Prurigo pigmentosa post-bariatric surgery: a case report.

Background: Prurigo pigmentosa (PP), also referred to as Nagashima disease, is an acquired dermatological condition that is characterized by pruritic erythematous eruptions including papules and plaques surrounded by a reticular pattern of hyperpigmentation. It was first described in 1971 when Japanese dermatologist Masaji Nagashima noticed similar dermatological manifestations among 8 patients of Asian descent. The disease has been strongly associated with ketosis and ketogenic diet; however, the underlying etiology is unknown. Effective treatment involves an oral antibiotic and a balanced diet. The disease classically affects young women of Asian descent, but cases affecting males and people of non-Asian ancestry have also been observed. We present an unusual case of PP in a Saudi male that started 18 days following bariatric surgery. Case Description: The patient is a 25-year-old morbidly obese Saudi male who complained of an intensely pruritic rash 3 weeks after undergoing bariatric surgery. His past medical history is positive for irritable bowel syndrome (IBS). A punch skin biopsy yielded the diagnosis, and a combination treatment consisting of minocycline and a topical corticosteroid was prescribed. The patient presented again 2 weeks after the initial visit with complete resolution of the rash. He reported adherence to the medication regimen. Pruritus had resolved. Upon examination, post-inflammatory hyperpigmentation in a reticular pattern was observed over the trunk, upper abdomen, and chest. Hydroquinone 4% cream was prescribed to treat the post-inflammatory hyperpigmentation. Conclusions: Nowadays, PP cases are being reported from all around the world, including cases of PP that appeared following bariatric surgery for weight loss without ketogenic dietary modification. Theoretically, the typical PP patient is a young adult female from Eastern Asia who has been adherent to a ketogenic diet. In contrast, we report a case of a Saudi male who did no dietary modifications, but underwent bariatric surgery. Treatment with minocycline resulted in successful complete resolution.

Burnout phenomenon in Saudi dermatology residents: a national assessment of prevalence and contributing factors.

A cross-sectional study was conducted between March and August 2021; an electronic survey was administered to all dermatology residents (n=79) in all centers with the Saudi Board Dermatology Training Program in the western, eastern and southern regions. Participation was voluntary, and written informed consent was obtained before the study. The survey was completed by 70 dermatology residents, for an 88.61% response rate. All the participants were aware of the study's aims, and their informed consent was obtained. The study design complied with the Declaration of Helsinki ethical standards and was approved by the Institutional Review Board at Imam Muhammad Ibn Saud Islamic University in Saudi Arabia. A total of 70 respondents completed the questionnaire. High emotional exhaustion (EE) was present in 47.1% of respondents, low personal accomplishment (PA) was present in 65.7%, and high depersonalization (DP) was the least prevalent (24.3%) across all burnout dimensions of dermatology residents. Overall burnout was present in 21.4% of the dermatology residents. Multivariate analysis showed that the odds of EE were significantly lower in males than females [odds ratio (OR)=0.2, P=0.016] and the higher number of patients seen per clinic (OR=1.09, P=0.032) was associated with higher odds of having a high risk of EE, while higher satisfaction with work-life balance was associated with lower odds of a high risk of EE (OR=0.47, P=0.005). A higher number of study hours/week was associated with lower odds of low PA (OR=0.95, P=0.02). Similarly, higher satisfaction with career was associated with lower odds of low PA (OR=0.35, P=0.042). Multivariate analysis showed that only exercise (OR=0.21, P=0.05) and satisfaction with work-life balance (OR=0.42, P=0.008) were associated with a lower risk of burnout. Our study adds the burnout rates among dermatology residents in Saudi Arabia, in addition to possible risk factors that can predict burnout, to the literature. These findings can be applied to improve training programs and reduce the burnout rate among residents.

Childhood Atopic Dermatitis: A Nationwide Measurement of Quality of Life among Saudi Patients.

Background: Atopic dermatitis (AD) negatively affects the quality of life (QoL). However, few studies from Saudi Arabia have assessed the effect AD has on the QoL of pediatric patients. Objective: To determine the psychological impact of AD on pediatric Saudi patients using the Children's Dermatology Life Quality Index (CDLQI). Methods: This cross-sectional was conducted across five tertiary hospitals located across five cities of Saudi Arabia from December 2018 to December 2019. The study included all Saudi patients aged 5-16 years who were diagnosed with AD for at least 6 months prior to visiting the dermatology clinic of the included hospitals. The quality of life in children with AD was assessed using the Arabic version of the CDLQI. Results: A total of 476 patients were included, of which 67.4% were boys. AD had a very large and extremely large effect on the QoL in 17.4% and 11.3% of the patients, respectively; the QoL of only 5.7% of the patients was not impacted due to AD. The average CDLQI score was not significantly different between males and females (9.7 vs. 9.1, respectively; P = 0.4255). Domains related to symptoms and emotions were affected to a greater extent compared with the remaining domains, while the school domain was the least affected. The correlation between age and CDLQI (r = 0.04, P = 0.52) and between the duration of the disease and CDLQI (r = 0.062, P = 0.18) was not significant. Conclusions: This study found that AD affects the QoL of a significant proportion of the Saudi pediatric patients, thereby highlighting the need to consider QoL as a measure of treatment success.

The nutrition transition and the double burden of malnutrition.

Chronic noncommunicable diseases are increasingly frequent in low- and medium-income countries, but problems of malnutrition, such as growth restriction in children or micronutrient deficiencies in both children and adults, persist in these same countries. This double burden of malnutrition and the emergence of chronic diseases such as type 2 diabetes strain healthcare systems and constitute a sometimes unbearable load for the countries concerned, for the government, but also for the individuals affected and their families. This double burden is often associated with the nutrition transition or the progression away from the local traditional diet towards a Westernized diet frequently high in fat, salt, and sugar, with low nutritional density. This transition is attributed to worldwide changes in dietary systems expressed by an increased availability of foodstuffs marketed across the planet, such as vegetable oils, sugars, and refined flours, but also the multiplication of points of sale of food that has been processed, even ultraprocessed. The efforts to battle this scourge must take into account the complexity of the phenomenon and the many factors associated with it. A systemic approach that considers the global forces governing the food systems must be promoted. Actions concerning nutrition must therefore emphasize simultaneously the problems of undernutrition and of overnutrition. WHO labels these interventions "double duty actions."

Consumption of ultra-processed foods predicts diet quality in Canada.

This study describes food consumption patterns in Canada according to the types of food processing using the Nova classification and investigates the association between consumption of ultra-processed foods and the nutrient profile of the diet. Dietary intakes of 33,694 individuals from the 2004 Canadian Community Health Survey aged 2 years and above were analyzed. Food and drinks were classified using Nova into unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods. Average consumption (total daily energy intake) and relative consumption (% of total energy intake) provided by each of the food groups were calculated. Consumption of ultra-processed foods according to sex, age, education, residential location and relative family revenue was assessed. Mean nutrient content of ultra-processed foods and non-ultra-processed foods were compared, and the average nutrient content of the overall diet across quintiles of dietary share of ultra-processed foods was measured. In 2004, 48% of calories consumed by Canadians came from ultra-processed foods. Consumption of such foods was high amongst all socioeconomic groups, and particularly in children and adolescents. As a group, ultra-processed foods were grossly nutritionally inferior to non-ultra-processed foods. After adjusting for covariates, a significant and positive relationship was found between the dietary share of ultra-processed foods and the content in carbohydrates, free sugars, total and saturated fats and energy density, while an inverse relationship was observed with the dietary content in protein, fiber, vitamins A, C, D, B6 and B12, niacin, thiamine, riboflavin, as well as zinc, iron, magnesium, calcium, phosphorus and potassium. Lowering the dietary share of ultra-processed foods and raising consumption of hand-made meals from unprocessed or minimally processed foods would substantially improve the diet quality of Canadian.

A Mediterranean diet pattern with low consumption of liquid sweets and refined cereals is negatively associated with adiposity in adults from rural Lebanon.

BACKGROUND: The beneficial impact of the traditional Mediterranean diet pattern on adiposity is still under debate, and this has never been assessed in a developing Mediterranean country. OBJECTIVES: To assess the relationships between adherence to a traditional Mediterranean diet and adiposity indexes, that is, body mass index (BMI) and waist circumference (WC), in a sample from rural Lebanon. DESIGN: A sample of 798 adults, aged 40-60 years, was selected in continental rural areas of Lebanon for a cross-sectional study. The questionnaire included socio-demographic, anthropometric and dietary sections. The daily consumption frequencies of selected food groups, categorized as positive or negative components, were calculated based on a food frequency questionnaire. Adherence to the Mediterranean diet was assessed using six a priori scores; including the widely used Mediterranean diet score (MDS). Associations between diet scores and BMI and WC were assessed. RESULTS: Overall, the diet of the study sample only partially matched the traditional Mediterranean diet. A total of 17.0% of men and 33.7% women were obese. The MDS was negatively associated (P<0.05) with WC, but not BMI, in men and women. The constructed composite Mediterranean score combining positive components of the diet (whole cereals, vegetables, legumes and fruit, olive oil and fish) and negative components adapted to this sample (refined cereals and pastries, and liquid sweets) was consistently and negatively associated with both BMI and WC for men and women in multivariate models. A 2-point increase in that score was associated with a decrease in BMI of 0.51 and 0.78 kg m(-2) and a decrease in WC of 2.77 and 4.76 cm in men and women, respectively. CONCLUSION: The results demonstrate that a Mediterranean diet is negatively associated with obesity and visceral adiposity in a rural population of a developing Mediterranean country.

Obesity and type 2 diabetes in Northern Canada's remote First Nations communities: the dietary dilemma.

First Nations populations in Northwestern Ontario have undergone profound dietary and lifestyle transformations in less than 50 years, which have contributed to the alarming rise in obesity and obesity-related diseases, in particular type 2 diabetes mellitus. Even though the genetic background of First Nations peoples differs from that of the Caucasians, genetics alone cannot explain such a high prevalence in obesity and type 2 diabetes. Modifications in lifestyle and diet are major contributors for the high prevalence of chronic diseases. What remains constant in the literature is the persistent view that locally harvested and prepared foods are of tremendous value to First Nations peoples providing important health and cultural benefits that are increasingly being undermined by western-based food habits. However, the complexities of maintaining a traditional diet require a multifaceted approach, which acknowledges the relationship between benefits, risks and viability that cannot be achieved using purely conventional medical and biological approaches. This brief review explores the biological predispositions and potential environmental factors that contribute to the development of the high incidence of obesity and obesity-related diseases in First Nations communities in Northern Canada. It also highlights some of the complexities of establishing exact physiological causes and providing effective solutions.

Complementary feeding patterns in a developing country: a cross-sectional study across Lebanon.

This first, large-scale study on complementary feeding in Lebanon analysed the timing and types of food introduced to infants according to mothers' demographic and socioeconomic and infants' characteristics. A cross-sectional survey over 10 months found that the majority of infants were introduced to solid foods at or after 4 months of age. A large number of infants were given liquids other than breast or formula milk earlier. Women in employment outside the home were almost twice as likely to introduce solid foods before age 4 months. The most common starting food was cereals. More than half the children consumed starchy foods and fruits every day, but not meats and fish.

Complementary feeding patterns in a developing country: a cross-sectional study across Lebanon

This first, large-scale study on complementary feeding in Lebanon analysed the timing and types of food introduced to infants according to mothers' demographic and socioeconomic and infants' characteristics. A cross-sectional survey over 10 months found that the majority of infants were introduced to solid foods at or after 4 months of age. A large number of infants were given liquids other than breast or formula milk earlier. Women in employment outside the home were almost twice as likely to introduce solid foods before age 4 months. The most common starting food was cereals. More than half the children consumed starchy foods and fruits every day, but not meats and fish

Irritability during the month of Ramadan.

OBJECTIVES: We hypothesized that people in Morocco are more irritable during the month of Ramadan than during the rest of the year. Our objectives were to measure irritability in fasting Muslims during the month of Ramadan, to describe its various modes of expression, and to examine risk factors for this irritability. METHODS AND SUBJECTS: We studied 100 healthy volunteers during the month of Ramadan for two successive years (1994 and 1995). All subjects were male (mean age, 32+/-5.8 years), and 51% of them were smokers. Irritability was assessed over a 6-week period (before, four times during, and after the end of Ramadan). We assessed both subjective (visual analog scale) and objective irritability. We also recorded the consumption of psychostimulants, duration of sleep, and anxiety level as measured by the Hamilton Anxiety Scale. RESULTS: Irritability was significantly higher in smokers than in nonsmokers before the beginning of Ramadan. It was higher in both groups during the Ramadan month. Irritability increased continuously during Ramadan and reached its peak at the end of the month. Consumption of psychostimulants (coffee and tea) and anxiety level followed the same pattern. Smokers and nonsmokers had a similar pattern of irritability over time, but irritability increased more in smokers than in nonsmokers.