Effect of Intermittent Fasting on Improve Body Composition and Anthropometric Measurements of Women with Polycystic Ovarian Syndrome / Efecto del ayuno intermitente para mejorar la composición corporal y las medidas antropométricas de mujeres con síndrome de ovario poliquístico

Introduction: Polycystic ovary syndrome is a metabolicdisorder that affects women of reproductive age and is associated with insulin resistance.Objectives: The study aims to evaluate the effect of intermittent fasting and dietary intervention in improving anthropometric measures and body composition.Material and Methods: An interventional trial was carriedout on eighty-six women between the ages of 19 and 40 with a body mass index of more than 25 kg/m2 were assigned to two intervention groups: the first group (n = 57) followed intermittent fasting plus dietary restriction, and the second group (n = 29) followed dietary restriction without intermittent fasting.Results: The results show that the fasting polycystic ovarian syndrome women experienced a significant (P < 0.05) increase in muscle mass (2.2 ± 2.4) compared to the non-fasting group (0.01 ± 1.5). At the end of the intervention, fasting women with the polycystic ovarian syndrome had significantly (P < 0.05) lost weight (9.2 ± 4.5kg), fat mass % (4.6 ± 3.4), and visceral fat (2.3 ± 2.1 kg), while gaining muscle mass (2.2 ± 2.4 kg). However, non-fasting women with polycystic ovarian syndrome showed significantly reduced body weight (2.4 ± 0.4 kg), fat mass % (1.2 ± 1.1), and visceral fat (0.5 ± 0.7). The results of the linear regression model showed that the highest effect of intermittent fasting was seen in weight, fat-free mass, and muscle mass. Body fat mass changed by 93% under the effect of intermittent fasting.Conclusion: Intermittent fasting may improve health outcomes, reduce body fat, maintain muscle mass, and aidweight loss in women with polycystic ovarian syndrome.Large-scale randomized controlled trials can improve our understanding of intermittent fasting in polycystic ovarian syndrome.(AU)

Impact of COVID-19 Self-Isolation on Medical Students' Education and Adherence to Protective Measures.

This study aims to evaluate the impact of self-isolation on the level of adherence to health protective measures among medical students in Jordan and on their clinical education. Because of being suspected of having or testing positive for COVID-19, 336 students were self-isolated . A questionnaire was sent to study the clinical adherence of students to COVID-19 protective measures after their self-isolation period, the student's satisfaction about the policy followed during the pandemic, the impact of these measures on their clinical training, and the level of vaccine acceptance among them. The study included 283 participants, with a mean age of 22.5 (±1.50) years; 49.5% males and 50.5% females. We found that students' adherence to protective measures generally increased after their self-isolation. Gender, age, and having an infection from the hospital were the most important predictors for better adherence to health safety measures. Most students (83%) have registered to take the vaccine. 97.5% of self-isolated students reported that they are aware and satisfied of the School of Medicine instructions and policies. The findings suggest the need to ensure that medical students' clinical training should not be negatively affected by COVID-19 and COVID-19 self-isolation, as medical students are adherent to COVID-19 precautionary measures and willing to take the vaccine.

Fears and uncertainties of expectant mothers during the COVID-19 pandemic: trying to reclaim control.

PURPOSE: The novel coronavirus disease (COVID-19) outbreak has exponentially spread across the globe and formed one of the greatest health threats in history. Pregnant women are vulnerable, and their vulnerability is amplified by the associated containment measures of the pandemic. In this study, we aim to explore and describe expectant mothers' experiences during the lockdown of COVID-19. METHOD: A qualitative descriptive design was used. Eighteen pregnant and postpartum women were recruited through purposive and snowball sampling. Semi-structured phone call interviews were conducted by a female researcher. Braun and Clarke's thematic data analysis was followed. RESULTS: Three main themes are developed: (1) Living with fears and uncertainties amid the COVID-19 pandemic, (2) Lockdown disrupting the normalcy of pregnancy, (3) Trying to control the chaos of life. Five subthemes underlined the three themes. CONCLUSION: Findings portrayed expectant mothers' uncertainties, fears, and the fragility of the healthcare systems in responding to mothers' needs during the COVID-19 pandemic. Although the pandemic has resulted in disruption of the normalcy of pregnancy, mothers sought adaptive means to protect themselves and maintain control. Governmental authorities and healthcare providers are directly responsible to maintain considerate perinatal care services for expectant mothers during lockdown and crises.

Age of Natural Menopause Among Jordanian Women and Factors Related to Premature and Early Menopause.

OBJECTIVE: The aim of this study was to assess factors related to the onset of premature/early natural menopause among Jordanian women. METHODS: A cross-sectional study was conducted in early 2016. Subjects were enrolled based on random drop-off technique to the Obstetrics and Gynecology clinics at the Jordan University Hospital. Women 18 years of age and above were initially eligible to enroll, and women who had surgically induced menopause or specific disease were excluded from the analysis. Relevant data were collected using a questionnaire that included 30 questions. The following variables were collected: socio-demographic, body mass index, chronic conditions, diseases, reproductive characteristics, and health status. Hormone indicators of menopause were tested by measuring estrogen (E2) and follicle-stimulating hormone (FSH) levels. Age at natural menopause (ANM) was self-reported retrospectively and considered an independent variable against BMI, smoking, hormone therapy, and concomitant diseases. Association analysis and multinomial logistic regression were used to examine the associated factors of ANM with adjusted odds ratios (ORs), and their 95% confidence intervals (CIs) were reported. RESULTS: A total of 409 women were included in the analysis, aged between 20-75 years. The mean ANM in our sample was 48.5±5.0, with 2.7% of the women experienced premature menopause (ANM <40) and 7.8% early menopause (ANM 40-44). Within the menopause women (n=242), the percentage of women who had premature menopause was 4.5%, 13.6% with early menopause, and 21.1% with late menopause (ANM >52). Smoking was the major risk factor for premature/early menopausal age among Jordanian women with an OR of 2.46 (95% CI: 1.08-5.59, p<0.05). On the other hand, women with occasional arthritis symptoms and diseases such as hypertension, diabetes, dyslipidemia, and their combination were associated with average (45-52 years) or late menopause (>52 years). CONCLUSION: Smoking is the main contributor of premature/early menopause in Jordanian women. Increased awareness and public health policy about the adverse effects of smoking on women's reproductive health are needed.

Pregnancy During COVID-19 Outbreak: The Impact of Lockdown in a Middle-Income Country on Antenatal Healthcare and Wellbeing.

INTRODUCTION: Since the emergence of coronavirus disease 2019 (COVID-19) as a major worldwide health threat, countries have implemented preventative measures to limit the spread of the disease and reduce the strain on their health services. The Hashemite Kingdom of Jordan is one of the countries where relatively strict lockdown measures were enforced. This study aims to evaluate the impact of the lockdown circumstances in Jordan on antenatal care services and health circumstances of pregnant women during this period. PARTICIPANTS AND METHODS: This study involved a cross-sectional survey of Jordanian women who are currently pregnant. An electronic survey was distributed among pregnant women in Jordan. A total of 944 completed responses were returned and analyzed. The sample size was statistically determined to be representative of the population. RESULTS: The results revealed a significant increase in the percentage of pregnant women not receiving antenatal care from 4% to 59.53% (p<0.001) during the lockdown period, despite the fact that some of these women were suffering from significant underlying medical conditions or serious pregnancy complications that require close antenatal surveillance. The survey also demonstrated that the lockdown circumstances impacted the physical, social, and mental wellbeing of the participants. CONCLUSION: Although the lockdown measures in Jordan have succeeded so far in relative containment of COVID-19, this research suggests that significant disruption to antenatal services has occurred and that the lockdown has affected the wellbeing of pregnant women in a number of aspects, which has the potential to cause antenatal health issues that are not directly related to the spread of COVID-19, but rather are a side effect of the way in which the outbreak is managed.

Prenatal detection of fetal heart disease at Jordan University Hospital: early experience in a developing country.

OBJECTIVE: To report on the first 5 years of establishment of fetal echocardiographic services at the Jordan University Hospital with emphasis on diagnosis and outcome. METHODS: A retrospective chart review was conducted on all fetal echocardiographic studies performed between January 2011 and December 2015. Data collected included maternal demographics, referral indications, fetal cardiac diagnosis, correlation to post-natal diagnosis, outcome of pregnancy including pre-mature delivery and perinatal mortality. Basic statistical analysis was performed including demographic analysis, and calculation of fetal echocardiographic sensitivity and specificity. RESULTS: A total of 208 fetuses underwent fetal echocardiographic evaluation at a mean gestational age of 26.5 (±5) weeks. The most common referral indication was a suspicion of CHD during the obstetric ultrasound (44.2%), followed by cardiac dysfunction (18.2%), and a family history of CHD (14.9%). Fetal echocardiography showed CHD in 71 fetuses (34%), heart failure in 26 (12.5%), arrhythmia in 9 (4.3%), and intracardiac masses in 2. In the remaining 100 fetuses (48%), fetal echocardiography showed normal evaluation. For detecting CHD, fetal echocardiography had a sensitivity and specificity of 91.7% and 95.4%, respectively. Perinatal mortality including termination of pregnancy, intrauterine fetal death, and neonatal mortality was highest in heart failure (77%), and was 41% for CHD. CONCLUSION: The fetal cardiac diagnostic services at the Jordan University Hospital have encouraging initial results with a relatively high sensitivity and specificity. The services further positively impacted the quality of counselling offered and facilitated pre- and post-natal management.

Relative Validity and Reproducibility of a Food Frequency Questionnaire to Assess Food Group Intake in Pregnant Jordanian Women.

BACKGROUND: Research on the relationship between maternal diet and pregnancy outcomes requires valid dietary assessment tools in pregnancy. OBJECTIVE: This study aimed to develop and examine the relative validity and reproducibility of a quantitative food frequency questionnaire (FFQ) to estimate food group intake in a sample of pregnant Jordanian women. DESIGN: In this validation study, food group intake from a culturally sensitive quantitative FFQ was compared with food group intake from three 24-hour dietary recalls. PARTICIPANTS AND SETTING: The validation study was conducted from 2015 to 2017 at the maternity clinics in Jordan University Hospital among 131 healthy singleton pregnant Jordanian women. Of these women, 30 also took part in the reproducibility phase, which involved repeated completion of the FFQ in a time frame of 1 month. Pregnant women who had gestational diabetes, preeclampsia, and chronic diseases were excluded. MAIN OUTCOME MEASURES: Relative validity and reproducibility of a 117-item quantitative FFQ used to estimate usual food intake over a period of 1 month. STATISTICAL ANALYSES PERFORMED: Intraclass correlation coefficients and weighted κ statistics were calculated to test the reproducibility between the two administrations of the FFQ. Pearson correlations were estimated to validate the FFQ against 24-hour dietary recalls. Cross-classification and Bland-Altman plots were used to examine the agreement between the two dietary assessment methods. RESULTS: The intraclass correlation coefficients between the two FFQs ranged from 0.24 for legumes to 0.93 for processed meats. A moderate level of agreement was observed between two FFQs. De-attenuated and energy-adjusted correlations ranged from 0.08 for sweets and sugar to 0.93 for sugary drinks. On average, 50.9% and 45.2% of participants were classified by the FFQ and the 24-hour dietary recalls into the same quartile based on their crude and energy-adjusted food group intake, respectively. Bland-Altman plots showed satisfactory agreement between two methods for most food groups. CONCLUSIONS: The FFQ showed moderate reproducibility and good relative validity for most food groups.

Risk factors of surgical failure following sacrospinous colpopexy for the treatment of uterovaginal prolapse.

PURPOSE: Trans-vaginal sacrospinous colpopexy is one of the surgical procedures used to repair varying degrees of vaginal vault and uterovaginal prolapse. The purpose of this study is to analyse the potential risk factors of surgical failure following sacrospinous colpopexy. METHODS: A retrospective study of 114 women who underwent unilateral sacrospinous colpopexy at Jordan University Hospital from January 2005 to January 2008 were included. Patient demographics, clinical characteristics and concomitant pelvic organ prolapse surgery were assessed. The patients were evaluated at 6 weeks, and every 6 months thereafter. Twelve (11 %) had recurrent apical (vaginal cuff) prolapse, 26 (23 %) had recurrent prolapse at any compartment were compared with those who had successful surgery. Univariate and logistic regression analyses were used to assess the independent prognostic values of the variables associated with surgical failure. RESULTS: After a mean follow-up of 40 months, the statistically significant predictors of surgical failure included the presence of advanced pre-operative stages of prolapse (stages III and IV), the more distally located points Ba, Bp and C and a lack of mesh augmentation of the anterior vaginal wall during surgery (P = 0.01, 0.027, 0.024, 0.034 and 0.006, respectively). However, a history of prior vaginal repair, the more distally located point Ba and a lack of anterior vaginal wall mesh augmentation were defined as independent predictive variables based on logistic regression analyses (P = 0.04, 0.005 and 0.046, respectively). CONCLUSIONS: The presence of advanced anterior vaginal wall prolapse, prior vaginal repair and a lack of mesh augmentation of the anterior compartment are significant risk factors for the surgical failure of sacrospinous suspension surgery.