Effect of the Low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAP) Diet on Control of Pediatric Irritable Bowel Syndrome and Quality of Life Among a Sample of Egyptian Children: A Randomized Controlled Clinical Trial.

BACKGROUND: Irritable bowel syndrome (IBS) is a pediatric pain-dominant functional gastrointestinal disorder that has a negative impact on all children's dimensions of quality of life. A dietary approach that focuses on limiting food elements with high fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) can be used to decrease symptoms of IBS. This study aims to evaluate the effect of low FODMAP dietary intervention on health-related quality of life among a sample of Egyptian children. METHODS: Eighty-four children aged 5-15 years old were randomly assigned to two groups, 42 patients in the low FODMAP diet group and 42 patients in the standard diet group. They received the diet for six weeks and were followed up weekly using a visual analog scale (VAS) for pain severity assessment, the Pediatric Quality of Life (PedsQL) Inventory Gastrointestinal (GI) Symptoms Module Scale, and the PedsQL Inventory Generic Core Scale to assess the physical and psychosocial functioning of the patients. RESULTS: The VAS score decreased more in the low FODMAP group, which caused a significant difference between the two groups (p<0.001). The PedsQL Inventory GI Symptoms Module score increased more among the low FODMAP group, and this caused a significant difference between the two groups (p<0.001). PedsQL Inventory Generic Core score increased more among the low FODMAPs group, and this caused a significant difference between the two groups (p<0.001). CONCLUSION: Low FODMAP dietary intervention in pediatrics for six weeks decreased abdominal pain severity, improved gastrointestinal symptoms, and improved the health-related quality of life of the affected children.

Lifestyle and eating habits changes among adults during COVID-19 era in Egypt: a population-based study.

BACKGROUND: The 2019 recent Coronavirus is without a doubt one of the most complicated viruses to ever pose a threat to humanity. Numerous viral containment strategies forced sedentary behaviors and dietary changes that would-otherwise- increase the chances of acquiring non-communicable diseases. OBJECTIVES: The objectives of the current study are to identify any changes in eating behaviors through the Mediterranean Diet Adherence in a sample of Egyptians throughout the COVID-19 era. METHODS: A cross-sectional study was done on a sample of 205 Egyptians by an online self-administered questionnaire. The questionnaire included socio-demographic factors, self-reported weights and heights, a validated Arabic form of the well-known International Physical Activity Questionnaire Short Form (IPAQ-SF), a validated Arabic version of 14-items Mediterranean Diet Adherence Screener (MEDAS), in addition to a section assessing dietetic changes. The data was then analyzed using the SPSS version 20 (Statistical Package for Social Sciences). RESULTS: The majority of the study sample were females (74.6%); had a high level of education (93.2%); and about 75% were married. Most of the participants were non-smokers, with around a 7% increased frequency of smoking after the COVID-19 pandemic. Fast food consumption was also reported by a major percentage of study participants (60%). Low Mediterranean Diet Adherence was found in 52.7%. Moreover, Physical Activity (PA) decreased to 61%. Moreover, there was a statistically significant increase seen in the participants' BMI as well as the number of sleeping hours (p = 0.001 and 0.043 respectively) after the pandemic. Both changed hunger sensation and any changes in physical activity were significantly associated with increased BMI (p < 0.001). CONCLUSION AND RECOMMENDATIONS: A substantial proportion of the participants showed unhealthy changes in their dietary habits as well as physical activity. Consequently, this calls for urgent public health policies and interventions to guard against the consequences of such unhealthy behaviors.

Health care workers' perceptions of their hospitals' preparedness during the COVID-19 virus pandemic in three different world regions.

Introduction: Pandemics are extraordinary circumstances that necessitate a multifaceted approach to getting the most out of healthcare systems. Health authorities should be aware of the beliefs and attitudes of healthcare professionals before adopting control measures and communication campaigns. We aimed to find out how hospital staff members in three economically diverse regions perceive their facility's preparedness for pandemics. Methodology: A hospital-based cross sectional study was done in three separate world regions, classified according to the World Bank's economics, using a web-based questionnaire. A convenience sample of 450 healthcare workers was collected and analyzed using SPSS version 20. Results: Physicians made up 94.4% of the 450 participants, with 50.3% from High-Income Foreign Countries (HIFC), 20.4% from High-Income Arab Countries (HIAC), and 29.3% from Lower Middle-Income Countries (LMIC). 81.5% of participants from HIAC had formal PPE training, compared to 22.7% and 64.4% of participants from LMIC and HIFC, respectively. Evidently, 39.4% of the HIFC's participants stated that the level of their hospital precautions during the pandemic was above average, as compared to 50% and 14.4% of participants from HIAC and LMIC, respectively. Compared to 42.4% of HIAC participants and 36.4% of LMIC participants, 44.6% of HIFC participants reported feeling at risk because of their clinical role. Conclusion: In all three regions, hospital readiness was well viewed by healthcare professionals; nevertheless, more needs to be done to provide them with psychological and social support. This research may help health authorities put up a suitable preparedness plan to face emerging pandemics. Further research is needed to determine the best course of action to combat comparable pandemics at various economic levels.

Effectiveness of virtual reality-based programs as vestibular rehabilitative therapy in peripheral vestibular dysfunction: a meta-analysis.

PURPOSE: To study the efficacy of virtual reality (VR) interventional programs as a vestibular rehabilitative method for patients with uncompensated peripheral vestibular disorders. METHODS: The databases PubMed, Google scholar, Embase and Cochrane Library were used (up to July 2021). Studies selected in this study were controlled trials in which virtual reality was used as vestibular rehabilitative therapy in comparison to any other vestibular rehabilitative methods or medical or dietary recommendations. Comparison was made in at least one of these outcomes measures; Subjective measures such as Dizziness Handicap Inventory, Vertigo Symptom Scale-Short Form questionnaire, Activities-specific Balance Confidence questionnaire, Dizziness Analogue Scale or Visual Analogue Scale, besides objective measures as posturography. Six articles were included in the meta-analysis; tested for heterogeneity of the estimates using chi-squared and I2 tests, outcomes were expressed as mean difference and 95% CI. Estimates from included studies were pooled using the random-effect model. RESULTS: virtual reality as a vestibular rehabilitative intervention was able to improve scores of Dizziness Handicap Inventory, Vertigo Symptom Scale-Short Form questionnaire, Visual Analogue sale and posturography as outcome measures of vestibular rehabilitation. CONCLUSION: virtual reality has a potential clinical benefit for vestibular rehabilitation in peripheral vestibular dysfunction compared with conventional vestibular rehabilitation methods. However, further research is needed to document the exact parameters of an optimal protocol for virtual reality rehabilitation, the period needed for effective rehabilitation and its side effects.

Neglected cause of retinal detachment: a hospital-based case-control study on occupational heavy lifting as a risk factor.

BACKGROUND: Heavy lifting may lead to sudden increase in venous, intra-abdominal, and intraocular pressure which in turn may cause retinal detachment (RD). The epidemiological evidence for this association is still inconclusive. This study was carried out to investigate the relationship between occupational heavy lifting and RD. METHODS: A case-control study was carried out on 151 RD cases and 113 controls free of RD attending the ophthalmology outpatient clinic at Ain Shams University. Personal, medical, and occupational data were collected using interview questionnaires in addition to conducting full ophthalmologic examination. RESULTS: The mean age of study participants was 45.8 ± 9.1 years (46.8 ± 8.9, 44.4 ± 9.2 for RD cases and controls respectively). Statistically significant differences were found between cases and controls regarding years of working, occupational categories, frequency of occupational heavy lifting, non-work heavy lifting, history of head trauma, history of eye surgeries, and family history of RD. Multivariate logistic regression analysis showed that lifting (Odds ratio (OR) = 4.8, p < 0.0001), history of head trauma (OR = 3.3, p = 0.013), diabetes mellitus (DM) (OR = 4.96, p < 0.0001), and previous eye surgeries (OR = 3.5, p = 0.003) increased the risk of RD. CONCLUSION: Occupational heavy lifting is associated with RD. Occupational categories, duration of lifting heavy objects during work and family history of RD had a significant effect on RD. An ergonomic approach should be adopted and practiced as it has a significant impact on reducing the risks of lifting and carrying heavy objects. The workplace's design (including having appropriate mechanical aids available) is also of significant importance to reducing the risks. During the patient's visit, ophthalmologists should consider and look for the occupational heavy lifting history as a potential risk factor of the patient's symptoms.

Impact of urinary incontinence on physical performance and quality of life (QOL) amongst a group of elderly in Cairo.

OBJECTIVES: Urinary incontinence (UI), involuntary loss of urine, is a common disorder affecting the elderly population worldwide. UI can be associated with poor quality of life (QOL) in this vulnerable population, as it limits both physical and social activities of daily living (ADLs). Additionally, it has a psychological and economic burden on individuals, healthcare services and society. This study was conducted to measure the frequency of UI amongst the elderly and determine its impact on the overall QOL, physical performance, and ADLs. PARTICIPANTS AND METHODS: A cross-sectional study was conducted in four primary healthcare centres in El-Obour City. Data collection was performed weekly on randomly chosen days. All elderly individuals aged 60 or above, who attended the centres on those days, were included. RESULTS: The overall frequency of UI was 38% amongst the population under study. UI ranged from mild (12.3%) to moderate (57.9%) to severe (29.8%). Amongst incontinent participants, the frequency of UI was 47.4% in men and 52.6% in women. The frequency of stress, urge, mixed and other types of UI were 7%, 33.3%, 40.4% and 19.3%, respectively. Incontinent elderly had significantly lower QOL regarding mental and physical indices than their continental counterparts. UI severity was inversely related to physical performance. CONCLUSION: UI has a high prevalence rate amongst elderly individuals and significantly affects all aspects of QOL, especially physical performance.

Treatment outcomes for childhood acute lymphoblastic leukemia in low-middle income country before minimal residual disease risk stratification.

BACKGROUND: Outcome of childhood acute lymphoblastic leukemia (ALL) in low- and middle-income countries is lagging in many aspects including diagnosis, risk stratification, access to treatment and supportive care. OBJECTIVE: to report the outcome of childhood ALL at Ain Shams University Children's Hospitals with the use of risk-based protocols before the implementation of minimal residual disease technology and to evaluate the use of double delayed intensification (DDI) in standard risk patients. METHODS: Two hundred and twenty patients with ALL diagnosed between January 2005 and December 2014 were included in the study. Patients were treated according to a modified CCG 1991 and 1961 for standard and high risk respectively. Patients were stratified into three risk groups: standard risk (SR), high-risk standard arm (HR-SA), and high-risk augmented arm (HR-AA). RESULTS: Among the whole cohort, the 10-year event-free survival (EFS) and overall survival (OS) were 78.1% and 84.3% respectively. Patients with Pre-B immunophenotype (IPT) had significantly better outcome than T-cell IPT (EFS 82.0% versus 58.6%, p < 0.001; OS 86.9% versus 69%, p = 0.003 for Pre-B and T-cell respectively). Among the SR group, patients treated with single delayed intensification (SDI) had comparable EFS and OS rates when compared to patients treated with DDI with EFS 82.4% versus 87.5%, p = 0.825 and OS 88.2% versus 93.5%, p = 0.638 for SDI and DDI groups, respectively. CONCLUSION: The use of risk-based protocol with simple laboratory techniques resulted in acceptable survival outcome in resource limited settings. The use of double delayed intensification showed no survival advantage in patients with standard risk.

Awareness about breast cancer and mammogram among women attending outpatient clinics, Ain Shams University Hospitals, Egypt.

BACKGROUND: Breast diseases in women, whether benign or malignant, are very commonly encountered. The breast is the commonest site for female cancer in Egypt (38.8%). Breast cancer screening can reduce morbidity and mortality and improve the survival rate for this malignancy. Mammogram can be used as a screening technique beside its role as diagnostic, especially in women over 40 years of age. OBJECTIVES: To assess knowledge, attitude and practice regarding breast cancer and awareness about mammogram as a screening method among a group of females attending Ain Shams University outpatient clinics. METHODS: A cross-sectional study was performed from August to September 2017. A systematic random sample was taken from attending females (18-70 years) in Ain Shams University outpatient clinics (Internal Medicine, Surgery, Pediatrics Hospital, and Maternity hospital). They were interviewed using a questionnaire inquiring about sociodemographic background, participants' knowledge, attitude, and practice towards breast cancer and its screening. RESULTS: The mean age ± SD of attending females (18-70 years) was 37 ± 11 years. Most study participants had correct information about mammography. They showed poor knowledge level about risk factors. Mass media such as TV and internet were identified as the main source of information on breast cancer by 43% and 23.9%, respectively. In general, participants had positive attitude towards breast cancer screening by mammography. Around 90% agreed that mammogram was the best way to find a very small lump in the breast, and 91.4% agreed that women who have regular screening by mammogram have better disease outcome than those who do not screen. Regarding mammography practice rate, a small percent of participants (8.1%) was advised by their doctors to conduct a screening mammography. The level of knowledge was significantly and positively correlated with their attitude towards breast cancer screening. CONCLUSION: The poor knowledge and practices of women illustrate the need for health education program directed to Egyptian females to improve their knowledge about breast cancer-especially its risk factors-and its screening. Using TV and Internet as media for spreading information about this disease is crucial.

Factors associated with irritable bowel syndrome among medical students at Ain Shams University.

BACKGROUND: Irritable bowel syndrome (IBS) is one of the most common and potentially disabling gastrointestinal disorders. The pathogenesis of this disorder remains obscure. However, many etiological explanations point toward bacterial etiology. Also, several studies have documented that psychological and social factors may play a role. Medical education is among the most challenging and stressful education, and this may predispose to high rates of IBS. OBJECTIVES: The aims of this study are to estimate the frequency of IBS in a selected sample of students of Faculty of Medicine in Ain Shams University and to find out the determinants associated with this disorder. STUDY DESIGN: A cross-sectional study was carried out among medical students from October 2017 to February 2018 at Faculty of Medicine-Ain Shams University. All participants were asked to complete a confidential self-administered questionnaire. An interview questionnaire was used for diagnosis of IBS according to Rome III criteria, while morbid anxiety and depression were diagnosed by using the Arabic version of Hospital Anxiety and Depression Scale (HADS). RESULTS: Three hundred eighty-two students completed the questionnaire. The frequency of IBS was 31.7% with higher proportion among females and among students with positive family history of IBS. However, IBS was significantly less prevalent among students practicing regular exercise. Lastly, based on (HADS), there was a statistical significant relationship between IBS and anxiety (p < 0.05), but not depression. CONCLUSION: The study revealed that around 31% of the studied group was suffering from IBS. Female gender, suffering from anxiety, and positive family history of IBS were the main associated factors for IBS. Screening of all medical students in the faculty for IBS is suggested. Providing psychological and emotional support along with stress management is highly recommended.