Dapagliflozin dampens liver fibrosis induced by common bile duct ligation in rats associated with the augmentation of the hepatic Sirt1/AMPK/PGC1α/FoxO1 axis.

Liver fibrosis is considered an epidemic health problem due to different insults that lead to death. Dapagliflozin (DAPA), a sodium-glucose cotransporter-2 (SGLT2) inhibitor, is one of the newer anti-diabetic drugs used to manage type 2 diabetes mellitus (T2DM). DAPA exerted beneficial effects in many human and rat models due to its antioxidant, anti-inflammatory and antifibrotic activities. AIM: Due to previously reported capabilities related to DAPA, we designed this study to clarify the beneficial role of DAPA in liver fibrosis triggered by common bile duct ligation (CBL) in male rats. METHODS: For 14 or 28 days after CBL procedures, DAPA was administered to the rats orally at a dose of 10 mg/kg once daily. The effects of DAPA were evaluated by assaying liver enzymes, hepatic oxidant/antioxidant parameters, serum levels of tumor necrotic factor alpha (TNF-α), and AMP-activated protein kinase (AMPK). In addition, we measured the hepatic expression of fibrosis regulator-related genes along with evaluating liver histological changes. KEY FINDINGS: DAPA successfully decreased hepatic enzymes and malondialdehyde levels, increased superoxide dismutase activity, elevated catalase levels, decreased serum levels of TNF-α, elevated serum levels of AMPK, decreased liver hydroxyproline content, upregulated Sirt1/PGC1α/FoxO1 liver gene expressions, down-regulated fibronectin-1 (Fn-1), collagen-1 genes in liver tissues, and improved the damaged liver tissues. Deteriorated biochemical parameters and histological liver insults associated with CBL were more pronounced after 28 days, but DAPA administration for 14 and 28 days showed significant improvement in most parameters and reflected positively in the histological structures of the liver. SIGNIFICANCE: The significance of this study lies in the observation that DAPA mitigated CBL-induced liver fibrosis in rats, most likely due to its antioxidant, anti-inflammatory, and antifibrotic effects. These results suggest that DAPA's beneficial impact on liver fibrosis might be attributed to its interaction with the Sirt1/AMPK/PGC1α/FoxO1 pathway, indicating a potential mechanistic action for future exploration.

Comparative study of Lepidium sativum orally administered seeds, hydrogel and atorvastatin on obesity of rats fed on a high fat diet.

BACKGROUND: Obesity has become a prevalent issue worldwide, leading to various complications such as hyperlipidemia, diabetes, and cardiovascular problems. Statins, as FDA approved anti-hyperlipidemic drugs, still pose some concerns upon their administration. Recently, researchers have looked for natural products as an alternative to manage hyperlipidemia and obesity. AIM: This work aimed to study the hypolipidemic effect of Lepidium sativum garden cress (GC) from different preparations; orally administered seeds, and hydrogel, in comparison to atorvastatin. METHODS: GC hydrogel was prepared from the GC aqueous extract and pharmaceutically evaluated for its pH, spreadability, seeds content, homogeneity, rheology, and in vitro release. The rat's body weight, blood glucose levels, total lipid profile, and liver biomarkers were evaluated on obese rats for one month. In addition, the histopathology study was also performed. RESULTS: GC hydrogel had acceptable pharmaceutical properties and showed a sustained release performance over 24 h. Oral and topical GC significantly reduced the lipid profiles, blood sugar and ALT, AST levels more than the negative control group and comparable to atorvastatin. It was found that oral GC showed a significant effect on the percentage decrease in the rat's body weight than the applied hydrogel. Histopathology study revealed a better outcome in the histological structure of pancreas and liver compared with rats feed on high fat diet post-treatment for one month. CONCLUSION: GC orally administered, or topically applied hydrogel could be a promising, safe alternative formulation to atorvastatin in managing hyperlipidemia and normalizing body weight of obese rats.

Postpartum family planning among women attending maternal and child health centers in Assiut Governorate, Upper Egypt.

BACKGROUND: Postpartum family planning (PPFP) is important in helping couples to achieve their reproductive intentions. National surveys have consistently reported higher fertility, lower use of family planning (FP), and higher unmet needs for FP in Upper Egypt. This study aims to identify the factors associated with the use of PPFP in Assiut Governorate, Upper Egypt, and to assess the current status of integration of PPFP counseling in the existing maternal and child health services (MCH). METHODS: The study employed a cross-sectional study design, collecting data from 455 postpartum women aged 15 to 49 years in 4 primary health care (PHC) centers in Assiut Governorate, Upper Egypt. The women were interviewed using a structured questionnaire. The questionnaire consisted of 4 sections: the first section included the participants' demographic characteristics; the second section included women's obstetric history; the third section included questions about PPFP knowledge, attitude, past and current use of contraception; and the fourth section assessed the current status of integrating PPFP counseling within antenatal, natal, and postnatal services. RESULTS: In total, 54.5% of postpartum women were using a modern contraceptive method. The significant predictors of using PPFP methods were as follows: receiving information about PPFP from health care providers (AOR = 11.46, p < 0.001), better attitude towards PPFP (AOR = 10.54, p < 0.001), using modern FP methods (AOR = 6.98, p < 0.001), resumption of menstruation (AOR = 4.11, p < 0.001), older age (AOR = 2.15, p < 0.05), and better PPFP knowledge (AOR = 1.72, p < 0.001). Only 5.3%, 1.3%, and 3.5% received PPFP counseling during antenatal care (ANC), delivery, and the postpartum period, respectively. CONCLUSIONS: Postpartum contraception use was associated with receiving PPFP counseling by health care providers and women's knowledge and attitude regarding PPFP. However, FP counseling was not integrated with other MCH services. Updating the components of MCH services to include PPFP counseling during ANC, at delivery, and during the postpartum period should be prioritized by program planners and policymakers.

Validity of immunoglobulin-binding protein 1 as a biomarker for lupus nephritis.

BACKGROUND: Lupus nephritis (LN) is a major issue that adds a burden on patients with systemic lupus erythematosus (SLE). Immunoglobulin-binding protein 1 (IGBP1) is identified as a phosphoprotein that has been recently reported to be linked to the B-cell receptor complex and regulates differentiation, proliferation, apoptosis, and tolerance of B cells. Its diagnostic and/or prognostic role in LN has been highlighted only recently. OBJECTIVES: This study aims to evaluate the relation between serum IGBP1 and SLE disease activity and/or renal activity and to investigate the validity of IGBP1 as a biomarker for LN. METHODS: 96 participants were enrolled and divided into three groups: nephritis, nonnephritis, and control groups. The patients with SLE were diagnosed according to the Systemic Lupus International Collaborating Clinics classification (SLICC) criteria. The serum IGBP1 level was assayed using an enzyme-linked immunosorbent assay (ELISA). Assessments were conducted using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2k) and renal biopsy for LN patients. RESULTS: The nephritis and nonnephritis groups had higher IGBP1 levels than the controls; the nephritis group had the highest serum IGBP1 levels (p < .001). Significant correlations were found between IGBP1 levels and proteinuria (r = 0.568, p = .001) and renal SLEDAI (r = 0.475, p = .006) in the nephritis group; on the other hand, the correlation of serum IGBP1 levels with SLEDAI-2K was non-significant for both groups (nephritis and nonnephritis groups). The IGBP1 levels were significantly different among histopathologic classes (p < .001), with class V showing the highest level. Moreover, it showed a significant positive correlation with the pathologic activity index. Compared with renal SLEDAI for identifying active renal affection in patients with SLE, the serum IGBP1 level with a cut-off value of 547.45 ng/mL is a valid biomarker for detecting active nephritis with 93.8% sensitivity and 96.9% specificity. CONCLUSION: The serum IGBP1 levels were high in patients with LN and were positively correlated with the pathologic activity index. The serum IGBP1 level of 547.45 ng/mL is a valid biomarker for detecting active nephritis. Thus, we recommend that clinicians monitor the serum IGBP1 level of patients with SLE to detect LN.

Stigma and discrimination against people living with HIV by health care providers in Egypt.

OBJECTIVE: HIV/AIDS has been recently increasingly observed in developing countries including Egypt. This study aimed to explore stigma and discrimination attitudes of health care providers (HCPs) in Egypt, as elimination of stigma in healthcare settings is a priority to improve case detection and management. METHODS: A Google form questionnaire using the validated Arabic version of Health Care Provider HIV/AIDS Stigma Scale (HPASS) was sent to physicians and nurses of Ministry of health (MOH) hospitals and University hospitals in 10 randomly selected Governorates in Egypt. Data was collected from July to August, 2022 from 1577 physicians and 787 nurses. Bivariate and multivariable linear regression analyses were used to identify the predictors of the stigmatizing attitude of HCPs towards People living with HIV (PLHIV). RESULTS: The majority of HCPs had worries about contracting HIV infection from their patients (75.8% of physicians and 77% of nurses). They believed that protective measures are not good enough to protect them from getting infected (73.9% of physicians and 74.7% of nurses). About half of the participants had worries about the safety of performing blood investigations to PLHIV (54% of physicians and 59.9% of nurses). Less than half of HCPs believed they have the right to refuse providing care to patients to protect themselves (44.6% of physicians and 50.1% of nurses). Only 10.5% of physicians and 11.9% of nurses have previously refused to provide health care to PLHIV. There was a significantly higher mean score of prejudice and stereotype among nurses compared to physicians (prejudice; 27.34 ± 7.88 vs 26.17 ± 7.5, stereotype; 18.54 ± 4.61 vs 16.43 ± 5.21, for nurses and physicians, respectively). Less years of physicians' experience (B = -0.10, p < 0.01) and rural residence (B = 1.48, p < 0.05) were significantly associated with higher prejudice score while having lower qualification (B = -1.47, p < 0.001) was significantly associated with higher stereotype score. CONCLUSION: Standards of practice should be developed to adjust the services and prepare HCPs to provide medical care free from stigma and discrimination against PLHIV. Improving knowledge of HCPs regarding the methods of transmission of HIV, the use of infection control measures and the emotional factors shaping lives of PLHIV should be targeted through updated training programs. More concern should be directed to young providers in the training programs.

Risk factors for polycystic ovary syndrome among women of reproductive age in Egypt: A case control study.

Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, associated with an increased risk of multiple diseases, and its pathogenesis is not fully understood. Purpose: identify risk factors for Polycystic Ovary Syndrome in reproductive-aged Egyptian women attending an outpatient gynecological clinic at a specialized hospital of Obstetrics and Gynecology in Port Said City, Egypt. The study population included 248 women; 124 women suffered from PCOS and 124 Non-PCOS. Methods: - Case-control study was conducted among women. PCOS women were diagnosed clinically by transvaginal ultrasound and laboratory investigations. Data were collected using; I) a structured interview questionnaire, including socio-demographic status, medical and family history, menstrual and obstetrical history and lifestyle habits, and clinical examination; II) anthropometric parameters; III) perceived stress scale. The mean age of cases was 26.18±0.45 years. The most common risk factors for PCOS were urban residence, high education, working, insufficient income, history of anemia, hypertension, cancer, and family history of PCOS and infertility, increasing body mass index, fast food, and drinking of coffee. The study concluded that the significant risk factors for polycystic ovarian disease in Egypt women included socio-demographic characteristics, medical and family history, increasing body mass index, and lifestyle habits. This study recommended that Polycystic Ovary Syndrome women follow a healthy diet and exercise regularly.

Contemporary outcomes of aortic arch hypoplasia and coarctation repair in a tertiary paediatric cardiac surgery centre.

OBJECTIVES: There are several studies reporting the outcomes of hypoplastic aortic arch and aortic coarctation repair with combination of techniques. However, only few studies reported of aortic arch and coarctation repair using a homograft patch through sternotomy and circulatory arrest with retrograde cerebral perfusion. We report our experience and outcomes of this cohort of neonates and infants. METHODS: We performed retrospective data collection for all neonates and infants who underwent aortic arch reconstruction between 2015 and 2020 at our institute. Data are presented as median and inter-quartile range (IQR). RESULTS: The cohort included 76 patients: 49 were males (64.5%). Median age at operation was 16 days (IQR 9-43.25 days). Median weight was 3.5 kg (IQR 3.10-4 kg). There was no 30 days mortality. Three patients died in hospital after 30 days (3.95%), neurological adverse events occurred in only one patient (1.32%) and recurrent laryngeal nerve injury was noted in four patients (5.26%). Only three patients required the support of extracorporeal membrane oxygenation (ECMO) with a median ECMO run of 4 days. Median follow-up was 35 months (IQR 18.9-46.4 months); 5 years survival was 93.42% (n = 71). The rate of re-intervention on the aortic arch was 9.21% (n = 7). CONCLUSION: Our experience shows excellent outcomes in repairing aortic arch hypoplasia with homograft patch under moderate to deep hypothermia with low in-hospital and 5 years mortality rates.

Effect of Implant Surface Modification on Bone Mineral Density and Survival Rate in the Maxilla After a Short Period Using Cone Beam Computed Tomography.

ABSTRACT: This study was aimed to objectively measure the changes in bone density amount obtained through cone-beam computed tomography around dental implants after a short period of time in the maxilla. Thirty-two SLActive Straumann implants were inserted into 12 healthy patients. Changes in bone density were measured at the surgery time (Bone mineral density (BMD)0) and 60 days after investment (Bone mineral density (BMD)60). Statistically, significant differences were observed between traumatic and sinus zones at the time of surgery and after 60 days respectively (P ≤ 0.05). For each group, a significant decrease in density was observed with the following variables (male, age of 18-40 years, sinus zone, and implant diameter of 4.1 mm). The survival rate was 83.8% after 60 days. Implant surface modification has no significant effect on bone mineral density after a short period of time in the sinus zone. Early loading of the prosthesis can be performed in the traumatic zone only.

Presurgical Assessment of Anatomical Landmark Position Using Two Views of Cone Beam Computed Tomography: A Comparative Radiological Study.

BACKGROUND: Cone beam computerized computed tomography (CBCT) has been widely indicated in dental implant procedure. The first step that the doctors should perform in local hospitals is to use orthopantomography for surgical planning to avoid and limit the risk of complications. As a result, determining the magnification amount of orthopantomography to achieve a precise diagnosis is clinically important. This study investigated the difference in measurement of the mental foramen (MF) position before dental surgery using 2 views of CBCT. MATERIALS AND METHODS: Cone beam computed tomography scan was performed for 100 patients who required implant placement. In the panoramic and three-dimensional views of CBCT, the vertical distance between the margin of the mandible and the lower border of MF, and the horizontal distance between the mandibular symphysis and the mesial anterior border of MF were calculated. The differences between the 2 views were compared using Wilcoxon-rank U test with P value ≤ 0.05 considered statistically significant. RESULTS: The findings of this study showed a substantial statistical difference in the horizontal distance for the dentate patients in panoramic and three-dimensional views (22.7 ±â€Š3.04 versus 21.1 ±â€Š1.6), (22.5 ±â€Š2.4 versus 20.9 ±â€Š1.5) and left side (22.4 ±â€Š2.8 versus 21.2 ±â€Š1.6), (22.4 ±â€Š2.8 versus 20.6 ±â€Š1.4) of both genders. Concerning the vertical distance, a significant difference was also observed in the dentate (12.1 ±â€Š2.1 versus 11.1 ±â€Š1.4), (10.6 ±â€Š1.4 versus 9.6 ±â€Š1.3) and left side of the jaw (11.6 ±â€Š1.95 versus 10.9 ±â€Š1.2), (10.5 ±â€Š1.2 versus 9.96 ±â€Š1.4) for both genders in both views. In the edentulous and right side of the jaw, however no statistical difference was observed between male and female patients in terms of horizontal and vertical measurements.

Morphometric Analysis of the Mental Foramen Variation in an Iraqi Population by Using Cone-Beam Computed Tomography.

ABSTRACT: The effects of gender, side, and ridge condition on the position of the mental foramen (MF) were investigated in this research. A total of 122 cone-beam computed tomography scans were chosen from healthy patients with age ranging from 18 to 72 years. The following parameters were used to evaluate images: MS-MF (horizontal distance to the mandibular symphysis from the anterior MF limit) and MB-MF (vertical measurement of distance from the inferior boundary of the mandible to the lower border of the MF). The mean distance between the MF and mandibular symphysis was 20.98 ±â€Š1.95. The average measurement between the MF and the mandible's lower boundary was 10.36 ±â€Š1.63. The horizontal distance was slightly different between males and females (21.5 ±â€Š1.59 and 20.6 ±â€Š1.6, respectively). In terms of gender and ridge condition, a significant difference in vertical distance (10.97 ±â€Š1.14 versus 9.9 ±â€Š1.24 and 10.13 ±â€Š1.5 versus 10.55 ±â€Š1.07, respectively) was observed. By contrast, in vertical and horizontal distances, significant differences were noted between edentulous men and women. Meanwhile, a significant difference between dentate male and female patients was found at vertical distances only. In conclusion, in both vertical and horizontal measurements, the location of the MF was higher in males than in females and edentulous more than dentate.

Evaluation of knowledge and practice of hymenoplasty among Egyptian gynaecologists: a cross-sectional study.

OBJECTIVES: The aims of the study were to evaluate the knowledge and practice of hymenoplasty among gynaecologists in Egypt. METHODS: A cross-sectional study was conducted in January 2020, in which a self-administered questionnaire was completed by 120 gynaecologists at private clinics and hospitals in Ismailia, Egypt. The questionnaire consisted of 19 items relating to participants' sociodemographic characteristics, knowledge and practice of hymenoplasty. RESULTS: Eighty-eight (73.3%) participants were not able to give an accurate definition of the hymen; furthermore, 65 (54.2%) were not aware of the different types of hymen. Forty-nine (40.8%) participants were able to define hymenoplasty and 39 (32.5%) knew the different hymenoplasty procedures. Hymenoplasty had been performed by 35 (29.2%) participants. Of these, 26 (74.3%) had carried out the procedure in a private clinic; the median annual number of procedures performed was four. Only two (5.7%) participants reported the occurrence of complications during the procedure. There were no sociodemographic differences between gynaecologists who had and had not performed hymenoplasty. CONCLUSION: There is a lack of sufficient knowledge about hymenoplasty among Egyptian gynaecologists; nevertheless, it continues to be practised in private clinics.

COVID-19 and perinatal outcomes among pregnant women admitted to isolation unit at Suez Canal university hospital, Egypt: A cross-sectional study.

This study described the maternal and perinatal outcomes of pregnant women infected with COVID-19. A cross-sectional descriptive design was used in this study of 75 women diagnosed with COVID-19 in the isolation unit of Obstetrics and Gynecology Department at Suez Canal University hospital. Data was collected by a structured interview questionnaire and assessment of patients' records in the period from April 26, 2021, to October 31, 2021. This study found that 7/29 (24.14%) of women had abortions, 9/46 (19.57%) had preterm labor, 2/19 (10.53%) had both postpartum hemorrhage and puerperal pyrexia, 2/46 (4.35%) had an antepartum hemorrhage, and 2/52 (3.85%) had preeclampsia. Regarding fetal complications, 2/46 (4.35%) had intrauterine fetal distress, and 2/52 (3.85%) had a stillbirth. Concerning neonatal outcomes, 31.25% of cases needed NICU admission, 12.5% required mechanical ventilation and developed ARDS, 18.75% had low birth weight, and only 6.25% of all cases died. This study concluded that pregnant women with COVID-19 seem to have a high risk of abortion and preterm birth. Their neonates are at high risk of NICU admission and low birth weight.

The effects of COVID-19 pandemic and its related lockdown on female sexual function and reproductive health: An observational study in Egypt.

This retrospective observational online study was carried out to evaluate the effect of the COVID-19 pandemic and its related lockdown on female sexual functions and reproductive health. It included 409 sexually active females. The sexual function was assessed using the Female Sexual Function Index (FSFI). The reproductive life was assessed by a structured self-administered questionnaire modified from Egypt Demographic and Health Survey. The study revealed a significant decrease in the overall FSFI score during the pandemic lockdown compared to the pre-pandemic score (19.3 ± 6 vs. 21.3 ± 6.4, P<0.001). Below half (41.6 %) of women were using contraception methods during the pandemic, while 27.9% had stopped taking contraception during the pandemic, 30.6% (57/186) of the pregnant women only tended to get pregnant. So, the COVID-19 pandemic and its related lockdown were associated with an elevated risk for female sexual dysfunction and altered women's reproductive health quality. Heath system should therefore develop new methods to provide basic reproductive health service, family planning services, and to ameliorate the female sexual function during COVID-19 pandemic including consults with physicians, counsellors, and psychologists, as well as health education programs, either in person or virtually via telemedicine.

Domestic violence against women during coronavirus (COVID-19) pandemic lockdown in Egypt: a cross-sectional study.

BACKGROUND: While it is necessary to limit the spread of the coronavirus (COVID-19) pandemic, efforts including social isolation, restricted travel, and school closures are anticipated to raise the probability of domestic violence (DV). This study aimed to estimate the prevalence, pattern, risk factors, and physical health outcomes of domestic violence against women during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted using a convenient sample. The data collection tool was based on Sect. 11 of the Egyptian Demographic Health Survey, 2014, which is designed to measure domestic violence. We used a Google form-designed questionnaire and distributed the link to social media platforms from May 2020 to June 2020 till the collection of the required sample of 388 completed questionnaires. RESULTS: The prevalence of every form of DV was 31%. Emotional violence was the most prevalent (43.5%) followed by physical (38.9%) and sexual violence (17.5%). About 10.5% of women reported suffering from all types of violence. The husband was the most common perpetrator of DV. The determinants of ever experiencing any form of DV were low education level of women (OR = 7.3, 95% CI 2.8-18.8), unemployment (OR = 2.31, 95% CI 4-3.5), husband's use of alcohol or substance (OR = 14.4, 95% CI 4.1-50.2), and insufficient income (OR = 2.01, 95% CI 2-3.2). The most common health consequences of DV were injuries such as cuts, bruises, and aches. CONCLUSIONS: The prevalence of ever experiencing any form of DV was 31% which is considered high. Emotional violence was the most common whereas sexual violence was the least common. Identifying the risk factors of DV would support the development and implementation of preventive and screening programs for early identification and offering social support to the victims. Policies should be adopted for the early detection and protection of women suffering from violent behaviors. Access to adequate prompt support and health-care services is crucial in order to decrease the consequences of violence. It is necessary to implement alcohol or drug abuse interventions, preventive measures, and screening programs in families to reduce DV.

Worry from contracting COVID-19 infection and its stigma among Egyptian health care providers.

BACKGROUNDS: Healthcare providers (HCPs) in COVID-19 epidemic face stressful workload of disease management, shortage of protective equipment and high risk of infection and mortality. These stressors affect greatly their mental health. The aim is to identify working conditions among Egyptian HCPs during COVID-19 epidemic as well as stigma and worry perceptions from contracting COVID-19 infection and their predictors. METHODS: A cross-sectional study was conducted among 565 HCPs. Data was collected through Google online self-administered questionnaire comprised seven parts: demographics characteristics, knowledge and attitude of COVID-19, working condition, worry of contracting COVID-19 at work, discrimination intention at work for COVID-19 patients, stigma assessment using impact stigma, and internalized shame scales. RESULTS: The vast majority of HCPs (94.7%) were worried from contracting COVID-19 at work. Risk factors for perceiving severe worry from contracting COVID-19 were expecting infection as a severe illness, believing that infection will not be successfully controlled, improbability to continue working during the pandemic even if in a well/fit health, high discrimination intention and impact stigma scales. Significantly high impact stigma scores were detected among those aged < 30 years, females, workers primarily in sites susceptible for contracting COVID-19 infection, those had severe worry from contracting infection at work, and high internalized shame scale. The risk factors for perceiving higher internalized shame scores were not having a previous experience in working during a pandemic, high discrimination intention towards COVID-19 patients and high impact stigma scale. CONCLUSIONS: Considerable levels of worry and stigma were detected among Egyptian HCPs during COVID-19 outbreak. The psychological aspect of health care providers should not be overlooked during epidemic; appropriate institutional mental health support should be provided especially for young HCPs, those without previous work experience in epidemic and those who work in high-risk units. Raising the community awareness about contribution of HCPs in fighting the epidemic might decrease stigmatization action toward HCPs.

Family planning perspectives and practices of married adolescent girls in rural Upper Egypt.

OBJECTIVES: The aims of the study were to explore the contraceptive practices of married adolescent girls in rural Upper Egypt and identify the determinants of their ever use of modern contraception. METHODS: The study was a household survey of 729 married adolescent girls in 23 villages of two governorates in Upper Egypt. Listing and enumeration of all households in the selected villages were performed prior to data collection, to recruit married adolescent girls below 20 years of age. The girls were interviewed using a structured questionnaire. RESULTS: Only 6% of married adolescent girls were using a modern contraceptive method; 10.6% had ever used a modern contraceptive method, mostly a short-acting method. Considerable proportions of participants believed that using contraception would reduce a woman's fertility and that women should not delay their first pregnancy (34% and 54.3%, respectively); only 50.2% believed that contraception could be used for birth spacing. Predictors of the ever use of a modern method of contraception among married adolescent girls were: accepting that contraception could be used for birth spacing (B = 1.82, p < .001), older age (B = 0.42, p < .01), better reproductive health knowledge (B = 0.23, p < .05) and sharing in contraceptive decision making (B = 0.55, p < .05). CONCLUSION: Married adolescent girls' current use and ever use of modern contraception were very low in rural Upper Egypt. Changing the social norms to create the desire to delay first childbirth, improving adolescent girls' reproductive health knowledge, correcting myths about contraception and building girls' agency to use contraception may increase their contraceptive use.

The role of levonorgestrel intra-uterine system in the management of adenomyosis: A systematic review and meta-analysis of prospective studies.

INTRODUCTION: The levonorgestrel intrauterine system (LNG-IUS) is a long-acting hormone-releasing uterine device that has many non-contraceptive benefits. The study aims to assess the safety and efficacy of LNG-IUS in the management of adenomyosis. MATERIAL AND METHODS: We searched the following bibliographic databases: MEDLINE via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Google Scholar for the relevant studies which used LNG-IUS in management of patients with clinically or ultrasonographic diagnosed adenomyosis.The main outcome measures are pain score at the end of follow-up, bleeding, symptomatic relief, uterine volume (mL), endometrial thickness (mm) and/or hemoglobin level. RESULTS: Ten prospective studies (patients n = 551) were included. The overall effect estimates showed that the LNG-IUS led to significant reductions in pain score after 12 months (standardized mean difference [SMD[ -3.87, 95% confidence interval [CI] -5.51 to -2.23, P < .001), 24 months (SMD -5.56, 95% CI -9.80 to -1.32, P = .01) and 36 months of insertion (SMD -3.81, 95% CI -4.27 to -3.36, P < .001). Similarly, the Pictorial Blood Assessment Chart (PBAC) showed significant reduction up to 36 months after LNG-IUS insertion (SMD -2.32, 95% CI -2.91 to -1.73, P < .001). The LNG-IUS led to significant reductions in the uterine volume 12 months (SMD -.60, 95% CI -0.88 to -.31, P < .001) and 36 months after insertion (SMD -0.42, 95% CI -0.69 to -0.14, P = .003). CONCLUSIONS: LNG-IUS is a promising and effective option for the management of adenomyosis. Its use effectively reduced the severity of symptoms, uterine volume and endometrial thickness, and improved laboratory outcomes.

A Framework for Evaluating Vendor Procurement in a Digital Health Project.

The eHealth Centre of Excellence, a Waterloo, Ontario-based organization that advances and promotes digital health initiatives in clinical care, developed and assessed an innovative evaluation procurement framework. The purpose of the framework was to assess and support long-term vendor-organization procurement partnerships to develop, improve and expand electronic referral (eReferral) solutions. The framework focused on six criteria: the quality of the eReferral solution, its implementation, the service provided, the extent of training and knowledge transfer, the quality of the vendor's team and the vendor's project experience. These domains were further defined by components and key performance indicators unique to the eReferral solution to accommodate the stakeholders' specified needs as well as change management challenges to create value for users and organizations in long-term relationships. The evaluation used both qualitative and quantitative methodologies. The framework used data from three sources: (1) the System Coordinated Access program and vendor team experience surveys that focused on the six criteria mentioned earlier; (2) key stakeholder interviews that focused on system quality, user satisfaction and perception of net benefits; and (3) a vendor scorecard that focused on deliverables and efficiencies. Vendor procurement should be viewed not as a process that ends when a vendor is selected but rather as a continuing and evolving relationship. Evaluation should assess the ability and willingness of vendors to support stakeholders and meet their needs, stimulate new ideas and adapt to changing environments and expanding systems. The model enabled recording of factors necessary for successful outcomes and provided a strategy to help select vendors for successful long-term partnerships.

Would placing pictorial health warnings on waterpipe devices reduce waterpipe tobacco smoking? A qualitative exploration of Egyptian waterpipe smokers' and non-smokers' responses.

BACKGROUND: Although Egypt places four generic pictorial health warnings (PHWs) on the front and back half of waterpipe tobacco packs (WTPs), waterpipe tobacco smoking (WTS) rates have continued to rise. It has been suggested that PHWs would be more salient if placed on the waterpipe device itself. This qualitative study explored how participants perceived the effects placing PHWs on waterpipe devices would have on warning salience and uptake or quitting of WTS. METHODS: We conducted 10 focus groups and 10 in-depth interviews with 90 adult waterpipe smokers and non-smokers, men and women, who lived in rural, semi-urban and urban regions of Egypt. We presented participants with four novel PHWs of different sizes positioned randomly at four locations on a waterpipe device (the glass body, metal holder, mouthpiece or hose), one at a time. At each session, participants viewed a PHW on all four locations. Novel warnings were shown on plain labels with a dark uniform background and featured pictures, text and the quitline number. Transcripts were analysed using thematic analysis. RESULTS: Participants thought placing PHWs on waterpipe devices might increase salience, prevent WTS initiation or trigger quit attempts; they favoured placing PHWs on the glass body, mouthpiece or waterpipe hose. Both waterpipe smoker and non-smoker participants thought these potential effects would affect non-smokers or non-established smokers more than established waterpipe users. CONCLUSIONS: Our exploratory study suggests that PHWs featured prominently on waterpipe devices could potentially deter experimentation with waterpipe tobacco products and promote cessation, especially among non-established users.