Publications by authors named "Ahmed Arafa"

45 Publications

Laparoscopic-assisted transanal pull-through for hirschsprung's children older than 3 years: A case series.

Afr J Paediatr Surg 2021 Oct-Dec;18(4):210-214

Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University Specialized Pediatric Hospital, Cairo University, Cairo, Egypt.

Context: Hirschsprung's disease (HD) is a congenital anomaly affecting the enteric nervous system commonly the rectosigmoid region. Treatment is surgical where the aganglionic segment is resected, and bowel continuity is restored by a coloanal anastomosis. In 1999, Georgeson et al. proposed a new technique of primary laparoscopic-assisted pull-through for HD as a new gold standard.

Aim: The aim of the study was to evaluate the outcome of the laparoscopic-aided transanal pull-through procedure for the management of HD in children older than 3 years of age.

Methods: This study was conducted on 15 consecutive patients presented to a university hospital, diagnosed as having HD relying on their clinical features, barium enema study and rectal biopsy. In all cases, laparoscopic-assisted transanal pull-through was attempted. The laparoscopic part included transition zone identification, seromuscular biopsy for fresh frozen histopathology and sigmoid and rectal mobilisation as much as possible down the peritoneal reflection. The transanal part included mobilisation of the rectal lower segment by 2-3 cm, resection till the ganglionic segment, and full-thickness two-layer coloanal anastomosis was done.

Results: Early complications occurred in eight cases: enterocolitis in four cases and perianal excoriation occurred in four cases. There were no cases of anastomotic leak. Late complications occurred in seven patients: four cases developed stricture at the site of coloanal anastomosis and three cases experienced enterocolitis at 6 and 9 months postoperatively.

Conclusion: Laparoscopic-aided transanal pull-through procedure is a safe, feasible modality for the management of HD in children more than 3 years.
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http://dx.doi.org/10.4103/ajps.AJPS_161_20DOI Listing
August 2021

Modifiable Risk Factors for Cardiovascular Disease in Korea and Japan.

Korean Circ J 2021 Aug 27;51(8):643-655. Epub 2021 May 27.

Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan.

Cardiovascular disease (CVD) is the leading cause of death and a major contributor to disability worldwide. Since the majority of cardiovascular events are preventable, identification of modifiable CVD risk factors and implementation of primordial prevention strategies should be a public health priority. In this aspect, the American Heart Association declared a strategic goal to reduce total CVD mortality in the US by 20% within 10 years via eliminating 7 major CVD risk factors (hypertension, diabetes, dyslipidemia, cigarette smoking, physical inactivity, obesity, and poor-quality diet) in 2010, and their strategy has been achieving. However, the applicability of similar metrics to prevent CVD among East Asians requires an in-depth investigation of the modifiable CVD risk factors based on national and regional evidence-based findings. Herein, this review article aims to discuss several modifiable risk factors for CVDs, using epidemiological evidence from cohort studies and nationally representative data of 2 East Asian countries: Korea and Japan.
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http://dx.doi.org/10.4070/kcj.2021.0121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326218PMC
August 2021

Diabetes and Risk of COVID-19 Mortality: A Systematic Review and Meta-Analysis.

Infect Dis Clin Pract (Baltim Md) 2021 May 15;29(3):e195-e197. Epub 2021 Jan 15.

Department of Public Health Graduate School of Medicine, Osaka University Osaka, Japan

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http://dx.doi.org/10.1097/IPC.0000000000000992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115424PMC
May 2021

Factors affecting prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Egypt: A cross-sectional study.

PLoS One 2021 2;16(6):e0252044. Epub 2021 Jun 2.

Department of Public Health and Community Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.

Purpose: This study aimed to assess the factors affecting the prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Upper Egypt.

Materials And Methods: In this cross-sectional study, the following data were retrieved from the hospital records of 632 injured patients between 1/1/2018 and 31/3/2018: age, sex, residence, means of transportation to the hospital, prehospital time delay, consciousness level on admission, source of injury, and type of worst injury.

Results: The prehospital time delay (>one hour) of the injured patients was positively associated with age >60 years and rural residence but inversely associated with consciousness level with odds ratios (95% confidence intervals) of 5.14 (2.26-11.68), 3.49 (2.22-5.48), and 0.56 (0.32-0.96), respectively.

Conclusion: The prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Egypt was associated with old age, rural residence, and consciousness level.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252044PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172024PMC
June 2021

Does multiple sclerosis increase the risk of preeclampsia? A systematic review and meta-analysis.

Hypertens Pregnancy 2021 May 17:1-6. Epub 2021 May 17.

Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.

: We investigated, via systematic review and meta-analysis, whether multiple sclerosis (MS) is associated with the risk of preeclampsia (PE).: From the eligible studies, we pooled odds ratios (ORs) and confidence intervals (CIs) of PE for pregnant women with MS compared with pregnant women without it using the fixed-effects model. The measured heterogeneity between studies.: Eight eligible studies (9 cohorts) were included. Pregnant women with MS had no excess risk of PE compared with pregnant women without MS (pooled OR = 0.99, 95% CI: 0.89, 1.09;  = 0.00%).: MS is not associated with PE.
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http://dx.doi.org/10.1080/10641955.2021.1921792DOI Listing
May 2021

Combined healthy lifestyle and depressive symptoms: a meta-analysis of observational studies.

J Affect Disord 2021 06 26;289:144-150. Epub 2021 Apr 26.

Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan. Electronic address:

Background: To systematically summarize the association between combined lifestyle (at least three factors, including but not limited to smoking, drinking, physical activity, body mass index, diet) and depressive symptoms by a meta-analysis in general populations.

Methods: Multiple electronic databases were searched for observational studies investigating combined lifestyle factors and depressive symptoms published before September 2020. Pooled risk estimates were calculated using random-effects models. Publication bias was conducted using the Egger's and Begg's tests.

Results: A total of 12 studies with 185,899 participants were included. The pooled OR of depressive symptoms in meta-analysis of 7 cross-sectional studies was 0.53 (0.39, 0.72), I = 83.6%, P for heterogeneity <0.001 and the pooled RR was 0.33 (0.12, 0.89), I = 95.3%, P for heterogeneity <0.001 in meta-analysis of 5 cohort studies for people with the highest versus lowest score of heathy lifestyles. In sensitivity analyses, the heterogeneity was significantly reduced in cross-sectional studies (pooled OR = 0.74 [0.65, 0.85], I = 21.7%, P for heterogeneity = 0.27) and cohort studies (pooled RR = 0.53 [0.38, 0.74], I = 15.2%, P for heterogeneity = 0.32). The publication bias corrected by "trim-and-fill" analysis yielded unchanged results.

Limitations: Limitations included residual confounding in original studies, heterogeneity between studies, and potential publication bias in the analysis of cross-sectional studies.

Conclusion: The healthy lifestyle was associated with a reduced risk of depressive symptoms. Adherence to overall healthy lifestyles is essential for the primary prevention of depression in general populations.
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http://dx.doi.org/10.1016/j.jad.2021.04.030DOI Listing
June 2021

Laparoscopic Rectal and Vaginal Pull-Through in the Same Setting in Cloaca with Common Channel of More Than 3 cm Separation.

Authors:
Ahmed Arafa

J Laparoendosc Adv Surg Tech A 2021 May 12. Epub 2021 May 12.

Department of Pediatric Surgery, Cairo University, Cairo, Egypt.

This study aims at evaluating the feasibility and outcome of a laparoscopically assisted rectal and vaginal pull-through procedure in the same setting for cases of long common channel in a cloaca >3 cm in length. I have 4 cases with a cloaca with long common channel >3 cm in length diagnosed by cloacogram and cystoscopy. As for the ages of our cases, two of them were 1 year old, and the other 2 cases were 2 years old. Laparoscopic rectal and vaginal pull-through in the same setting was performed in all cases. The operative time was 3 hours. A tension-free anastomosis of the rectum in anal complex was carried out; also anastomosis of vagina to the perineum was realized after laparoscopic mobilization of the vagina, separation from the bladder neck at the confluence and pull-through. This is to avoid perineal or perirectal dissection. Frequent anal and vaginal dilation after 2 weeks from operation was carried out. Our cases have not demonstrated any stricture, or urethrovaginal fistula. This procedure resulted in a good cosmetic and unimpaired functional outcome. It has been conducted also to avoid excessive perineal dissection, and reduce risk of urinary incontinence by evading the occurrence of urethral sphincter damage. Laparoscopic-assisted rectal and vaginal pull-through is a new approach for long common channel cloaca that avoids perineal dissection, reducing dissection, and risk of urinary incontinence. This technique should be used and implemented on a wide scale.
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http://dx.doi.org/10.1089/lap.2020.0828DOI Listing
May 2021

Smoking cessation, weight gain, cardiovascular risk, and all-cause mortality: a meta-analysis.

Nicotine Tob Res 2021 Apr 20. Epub 2021 Apr 20.

Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.

Objective: Quitting smoking usually results in weight gain, rising the concern that weight gain after smoking cessation may attenuate the benefits of smoking quitting on cardiovascular health. We aimed to examine the risk of cardiovascular disease (CVD) among smoking quitters compared with smokers, stratified by post-cessation weight change.

Methods: We searched PubMed, Scopus, and Web of Science for eligible studies published before September 2020. Cohort studies examining the relative risk (RR) of CVD among smoking quitters stratified by post-cessation weight change, with smokers being treated as the reference, were included. Two investigators extracted the key characteristics of each included study using a standard electronic form.

Results: We identified 9 studies for this meta-analysis. Compared with smokers, the pooled RRs (95% confidence interval) of CVD among quitters with weight gain and among those without were 0.74 [0.66, 0.83]) and 0.86 [0.80, 0.92]), with no evidence of heterogeneity between studies being observed. Moreover, the associations appeared to be significantly stronger among quitters with weight gain than those without, particularly in the analysis of coronary heart disease and stroke (pooled RRs = 0.65 [0.59, 0.71] vs. 0.79 [0.71, 0.88] for coronary heart disease and 0.67 [0.62, 0.73] vs. 0.76 [0.72, 0.81] for stroke, respectively; P for interaction < 0.05).

Conclusions: Smoking cessation was associated with a significantly lower risk of CVD and all-cause mortality, regardless of post-cessation weight gain. A greater risk reduction among quitters with weight gain than those without merits further investigations.
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http://dx.doi.org/10.1093/ntr/ntab076DOI Listing
April 2021

Engaging in musical activities and the risk of dementia in older adults: A longitudinal study from the Japan gerontological evaluation study.

Geriatr Gerontol Int 2021 Jun 6;21(6):451-457. Epub 2021 Apr 6.

Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.

Aim: Leisure cognitive activities are suggested to reduce the risk of dementia. Herein, we aimed to investigate the prospective association between engaging in different musical activities and the risk of dementia among Japanese older adults.

Methods: Longitudinal data of 52 601 participants aged ≥65 years from the Japan Gerontological Evaluation Study were analyzed. Musical activities in the form of playing a musical instrument, practicing karaoke and choir or folk singing were assessed using a questionnaire, while dementia was diagnosed using the standardized dementia scale of the long-term care insurance system. The Cox regression was used to obtain the hazard ratios and 95% confidence intervals (CIs) for incident dementia according to engagement in musical activities.

Results: Compared with engaging in no musical activities at all, the hazard ratios engaging in one and more than one musical activity, after 5.8 years of a median follow-up period, were 0.94 (95% CI 0.82-1.07) and 0.59 (95% CI 0.32-1.10) in men versus 0.79 (95% CI 0.69-0.90) and 0.89 (95% CI 0.63-1.26) in women, respectively. Playing a musical instrument and practicing karaoke, compared with no musical activities at all, were associated with a faintly decreased risk of dementia in men and a significantly decreased risk of dementia in women; hazard ratios 0.70 (95% CI 0.45-1.02) and 0.90 (95% CI 0.79, 1.04) in men versus 0.75 (95% CI 0.58-0.98) and 0.77 (95% CI 0.68-0.89) in women, respectively.

Conclusion: Engaging in musical activities, especially playing a musical instrument and practicing karaoke, was associated with a reduced risk of dementia among Japanese older women. Geriatr Gerontol Int 2021; 21: 451-457.
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http://dx.doi.org/10.1111/ggi.14152DOI Listing
June 2021

Implementing Medical Chatbots: An Application on Hidradenitis Suppurativa.

Dermatology 2021 Mar 19:1-7. Epub 2021 Mar 19.

Department of Dermatology, University Hospital Zurich, Zurich, Switzerland,

Background: The use of digital health resources is growing quickly as they are easily accessible and permit self-evaluation. Yet, research on consumer health informatics platforms is insufficient. Chatbots, interactive conversational platforms based on artificial intelligence, can facilitate access to specific information. Hidradenitis suppurativa (HS) is burdensome and has a high threshold for consultation.

Objectives: We aimed to identify the most important principles for the assembly of medical chatbots through the analysis of usage data.

Methods: The HS Chatbot1 is a question-and-answer platform in the style of a chatbot. Usage data were collected over the course of a year. 254 responses were statistically analysed.

Results: 239 users were alleged patients. 82.9% were looking for a tentative diagnosis. The users were on average 32.49 (±11.33) years old and predominantly female (70.2%). The average number of clicks per visit on the website was 14.69 (±8.83).

Conclusions: A medical chatbot has to be customised to the specific subject whilst general principles have to be considered. High-quality information has to be available in just a few clicks. People concerned about HS are looking for a diagnosis online and often have not seen a doctor previously. Guidance towards appropriate care should be provided.
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http://dx.doi.org/10.1159/000511706DOI Listing
March 2021

Public attitudes towards people who stutter in South Egypt.

PLoS One 2021 4;16(2):e0245673. Epub 2021 Feb 4.

Department of Communication Sciences and Disorders, West Virginia University, Morgantown, West Virginia, United States of America.

Purpose: Stuttering is a multifactorial speech disorder with significant social and psychological consequences. There is a lack of knowledge about public attitudes towards people who stutter (PWS) and the factors that can determine such attitudes in underprivileged communities. This study aimed to assess the public attitudes in South Egypt towards PWS and compare our results with those stored in a reference database representing 180 different samples.

Methods: A multi-stage random sampling approach was used to recruit 650 people from Beni-Suef City in South Egypt. All participants were interviewed using the Arabic version of the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) after getting their informed consent. This instrument assesses people's Beliefs and Self Reactions towards PWS in addition to their sociodemographic characteristics.

Results: The Beliefs and Self Reactions subscores in addition to the Overall Stuttering Score of the Egyptian sample were remarkably lower than the median values of the reference database (12 versus 34), (-4 versus 2), and (4 versus 18), respectively. TV, radio, and films were the main sources of knowledge about stuttering. Egyptian participants who reported average to high income were more likely to have a positive attitude (≥50% of Overall Stuttering Score) towards PWS than their counterparts with low income (Odds Ratio = 1.57, 95% Confidence Interval: 1.08-2.28).

Conclusion: People in South Egypt showed a less positive attitude towards PWS compared with other populations worldwide. Further studies should focus on changing the public attitudes towards PWS through awareness programs that consider the cultural perspectives of the society.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245673PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861357PMC
July 2021

Completeness of Medical Records of Trauma Patients Admitted to the Emergency Unit of a University Hospital, Upper Egypt.

Int J Environ Res Public Health 2020 12 24;18(1). Epub 2020 Dec 24.

Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.

Trauma records in Egyptian hospitals are widely suspected to be inadequate for developing a practical and useful trauma registry, which is critical for informing both primary and secondary prevention. We reviewed archived paper records of trauma patients admitted to the Beni-Suef University Hospital in Upper Egypt for completeness in four domains: demographic data including contact information, administrative data tracking patients from admission to discharge, clinical data including vital signs and Glasgow Coma Scale scores, and data describing the causal traumatic event (mechanism of injury, activity at the time of injury, and location/setting). The majority of the 539 medical records included in the study had significant deficiencies in the four reviewed domains. Overall, 74.3% of demographic fields, 66.5% of administrative fields, 55.0% of clinical fields, and just 19.9% of fields detailing the causal event were found to be completed. Critically, oxygen saturation, arrival time, and contact information were reported in only 7.6%, 25.8%, and 43.6% of the records, respectively. Less than a fourth of the records provided any details about the cause of trauma. Accordingly, the current, paper-based medical record system at Beni-Suef University Hospital is insufficient for the development of a practical trauma registry. More efforts are needed to develop efficient and comprehensive documentation of trauma data in order to inform and improve patient care.
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http://dx.doi.org/10.3390/ijerph18010083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795587PMC
December 2020

Psychological impacts of COVID-19 pandemic on the university students in Egypt.

Health Promot Int 2020 Dec 25. Epub 2020 Dec 25.

Faculty of Medicine, Department of Occupational Medicine, Sohag University, Sohag, Minia, 61511 Egypt.

University students are at elevated risk for mental health problems. The COVID-19 pandemic and subsequent public health measures taken to combat it burdened the students' life with additional dramatic psychological impacts. The aim of this study was to investigate the psychological impacts that affected the university students in Egypt during the COVID-19 pandemic. An online survey was sent to the Egyptian university students via all means of online communication during the first week of May 2020 by using a non-probability snowball sampling. A survey included a short version Depression Anxiety Stress Scale-21 (DASS-21) and socio-demographic data. Overall, 70.5, 53.6 and 47.8% of Egyptian students had depression, anxiety and stress, respectively. Being a female, having a relative or acquaintance infected with COVID-19, having a preexisting chronic disease and lacking of psychological support from families, community and universities increase the risk of depression, anxiety and stress among Egyptian students. Being a medical student is associated with depression while, spending more time to follow news of COVID-19 pandemic is associated with increased anxiety. Egyptian students experience varying levels of psychological disturbance during COVID-19 pandemic. This study suggests that mental health of the university students should be carefully, monitored during the crisis and the universities should provide psychological-oriented services, adapted to these circumstances to mitigate its emotional impact on the students.
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http://dx.doi.org/10.1093/heapro/daaa147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7799058PMC
December 2020

Depressed, anxious, and stressed: What have healthcare workers on the frontlines in Egypt and Saudi Arabia experienced during the COVID-19 pandemic?

J Affect Disord 2021 01 24;278:365-371. Epub 2020 Sep 24.

Department of Public Health, Faculty of Medicine, Minia University, El-Minia, Egypt; Department of Public Health and Occupational Medicine, Faculty of Health Sciences - AlQunfudah, Umm AlQura University, Meccah, Saudi Arabia.

Introduction: As the Novel Corona Virus Disease (COVID-19) was declared by the world health organization a pandemic in March 2020, thousands of healthcare workers (HCWs) worldwide were on the frontlines fighting against the pandemic. Herein, we selected two Middle East countries; Egypt and Saudi Arabia to investigate the psychological impacts of the COVID-19 pandemic on their HCWs.

Methods: In this cross-sectional study, a Google survey was used to access HCWs in many hospitals in Egypt and Saudi Arabia between the 14th and 24th of April 2020. The survey assessed HCWs regarding their sociodemographic and occupational features, sleeping hours, and psychological impacts of the COVID-19 pandemic using the Depression Anxiety Stress Scale-21 (DASS-21).

Results: This study included 426 HCWs (48.4% physicians, 24.2% nurses, and 27.4% other HCWs). Of them, 69% had depression, 58.9% had anxiety, 55.9% had stress, and 37.3% had inadequate sleeping (<6 h/day). Female sex, age ≤30 years, working in Egypt, attending emergency and night shifts, watching/reading COVID-19 news ≥2 h/day, and not getting emotional support from family, society, and hospital were associated with a high likelihood of depression, anxiety, stress, and inadequate sleeping.

Limitations: the cross-sectional design restricted our ability to distinguish between preexisting and emerging psychological symptoms.

Conclusion: HCWs on the frontlines in Egypt and Saudi Arabia experienced depression, anxiety, stress, and inadequate sleeping during the COVID-19 pandemic.
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http://dx.doi.org/10.1016/j.jad.2020.09.080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831891PMC
January 2021

Age-related differences in driving behaviors among non-professional drivers in Egypt.

PLoS One 2020 3;15(9):e0238516. Epub 2020 Sep 3.

Department of Public Health and Community Medicine, Beni-Suef University, Beni-Suef, Egypt.

Purpose: This study aimed to investigate whether young and old non-professional drivers in South Egypt have aberrant driving behaviors compared with their middle-aged counterparts.

Materials And Methods: In this cross-sectional study, a total of 1764 non-professional drivers aged ≥ 19 years, residing in Beni-Suef in South Egypt, and having ≥ one year of driving experience were randomly selected. All drivers were asked to fill out a self-administered questionnaire, including personal information, driving habits, and the Arabic version of the Driver Behavior Questionnaire which evaluates driving violations, errors, and lapses.

Results: This study included 560 young drivers (19-25 years), 850 middle-aged drivers (26-59 years), and 354 old drivers (≥ 60 years). Compared with middle-aged drivers, young drivers reported more non-use of the seatbelt, eating while driving, and driving while feeling drowsy. Old drivers, in contrast, showed more careful driving behaviors including fewer violations, errors, and lapses and less likelihood of driving while feeling sleepy.

Conclusion: This study supports the conception that young drivers pose less careful driving habits. Initiating educational programs targeting young drivers to improve their driving habits and create a traffic safety culture in Egypt is highly warranted.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238516PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7470271PMC
October 2020

Psychological Impacts of the COVID-19 Pandemic on the Public in Egypt.

Community Ment Health J 2021 01 16;57(1):64-69. Epub 2020 Aug 16.

Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.

This study aimed to evaluate the prevalence of depression, anxiety, stress, and inadequate sleeping among the public in Egypt during the novel Corona Virus Disease (COVID-19) pandemic. An online snowball sampling approach was used to collect data from netizens in four Egyptian governorates between 16 and 30 April 2020. A semi-structured questionnaire was designed to assess sociodemographic characteristics, sleeping hours per day, and psychological disturbances (depression, anxiety, and stress) of participants using the Depression Anxiety Stress Scale-21. Out of 1629 participants, 48.1% were aged ≤ 30 years, 42.4% were men, and 20.0% were working in the health sector. The participants reported a high prevalence of depression (67.1%: mild to moderate 44.6% and severe to very severe 22.5%), anxiety (53.5%: mild to moderate 30.6% and severe to very severe 22.9%), stress (48.8%: mild to moderate 33.8% and severe to very severe 15.0%), and inadequate sleeping (< 6 h/day) 23.1%. Female sex, working in sectors other than the health sector, watching/reading COVID-19 news ≥ 2 h/day, and lack of emotional support from family and society were associated with a high prevalence of severe to very severe depression, anxiety, and stress. In conclusion, the psychological impacts of COVID-19 on the public in Egypt were enormous, therefore, providing psychological support and counsel is warranted.
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http://dx.doi.org/10.1007/s10597-020-00701-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429137PMC
January 2021

Night Work, Rotating Shift Work and the Risk of Cancer in Japanese Men and Women: the JACC Study.

J Epidemiol 2020 Aug 15. Epub 2020 Aug 15.

Department of Public Health, Graduate School of Medicine, Hokkaido University.

Background: Limited epidemiological evidence has suggested a positive relationship between night shift work and the risk of cancer. Herein, we investigated the prospective association between different forms of work schedule and the risk of numerous cancers and all-cause cancer among Japanese men and women.

Methods: This cohort study included 45,390 working men and women aged 40-79 years and registered in the Japan Collaborative Cohort Study (JACC Study). The Cox proportional hazards models were used to calculate the hazard ratios (HRs) and their 95% confidence intervals (CIs) for incident cancer among those who reported engagement in night work and rotating shift work for their longest occupations compared with day work.

Results: Within a median follow-up duration of 14.2 years, 2283 (9.4%) men and 1309 (4.5%) women developed cancer. Among men, rotating shift work was significantly associated with increased risk of esophageal cancer (HR= 2.47, 95% CI, 1.42-4.31) and decreased risk of liver cancer (HR= 0.54, 95% CI, 0.30-0.98). Also, rotating shift work tended to be associated with the increased risk of prostate cancer (HR= 1.42, 95% CI, 0.95-2.12). Night work and rotating shift work were not related to the risk of all-cause cancer in either sex.

Conclusion: Rotating shift work might contribute to the increased risk of esophageal cancer and prostate cancer and the decreased risk of liver cancer among Japanese men.
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http://dx.doi.org/10.2188/jea.JE20200208DOI Listing
August 2020

The association of acne and menstrual symptoms among young women (18-25 years) in Egypt: a population-based cross-sectional study.

Int J Adolesc Med Health 2020 Jun 10. Epub 2020 Jun 10.

Department of Gynecology and Obstetrics, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.

Background Acne and menstrual symptoms are highly prevalent among young women. Since both acne and menstrual symptoms have similar hormonal pathogenesis, it is highly suggested that the two conditions are associated. Herein, we conducted this study to assess the relationship between acne and menstrual symptoms among young women. Subjects and methods In this population-based cross-sectional study, a multi-stage random sampling approach was used to include 3065 young women (18-25 years) from Egypt. Women were interviewed for their socio-demographic characteristics, gynecological history, premenstrual and menstrual symptoms, and history of acne and perimenstrual acne flare during the past 6 months. Results The mean age of women was 21.5 ± 2.2 and their age of menarche was 13.1 ± 1.5 years. During the previous 6 months, 44.8% of participants had acne. After adjusting for socio-demographic and gynecological characteristics, acne was associated with most menstrual symptoms with odds ratios (ORs) and 95% confidence intervals (CIs) as follows: [premenstrual symptoms: 1.23 (1.05-1.44) for irritation or nervousness, 1.45 (1.24-1.68) for fatigue, 1.37 (1.15-1.62) for breast tenderness, 1.48 (1.21-1.80) for abdominal bloating, and 1.36 (1.11-1.66) for nausea or vomiting], [menstrual symptoms: 1.63 (1.19-2.23) for dysmenorrhea and 1.24 (1.06-1.45) for dysmenorrhea requiring drugs], and [symptoms severity: 1.44 (1.24-1.68) for missing events and 1.38 (1.16-1.64) for medical consultation]. Of acne patients, 56.7% reported perimenstrual acne flare: 58.5% before menses, 35% during menses, and 6.5% after menses. Conclusion This study supports the concept that acne is associated with menstrual symptoms. Physicians should consider screening for menstrual symptoms among young women with acne.
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http://dx.doi.org/10.1515/ijamh-2019-0220DOI Listing
June 2020

Urinary Stones and Risk of Coronary Heart Disease and Stroke: the Japan Public Health Center-Based Prospective Study.

J Atheroscler Thromb 2020 Nov 5;27(11):1208-1215. Epub 2020 Jun 5.

Epidemiology and Prevention Division, Research Center for Cancer Prevention Group, Center for Public Health Sciences, National Cancer Center.

Aim: Evidence is lacking about whether urinary stones are associated with the subsequent risk of cardiovascular diseases. Herein, we investigated the association between history of urinary stones and the risk of coronary heart disease (CHD) and stroke among middle-aged Japanese.

Methods: This cohort study included 89,037 Japanese men and women (45-74 years) registered in the Japan Public Health Center-based prospective study. Cox proportional hazard models were used to calculate the hazard ratios (HRs) and their 95% confidence intervals (CIs) for incident CHD and stroke among Japanese adults with a self-reported history of urinary stones compared with those without it. The following covariates were included in the regression models: age, sex, area, body mass index, and histories of hypertension, diabetes, hyperlipidemia, smoking habit, alcohol intake, and physical activity.

Results: In total, 1.31% of Japanese adults reported a positive history of urinary stones. Throughout a median follow-up period of 12 years, 1.16% of Japanese adults developed CHD, and 4.96% developed stroke. No associations were detected between history of urinary stones and the risk of CHD (HR 1.04; 95% CI: 0.64-1.67), stroke (HR 0.92; 95% CI: 0.71-1.20), or total CVD (HR 0.95; 95% CI: 0.75-1.19). Younger urinary stone formers (45-59 years) tended to have a higher, though statistically insignificant, risk of CHD than older urinary stone formers (60-74 years): [(HR 1.15; 95% CI: 0.61-2.15) versus (HR 0.83; 95% CI: 0.40-1.76)], respectively.

Conclusion: The history of urinary stones was shown to be not associated with the risk of CVD among Japanese adults.
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http://dx.doi.org/10.5551/jat.54775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803838PMC
November 2020

The association between smoking and risk of skin cancer: a meta-analysis of cohort studies.

Cancer Causes Control 2020 Aug 27;31(8):787-794. Epub 2020 May 27.

Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita-shi, Osaka, 565-0871, Japan.

Purpose: The association between smoking and the risk of skin cancers has been studied without reaching consistent findings. This study aims to assess this association through an updated meta-analysis of cohort studies.

Methods: We retrieved cohort studies that investigated the temporal association between smoking and the risk of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM). Pooled relative risks (RRs) and confidence intervals (CIs) of the included articles were calculated for current, former, and heavy smoking compared with never smoking. Publication bias was detected using the Egger's regression.

Results: A total of 15 studies, published between 1990 and 2018, were included. Current smoking was associated with a higher risk of SCC (pooled RR = 1.32, 95% CI 1.15, 1.52) but with a lower risk of BCC (pooled RR = 0.85, 95% CI 0.75, 0.96) and MM (pooled RR = 0.72, 95% CI 0.64, 0.82). No publication bias was detected, and no single study had a substantial impact on the pooled results. Similar results were detected for heavy smoking, while former smoking was not associated with the risk of skin cancer.

Conclusion: Current smoking and heavy smoking were associated with a higher risk of SCC but a decreased risk of BCC and MM, while former smoking was not associated with skin cancer risk.
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http://dx.doi.org/10.1007/s10552-020-01319-8DOI Listing
August 2020

Association of hepatitis B virus infection and psoriasis: A meta-analysis.

Australas J Dermatol 2020 Nov 14;61(4):382-384. Epub 2020 May 14.

Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

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http://dx.doi.org/10.1111/ajd.13320DOI Listing
November 2020

Association between intrahepatic cholestasis of pregnancy and risk of gestational diabetes and preeclampsia: a systematic review and meta-analysis.

Hypertens Pregnancy 2020 Aug 24;39(3):354-360. Epub 2020 Apr 24.

Department of Public Health, Graduate School of Medicine, Osaka University , Osaka, Japan.

Objective: To investigate the association between intrahepatic cholestasis of pregnancy (ICP) and the risk of gestational diabetes mellitus (GDM) and preeclampsia via meta-analysis.

Methods: Pooled odds ratio (OR) and confidence interval (CI) of GDM and preeclampsia for women with ICP were calculated using the fixed- or random-effects model.

Results: Women with ICP were more likely to have GDM (pooled OR = 2.19, 95% CI: 1.58, 3.03,  = 88.25%) and preeclampsia (pooled OR = 2.58, 95% CI: 2.37, 2.81,  = 0%) than women without ICP.

Conclusion: The present study supports the concept that ICP is associated with the risk of GDM and preeclampsia.
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http://dx.doi.org/10.1080/10641955.2020.1758939DOI Listing
August 2020

Knowledge of and attitudes towards cardiopulmonary resuscitation among junior doctors and medical students in Upper Egypt: cross-sectional study.

Int J Emerg Med 2020 Apr 22;13(1):19. Epub 2020 Apr 22.

Department of Emergency Medicine, School of Medicine, University of Maryland, Baltimore, USA.

Background: Cardiopulmonary resuscitation (CPR) is a fundamental skill that should be acquired by all medical community members. This study aims to evaluate the knowledge and attitudes of junior doctors and medical students towards CPR and CPR training at Beni-Suef University Hospital in Upper Egypt, a representative region with conditions common to LMIC settings.

Participants And Methods: In this cross-sectional study, a total of 205 participants (60 junior doctors and 145 medical students) responded to a self-administered questionnaire assessing their knowledge regarding basic life support (BLS) and CPR techniques in neonates, children, and adults, in addition to attitudes towards the importance and necessity of CPR and CPR training.

Results: Of the 60 junior doctors that participated in the study, only 31.7% had adequate knowledge of CPR, but up to 95% reported positive attitudes towards CPR training. Among the 145 medical student participants, only 6.2% had adequate knowledge of CPR, while 91% reported positive attitudes towards training. Deficiencies in CPR knowledge were more apparent in questions related to CPR in children and neonates. Junior doctors and medical students with previous CPR training demonstrated significantly better CPR knowledge than their counterparts without prior training. A statistically significant positive correlation was detected between CPR knowledge and attitude towards CPR training among medical students (r = 0.41, p < 0.001).

Conclusion: The results of this study demonstrate suboptimal and inadequate CPR knowledge among junior doctors and medical students in a representative hospital in Upper Egypt. However, participants reported overwhelmingly positive attitudes and eagerness towards the implementation of CPR training. Further research needs to be done to establish CPR skill proficiency as well as to investigate barriers to CPR training, effectiveness of available programs, and the potential implementation of such a program in Egypt and other LMICs.
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http://dx.doi.org/10.1186/s12245-020-00277-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178981PMC
April 2020

Effects of strawberry intervention on cardiovascular risk factors: a meta-analysis of randomised controlled trials.

Br J Nutr 2020 08 2;124(3):241-246. Epub 2020 Apr 2.

Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.

We conducted a meta-analysis of randomised controlled trials (RCT) to examine the effects of strawberry interventions on cardiovascular risk factors. We searched multiple databases including PubMed, Web of Science and Scopus to identify eligible studies published before 19 May 2019. The endpoints were blood pressure, total cholesterol (TC), HDL-cholesterol, LDL-cholesterol, TAG, fasting blood glucose, endothelial function and inflammatory factors. Pooled analyses were performed using random- or fixed-effects models according to a heterogeneity test. We also conducted sub-group analyses by baseline endpoint levels. We included eleven RCT in this meta-analysis (six for blood pressure, seven for lipid profile, seven for fasting blood glucose and six for C-reactive protein (CRP)). Overall, the strawberry interventions significantly reduced CRP levels by 0·63 (95 % CI -1·04, -0·22) mg/l but did not affect blood pressure, lipid profile or fasting blood glucose in the main analyses. Our analysis stratified by baseline endpoint levels showed the strawberry interventions significantly reduced TC among people with baseline levels >5 mmol/l (-0·52 (95 % CI -0·88, -0·15) mmol/l) and reduced LDL-cholesterol among people with baseline levels >3 mmol/l (-0·31 (95 % CI -0·60, -0·02) mmol/l). There was little evidence of heterogeneity in the analysis and no evidence of publication bias. In summary, strawberry interventions significantly reduced CRP levels and may improve TC and LDL-cholesterol in individuals with high baseline levels.
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http://dx.doi.org/10.1017/S000711452000121XDOI Listing
August 2020

A report of two infant cases operated for jejunal duplication cyst associated with malrotation and volvulus.

Int J Surg Case Rep 2020 7;67:227-230. Epub 2020 Feb 7.

Pediatric Surgery Department, Cairo University, Egypt. Electronic address:

Introduction: Both Enteric duplication and intestinal malrotation are concerning causes for intestinal obstruction in the pediatric age group and they very rarely coexist in the same patient.

Presentation Of Cases: We present 2 cases of previously healthy children, the first is a 4-month-old infant and the second is a 1.5-year-old boy, both presented with recurrent attacks of bilious vomiting that proved to be due to acute midgut volvulus caused by an enteric duplication cyst associated with intestinal malrotation.

Discussion: Enteric duplication and intestinal malrotation are two of the concerning causes of billious vomiting in the pediatric age group. They could be encountered at any level of the alimentary tract from the tongue to the anus. The term malrotation refers to all abnormalities of intestinal position. The coincidence of intestinal malrotation and an enteric duplication cyst (EDC) is very rare and has been described only in a few case reports.

Conclusion: The concomitance of EDC and intestinal malrotation is extremely rare and should be kept in mind in a child presenting with bilious vomiting especially in a child preoperatively diagnosed with a duplication cyst.
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http://dx.doi.org/10.1016/j.ijscr.2020.02.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047138PMC
February 2020

Hepatitis C virus infection and risk of pancreatic cancer: A meta-analysis.

Cancer Epidemiol 2020 04 20;65:101691. Epub 2020 Feb 20.

Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.

Background: A growing body of evidence has suggested an association between Hepatitis C virus (HCV) infection and risk of pancreatic cancer (PAC). Herein, we conducted a meta-analysis of available evidence to explore this association.

Methods: We systematically retrieved studies that investigated the association between HCV infection and risk of PAC. Pooled odds ratio (OR) with corresponding 95 % confidence interval (CI) of PAC for patients with HCV infection was calculated using the fixed- or random-effects model.

Results: A total of 16 studies (8 cohort and 8 case-control) were included in this meta-analysis. Combined, patients with HCV infection were more likely to develop PAC than people without it (pooled OR = 1.51, 95 % CI: 1.31, 1.74; I = 63.49 %, p-value for heterogeneity< 0.001). Studies that adjusted their results for diabetes, chronic pancreatitis, alcohol intake, and smoking showed lower ORs than studies that did not adjust for them.

Conclusion: HCV infection was associated with increased risk of PAC, but this association was attenuated among studies that adjusted their results for potential risk factors for PAC. Future prospective cohort studies are needed to confirm this association.
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http://dx.doi.org/10.1016/j.canep.2020.101691DOI Listing
April 2020

Urinary C-peptide creatinine ratio to differentiate type 2 diabetes mellitus from type 1 in pediatric patients.

Eur J Pediatr 2020 Jul 13;179(7):1115-1120. Epub 2020 Feb 13.

Pediatric Department, Faculty of Medicine, Tanta University Hospital, El motasem street No 6, Tanta, Egypt.

Type 2 diabetes mellitus (T2DM) is frequently misdiagnosed in children and treated as type 1 DM (T1DM) with insulin. Urinary C-peptide to creatinine ratio (UCPCR) can be used to measure ß cell function and endogenous insulin. We aimed to assess the value of UCPCR to differentiate T2DM from T1DM in pediatric patients. We assessed UCPCR from urine sample taken 2 h after lunch in 50 children with T1DM and 30 children with T2DM (duration of the disease ≥ 2 years and without renal impairment). Fasting and postprandial C-peptide levels were also evaluated in all included children. Receiver operating characteristic (ROC) curve was performed to assess the optimal UCPCR cutoff level to differentiate T2DM from T1DM in children. UCPCR was significantly lower in children with T1DM compared with those with T2DM (P < 0.001). There was a significant positive correlation between UCPCR and fasting C-peptide, postprandial C-peptide, and age of onset. There was a significant negative correlation between the UCPCR and both HbA1c and duration of DM in T1DM. Fasting C-peptide had a sensitivity of 63%, a specificity of 84% at a cutoff point ≥ 1.3 ng/ml to differentiate T2DM from T1DM. Postprandial C-peptide had a sensitivity of 87%, a specificity of 86% at a cutoff point ≥ 3.2 ng/ml to differentiate T2DM from T1DM. Finally, UCPCR had a sensitivity of 97%, a specificity of 88% at a cutoff point ≥ 0.28 nmol/nmol to differentiate T2DM from T1DM in pediatric patients.Conclusion: UCPCR is an easy noninvasive reliable marker to differentiate T2DM from T1DM in pediatric patients.What is Known:• Type 2 DM (T2DM) is frequently misdiagnosed in children and treated as type 1 DM (T1DM) with insulin.• Urinary C-peptide to creatinine ratio (UCPCR) can be used to measure ß cell function and endogenous insulin.What is New:• We revealed that UCPCR had a sensitivity of 97%, a specificity of 88% at a cutoff point ≥ 0.28 nmol/nmol to differentiate T2DM from T1DM.• UCPCR is an easy noninvasive dependable marker to diagnose T2DM from T1DM in pediatric patients.
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http://dx.doi.org/10.1007/s00431-020-03606-7DOI Listing
July 2020

Oxalates, urinary stones and risk of cardiovascular diseases.

Med Hypotheses 2020 Apr 14;137:109570. Epub 2020 Jan 14.

Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address:

Increased level of oxalates in urine and plasma can be attributed to endogenous overproduction, increased ingestion or excessive intestinal absorption. When a supersaturation status is reached, oxalates combine with calcium and crystallize to form 80% of the urinary stones. Several cardiovascular diseases such as coronary heart disease and stroke are thought to be associated with the formation of urinary stones via sharing the same pathogenesis and/or risk factors. This review investigated the evidence linking oxalates/urinary stones to cardiovascular diseases. Eventually, two theories can explain the possible association between urinary stones and cardiovascular diseases: the theory of common origin and the theory of common risk factors. While the first theory is based on the common vascular pathophysiology of urinary stones and cardiac events, the later suggests that metabolic syndrome traits increase the risk of urinary stones and cardiovascular diseases independently. A few cohort studies showed a higher risk of coronary heart disease and stroke among people with history of urinary stones than people without it while other cohort studies did not. These studies had different definitions for cardiovascular diseases, used various methods to assess urinary stones, and some of them did not control for potential confounders. When they were pooled together in meta-analyses, a significant heterogeneity across studies was observed. In conclusion, although there is some evidence indicating that urinary stones could increase the risk of cardiovascular diseases, a substantial causal relationship cannot be settled.
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http://dx.doi.org/10.1016/j.mehy.2020.109570DOI Listing
April 2020

Cloning and Overexpression of Strictosidine β-D-Glucosidase Gene Short Sequence from in .

Adv Pharm Bull 2019 Oct 24;9(4):655-661. Epub 2019 Oct 24.

Molecular Biology Department, Genetic Engineering and Biotechnology Research Institute, Sadat City University, Sadat City, Egypt, 32897.

Strictosidine-β-D-glucosidase (SGD) is considered as a key enzyme in the production of bisindole alkaloids in . The present study illustrated the production of a short sequence of this enzyme in without codon optimization. Strictosidine-β-D-glucosidase () gene short sequence (1434 bp), which lacks the conserved sequence KGFFVWS and the localization peptide sequence at the C-terminal, was amplified from cDNA of leaves, cloned and expressed in . The activity of the produced protein in cell free lysate was tested using total alkaloid extract of leaves. HPLC and LC-MS analysis of the assay mixture revealed the disappearance of the strictosidine peak. SGD short sequence can be produced in in active form without codon optimization.
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http://dx.doi.org/10.15171/apb.2019.076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912177PMC
October 2019

Medical waste handling and hepatitis B virus infection: A meta-analysis.

Am J Infect Control 2020 03 11;48(3):316-319. Epub 2019 Sep 11.

Department of Public Health, Graduate School of Medicine, Osaka University, Osaka, Japan; Department of Public Health, Faculty of Medicine, Minia University, El-Minia, Egypt.

Background: Hepatitis B virus (HBV) infection is a significant occupational hazard in health care settings and represents a public health concern. The aim of this study was to investigate the association between medical waste handling and HBV infection by conducting a meta-analysis of available evidence.

Methods: Pooled odds ratios (ORs) and confidence intervals (CIs) of the included studies were calculated, using the random-effects model, for medical waste handlers versus non-medical waste handlers. Publication bias was detected using the regression test for funnel plot asymmetry, and quality assessment was conducted according to the Newcastle-Ottawa Scale.

Results: Nine cross-sectional studies, published between 1992 and 2018, were included. Medical waste handling was associated with higher odds of HBV infection compared to non-medical waste handling (pooled OR = 2.88; 95% CI, 1.40-5.93; I = 61.36%; P value for heterogeneity = .008). Subgroup analysis showed higher odds of HBV infection in studies conducted in Africa (pooled OR = 3.61; 95% CI, 1.19-11.00). Most studies were of poor to fair quality; yet, little evidence of publication bias was detected (P value for publication bias = .983). No single study showed a substantial impact on the pooled results.

Conclusions: The present meta-analysis supports the suggestion that medical waste handling is associated with HBV infection. This association was shown to be more obvious in African health care settings.
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http://dx.doi.org/10.1016/j.ajic.2019.08.011DOI Listing
March 2020
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