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Purpose: This is the first study to assess the impact of an online microsurgical testicular sperm extraction (mTESE) masterclass. We: 1) describe the masterclass’s scientific content; 2) appraise the participants’ acquisition of knowledge; 3) gauge whether the extent of improvement of the participants’ knowledge/skills was influenced by demographic/professional attributes; and 4) evaluate the participants’ satisfaction. Materials and Methods: This masterclass comprised five didactic lectures followed by 4 case discussions. Online surveys assessed the above objectives using a baseline questionnaire including demographics and past mTESE experience/training, a 24-question pre- and post-quiz, and a satisfaction questionnaire. Results: Participants were between 20–70 years old, with 80.37% males, mainly from Asia, Africa, and Europe, from clinical backgrounds (69.3%), and in public practice (64.4%). Half the sample reported no past mTESE training and very low skills, ≈60% wanted considerably more training, and 50% felt that good training was not readily available. Satisfaction was 98% to >99%. Pre- and post-quiz comparisons confirmed remarkable improvements in knowledge/skills, exhibiting five striking characteristics. Improvements were a) Broad i.e., across 19 of the 24 mTESE questions; b) Deep, of magnitude, as pre-/post-quiz scores improved from mean 13.71±4.13 to 17.06±4.73; c) Highly significant, consistently with p-values 5-year, those in public practice significantly more than private practice participants, and those with lower self-rating in performing mTESE significantly more than those with higher self-rating. Conclusions: The masterclass was successful with very high satisfaction levels, and markedly improved mTESE knowledge/ skills among the participants. Global Andrology Forum’s model can be adopted by organizations with similar goals. Future research needs to evaluate such training to develop a practically non-existent evidence base.

Abstract Background No previous research of university students in Finland assessed lifestyle behavioral risk factors (BRFs), grouped students into clusters, appraised the relationships of the clusters with their mental well-being, whilst controlling for confounders. The current study undertook this task. Methods Students at the University of Turku (n = 1177, aged 22.96 ± 5.2 years) completed an online questionnaire that tapped information on sociodemographic variables (age, sex, income sufficiency, accommodation during the semester), four BRFs [problematic alcohol consumption, smoking, food consumption habits, moderate-to-vigorous physical activity (MVPA)], as well as depressive symptoms and stress. Two-step cluster analysis of the BRFs using log-likelihood distance measure categorized students into well-defined clusters. Two regression models appraised the associations between cluster membership and depressive symptoms and stress, controlling for sex, income sufficiency and accommodation during the semester. Results Slightly more than half the study participants (56.8%) had always/mostly sufficient income and 33% lived with parents/partner. Cluster analysis of BRFs identified three distinct student clusters, namely Cluster 1 (Healthy Group), Cluster 2 (Smokers), and Cluster 3 (Nonsmokers but Problematic Drinkers). Age, sex and MVPA were not different across the clusters, but Clusters 1 and 3 comprised significantly more respondents with always/mostly sufficient income and lived with their parents/partner during the semester. All members in Clusters 1 and 3 were non-smokers, while all Cluster 2 members comprised occasional/daily smokers. Problematic drinking was significantly different between clusters (Cluster 1 = 0%, Cluster 2 = 54%, Cluster 3 = 100%). Cluster 3 exhibited significantly healthier nutrition habits than both other clusters. Regression analysis showed: (1) males and those with sufficient income were significantly less likely to report depressive symptoms or stress; (2) those living with parents/partner were significantly less likely to experience depressive symptoms; (3) compared to Cluster 1, students in the two other clusters were significantly more likely to report higher depressive symptoms; and (4) only students in Cluster 2 were more likely to report higher stress. Conclusions BRFs cluster together, however, such clustering is not a clear-cut, all-or-none phenomenon. Students with BRFs consistently exhibited higher levels of depressive symptoms and stress. Educational and motivational interventions should target at-risk individuals including those with insufficient income or living with roommates or alone.

Purpose: There are no published examples of a global online research collaborative in andrology. We describe the development, profile and member characteristics of the first consortium of this type, the Global Andrology Forum (GAF). Materials and Methods: An online survey sent to all GAF members collected demographic information (sex, age, experience, academic title, degrees, country, specialty, profession). It also tapped data on members’ characteristics e.g., skills in research, software and statistics; preferred activities; time commitments; expected roles; and interest in participating in research, in GAF’s scientific activities and collaborative online research. The findings were analyzed and tabulated. We outline members’ demographic and professional characteristics and scientific achievements to date. A narrative approach outlined GAF’s structure and functioning. Results: A total of 418 out of 540 members completed the survey and were included in the analysis (77.4% response rate). The sample comprised mainly urologists (34.2%) and a third of the respondents had practiced for >15 years (33.3%). Up to 86.1% of the members expressed interest in being actively engaged in writing scientific articles. A third of the sample (37.1%) could dedicate 4 to 6 hours/week. Few respondents reported skills in statistics and artwork (2.6% and 1.9% respectively). Members were assigned to specific roles based on their expertise and experiences. Collaborative working ensured the timely completion of projects while maintaining quality. For outcomes, GAF published 29 original articles within one year of its creation, with authors from 48 countries spanning topics that included varicocele, sperm DNA damage, oxidative stress, semen analysis and male infertility, oocyte/embryo, and laboratory issues of assisted reproductive technique (ART) and male infertility evaluation. Conclusions: GAF is a successful global online andrology research model. A healthy number of scientific articles have been published. Given such effectiveness, adopting the GAF model could be useful for other disciplines that wish to create and coordinate successful international online research groups.

Purpose: This is the first study to design and assess a research capacity building (RCB) specifically tailored for clinical and nonclinical andrology practitioners worldwide. We appraised: 1) the barriers and enablers to research among these practitioners; 2) attendees’ satisfaction with the webinar; and 3) research knowledge acquisition as a result of the webinar (before/after quiz). Materials and Methods: A online RCB webinar was designed, comprising two presentations in research design and systematic review/meta-analysis (SR/MA). An online survey using validated published questionnaires assessed the three above-stated objectives. Paired t-test compared the means of the pre- and post-webinar scores. Subgroup analysis was performed on the participants’ professional background, sex, and number of years in practice. Results: A total of 237 participants attended the webinar, of which 184 completed the survey and are included in the current analysis. Male participants were about double the females and 60.9% were from Asian countries. The most common research enablers were to publish scientific papers (14.8%) and to develop research (14.7%) or new skills (12.7%). The most common barriers were the lack of training in research (12.4%), training in research software (11.8%), and time for research (11.8%). Satisfaction with the webinar was considerably high (86.3%–88.4%) for the different features of the webinar. Compared to the pre-webinar knowledge level, there were significant improvements in participants’ research knowledge acquisition after the webinar in terms of the total score for the quiz (13.7±4.31 vs. 21.5±4.7), as well as the scores for the study design (7.12±2.37 vs. 11.5±2.69) and SR/MA sessions (6.63±2.63 vs. 9.93±2.49) (p

Background The pre-treatment characteristics of the patient and ectopic pregnancy to determine the patients who are likely to successfully respond to methotrexate (MTX) therapy remain controversial. This study investigated the outcomes of ectopic pregnancy after one and two MTX doses and their independent predictors.Methods Retrospective cross-sectional study of women who consented to MTX treatment in 2017–2018 at our institution (N = 317). Of these, patients with Caesarean scar pregnancies were excluded because they require different treatment protocols (n = 25). All patients were treated according to our institution’s protocol based on international guidelines and standardised across the three hospitals included in the current study. We retrieved patients’ demographics, laboratory, ultrasonography, and clinical characteristics from our hospital database. Serum β-human chorionic gonadotropin (β-hCG) was measured using electrochemiluminescence immunoassay; ectopic pregnancy was diagnosed using ultrasonography (transvaginal probe).Results Two ninety-two patients were included in the current analysis. Age, pre-treatment β-hCG levels, sonographic presence of yolk sac, presence of foetal cardiac activity, and pelvic pain were significantly different between patients with successful and unsuccessful outcomes. Younger age (adjusted odds ratio [aOR] 2.33, 95% confidence interval (CI) 1.16–4.66, p = .017), no pelvic pain (aOR 2.65, 95%CI 1.03–6.83, p = .043), lower initial β-hCG level (aOR 1.32, 95%CI 1.08–1.59, p = .005), and absence of foetal cardiac activity (aOR 12.63; 95% CI 1.04–153.6; p = .047) were independently associated with success. Treatment failure odds were >2 folds higher for each 10-year age increase (p = .017), 32% higher for each 1000 IU/L increase in initial β-hCG level (p = .005), and >2 folds higher in presence of pelvic pain (p = .043).Conclusions MTX is effective in most patients, averting invasive surgery, which might affect fertility. Pre-treatment β-hCG levels, age, pelvic pain, and foetal cardiac activity was independently associated with outcomes. Research should assess the relationship between the ectopic pregnancy size and treatment outcomes and refine β-hCG titres where treatment would be ineffective.

BackgroundStudies exploring the effect of COVID-19 on male reproductive system suggest a detrimental association, however with conflicting results. The aim of this study was to assess the association between COVID-19 infection and male reproductive potential including hormone profiles and semen parameters.MethodsThis prospective cohort study included 48 patients with confirmed COVID-19 infection. Patients were subdivided into an asymptomatic group (n = 30) and a group with COVID-19 symptoms (n = 18). Serum hormone levels including testosterone, LH, FSH and estradiol were collected during active infection (baseline, time 0), and at 3 and 6 months following COVID-19 infection. Semen samples (basic semen analysis and oxidation reduction potential) were examined at 3 and 6 months following infection. Student and paired-t tests were used to compare continuous variables between the study groups and across the studied time intervals, respectively. Multivariate binary logistic regression analysis was performed to explore predictors for COVID-19 symptoms during active infection.ResultsPatients with COVID-19 symptoms were significantly older (p = 0.02) and had significantly lower serum testosterone levels (p = 0.01) and significantly higher LH: testosterone ratio (p = 0.01) than asymptomatic patients. Multivariate analysis revealed older age (OR = 1.18, p = 0.03) and lower serum testosterone level (OR = 0.8, p = 0.03) as independent predictors of symptomatic COVID-19 infection. Significant increase in testosterone (p

Abstract Background No study appraised the knowledge gaps and factors impacting men’s sexual and reproductive health (SRH) in MENA (Middle East and North Africa). The current scoping review undertook this task. Methods We searched PubMed and Web of Science (WoS) electronic databases for original articles on men’s SRH published from MENA. Data was extracted from the selected articles and mapped out employing the WHO framework for operationalising SRH. Analyses and data synthesis identified the factors impacting on men’s experiences of and access to SRH. Results A total of 98 articles met the inclusion criteria and were included in the analysis. The majority of studies focused on HIV and other sexually transmissible infections (67%); followed by comprehensive education and information (10%); contraception counselling/provision (9%); sexual function and psychosexual counselling (5%); fertility care (8%); and gender-based violence prevention, support/care (1%). There were no studies on antenatal/intrapartum/postnatal care and on safe abortion care (0% for both). Conceptually, there was lack of knowledge of the different domains of men’s SRH, with negative attitudes, and many misconceptions; as well as a deficiency of health system policies, strategies and interventions for SRH. Conclusion Men’s SRH is not sufficiently prioritized. We observed five ‘paradoxes’: strong focus on HIV/AIDS, when MENA has low prevalence of HIV; weak focus on both fertility and sexual dysfunctions, despite their high prevalence in MENA; no publications on men’s involvement in sexual gender-based violence, despite its frequency across MENA; no studies of men’s involvement in antenatal/intrapartum/postnatal care, despite the international literature valuing such involvement; and, many studies identifying lack of SRH knowledge, but no publications on policies and strategies addressing such shortcoming. These ‘mismatches’ suggest the necessity for efforts to enhance the education of the general population and healthcare workers, as well as improvements across MENA health systems, with future research examining their effects on men’s SRH.

Rectal cancer is associated with a high risk of metastases and local recurrence; local recurrence rates after surgical treatment being up to 32%. An accurate local staging at the time of initial diagnosis is therefore very important. Magnetic Resonance Imaging (MRI) is already established as an accurate tool for the preoperative staging of rectal cancer and has resulted in marked improvements in staging accuracy. Material and Methods: This study used MRI in comparing the morphologic features of rectal cancer before and after 8 weeks of chemo-radiation treatment (CRT) and to correlate the post treatment MRI appearances with the histological findings in resected tumors. 45 patients with histo-pathologically proven rectal adenocarcinoma received standardized 8 weeks chemo-radiation therapy and subjected to MRI before and after treatment for clinical staging. A correlation between pathological response and MRI findings was done. Results: The MRI diagnostic accuracy to diagnose T2 is 74.2% with relatively low specificity (64.7%). The diagnostic accuracy of MRI in evaluation of stage T3 and T4, the MRI sensitivity was 96.2% however of low specificity 26.3%. The diagnostic accuracy was 66.7%. Additionally, in evaluation of T2 stage, the sensitivity of MRI was very low 27.3% and specificity relatively high 94.7%. Diagnostic accuracy was 70%. Post RCT, based on downstaging after CRT, the sensitivity of MRI to show no tumor was very low 0% with diagnostic accuracy 88.9%. However, to evaluate stage T2, the sensitivity was 84.6% with low specificity 66.7% and the diagnostic accuracy was 74.2%. Conclusion: MRI had an accuracy average of 81.6% in T stage and 68.9% in N stage in re-staging rectal tumors after CRT. Over-staging results of majority of the inaccuracy. The statistical agreement between post-CRT MRI and the pathologic staging involving T and N stages was not satisfactory. In view of the above, Post CRT, restaging rectal cancer remains a challenge.

Abstract Background Globally, with the COVID-19 pandemic, dental services were limited to emergency/ urgent conditions and were provided only after tele-triage referral for face-to-face management. However, no previous research explored whether the pain severity (PS) drives the tele-triage decisions. The current study examined the association between PS and tele-triage decision of whether to manage the condition remotely or refer the caller for face-to-face management. Methods This retrospective cross-sectional study analyzed the PS reported by hotline callers, using numerical rating scale (NRS-11), during the first wave of COVID-19 lockdown (23 March–31 August 2020) and its association with tele-triage decision controlling for age, sex, history of chronic illness, and dental discipline needed. Binomial logistic regression assessed the association between the PS (exposure) and tele-triage decision (outcome). ANOVA compared PS across tele-triage categories, dental history and tentative diagnosis. Results PS was significantly associated with tele-triage decisions (p

Background: There are no studies in Qatar or in the Middle East to investigate parental perception of healthy diet in childhood. Purpose: To investigate parental perception of childhood healthy diet in the State of Qatar. Methods: Cross-sectional prospective study at Hamad Medical Corporation, State of Qatar. Parents of children

Purpose: To identify parental awareness and knowledge regarding child abuse and neglect in the State of Qatar. Methods: A cross-sectional study using a questionnaire was conducted at Hamad Medical Corporation, the only tertiary pediatric hospital in the State of Qatar at the time of the study. Parents of children of all ages were offered a questionnaire that included demographic details, parental knowledge, and awareness of child abuse and neglect. Results: 300 questionnaires were completed (response rate = 95%). More than 70% of parents were older than 30 years of age, 60% of them were females, and 66% were college graduates. The majority of the participants stated their familiarity about child abuse, and 6% witnessed morbidity or mortality due to child abuse in the society. Despite the identified laws, only 50% of the parents were aware of laws restricting child abuse. In regards to children with special needs, only 16% of the participants agreed that disabled children are at a higher risk of abuse compared to healthy children, while 33% were neutral and 52% disagreed. In addition, one-fifth of the respondents stated that hitting is discipline, while 63% disagreed. Almost one-third of the respondents agreed that hitting hands and buttock or hitting with soft objects is acceptable form of discipline. Unexpectedly, one-quarter of participants stated that it is okay to hit a child as long as no damage incurs. As for verbal abuse, around one-third of parents stated that yelling is not a form of child abuse, and that yelling does not affect growth and development. Comparing both corporal and verbal abuse, approximately 70% of parents stated that yelling is less harmful than hitting. In terms of child neglect, around half of the respondents agreed with the statement “Leaving a child (

Oxidative stress (OS) is detrimental to sperm functions, and the oxidation reduction potential (ORP) is a good measure of OS as it considers the balance between oxidants and reductants. Total motile sperm count (TMSC) is viewed as the single most important semen analysis parameter that can predict male infertility severity, and its correlation with ORP has never been undertaken. The objectives of this study were to assess the correlation between ORP and TMSC, to identify the ORP cutoff value based on the TMSC result, and to compare this cutoff value with previously reported ORP cutoff values in literature. One thousand one hundred and sixty-eight infertile patients and 100 fertile controls were enrolled. Demographic and semen data of the participants were retrieved and analyzed. Wilcoxon's rank-sum test compared variables between infertile men and fertile controls; Spearman's correlation assessed the static ORP (sORP)-TMSC relationship for the whole sample and among each group individually. Using a 20×106TMSC threshold, receiver operator characteristic (ROC) analysis determined the sORP cutoff associated with the highest predictive values. TMSC was significantly negatively correlated with sORP across all participants (r = 0.86, P < 0.001), among infertile patients (r = 0.729, P < 0.001), and among fertile controls (r = 0.53, P < 0.001). A 20-million TMSC threshold determined an sORP cutoff value of 2.34 mV/106sperm/ml to be associated with 82.9% sensitivity, 82.8% specificity, 91.5% positive predictive value (PPV), 68.5% negative predictive value (NPV), and 82.9% overall accuracy. Compared with previously reported cutoff values in searched literature, the 2.34 mV/106sperm/ml cutoff value identified in our study yielded the highest overall diagnostic accuracy in the evaluation of infertile men.

INTRODUCTION[|]It is assumed that lower endotracheal tube (ETT) cuff pressure is associated with a lower incidence of postoperative sore throat. However, this is not confirmed in many studies. The relation between ETT size and cuff pressure and the incidence of postoperative sore throat were studied in three different facilities.[¤]METHODS[|]Three facilities at Hamad Medical Corporation, Qatar, Tertiary care hospital/two secondary care hospitals (2ry (1) and 2ry (2)) were addressed in this study. ETT cuff pressure and size were measured by blinded observer after induction of general anesthesia and patients' intubation before the surgery. The sore throat was recorded after full recovery of the patients and before discharge from PACU by a blinded observer. Statistical analysis was performed using Chi-square for comparing between two categorical variables, Pearson Correlation for parametric variables were used to correlate tube size to cuff pressure. Spearman's for non-parametric variables was used to correlate throat pain to changes in cuff pressure and tube size (Sig. is p

Abstract Background Giant parathyroid adenoma is a rare type of parathyroid adenoma defined as weighing > 3.5 g. They present as primary hyperparathyroidism but with more elevated laboratory findings and more severe clinical presentations due to the larger tissue mass. This is the first reported case of giant parathyroid adenoma from the Middle East. Case presentation A 52-year-old Indian woman presented with a palpable right-sided neck mass and generalized fatigue. Investigations revealed hypercalcemia with elevated parathyroid hormone and an asymptomatic kidney stone. Ultrasound showed a complex nodule with solid and cystic components, and Sestamibi nuclear scan confirmed a giant parathyroid adenoma. Focused surgical neck exploration was done and a giant parathyroid adenoma weighing 7.7 gm was excised. Conclusions Giant parathyroid adenoma is a rare cause of primary hyperparathyroidism and usually presents symptomatically with high calcium and parathyroid hormone levels. Giant parathyroid adenoma is diagnosed by imaging and laboratory studies. Management is typically surgical, aiming at complete resection. Patients usually recover with no long-term complications or recurrence.

Background and Aims: Human plasma protein fraction 5% (PPF5%) is an albumin-based colloid used to expand the plasma volume during volume deficiency. The current basic medical experimental study assessed in vitro coagulation of PPF5% solution and its effects on blood coagulation and chemistry. Methods: The study involved 20 volunteers, and each volunteer donated 20–50 ml of fresh blood. Three dilutions of blood with PPF5% dilutions were prepared (30, 50, and 70%). The fibrinogen dose required to correct coagulation in the 50% diluted samples was assessed (two doses used). The thromboelastogram (TEG) measured the haemostatic parameters (fibrinogen level, initiation of coagulation [R time], kinetics [K], acceleration of coagulation [α angle], maximum amplitude [MA] and coagulation index [CI]), and the ABL gas analyser measured the blood chemistry changes. Results: All dilutions showed significant TEG and blood chemistry changes when compared to controls. The two doses of fibrinogen corrected the clot formation speed with no significant difference in speed between the two doses. Acidosis measured by the strong ion gap (SID) and pH were significant for all dilutions when compared with the baseline. The 30% dilution remained within the lower normal acceptable value while 50% dilution was beyond the critical normal values. Conclusion: In vitro PPF5% to replace blood loss up to 50% dilution did not have significant coagulation and blood chemistry effects while coagulopathy should be expected in extreme dilutions (70%). Fibrinogen in a dose equivalent to 4 gm/70 kg adult improved clot strength at 50% dilution.

Purpose: The lack of available guidelines for the management of prostatic abscess (PA) results in inconsistencies in its management. The most commonly used management modalities were conservative treatment with parenteral antibiotics alone, transrectal ultrasound-guided (TRUS) needle aspiration, or transurethral deroofing (TUD). The current study is a retrospective study and examines prostatic abscess cases treated by either one or more of the different modalities. We assess and compare presentation, diagnosis, management, and outcomes of prostatic abscess and we compare the outcomes of the three management modalities. Methods: We retrieved the records of all patients ( n = 23) admitted to the Urology department at Al Wakra hospital with the computed tomography (CT) diagnosis of prostatic abscess from January 2013 to March 2018. Data collected included demographic, clinical, laboratory, and imaging findings, as well as management modality, duration of hospital stay, duration of follow up, outcome, and recurrence. Results: A total of nine (39.1%) patients had conservative treatment only; eight (34.8%) had TUD, and six (26.1%) had TRUS needle aspiration. The mean age was 52.7 years. Lower urinary tract symptoms and fever were the most common presentations (95.7% and 82.6%, respectively). CT scan of the abdomen and pelvis with contrast was undertaken for all patients and it showed that multiple abscesses were observed in 14 (60.9%) cases. The overall mean hospital stay was 8.45 days (range 2–21 days). We observed no recurrences for patients treated conservatively or those who undertook TUD, but three patient (50%) recurrences were noted in TRUS aspiration patients. There was no mortality across the sample. Conclusion: Early diagnosis of prostatic abscess and prompt management may have decreased the morbidity and mortality. Conservative management can succeed in subcentimeter abscesses but TUD is the definite therapy for large and multiloculated abscess. TRUS aspiration does have a role in treatment, but it has higher recurrence and longer hospital stay.

Objectives: This study identifies and describes the clustering of 5 behavioral risk factors (BRFs) among university students. We also investigated whether cluster membership is associated with the students’ self-rated academic performance and self-rated health. Material and methods: A sample of 1300 undergraduates at 6 universities and 3 colleges in Libya completed a self-administered questionnaire that assessed BRFs (nutrition, physical activity, alcohol consumption, smoking, illicit drug use, inadequate sleep). A two-step cluster analysis generated student clusters with similar lifestyles. Results: Two contrasting clusters of almost even size emerged (after exclusion of alcohol and illicit drug use due to very low prevalence). Cluster 1 comprised students with higher engagement in all forms of physical activity, higher levels of health consciousness, greater daily fruit/vegetable intake and better sleep patterns than students in cluster 2. Only as regards the consumption of sweets, cluster 1 students had less favorable practices than cluster 2 students. The prevalence of smoking was equally low in both clusters. Students in cluster 2, depicting a less healthy lifestyle, were characterized by a higher proportion of women, of students with less income and of higher years of study. Belonging to cluster 2 was associated with lower self-rated health (OR: 0.46, p < 0.001) and with lower self-rated academic performance (OR: 0.66, p < 0.001). Conclusion: Preventive programs should not address BRFs in isolation and should particularly target students with clustering of BRFs using specifically tailored approaches.

Abstract Background Malignant struma ovarii (MSO) is a very rare, germ cell tumor of the ovary, histologically identical to differentiated thyroid cancers. Struma ovarii (SO) is difficult to diagnose on clinical basis or imaging and is mostly discovered incidentally, with few published cases in the literature. Case presentation A 42-year old primiparous woman presented with abdominal pain and midline pelvic palpable firm mass arising from the pelvis. Imaging showed pelvic solid cystic mass. Total abdominal hysterectomy, bilateral salpingo-oopherectomy (TAH BSO) and infracolic omentectomy were performed. Histopathology revealed left ovary papillary thyroid carcinoma (PTC) arising in SO (11 cm) and metastatic papillary thyroid carcinoma in the right ovary. Thyroid functions tests were all normal, ultrasound thyroid showed two complex nodules in the left thyroid lobe. Total thyroidectomy was decided, but the patient refused further surgical management and was lost to follow up as she left the country. We undertook a comprehensive literature search, and MSO and thyroid management data from 23 additional publications were analyzed and tabulated. This PTC MSO is probably the largest reported in the literature. Conclusions Among the different surgeries for MSO, TAH + BSO appears to have the best clinical outcome. However, unilateral salpingo-oopherectomy/ unilateral oophorectomy and bilateral salpingo-oopherectomy also seem effective. Ovarian cystectomy alone seems associated with higher recurrence. There remains no consensus on the associations between MSO tumor size and potential extent of metastasis, and about the management of thyroid gland. However, surveillance and thyroid gland work up to detect concurrent thyroid cancer are recommended.

Little is known about the relationships between weight satisfaction, body image concern, healthy nutrition, health awareness, and physical activity among college students across culturally different countries. We assessed country and sex-specific associations between health status (self-rated health, depression, BMI), healthy behavior (healthy nutrition, physical activity, health awareness), weight satisfaction, and body image concern via a cross-sectional survey (5888 undergraduates) in Egypt, Palestine, and Finland. This health and wellbeing survey employed identical self-administered paper questionnaires administered at several Universities in two Eastern Mediterranean countries (Egypt, Palestine—Gaza Strip), and an online-survey comprising the same questions in Finland. Regression analyses were employed. Health status variables exhibited the strongest associations; high BMI and more depressive symptoms were more often among students satisfied with their weight (except in Palestine), but they were positively associated with body image concern irrespective of country or gender. Self-rated health was not associated with body image concern or weight satisfaction. Healthy behaviors were not associated with body image concern or weight satisfaction. Depressive symptoms and BMI were the most prominent predictors for body image concern. There were country-specific consistent results when using the body image concern score. Further research is necessary to compare body image across different cultures and countries.

BackgroundLimited research has explored clustering of lifestyle behavioral risk factors (BRFs) among university students. This study aimed to explore clustering of BRFs, composition of clusters, and the association of the clusters with self-rated health and perceived academic performance.MethodWe assessed (BRFs), namely tobacco smoking, physical inactivity, alcohol consumption, illicit drug use, unhealthy nutrition, and inadequate sleep, using a self-administered general Student Health Survey among 3,706 undergraduates at seven UK universities.ResultsA two-step cluster analysis generated: Cluster 1 (the high physically active and health conscious) with very high health awareness/consciousness, good nutrition, and physical activity (PA), and relatively low alcohol, tobacco, and other drug (ATOD) use. Cluster 2 (the abstinent) had very low ATOD use, high health awareness, good nutrition, and medium high PA. Cluster 3 (the moderately health conscious) included the highest regard for healthy eating, second highest fruit/vegetable consumption, and moderately high ATOD use. Cluster 4 (the risk taking) showed the highest ATOD use, were the least health conscious, least fruit consuming, and attached the least importance on eating healthy. Compared to the healthy cluster (Cluster 1), students in other clusters had lower self-rated health, and particularly, students in the risk taking cluster (Cluster 4) reported lower academic performance. These associations were stronger for men than for women. Of the four clusters, Cluster 4 had the youngest students.ConclusionOur results suggested that prevention among university students should address multiple BRFs simultaneously, with particular focus on the younger students.

We examined nutrition behaviour, self-reported health and 20 health complaints of undergraduates in Finland. Students at the University of Turku in Finland participated in a cross-sectional online survey (N = 1189). For nutrition behaviour, we computed two composite food intake pattern scores (sweets, cakes and snacks; and fruits and vegetables), a dietary guideline adherence index and the subjective importance of healthy eating. Multinomial logistic regression assessed the association of students’ nutrition behaviour with three levels of self-reported health, controlling for many potential confounders (age, sex, living with partner, economic situation, moderate physical activity, Faculty and BMI). Factor analysis of the 20 health complaints revealed three components (psychological, pains/aches and circulatory/breathing symptoms). Multiple linear regression tested the association of students’ eating habits with the three components of health complaints, controlling for the same confounders. Fruits and raw and cooked vegetable consumption, dietary guideline adherence index and subjective importance of healthy eating were highest among students with excellent/very good self-reported health, exhibiting a decreasing trend for those individuals with poor/fair self-reported health. High levels of psychological symptoms were associated with decreased consumption of fruits and vegetables, less dietary guideline adherence and less subjective importance of healthy eating. Pain/aches symptoms were associated with a higher consumption of sweets, cookies and snacks and a lower adherence to dietary guidelines. More healthy nutrition behaviour was consistently associated with better self-reported health and less health complaints. Of the four nutrition behaviour indicators we employed, the dietary guideline adherence index was the best indicator and exhibited the most consistent associations with self-reported health and health complaints.

Background: To ensure the oral health of a population, clinicians must deliver appropriate dental services, and local communities need to have access to dental care facilities. However, establishment of this infrastructure must be based on reliable information regarding disease prevalence and severity in the target population. Objectives: The aims of this study were to measure the incidence of dental caries in school children aged 12–14 throughout Qatar, including the influence of socio-demographic factors. Materials and methods: A cross-sectional study was conducted in Qatar from October 2011 to March 2012. A total of 2113 children aged 12–14 were randomly selected from 16 schools located in different geographic areas. Three calibrated examiners using World Health Organization (WHO) criteria to diagnose dental caries performed the clinical examinations. Data analyses were subsequently conducted. Results: The mean decayed, missing, and filled teeth index values were respectively 4.62 (±3.2), 4.79 (±3.5), and 5.5 (±3.7), for 12, 13, and 14 year-old subjects. Caries prevalence was 85%. The mandibular incisors and canines were least affected by dental caries, while maxillary and mandibular molars exhibited the highest incidence of dental caries. Dental caries were affected by socio-demographic factors; significant differences were detected between female and male children, where more female children showed dental caries than male children. In addition, children residing in semi-urban areas showed more dental caries than in urban areas. Conclusion: Results indicated that dental caries prevalence among school children in Qatar has reached critical levels, and is influenced by socio-demographic factors. The mean decayed, missing, and filled teeth values obtained in this study were the second highest detected in the Eastern Mediterranean region. Keywords: Prevalence, Dental caries, DMFT index, School children, Qatar

Background: We examined perceived health status and physical and psychological well-being of 3,271 undergraduate students attending eleven faculties in a university in Egypt. Methods: During 2009-2010, participants completed a self-administered questionnaire that gathered socio-demographic, physical and psychological health data. Body mass index (BMI) was calculated from students′ measured height and weight. Differences across these variables were computed by gender and participating faculties. Results: Whilst more females watched and rated their health favorably, they were more likely to feel psychosomatic/physical health problems, to have seen a medical practitioner or been ill that they had to stay in bed. Females were consistently more likely to feel burdened overall, and across several aspects apart from financial problems. Less females had ′normal′ BMI, were satisfied with current weight, perceived their body image as ′just right′, or were not worried about their shape. More males rated their quality of life favorably. About 25% of males and 32% of females were either overweight/obese. Exams, presentations, and the lack of time for studies were the frequently-reported burdens. Comparisons of health/well-being indicators across the participating faculties suggested some evidence of ′clustering′: Favorable indicators would cluster at some faculties; and conversely, less favorable variables would cluster at other faculties. Conclusions: Generally, the levels of some health complaints and psychological problems/burdens are higher than in other countries. Increased vigilance of university administrators and leaders to monitoring the health and well-being of their students, as well as their health needs is required if policy makers are to operate from a valid evidence base platform. Given cultural factors prevalent in the Eastern Mediterranean region generally, female students might require particular attention. The clustering effects suggest the need for local (faculty-specific) health and well-being profiles as basis and guidance for relevant health promotion programs in faculty/university settings.

Background: We assessed associations between educational achievement and alcohol consumption. Methods: We employed five alcohol consumption measures (length of time of and amount consumed during most recent drinking occasion, frequency of alcohol consumption, heavy episodic drinking, problem drinking); and three educational achievement indicators (students′ subjective importance of achieving good grades, students′ appraisal of their academic performance in comparison with peers, students′ actual module mark). Results: Males were positively associated with all five alcohol consumption measures. Age was negatively associated with three alcohol consumption measures. While students΄ importance of good grades was negatively associated with three alcohol consumption measures, academic performance in comparison with peers was negatively associated with heavy episodic drinking. Actual module mark was not associated with any alcohol consumption measure. Conclusions: Alcohol consumption showed negative associations with motivation for and subjectively achieved academic performance. University alcohol prevention activities might have positive impact on students′ academic success.

Pain is a challenge for orthopedic healthcare professionals (OHCP). However, pain studies examined the competencies of a single OHCP category, did not consider various pain management domains or barriers to optimal pain service, and are deficient across the Arabic Eastern Mediterranean region. We surveyed OHCP’s recognition and knowledge of pain and perceived barriers to optimal pain service (361 OHCP, five hospitals). Chi square compared doctors’ (n = 63) vs. nurses/physiotherapists’ (n = 187) views. In terms of pain recognition, more nurses had pain management training, confidently assessed pediatric/elderly pain, were aware of their departments’ pain protocols, and felt that their patients receive proper pain management. More doctors comfortably prescribed opiate medications and agreed that some nationalities were more sensitive to pain. For pain knowledge, more nurses felt patients are accurate in assessing their pain, vital signs are accurate in assessing children’s pain, children feel less pain because of nervous system immaturity, narcotics are not preferred due respiratory depression, and knew pre-emptive analgesia. As for barriers to optimal pain service, less nurses agreed about the lack of local policies/guidelines, knowledge, and skills; time to pre-medicate patients; knowledge about medications; complexity of the clinical environment; and physicians being not comfortable prescribing pain medication. We conclude that doctors required confidence in pain, especially pediatric and geriatric pain, using vital signs in assessing pain and narcotics use. Their most perceived barriers were lack of local policies/guidelines and skills. Nurses required more confidence in medications, caring for patients on narcotics, expressed fewer barriers than doctors, and the complexity of the clinical environment was their highest barrier. Educational programs with clinical application could improve OHCPs’ pain competencies/clinical practices in pain assessment and administration of analgesics.

Background: Little is known on the food consumption habits and adherence to dietary guidelines among young adults. We examined students' adherence to recommended guidelines, and the associations between importance of eating healthy and guidelines adherence. Methods: A total of 3271 undergraduates at 11 faculties, Assiut University, Egypt (2009–2010), completed a questionnaire reporting their consumption of 12 food groups; number of servings of fruits/vegetables/day; and how important it is for them to eat healthy. We employed the WHO guidelines for the Eastern Mediterranean region (WHO 2012) to compute students' adherence to dietary guidelines for the different food groups. Chi-square tested the differences for adherence to guidelines by gender, and the associations between the importance of healthy eating and guidelines adherence for the whole sample and by gender. Results: Except for cereal products, no food group had an adherence level> 45%. Gender differences were observed (men had better adherence for sweets, cake/cookies, snacks, and raw vegetables but not for fast food/canned food or cooked vegetables, P < 0.001 for each). There was a significant positive trend between the increase of subjective importance of eating healthy and adherence to guidelines (P = 0.012–< 0.001). However, this association was only for some food groups and gender dependent. Conclusions: Across the majority of food groups we examined, this sample exhibited low adherence levels to International Nutrition Guidelines. Healthier eating educational/intervention efforts should target foods exhibiting low adherence (most food groups, particularly salad/raw vegetables, fresh fruits, dairy/dairy products, meat/sausage products); consider gender differences (females reported lower adherence across most food groups); and note the relation between adherence and subjective importance of eating healthy by food groups and gender.

Research on healthy behaviour such as physical activity and healthy nutrition and their combination is lacking among university students in Arab countries. The current survey assessed healthy nutrition, and moderate/vigorous physical activity (PA) of 6266 students in Egypt, Libya, and Palestine. We computed a nutrition guideline achievement index using WHO recommendation, as well as the achievement of PA recommendations using guidelines for adults of the American Heart Association guidelines. Latent class regression analysis identified homogenous groups of male and female students, based on their achievements of both guidelines. We examined associations between group membership and achievement of guidelines. A three-class solution model best fitted the data, generating three student Groups: “Healthy Eaters” (7.7% of females, 10.8% of males), “Physically Active” (21.7% of females, 25.8% of males), and “Low Healthy Behaviour” (70.6% of females, 63.4% of males). We did not observe a latent class that exhibited combined healthy behaviours (physically active and healthy eaters), and there were no major differences between countries. We observed a very low rate of healthy nutrition (≈10% of students achieved greater than four of the eight nutrition guidelines), with little gender differences across the countries. About 18–47% of students achieved the PA guidelines, depending on country and gender, more often among males. Few females achieved the PA guidelines, particularly in Libya and Palestine. Culturally adapted multi-behavioural interventions need to encourage healthy lifestyles, nutrition and PA behaviours. National policies need to promote active living while addressing cultural, geographic, and other barriers to young adults’ engagement in PA.