Effect of ketogenic diets on lipid metabolism in adults: protocol for a systematic review.

INTRODUCTION: The ketogenic diet is a very low carbohydrate diet known for its ability to reduce weight and counteract hyperglycaemia. However, ketogenic diets recommend an increased intake of fats, raising concerns about cardiometabolic risk in adults. Due to the higher intake of fats in the ketogenic diet, there is significant variability in outcomes of lipid metabolism in the population. Interventions have reported improvements in lipid profile while other studies did not find changes, and there are reports of increased low density lipoprotein (LDL) and triglyceride values. Hence, this is a protocol for a systematic review of the published literature and a summary of the effect of ketogenic diets on lipid metabolism in adults. METHODS AND ANALYSIS: Five databases (PubMed, Embase, Scopus, Cochrane Library and Web of Science) will be searched for studies on ketogenic diets in adult populations. Studies will be included if they report results from ketogenic diet interventions among adults. Exclusion is populations with diagnosed neurological disorders. Two reviewers will independently screen retrieved citations, extract data and appraise the risk of bias. Quantitative estimates (eg, standardised mean difference) measuring the change in the total cholesterol, LDL and triglyceride concentration will be pooled using random effects meta-analysis to produce one summarised weighted estimate. Sources of heterogeneity will be explored using subgroup analysis. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis for Protocols (PRISMA), and the final review will be reported following the PRISMA 2020 guidelines. ETHICS AND DISSEMINATION: The present protocol and the systematic review to be carried out do not require ethics clearance. The data source will be published studies. This review will provide estimates to inform the public about the effect of ketogenic diets on lipid metabolism and the possible peril of increasing cardiometabolic risk. The results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42022309665.

The association of social media with dietary behaviors among adults in the United Arab Emirates.

Background: Social media is an online community that offers a digital setting where people create, share, and access a wide range of information, knowledge, and viewpoints. This study assessed the association between social media use and eating behaviors and whether sociodemographic characteristics and lifestyle habits are correlated with this association. In addition, it assessed whether this effect is different according to changes in lifestyle habits due to the COVID-19 pandemic among adults in the United Arab Emirates (UAE). Methodology: A cross-sectional web-based study was conducted among 1056 adults living in the UAE. Information on sociodemographic characteristics, social media use, and dietary habits were collected. The Scale of Effects of Social Media on Eating Behavior (SESMEB) was used and a total score ranging from 18 to 90 was generated with higher scores corresponding to a greater effect. The general linear model analysis assessed associations of certain characteristics with the score. Independent T-test and one-way ANOVA test were used to investigate differences based on changes in lifestyle habits due to COVID-19. Results: Most participants (80.3 %) reported using social media >2 h/day. The mean score was 44.15 ± 12.68 (range 18-90). Increasing age, being a male, spending less time on social media, and not following influencers were associated with lower SESMEB scores. Not consuming breakfast and spending more time on screens for leisure were associated with higher scores (p < 0.05). Significantly higher scores were recorded for those previously infected with COVID-19 and who reported an increase in screen time, food intake, body weight, and meals/day (p < 0.05). Conclusion: Social media appears to have an association with adults' dietary habits in the UAE. Spending more time on social media, being a female, and having more screen time were associated with a higher impact. Targeted programs are needed to increase awareness and advocate for a positive lifestyle with social media use.

Implementation of simulation training in the Intensive Care Units (ICU) during the COVID-19 pandemic: A scoping review.

INTRODUCTION: In response to the important influx of critically ill patients as well as resources limitation, simulation would be a tool ensuring the continuum of medical training. AIM: To assess the impact of simulation training on both education and performance related to protocol development during COVID-19 pandemic, in critical care. METHODS: This scoping review was written in accordance with the PRISMA Guideline. Data sources and studies were identified by searching "MEDLINE", "Cochrane library" databases and "Clinical trial.gov". Study inclusion adhered to the PICO criteria: Population, Intervention, Comparison, and Outcomes. The Kirkpatrick Model, is a tool for evaluating the level of impact of training results according to four levels Results: The search algorithm yielded sixteen articles of which eight were meeting criteria for inclusion and finally seven were available. The number of participants ranged from 12 to 108 with a median of 61 (IQR: 8-76). The length of intervention ranged from 12 min to three hours with a median of 38 min (IQR: 12-135). Studies reported that incorporating simulation yields a more pronounced impact compared to theoretical and clinical training alone in enhancing knowledge and confidence. Regarding the role of simulation in protocol development, results have shown that in the pre-test, all the participants failed donning and doffing Personal Protective Equipment (PPE), the mean cognitive load was high (7.43±0.9 points) and the performance was low (2.5±0.8) while in the post-test, 100% of participants were successful in donning the PPE, the mean of the cognitive load decreased (4.1±1.4 points), and the performance substantially increased (7.9±1.1). In addition, five studies showed behavioral changes after training and thus the simulation reached Kirkpatrick level three. CONCLUSION: Results supported the impact of simulation, in critical care, as an effective method to enhance knowledge and confidence, and to improve protocol development during pandemics such as COVID-19.

Ostracism Predicting Suicidal Behavior and Risk of Relapse in Substance Use Disorders.

INTRODUCTION: The present study investigated the predictive relationship between ostracism and suicidal behaviors in individuals with substance use disorders. It also attempts to highlight the mediating role of the risk of relapse between ostracism and suicidal behavior. METHODS: The study was based on a cross-sectional survey design. The sample comprised 100 men aged between 30 to 45 years (M = 35.25, SD = 3.06) from Karachi. The purposive sampling technique was employed. The study employed demographic forms and three self-reporting measures: the Ostracism Experience Scale (OES-A), the Advance Warning of Relapse Questionnaire 3.0 (AWARE), and the Suicide Behaviors Questionnaire-Revised (SBQ-R). RESULTS: Ostracism significantly predicted relapse risk and suicidal behavior. Risk of relapse positively predicted both dimensions of ostracism (ignored: r = 0.33, p < 0.01; excluded: r = 0.43, p < 0.01) and suicidal behavior (r = 0.35, p < 0.01). Additionally, the risk of relapse strongly correlated with overall ostracism score (r = 0.43, p < 0.01). However, no significant mediating effect of ostracism on suicidal behavior was found. The effect was mediated through the risk of relapse (B indirect = 0.12, 95% CI = 0.04, 0.23). These findings suggest that ostracism increases the likelihood of recurrence, which in turn is associated with suicidal behavior. The mediation model explained 17% of the variation in suicidal behavior. CONCLUSION: The findings propose the importance of addressing ostracism as a risk factor for suicidal behavior and relapse in substance use disorders. The results suggest that reducing the adverse effects of ostracism and improving social support for individuals can have a significant impact on their mental health.

Validity of Measured vs. Self-Reported Weight and Height and Practical Considerations for Enhancing Reliability in Clinical and Epidemiological Studies: A Systematic Review.

Self-reported measures of height and weight are often used in large epidemiological studies. However, concerns remain regarding the validity and reliability of these self-reported measures. The aim of this systematic review was to summarise and evaluate the comparative validity of measured and self-reported weight and height data and to recommend strategies to improve the reliability of self-reported-data collection across studies. This systematic review adopted the PRISMA guidelines. Four online sources, including PubMed, Medline, Google Scholar, and CINAHL, were utilised. A total of 17,800 articles were screened, and 10 studies were eligible to be included in the SLR based on the defined inclusion and exclusion criteria. The findings from the studies revealed good agreement between measured and self-reported weight and height based on intra-class correlation coefficient and Bland-Altman plots. Overall, measured weight and height had higher validity and reliability (ICC > 0.9; LOA < 1 SD). However, due to biases such as social pressure and self-esteem issues, women underreported their weight, while men overreported their height. In essence, self-reported measures remain valuable indicators to supplement the restricted direct anthropometric data, particularly in large-scale surveys. However, it is essential to address potential sources of bias.

Impact of Skills for Change Program on metabolic control, diet and physical activity levels in adults with type 2 diabetes: A cluster randomized trial.

BACKGROUND: Type 2 diabetes mellitus is highly prevalent in the Arab Gulf countries. Despite this, limited culturally-adapted lifestyle intervention studies have been conducted in this region. METHODS: In this culturally adapted 12-month cluster randomized trial, 382 patients with type 2 diabetes, aged 20-70 years were recruited from 6 public healthcare centers (3 interventions and 3 controls) in Al Ain, United Arab Emirates. The primary outcome of this study was a change in hemoglobin A1c (HbA1c). The secondary outcomes were Body Mass Index (BMI), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, total cholesterol, dietary intake, and physical activity levels. A diet and physical activity intervention, guided by the social cognitive theory, was delivered individually and in group format to the intervention group. The control group continued receiving only their usual diabetes management care. The data were collected at baseline and 1 year after participation. RESULTS: The mean baseline HbA1c levels of the control and the intervention groups were 7.45 ± 0.11% and 7.81 ± 0.11%, respectively. At the end of the 12-month intervention, there was no significant difference in the changes of mean HbA1c between the intervention and the control groups. On the other hand, BMI and daily caloric intake were significantly decreased in the intervention compared to the control group by 1.18 kg/m2 (95% CI: -1.78 - -0.60) and 246 kcal (95% CI: -419.52 - -77.21), respectively, after controlling for age, gender, education, marital status, duration since diabetes diagnosis, diabetes treatment, treatment clinic, and baseline values. Sitting time during the week-end was significantly lower, difference 52.53 minutes (95% CI: 93.93 - -11.14). CONCLUSIONS: This community-based lifestyle intervention for patients with baseline HbA1c <8% did not result in a significant decrease of HbA1c but reduced caloric intake, body weight, and weekend inactivity after controlling for the covariates. TRIAL REGISTRATION: This trial was registered on February 11, 2020 with Clinicaltrials.gov (NCT04264793).

Prevalence, Characteristics, and Treatment Pattern of Menstrual-Related Headache Among Undergraduate Health Sciences Students at Addis Ababa University, Ethiopia.

Background: Menstrual-related headache (MRH) is the most prevalent health condition among young females that limits productivity and social life. However, the magnitude of the problem and its characteristics have not been studied in Ethiopia. Objective: This study aimed to assess the prevalence, characteristics, and treatment of MRH among undergraduate female students at the College of Health Sciences, Addis Ababa University, Ethiopia. Methods: A cross-sectional study was conducted among undergraduate female students from May to June 2023. A random sample of 1000 females were approached who fulfilled the eligibility criteria using the online electronic method. Descriptive statistics were used to summarize participant characteristics. Multivariate logistic regression analysis was performed to identify factors associated with the severity of pain. All statistical analyses were performed using SPSS version 26. A p-value ≤ 0.05 was considered statistically significant. Results: Of the 1000 students who approached online, 757 were included in the final analyses. The prevalence of MRH was (86, 11.4%) and 32.6% of them has experienced the headache before two to three days of menses. The median number of days of missed social activities and reduced productivity was three and one day, respectively. Being single was 6.24 times more likely to have severe MRH (AOR = 6.24, 95% CI: 2.73-14.26, p=0.001) and pharmacy students were less likely (AOR = 0.31, 95% CI: 0.16-0.61, p = 0.001) to have severe pain. Conclusion: Our findings illustrated that MRH among young female students adversely affects students' productivity and social life. This demands interventions to reduce the impact and should pay attention in the future, particularly to create awareness to enhance screening and rendering various treatment options for the target population.

Enhancing proficiency in ascites puncture through procedural simulation: an audit type study investigating medium-term skill retention.

INTRODUCTION: Medical simulation has become an essential teaching method for all health professionals. It not only allows to acquire technical and non-technical knowledge, but also helps the maintenance of acquired knowledge in the medium and long term. Ascites puncture is part of the basic technical procedures learned by medical students during their internship. OBJECTIVES: To evaluate the role of simulation-based learning of ascites puncture on the improvement of theoretical knowledge and maintenance of skills at 3 months. METHODS: We conducted an audit type study with two cycles of data collection at the simulation center at the Faculty of Medicine of Sousse between November 2020 and June 2021. We included learners in their third year of medical studies who had a hospital internship in the gastroenterology department at Sahloul Hospital in Sousse. All learners attended the initial simulation session on ascites fluid puncture. Thereafter, they were free to accept or refuse participation in the evaluation session that was scheduled after 3 months, depending on their availability. RESULTS: Forty learners participated in the procedural simulation of the ascites fluid puncture technique. Thirty-four (85%) were female and six (5%) were male. In our study, we showed that following procedural simulation training of ascites puncture, there was a significant improvement in the theoretical knowledge of the learners (p < 0.000). Objective assessment of technical skills after 3 months showed the benefit of performance maintenance (p < 0.000). CONCLUSION: Our study confirmed the benefit of simulation-based learning on the improvement of theoretical knowledge and the maintenance of technical performance in the medium term.

Could psychobiotics and fermented foods improve mood in middle-aged and older women?

Menopause is a natural physiological phase during which women experience dramatic hormonal fluctuations. These lead to many symptoms, such as depression and anxiety, which, in turn, can negatively affect quality of life. Proper nutrition has an influential role in alleviating depression as well as anxiety. It is well known that gut microbiota dysbiosis contributes to the development of mood disorder. There is mounting evidence that modulating the gut-brain axis may aid in improving mood swings. In this context, this narrative review summarizes recent findings on how aging changes the composition of the gut microbiota and on the association between gut microbiota and mood disorders. In addition, it evaluates the effectiveness of psychobiotics and fermented foods in treating mood swings in middle-aged and older women. A search was done using PubMed, Scopus, and Google Scholar, and thirteen recent articles are included in this review. It is evident that psychobiotic supplementation and fermented foods can improve mood swings via several routes. However, these conclusions are based on only a few studies in middle-aged and older women. Therefore, long-term, well-designed randomized controlled trials are required to fully evaluate whether psychobiotics and fermented foods can be used to treat mood swings in this population.

Public's calorie literacy and perceived effectiveness of restaurant menu calorie labeling in the United Arab Emirates.

Restaurant menu calorie labeling is regarded as a promising, cost-effective, and innovative method that will have an impact on the food environment, raise awareness among consumers, and aid in global efforts to prevent obesity. This study aimed to assess the public's calorie literacy, dining practices, and perceived effectiveness of restaurant menu labeling implementation in the United Arab Emirates (UAE). A descriptive, web-based cross-sectional study was conducted among 1279 adults in the UAE. Socio-demographic characteristics, calorie literacy, and perceived effectiveness of restaurant menu labeling among participants were investigated. Chi-square analysis was used to compare indicators across demographic characteristics. More females than males completed the online survey, (56.1% and 43.9%). Most of the participants aged < 30 years old (54.8%), The majority of participants reported eating away from home at least once per week (89.6%). 66.0% of participants were knowledgeable about calorie definition, but only 37.1% knew about average daily energy requirements. Younger participants, with a normal BMI, and higher education levels reported a significantly higher likelihood of eating at a chain restaurant with caloric information on the menu (p <0.05). The majority of participants (76.0%) preferred to see calorie information and other nutrition information on menus. To conclude, menu labeling is a welcomed policy to be implemented in food outlets. Further investigation is necessary to ascertain the most efficacious method of presenting nutrition information to consumers to facilitate informed purchasing decisions considering the potential benefits of mandating calorie declaration in obesity prevention efforts.

Validity and Reliability of the Arabic Version of the Three-Factor Eating Questionnaire-R18.

The present study translated and validated an Arabic version of the Three-Factor Eating Questionnaire-R18 (TFEQ-R18), which assesses eating behaviour traits among Arabic speakers in the three domains: cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE). Three bilingual experts first translated the English questionnaire into Arabic, and the questionnaire's comprehension was tested among 298 Arabic speakers. Confirmatory factor analysis (CFA) tested the model fit and flagged four items in the questionnaire with low consistency. These items were modified, and the revised Arabic version of TFEQ-R18 was validated in a population of 513 individuals. Validity was evaluated using CFA and Pearson's correlation coefficients, internal consistency using Cronbach's α, and the reproducibility of the questionnaire was confirmed with Bland-Altman analysis and T-test. The construct validity of the Arabic TFEQ-R18 was evaluated by comparing the response score in the population based on gender, BMI and age group. CFA confirmed that the model fit is good and strongly agrees with the collected data. Except for item 15 in the CR domain, all questions showed moderate to high correlation within their respective domains. The Cronbach's α for UE, EE, and CR domains recorded was 0.778, 0.784 and 0.588, respectively. Item 15 had the lowest consistency in the Arabic-TFEQ-R18, and Cronbach's α increased to 0.608 with its removal. There was no significant difference between the first and second attempts of the Arabic TFEQ-R18, indicating good test-retest reliability. Moreover, UE and EE were positively correlated to the BMI of the participants (r = 0.159, p = 0·000; r = 0.158, p = 0·000, respectively). The study concludes that the Arabic TFEQ is a valid and reliable tool for studying the three psychometric domains of UE, EE and CR among Arabic speakers.

Pregnant Women's Perception and Knowledge of the Impact of Obesity on Prenatal Outcomes-A Cross-Sectional Study.

The prevalence of obesity and overweight has been rapidly increasing and is significantly higher among adult females in the Arab States. The aim of the present study was to explore pregnant Emirati women's perception of their weight, their knowledge of the healthy gestational weight gain, and the possible weight-related pregnancy complications. A total of 526 self-administered questionnaires were obtained with a response rate of 72%. The majority (81.8%, n = 429) entered pregnancy as overweight or obese. The percentage of pregnant women who underestimated their weight category was 12.1% in normal weight participants, 48.9% in overweight participants, and 73.5% in obese participants (p < 0.001). The overweight and obese participants were 13 times more likely to underestimate their weight status and 3.6 times more likely to correctly select their healthy gestational weight gain. Women's awareness of pregnancy-related complications due to weight varied from 80.3% for diabetes to 44.5% for fetal complications; their awareness of breastfeeding difficulty was the lowest at 2.5%. Moreover, there was a misconception about personal BMI and the appropriate range for gestational weight gain (GWG). Healthy lifestyle counselling urgently needs to be addressed in preventative health programs such as pre-marital and preconception counselling.

Examination of sleep in relation to dietary and lifestyle behaviors during Ramadan: A multi-national study using structural equation modeling among 24,500 adults amid COVID-19.

Background: Of around 2 billion Muslims worldwide, approximately 1.5 billion observe Ramadan fasting (RF) month. Those that observe RF have diverse cultural, ethnic, social, and economic backgrounds and are distributed over a wide geographical area. Sleep is known to be significantly altered during the month of Ramadan, which has a profound impact on human health. Moreover, sleep is closely connected to dietary and lifestyle behaviors. Methods: This cross-sectional study collected data using a structured, self-administered electronic questionnaire that was translated into 13 languages and disseminated to Muslim populations across 27 countries. The questionnaire assessed dietary and lifestyle factors as independent variables, and three sleep parameters (quality, duration, and disturbance) as dependent variables. We performed structural equation modeling (SEM) to examine how dietary and lifestyle factors affected these sleep parameters. Results: In total, 24,541 adults were enrolled in this study. SEM analysis revealed that during RF, optimum sleep duration (7-9 h) was significantly associated with sufficient physical activity (PA) and consuming plant-based proteins. In addition, smoking was significantly associated with greater sleep disturbance and lower sleep quality. Participants that consumed vegetables, fruits, dates, and plant-based proteins reported better sleep quality. Infrequent consumption of delivered food and infrequent screen time were also associated with better sleep quality. Conflicting results were found regarding the impact of dining at home versus dining out on the three sleep parameters. Conclusion: Increasing the intake of fruits, vegetables, and plant-based proteins are important factors that could help improve healthy sleep for those observing RF. In addition, regular PA and avoiding smoking may contribute to improving sleep during RF.

Comparison of students' perceptions of online and hybrid learning modalities during the covid-19 pandemic: The case of the University of Sharjah.

Hybrid learning enables educators to incorporate elements of conventional face-to-face learning methods with structured online schemes. This study aimed to assess university students' perceptions of online and hybrid learning during the ongoing COVID-19 pandemic. A web-based cross-sectional study was conducted at the University of Sharjah, in the United Arab Emirates (n = 2056). Students' sociodemographic characteristics, perceptions of online and hybrid learning, concerns, and university life changes, were investigated. Perception statements were dichotomized into "positive" and "negative" based on a 50% cut-off point. Scores of > 7 and >5 indicated positive perceptions of online and hybrid learning respectively while scores of ≤ 7 and ≤ 5 indicated negative perceptions. Binary logistic regression analysis was performed to predict students' perceptions of online and hybrid learning according to demographic variables. Spearman's rank-order correlation was performed to determine the relationship between students' perceptions and behaviors. Most students preferred online learning (38.2%) and on-campus learning (36.7%) to hybrid learning (25.1%). Around two-thirds of the students had a positive perception of online and hybrid learning in terms of university support, however, half of them preferred the assessment during online or on-campus learning. Main difficulties reported in hybrid learning were lack of motivation (60.6%), discomfort when on-campus (67.2%), and distraction due to mixed methods (52.3%). Older students (p = 0.046), men (p<0.001), and married students (p = 0.001) were more likely to have a positive perception of online learning, while sophomore students were more likely to have a positive perception of hybrid learning (p = 0.001). In this study, most students preferred online or on-campus over hybrid learning and expressed certain difficulties while on hybrid learning. Future research should focus on investigating the knowledge and capability of graduates from a hybrid/online model compared to a traditional model. Obstacles and concerns should be considered for future planning to ensure the resilience of the educational system.

Soluble and Insoluble Dietary Fibre in Date Fruit Varieties: An Evaluation of Methods and Their Implications for Human Health.

Dietary fibre analysis is expensive due to its reliance on enzymes such as α-amylase, protease, and amyloglucosidase. This study investigated whether enzymes are essential in analysing insoluble, soluble, and total dietary fibre (IDF, SDF and TDF) contents in dry fruits with very low starch and protein contents. The IDF, SDF, and TDF were measured in date fruits using the enzymatic gravimetric method AOAC 991.43 in the ANKOM dietary fibre analyser, with and without enzymatic digestion. The study analysed six date fruit varieties with a range of texture profiles. Our results highlighted agreement between both methods in the measured IDF, SDF, and TDF values. TDF values in date fruit varieties varied considerably, from 5.67% g/100 g to 10.33% g/100 g. Results from both methods also indicate that IDF constituted the bulk of dietary fibre content in all date fruit varieties (77.8% to 91.6%), while the proportion of SDF was between 8.4% and 22.2%. This study confirms that dates are a rich source of dietary fibre, and can be a valuable functional ingredient in foods that reduce the risk of chronic diseases. The study confirmed that the inexpensive non-enzymatic technique is a viable substitute for the enzymatic method for analysing dietary fibre in dry fruits.

The Role of Lifestyle Interventions in the Prevention and Treatment of Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is one of the most common pregnancy-related endocrinopathies, affecting up to 25% of pregnancies globally. GDM increases the risk of perinatal and delivery complications, and the chance of developing type 2 diabetes mellitus and its complications, including cardiovascular diseases. This elevated risk is then passed on to the next generation, creating a cycle of metabolic dysfunction across generations. For many years, GDM preventive measures have had inconsistent results, but recent systematic reviews and meta-analyses have identified promising new preventative routes. This review aims to summarize the evidence investigating the efficacy of lifestyle treatments for the prevention of GDM and to summarize the effects of two lifestyle interventions, including physical activity and dietary interventions. Based on the present research, future studies should be conducted to investigate whether initiating lifestyle interventions during the preconception period is more beneficial in preventing GDM. In addition, research targeting pregnancy should be designed with a personalized approach. Therefore, studies should customize intervention approaches depending on the presence of modifiable and non-modifiable risk factors at the individual level.

Total Usual Nutrient Intakes and Nutritional Status of United Arab Emirates Children (4 Years-12.9 Years): Findings from the Kids Nutrition and Health Survey (KNHS) 2021.

This study aims at investigating the anthropometric status and food consumption patterns of children in the United Arab Emirates (UAE) and assessing their adherence to nutrient and dietary recommendations. It is a population-based cross-sectional survey of 690 children (4-12.9 years), from 3 major Emirates. Socio-demographic and anthropometric characteristics were collected. Dietary intakes were assessed using the 24-hour recall approach. Of the total sample, 4% were stunted, 8% were wasted and 28% were overweight/obese. A third of participating children consumed above the Estimated Energy Requirement, while the majority's intakes carbohydrate, total fat, and protein were within the recommendations; whereas over 70% and 90% of participants consumed above the WHO daily limits of free sugars and saturated fats, respectively. Inadequate intakes of linoleic acid (36% of children), alpha-linolenic acid (91%) and dietary fiber (100%) were observed. All children failed to meet the recommendation for vitamin D and considerable proportions had inadequate intakes of vitamin A, calcium, zinc, folate, and magnesium. Compared with the American Heart Association/American Academy of Pediatrics recommendations, low dietary adherence was noted for fruits (9%), vegetables (4%), and milk/dairy (14%). These findings may be used in the development of nutritional policies aimed at improving the diets of children in the UAE.

Cancer Patients during COVID-19 Pandemic: A Mini-Review.

Since its emergence, coronavirus disease 2019 (COVID-19) has affected the entire world and all commerce and industries, including healthcare systems. COVID-19 adversely affects cancer patients because they are immunocompromised. Increased COVID-19 infection and shortage of medical supplies, beds and healthcare workers in hospitals affect cancer care. This paper includes a description of the existing research that shows the impact of COVID-19 on the management of cancer patients. Aged people with various chronic conditions such as cancer and comorbidities face more challenges as they have a greater risk of disease severity. COVID-19 has affected care delivery, including patient management, and has been responsible for increased mortality among cancer patients. Cancer patients with severe symptoms require regular therapies and treatment; therefore, they have a higher risk of exposure. Due to the risk of transmission, various steps were taken to combat this disease; however, they have affected the existing operational efficiency. Herein, we present the changing priorities during COVID-19, which also affected cancer care, including delayed diagnosis, treatment, and surgeries.

The benefits of physical activity in middle-aged individuals for cardiovascular disease outcomes.

Regular physical activity (PA) has a positive role in preventing cardiovascular disease (CVD). Due to a trend toward a more sedentary lifestyle, the middle-aged population (35-65 years) is at greater risk of developing CVD. It is well established that PA improves cardiorespiratory fitness and reduces the risk of cardiovascular mortality and cardiovascular events, including stroke, coronary heart disease, heart failure, hypercholesterolemia, atherosclerosis, diabetes, and blood pressure. PA can potentially decrease oxidative stress and systemic inflammation, which are the two main underlying mechanisms leading to CVD. By reducing CRP, TNF-α, INF-γ, NF-κB and increasing IL-10, IL-4, and IL-8, PA can prevent the initiation and progression of CVD in middle-aged adults, highlighting the importance of being physically active for this age group. The general recommendation for PA to prevent CVD is at least 150 min/week at a moderate level of intensity; the type of PA should be adapted to the fitness level and medical condition of the individual. However, standardized guidelines for middle-aged individuals with cardiovascular events still need to be established.

Value of simulation as a means of evaluating learning on the management of patients with COVID19.

INTRODUCTION: Medical simulation is a crucial educational tool for training healthcare professionals, renowned for its effectiveness in learning. However, its application as an assessment tool remains uncommon. AIM: To evaluate simulation as a tool for assessing training in the management of COVID-19 patients. METHODS: This descriptive cross-sectional study was conducted in June 2021 at the Department of Pediatrics, Sahloul University Hospital in Sousse, Tunisia. All medical and paramedical staff in the department underwent comprehensive training in the management of COVID-19 patients, including video training for donning and doffing protective equipment when in contact with infected patients. A simulation-based assessment of these procedures was carried out among the department staff having received this training. RESULTS: Our study included a total of 67 participants, comprising 28 medical staff (41.8%) and 39 paramedical staff (58.2%). During the assessment scenario, over 50% of participants successfully completed the main steps for both donning (8 out of 11 steps) and doffing procedures (10 out of 11 steps). However, there were instances of incorrect execution in some critical steps. In the doffing test, only 16.4% of participants performed the fitcheck correctly, with a notable difference between paramedical staff and medical staff (25.6% vs 3.6%, p=0.02). The practice of double gloving was observed in only 38.8% of cases, with higher adherence among physicians compared to paramedical staff (57.1% vs 25.6%, p=0.009). Regarding the doffing procedure, we observed that not all staff performed hydroalcoholic friction adequately. Similarly, only 22.4% of participants followed the recommended sequence of gestures, with a significantly higher compliance rate among doctors compared to paramedical staff (50% vs 2.6%, p<0.001). CONCLUSIONS: Simulation is a swiftly expanding assessment tool. In our study, it helped reveal specific skill deficiencies that would have gone unnoticed in written or oral assessments.