Exploration of the nutrition knowledge among general population: multi-national study in Arab countries.

BACKGROUND: Knowing what to eat and realizing the significance of healthful eating habits are among the important steps to promoting eating behavior. The current study aims to assess the nutrition knowledge (NK) among a convenient sample in four different countries, determine the association between different demographic factors and NK, and investigate the need for future interventions on nutrition in the four selected countries. METHODS: A cross-sectional multi-national survey study among a convenient sample of 8,191 subjects from Egypt, Syria, Saudi Arabia, and Jordan who undertook surveys between January 2019 and January 2020. A pre-tested interview questionnaire was utilized for data collection from study participants. It included three sections: i) Sociodemographic characteristics:. ii). Section two included twenty-one questions related to NK.. iii). Section three included one question about NK sources. RESULTS: About three-quarters showed inadequate nutrition knowledge (73.1%). Youth (15-24 yrs.) were more dependent on social media, with 87% using it as a primary source of NK, while adults (≥ 25 yrs.) demonstrated that 43% of them used social media. In contrast, TV was more prominent among them, with participants' characteristics such as living with parents, body mass index, and country of residence showing no association with NK. However, female sex, education, and reading nutrition articles are significantly correlated with adequate knowledge (p < 0.001). Significant predictors of satisfactory knowledge were age, sex, education, living with parents, and reading nutrition articles. CONCLUSION: The study revealed low levels of NK indicating an urgent need to implement educational programs to promote nutrition knowledge. As NK is a modifiable determinant of diet intake and can positively impact the need for developing strategies in counselling and raising awareness among the general population to improve their health status.

Cryptorchidism and Fertility.

Cryptorchidism, the failure of one or both testes to descend into the scrotum prenatally, occurs in 2.4%-5% of newborns. Many of these testes will descend spontaneously shortly after birth, but ~23% will remain undescended unless surgery is performed. Bilaterally cryptorchid men have a six times greater risk of being infertile when compared with unilaterally cryptorchid men and the general male population. Approximately 10% of infertile men have a history of cryptorchidism and orchidopexy. The main reasons for infertility in men with a history of cryptorchidism treated by orchidopexy are maldevelopment of the testes and an improper environment for the normal development of the testes, hyperthermia, and antisperm antibodies.

Slow vs rapid delivery rate shock wave lithotripsy for pediatric renal urolithiasis: a prospective randomized study.

PURPOSE: We compared slow vs fast shock wave frequency rates in disintegration of pediatric renal stones less than 20 mm. MATERIALS AND METHODS: Our study included 60 children with solitary 10 to 20 mm radiopaque renal stones treated with shock wave lithotripsy. Patients were prospectively randomized into 2 groups, ie those undergoing lithotripsy at a rate of 80 shock waves per minute (group 1, 30 patients) and those undergoing lithotripsy at a rate of 120 shock waves per minute (group 2, 30 patients). The 2 groups were compared in terms of treatment success, anesthesia time, secondary procedures and efficiency quotient. RESULTS: Stone clearance rate was significantly higher in group 1 (90%) than in group 2 (73.3%, p = 0.025). A total of 18 patients in group 1 (60%) were rendered stone-free after 1 session, 8 required 2 sessions and 1 needed 3 sessions, while shock wave lithotripsy failed in 3 patients. By comparison, 8 patients (26.6%) in group 2 were rendered stone-free after 1 session, 10 (33.3%) required 2 sessions and 4 (13.3%) needed 3 sessions to become stone-free. Mean general anesthesia time was significantly longer in group 1 (p = 0.041). Postoperatively 2 patients in group 1 and 4 in group 2 suffered low grade fever (Clavien grade II). Significantly more secondary procedures (percutaneous nephrolithotomy, repeat shock wave lithotripsy) were required in group 2 (p = 0.005). The predominant stone analysis was calcium oxalate dihydrate in both groups. Efficiency quotient was 0.5869 and 0.3437 for group 1 and group 2, respectively (p = 0.0247). CONCLUSIONS: In children with renal stones slow delivery rates of shock wave lithotripsy have better results regarding stone clearance than fast delivery rates.

Changing patterns (age, incidence, and pathologic types) of schistosoma-associated bladder cancer in Egypt in the past decade.

OBJECTIVE: To assess the patterns of schistosomiasis-associated bladder cancer in Egypt from 2001 to 2010 in a retrospective study. Bilharzial bladder carcinoma is the most common cancer, particularly in Egyptian men. Classically, carcinoma in a bilharzial bladder is most commonly of the squamous cell type. During the past decade, certain changes have occurred in the features in Schistosomiasis-associated carcinoma in Egypt with a decline in the frequency of squamous cell carcinoma and increase in the frequency of transitional cell carcinoma. METHODS: This was a retrospective study of 1932 patients treated at Kasr Al Aini Hospital, Cairo University, from 2001 to 2010. Two groups were selected: group 1 included 1002 patients from 2001 to 2005 and group 2 included 930 patients from 2006 to 2010. RESULTS: The mean patient age increased from 41±11.2 years to 52±8.6 years, and the male/female ratio changed from 5.6:1 to 4.2:1. The incidence of associated bilharziasis decreased from 80% to 50%. A significant increased occurred in transitional cell carcinoma from 20% to 66%, with a significant decrease in squamous cell carcinoma from 73% to 25%. No difference was observed in the tumor stage or grade or incidence of lymph node metastases between the 2 groups. CONCLUSION: The pattern of incidence of the various histologic types of bladder cancer have changed, with most cases now transitional cell carcinoma, in contrast to the findings in the earlier Egyptian series. Additional studies are encouraged to explain the factors explaining these changes.

Long-term follow-up (18-35 years) of male patients with history of bladder exstrophy (BE) repair in childhood: erectile function and fertility potential outcome.

INTRODUCTION: Bladder exstrophy is a rare condition that may lead to severe psychosexual malformation and require a lifelong follow-up. AIM: We describe the long-term sexual outcome of patients with bladder exstrophy treated at our institution at early stage. METHODS: Thirty patients with mean age of 26 years (range 18-35 years) were included in the study. Fifteen patients underwent staged primary reconstruction, five patients underwent complete primary repair, and 10 patients underwent primary or secondary ureterosigmoidostomy. MAIN OUTCOME MEASURES: Evaluation consisted of pediatric medical records, interview questionnaire including the psychosexual history, International Index of Erectile Function (IIEF), and semen analysis. RESULTS: Erectile functions were maintained in 28 patients based on IIEF domain score. In all cases, penile length was objectively less than average (mean 7.65 cm). Seven patients were not satisfied with their penile length, and four cases complained of slight curvature. Ten patients were married (33%), of whom four patients had children (after normal conception in three, and after assisted reproductive technique in one). The remaining 20 patients were not married because of the feeling of sexual inadequacy to be able to engage in sexual intercourse (six patients), afraid of the cosmetic appearance of the genitalia (10 patients), and incontinence (four patients). Retrograde ejaculation was documented in 16 cases (53.5%), low volume ejaculate in eight cases (26.5%), and anejaculation in six cases (20%). Cosmetic outcome was considered satisfactory by 50% of the patients. Sixteen patients voided per urethra, four performed clean intermittent catheterization, and 10 patients had ureterosigmoidostomy diversion. Urinary tract infection was documented in 20% of the cases, and recurrent attacks of pyelonephritis in 10% of the cases. CONCLUSION: Long-term outcome of bladder exstrophy repair in male patients showed fair results with respect to sexual function with more or less stable sexual relationship. We should do our best to solve the problem of those with restricted sexual lives.

Radical cystectomy with preservation of sexual function and fertility in patients with transitional cell carcinoma of the bladder: new technique.

OBJECTIVES: Radical cystectomy is the standard treatment for patients with invasive bladder carcinoma. Preservation of sexual function and fertility are important for surgery acceptance in young patients with this disease, and part of the prostate is generally preserved for this reason; however, this may compromise the radical nature of the surgery. Herein a novel technique of radical cystectomy with preservation of the vas deferens only is described aimed at preservation of sexual function and better cancer control. METHODS: Between March 2002 and February 2004, four potent male patients with muscle invasive transitional cell carcinoma of the bladder underwent nerve-sparing radical cystectomy with urinary diversion. The bladder, prostate with prostatic urethra, regional lymph nodes and seminal vesicles were removed while the vas deferens was preserved until its terminal end and anastomosed (in the perineum) to the bulbar urethra (end to side). The diversion was ureterocolic in three patients and ileal conduit in one patient. The median age of the patients was 45.0 years (range 35-55). The mean follow-up was 35.5 months (range 23-46 months). RESULTS: There was no mortality. All patients were free of the disease (no local or distant recurrence) at the last follow-up. All patients reported adequate sexual function with normal erections and satisfactory intercourse similar to that reported before surgery. Two patients maintained antegrade ejaculation allowing procreation in one case. CONCLUSION: This technique allows preservation of sexual function in nearly all cases with better oncological outcome than any other techniques of radical cystectomy aimed at preservation of sexual function.

Management of high-grade renal injuries in children after blunt abdominal trauma: experience of 40 cases.

OBJECTIVE: We present our experience of management of high-grade renal trauma in a pediatric population, including assessment of the long-term function and morphology of the ipsilateral kidney. PATIENTS AND METHODS: From 1997 to 2005, 40 children with high-grade renal injury (III, IV, V) after blunt abdominal trauma were managed. Initial evaluation included vital signs, color of urine, hemoglobin (Hb%), hematocrit, serum creatinine and computed tomography (CT). Follow up included vital signs, urine analysis, Hb%, CT, +/-intravenous pyelogram and renogram. RESULTS: One patient needed superselective embolization due to continuing hemorrhage in spite of conservative treatment. Internal stenting plus percutaneous tube drain was indicated in three cases due to progressive extravasation. Exploration was indicated in four cases, one at presentation due to hemodynamic instability which ended in nephrectomy; the other three were successfully repaired. Conservative treatment was successful in 32 cases (80%). Blood transfusion was indicated in 16 cases (40%). Length of hospital stay was 4-20 days (mean 12.1). At the last follow up (range 1-8 years, mean 3.5), scars were detected in 10 cases, while all showed normal levels of Hb% and creatinine. No patient developed hypertension. Apart from in the nephrectomy case, the ipsilateral kidney showed split function of 40-50%. CONCLUSION: After exclusion of hemodynamic instability and continuing hemorrhage, conservative treatment is successful in 80% of patients. Internal stenting with or without percutaneous drainage is indicated if there is progressive urinoma. Angioembolization is successful in selected cases.

Preservation of ejaculatory and erectile function after radical cystectomy for urothelial malignancy.

BACKGROUND: During treating cancer patients, sexual issues should not be forgotten. With increasing survival from urologic cancer, quality of life and quality of sexuality have became very important targets in treating those patients. Fertility to those patients who desire fatherhood is sometimes more important than cancer morbidity, especially young patients in the rural areas in our country, to the extent that they may refuse the operation. We describe a new technique to preserve the erectile function and antegrade ejaculation after radical cystectomy. PATIENTS AND METHODS: Seven potent men with a median age of 40 years (range 35-50) presented with invasive transitional cell carcinoma (TCC) of the lateral or the anterior bladder wall. All patients wished to preserve the ejaculatory function and fertility potential. We described the surgical technique of nerve sparing radical cystectomy with preservation of the vas deferens, seminal vesicles, whole prostate and neurovascular bundles. The follow up period ranged from six months to three years (mean 20 months) to assess recurrence, erectile function and ejaculatory function. RESULTS: Erectile function is normal in all patients with satisfactory sexual intercourse. Antegrade ejaculation was documented in six cases. One of them fathered a child. No local or distant recurrence was detected in the seven patients at the last follow-up. CONCLUSION: The technique of radical cystectomy (with preservation of the vas deferens, whole prostate and seminal vesicle) is a good option in selected young men with bladder carcinoma in whom preservation of fertility is desirable.