children and adolescents. Physical inactivity, sedentary behaviour, bad eating habits, behavioural lifestyle, excessive stress, depression, anxiety, behavioural risk factors, sex, and ethnic minorities were associated with obesity during the COVID-19 pandemic lockdown. CONCLUSION: During the COVID-19 pandemic, physical inactivity, sedentary lifestyle, and poor eating patterns were the most common risk factors for obesity. Additionally, unhealthy eating habits, excessive behavioural stress, depression, anxiety, low mood, age, gender, and ethnic minorities have been identified as risk factors for obesity during the COVID-19 pandemic.

Gestational Weight Gain During the COVID-19 Pandemic.

INTRODUCTION: Healthy gestational weight gain (GWG) is associated with improved pregnancy and delivery outcomes. The COVID-19 pandemic changed eating behaviours and physical activity, and thus may have impacted GWG. This study examines the impact of the COVID-19 pandemic on GWG. METHODS: Participants (N = 371, 86% of the larger study) were part of a study focused on GWG among TRICARE beneficiaries (i.e., active-duty military personnel and other beneficiaries). Participants were randomized to two treatment groups (GWG intervention (n = 149 pre-COVID and n = 98 during COVID), and usual care condition (n = 76 pre-COVID and n = 48 during COVID). GWG was calculated as the difference between screening weight and at 36 weeks gestation. Participants who delivered prior to the COVID-19 pandemic (March 1, 2020, N = 225) were compared to participants whose pregnancies occurred during the pandemic (N = 146). RESULTS: We found no significant difference in GWG between those who delivered prior to the pandemic (11.2 ± 4.3 kg) and those whose pregnancies occurred during COVID-19 (10.6 ± 5.4 kg), with no effect of intervention arm. While excessive GWG was higher pre-COVID (62.8%) than during the pandemic (53.7%), this difference was not significant overall or by intervention arm. In addition, we found lower attrition during the pandemic (8.9%) than in the pre-COVID period (18.7%). DISCUSSION: In contrast to prior research that indicated challenges with engaging in health behaviors during the COVID-19 pandemic, we found that women did not have increased GWG or higher odds of excessive GWG. This research contributes to our understanding of how the pandemic impacted pregnancy weight gain and engagement in research.

Factors Related to the Presence of Lowback Pain during Remotework in the Covid-19 Pandemic in Brazil

Objectives: With the new needs that the market and the population presented, there was a need to adopt strategies to make the new work environment as safe and comfortable as possible, preserving the health of workers regardless of the work environment. Given this context, it is extremely important that the workers have knowledge about ergonomics and how environmental factors can affect their work capacity and comfort, factors such as ambient light, noise, air flow, temperature, long period in a static position and inappropriate furniture. The aim of the study was to identify the etiology of low back pain during remote work during the COVID-19 pandemic. Method(s): Two questionnaires were applied, one of them developed by the researchers and the other a disability questionnaire (Roland-Morris Disability Questionnaire-RMDQ) in the form of Google Forms for adults (n = 54) of both sexes, aged over 18 years who were working remotely during the period of the COVID-19 pandemic in Brazil in the year 2021. Result(s): With the application of the questionnaires, it was possible to notice an increase in the emergence and worsening of lowback pain in individuals who performed remote work during the COVID-19 pandemic;this increase related to factors such as: inadequate furniture at home, excessive number of hours in the sitting position using the computer, decrease in regular physical activities and weight gain. Conclusion(s): From the beginning of remote work, during the COVID-19 pandemic, most individuals studied either developed lowback pain or had increased low back pain, resulting in mild disability. These data are preliminary in Brazil;in the future, we seek to expand to a larger number of participants, as well as to create strategies and health-promoting actions for low back pain prevention.

Religion and Pandemic Weight Gain: A Refuge from the Storm?

The COVID-19 pandemic was an inherently stressful global crisis that was associated with weight gain for over 40% of the American public. Building on previous research, we draw on recently collected national survey data from the United States to examine the effects of religious attendance (both in-person and virtual), the sense of divine control, and religious/spiritual (R/S) struggles on pandemic weight gain. A series of logistic regression models were conducted. Our findings suggest that divine control and monthly in-person religious attendance were associated with a lower risk of pandemic weight gain, while R/S struggles were associated with a higher risk of weight gain. Our results reveal the complex role that religiosity can play with respect to pandemic weight gain.

Clinical Nutrition in Covid-19 Patients-A Systematic Review

Introduction There is currently a lack of evidence on clinical nutrition in Covid-19. Aim of the work: Systematic overview of clinical nutrition in Covid-19. Material and methods A systematic literature search: 2 meta-analyses, 12 systematic reviews and meta-analyses, 9 prospective randomized controlled trials, 3 prospective observational studies, 7 retrospective studies, 25 narrative reviews. Results a) Obese patients have an increased risk of a severe course of the disease, b) there is a connection between obesity and an increased risk of death, c) Covid-19 mortality increases from a BMI>27 kg/m2, in all BMI classes 1,6% per 1 kg/m2 in the event of weight gain, in the case of severe obesity (> 40-45 BMI) by a factor of 1,5 to 2 and per 5 kg/m2, d) the risk of a severe course of Covid-19 increases also with increased visceral fat tissue percentage, total body fat mass and upper abdominal circumference, e) the mortality rate can be 10 times higher in malnourished Covid-19 patients, f) serum albumin provides evidence of a poor course of the disease, g) enteral omega-3 fatty acid intake could stabilize kidney function and improve the outcome, h) foods with a low glycemic index should be preferred, i) vitamin D deficiency should be avoided, daily vitamin D and zinc supplementation can be beneficial, j) one-time high dose vitamin D and enteral vitamin C provide no benefit, but the risk of thrombosis could be reduced and the antibody response enhanced with zinc, k) nutritional intervention reduces mortality. Conclusion Screening and assessment of nutritional status are important in Covid-19 patients. Overall, there are insufficient clinical results on specific nutritional therapy.Copyright © 2022 Georg Thieme Verlag. All rights reserved.

CLINICAL CASE OF SEVERE COVID-19 IN A CHILD WITH MORBID OBESITY.

The pandemic of coronavirus infection is characterized by a low percentage of complications and severe forms in sick children compared to the adult population. However, there have been described cases of severe clinical course of COVID-19 in children with comorbidities among which is obesity. The aim of this study was to analyze the severe course of a new coronavirus infection paralleled with morbid obesity in a pediatric patient. Materials and methods. All accompanying patient medical documentation was examined. Results and discussion. From the anamnesis of life it is known that the patient was long time complained of intensively increased body weight, on which she repeatedly underwent examinations. In 2018, hypothalamic pubertal syndrome was diagnosed for the first time, for which the patient received hypoglycemic and antihypertensive drugs, hepatoprotectors on an ongoing basis. In the epidemiological anamnesis, the intrafamilial COVID-19 contact with mother was established. The main disease began acutely with a rise in body temperature up to 39-39.5degreeC, cough and weakness. During the first week of illness, the patient did not seek medical help and receive self-treatment, but the positive effect was not achieved. Saturation measurement showed low oxygen level (SpO2 71%). In this regard, the patient underwent chest computed tomography, which revealed a bilateral interstitial polysegmental lung lesion with signs of consolidation. After emergency hospitalization, the patient was prescribed empiric antibiotic therapy, anti-inflammatory and antithrombotic treatment, as well as respiratory support. A positive PCR result of a throat and nasal swab for SARS-CoV-2 was obtained in the hospital. Due to a poor response to therapy, the patient was transferred to a respiratory hospital. At the time of hospitalization, the condition was considered severe due to severe respiratory failure and premorbidity. The range of treatments included oxygenotherapy, antibacterial and anticoagulation therapy, as well as surfactant and the nucleoside analogue Remdesivir. During treatment, the clinical picture gained a positive trend, and after 6 days of hospitalization the patient no longer needed respiratory support. According to the results of repeated computed tomography, bilateral interstitial polysegmental pneumonia was diagnosed with damage to the lung tissue up to 95%. The patient remained stable and showed no signs of respiratory failure during the following days of hospitalization. On the 20th day of ilness, the patient was discharged from hospital with full clinical recovery. Conclusion. This clinical case demonstrates the role of premorbid background in aggravating the clinical picture of a new coronavirus infection in a child. Careful study of anamnestic characteristics is necessary in patients of any age, even with an uncomplicated disease course.Copyright © 2023 Saint Petersburg Pasteur Institute. All rights reserved.

Study The Impact Of Covid-19 Pandemic Confinement On Body Weight In Young Adults Of 17-18 Yrs In Jaipur

Background: The COVID-19 Pandemic hit INDIA in March 2020. This pandemic lead to confinement of students at home for more than a year. This influenced their dietary behaviours and physical activity along with increase in stress levels. The net result of pandemic was alterations in weight, increasing the risk of obesity and diseases associated with obesity especially in affluent class. AIMS and OBJECTIVES: This study aims to evaluate the effect of confinement on body weight in students of 17-18 yrs of Jaipur and to identify the contributory factors. Material and Methods: A school based, cross-sectional, observational study was carried out from January 2021 to june 2021involving 300 students in age group of 17-18 years studying in private school belonging to affluent class. Students were made to fill a proforma regarding their daily lifestyle and physical activities. Physical activity was evaluated with the International Physical Activity Questionnaire. Weight before the pandemic confinement was compared to the post confinement weight. Data was analysed using DATAtab Team (2023). DATAtab: Online Statistics Calculator. DATA tab e.U. Graz, Austria. URL https://datatab.net/ Results: More than 50% of students gained significant weight during the pandemic. Only one third of participants were moderately physically active. Factors contributing to weight gain included increased consumption of unhealthy food, altered sleep pattern, increased screen time and decreased physical activity. Conclusion: The study showed that confinement lead to significant weight gain in students of affluent class .The findings showed the short term effects of pandemic confinement. This study during Covid19 confinement will help the health authorities in understanding and implementing newer policies for healthy lifestyle when newer pandemics waves arrive. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Successful matched unrelated donor hematopoietic stem cell transplantation for infantile Wolman disease

Introduction: Wolman disease is a rare genetic disorder with an autosomal recessive inheritance. A mutation in the LIPA gene causes lysosomal acid lipase (LAL) deficiency results in lipid storage and adrenal insufficiency. Death in early infancy is due to liver failure. Patients and methods: We describe the clinical course of a three-month-old infant diagnosed with Wolman disease. A rapid mutational analysis confirmed a LIPA gene defect. Results: He underwent matched unrelated donor peripheral blood stem cell hematopoietic stem cell transplantation (HSCT) at 3 months of age, with a treosulfan-based conditioning, which resulted in engraftment with donor-derived hematopoietic cells. He required supportive care for sinusoidal obstruction syndrome and mucositis. He was administered low dose prednisolone for grade I skin graft versus host disease, and a complete donor chimerism was documented on several occasions. At one year post HSCT, his growth and development were optimal, and there was no hepatosplenomegaly. He is maintained on glucocorticoid and mineralocorticoid supplements for primary hypoaldosteronism. Conclusion: The case emphasizes the timely diagnosis and the potential for successful treatment of Wolman disease by HSCT. © 2022 Pediatric Hematology Oncology Chapter of Indian Academy of Pediatrics

Risk factors associated with overweight and obesity in children and adolescents during the COVID-19 pandemic in Chile.

The COVID-19 pandemic has caused changes in people's lifestyles, mainly in healthy eating habits and behaviors. Therefore, our objective was to evaluate the association of eating habits, family eating behaviors, lifestyles, and perception of nutritional status with the risk of overnutrition in children and adolescents during the COVID-19 pandemic. A cross-sectional study was conducted on a sample of 661 Chilean children and adolescents. The study tool was an online self-report questionnaire taken during the COVID-19 lockdown. We observed overnutrition in 37.5%. Habits such as sleeping the recommended number of hours by age group and having healthy family behaviors decreased the risk of overnutrition by 49.0% (OR= 0.510, p= <0.001) and 10.8% (OR= 0.892, p= 0.01), respectively. Parents' perception of weight gain during the pande-mic, the distortion of nutritional status and the health risk of their children's nutritional status increased 4.8 (OR= 4.846, p= <0.001), 8.5 (OR= 8.580, p= <0.001) and 3.8 (OR= 3.826, p= <0.001) times, respectively, the risk of overnutrition in children and adolescents. In conclusion, the COVID-19 lockdown and school closures may have affected lifestyles. In addition, the role of parents in the perception of nutritional status and family eating behaviors is fundamental since they could be a predictor of the risk of overnutrition. These findings propose further research to design plans and programs to avoid the consequences related to overweight and obesity.Copyright © 2023, Sociedad Chilena de Nutricion Bromatologia y Toxilogica. All rights reserved.

ON ROUTE TO HEALTH EDUCATION DIAGNOSING HEALTHY EATING HABITS AMONG ADOLESCENTS

Adolescents' general well-being and health in particular, are conditioned by healthy eating habits which many adolescents lack. Learning their actual eating habits, is therefore, a seminal step towards creating an educational curriculum aimed to improve the dietary habits among adolescents, and in the long run create healthier individuals, stronger collective immunity and physical longevity, what was the aim of this research. To accomplish the end, this study has registered the eating habits among Pristina adolescents aged 12-15, focusing on their daily food consumption practices, including meal consumption temporal distribution, meals' ingredient structure and the correlation between eating habits and adolescents leisure time activities (reading books, watching TV, playing video games, etc.). A sample of 209 high school Pristina adolescents was selected to participate in a printed survey conducted in the period between the 19th and 23rd of October 2020, in the heat of the COVID 19 pandemic. The quantitative data collected through the survey was later processed and analyzed by using SPSS data analysis software. The key findings reveal regularity in meal consumption, even in circumstances of global COVID 19 pandemic. Almost all adolescents have three meals a day, (breakfast, lunch, and dinner) with varying times of consumption, with bread (84%) and fruits (71%) being the most frequently consumed food articles, while water (96%) and juice (51%) are the adolescents choice of liquids. As for the snack, 36% of respondents consume snack between lunch and dinner, while 25% eat snacks between breakfast and lunch. The results also revealed adolescents frequent use of social media (75%) and game playing (51%), high engagement in sport (99%), satisfaction with physical appearance (81%), and fairly high gain weight in one year (62%) Cross matching the results showed interesting correlations. Male adolescents with regular eating habits who enjoy spending time on the internet or gaming, have gain weight in the last year. There is also discrepancy in the eating and leisure time activities among urban and rural respondents. The former, have meals late in the day, purchase food more often, have snacks and engage in digital forms of entertainment and leisure activities. Adolescents form rural areas, on the other hand, have more healthy diets, consume home prepared and diverse food and tend to engage more in reading then social media or gaming. The findings justify and demand further actions. They can serve as an interpretative background to state statistics on the effects of bad eating habits among adolescents (increased body weight, blood parameters, vitamin and mineral deficiency, etc.). More importantly, these findings can help advocate for an obligatory school curriculum in healthy food consumption, can help design a program for extra-curricular activities intended to promote healthy lifestyle, and even a digital platform to accomplish the same ends while at the same time more easily penetrate the digital world of social media, frequented by adolescents on daily basis. © 2023, Consulting and Training Center - KEY. All rights reserved.

Impact of COVID-19 Pandemic on Weight Change Among Adults in the UAE.

Background: The COVID-19 pandemic which started in November 2019 and since then has led to multiple lockdowns aimed towards controlling the pandemic, these lockdowns contributed to major changes in individuals' lifestyles including eating patterns and restriction of physical activity due to continues house confinement. Such changes have significantly contributed to weight change, with increasing rates of obesity in the UAE, COVID-19 have posed a major concern to the country's obesity levels. Aim: To measure the prevalence and investigate the views related to weight change among adults in the UAE during the COVID-19 pandemic. Methods: A cross-sectional study was conducted through a self-administered online questionnaire distributed using social media platforms between February 15th and March 14th, 2021. The sample size was 439 adults in the UAE (18-59 years), collected by volunteer sampling. Analysis was done using SPSS with a significance of 5.0%. Exclusion criteria included pregnancy and bariatric surgeries history. Results: 51.1% of participants gained weight, 36.2% lost weight and 12.7% maintained their weight. Meal consumption frequency and weight gain were correlated. Consuming fast food resulted in 65.7% of participants gaining weight. 66.2% of people who lost weight during the COVID-19 pandemic did exercise. Stress management and sleeping patterns were not contributing factors to the weight change. 64.4% of the participants who were not satisfied with their weight and believed that they need to make changes in their lifestyle received no guidance from professional personnel to reach their desired weight. Conclusion: In this study, the majority of participants have witnessed an increase in weight. UAE health authorities must provide guidance and support to the population via structured nutritional programs and lifestyle awareness campaigns.

Indirect effects of the COVID-19 pandemic on risk of gestational diabetes and factors contributing to increased risk in a multiethnic population: a retrospective cohort study.

BACKGROUND: The COVID-19 pandemic has had indirect effects on pregnancy outcomes. There is limited data on the impact on gestational diabetes (GDM) in diverse populations and the possible underlying mediators. This study aimed to assess the risk of GDM pre-COVID-19 and in two distinct pandemic exposure periods, and to determine the potential factors contributing to increased risk in a multiethnic population. METHODS: A multicentre, retrospective cohort study was performed of women with singleton pregnancy receiving antenatal care at three hospitals two years pre-COVID-19 (January 2018 - January 2020), first year of COVID-19 with limited pandemic-mitigating restrictions (February 2020 - January 2021) and second year of COVID-19 with stringent restrictions (February 2021 - January 2022). Baseline maternal characteristics and gestational weight gain (GWG) were compared between cohorts. The primary outcome was GDM, assessed using univariate and multivariate generalised estimating equations models. RESULTS: 28,207 pregnancies met the inclusion criteria, 14,663 pregnancies two years pre-COVID-19, 6,890 in COVID-19 Year 1 and 6,654 in COVID-19 Year 2. Maternal age increased across exposure periods (30.7 ± 5.0 years pre-COVID-19 vs 31.0 ± 5.0 years COVID-19 Year 1 vs 31.3 ± 5 years COVID-19 Year 2; p < 0.001). There were increases in pre-pregnancy body mass index (BMI) (25.5 ± 5.7 kg/m2 vs 25.7 ± 5.6 kg/m2 vs 26.1 ± 5.7 kg/m2; p < 0.001), proportion who were obese (17.5% vs 18.1% vs 20.7%; p < 0.001) and proportion with other traditional risk factors for GDM including South Asian ethnicity and prior history of GDM. Rate of GWG and proportion exceeding recommended GWG increased with pandemic exposure (64.3% vs 66.0% vs 66.6%; p = 0.009). GDM diagnosis increased across exposure periods (21.2% vs 22.9% vs 24.8%; p < 0.001). Both pandemic exposure periods were associated with increased risk of GDM on univariate analysis, only COVID-19 Year 2 remaining significantly associated after adjusting for maternal baseline characteristics and GWG (OR 1.17 [1.06, 1.28], p = 0.01). CONCLUSIONS: Diagnosis of GDM increased with pandemic exposure. Progressive sociodemographic changes and greater GWG may have contributed to increased risk. However, exposure to the second year of COVID-19 remained independently associated with GDM after adjusting for shifts in maternal characteristics and GWG.

Female Awareness about Gestational Diabetes and its Health Risk Effect on Pregnancy Outcome among Women in the Kingdom of Saudi Arabia

Uncontrolled gestational diabetes mellitus causes severe maternal and fetal complications such as pre-eclampsia, macrosomic baby, fetal demise, neonatal hyperbilirubinemia, and hypoglycemia and also increases obesity and type 2 DM risk in offspring later in life. This study aimed to assess awareness of women in the Kingdom of Saudi Arabia regarding diabetes and its health risk effect on pregnancy outcome and to measure the prevalence of gestational DM among them. This is a comparative cross-sectional descriptive study conducted in Department of Obstetrics and Gynecology, Faculty of Medicine Umm Al Qura University involving 480 women living in the Kingdom of Saudi Arabia during June 2021-June 2022. Data was collected through an online questionnaire formulated to survey saudi women due to covid 19 pandemics measures. About 20% had DM. Prevalence of gestational DM was 11.5% among currently pregnant participants. 76% of participants had family history of diabetes. After doing linear regression of predictors for knowledge about gestational DM, gravidity and parity became non-significant, however being in medical field, husband in medical field, having DM, past or family history of DM remained significant (p<0.001, 0.045, <0.001, 0.002 and 0.006 respectively). The highest predictor is being in medical field (B =7.218), followed by having DM (B =2.697), followed by husband in medical field (B =2.159), past history of DM (B =1.945), then family history of DM (B =1.727). Health care efforts and interventions are required to increase the awareness especially about the importance of screening for gestational DM due to the bad sequences of gestational DM.

Impact of COVID-19 mandatory lockdown on maternal gestational weight gain and neonatal macrosomia rate at an academic medical center in Israel.

BACKGROUND: In an effort to prevent the spread of coronavirus disease 2019 (COVID-19), governments restricted outdoor activities and imposed lockdown quarantine. This change in lifestyle probably affected individuals' eating habits and physical activity. OBJECTIVE: To examine the effect of lockdown due to the COVID-19 pandemic on maternal antenatal weight gain, neonatal macrosomia, and other maternal and neonatal outcomes of women delivering at an academic medical center in Israel. METHOD: A retrospective, two-period cohort study conducted at a university teaching medical center in Afula, Israel. The study period was between April and September 2020. This period signifies worsening in pandemic situations, during which citizens experienced strict prolonged lockdown measures. The parallel unexposed period (control period) was between April and September 2019. Singleton pregnancies delivered at >24 weeks were eligible. Primary outcome was incidence of macrosomia. Secondary outcomes included gestational weight gain, body mass index (BMI) at delivery, rates of gestational diabetes mellitus (GDM), mode of delivery, postpartum hemorrhage (PPH), and neonatal outcomes reflecting neonatal birth weight and condition at delivery. RESULTS: A total of 4,765 women were included, 2,442 in the study group and 2,323 in the control group. The incidence of macrosomia was significantly higher in 2020 (6.2%) than in 2019 (4.9%), (p = .048; OR: 1.29; 95% CI: 1.002- 1.65). Women gained significantly more weight (median 1 kg more), weighed more at delivery (median 1 kg), and had higher BMI at delivery in 2020 compared with those in 2019 (p < .01). The incidence of GDM was 9.5% and 8.5% in the study and control groups respectively (p = .26; OR: 1.12; 95% CI: 0.92-1.37). Greater percentage of women did not perform the glucose challenge test in 2020 (9.9%) compared with those in 2019 (7.5%) (p = .003, OR: 1.36; 95% CI: 1.11-1.67). The incidence of any hypertension related to pregnancy was significantly higher in 2020 compared to 2019 (5.8% vs 4.4% respectively, (p = .042; OR: 1.32; 95% CI: 1.02-1.71). The proportion of women who smoked during pregnancy was also significantly higher in 2020 than in 2019 (5.1% vs 3.7%, respectively, p = .02; OR: 1.40; 95% CI: 1.06-1.86). Delivery mode did not differ, while the incidence of PPH was significantly higher in 2020 than in 2019 (5.6% vs 3.4%, respectively, p = .001; OR: 1.65; 95% CI: 1.25-2.19). Neonatal condition at delivery was comparable. CONCLUSION: COVID-19-related lockdown was associated with the increased rate of macrosomic infants. This indirect effect of the pandemic is probably related to poorer maternal antenatal metabolic health status. Long-term consequences should be further examined.

The impact of rotational shift work schedules on energy intake: a systematic review and meta-analysis

Shift workers are known to have poorer metabolic health outcomes compared to day workers,(1) whilst those who work in rotating shift work roles have the highest risk.(2) To date, overall energy intake in shift workers has been found to be similar to day workers,(3) but it is unknown whether energy intake in workers on rotating shift schedules may be a contributing factor to the observed higher chronic disease risk. A systematic review and meta-analysis were conducted to explore how rotating shift work schedules impact total energy intake compared to fixed day/morning work schedules. Intra-person differences in energy intake amongst rotating shift workers on day/morning versus night shifts was also examined. Searches were conducted on CINAHL, Cochrane, Embase, MEDLINE PsycINFO and Scopus databases to identify articles reporting energy intake for rotating shift workers and fixed day workers. Articles were screened in duplicate against inclusion criteria using Covidence software. Data were extracted by one reviewer and checked independently by one of three reviewers. Quality assessment of included studies was assessed in duplicate using the American Dietetic Association (ADA) Quality Criteria Checklist for Primary Research. Meta-analyses were performed in RevMan using a random effects model, to compare mean difference in 24-hour energy intake with 95% confidence intervals. Heterogeneity was assessed with the I-squared test (I2). Thirty-one studies (n = 18196 participants) met the inclusion criteria and were included in the review with data for the two meta-analyses comprising 18 studies and seven studies, respectively. Overall, rotating shift workers had significantly higher average 24-hour energy intake compared to fixed day or morning work schedules (weighted mean difference [WMD] = 264 kJ;95% CI [70, 458], p < 0.008;I2 = 63%). Within rotating shift workers, the mean difference in 24-hour energy intake across morning/day shifts compared to night shifts was not statistically significant (WMD = 101 kJ;95% CI [-651, 852];p = 0.79;I2 = 77%). Results indicate workers on rotating shift schedules had a higher average 24-hour energy intake compared to their fixed day schedule counterparts. However, energy intake across shift schedules did not differ for individuals working this pattern. A higher 24-hour energy intake in rotating shift workers can contribute to gradual weight gain and higher metabolic risk in rotating shift work populations.