Consensus evidence-based clinical practice recommendations for the diagnosis and treat-to-target management of osteoporosis in chronic kidney disease stages G4-G5D and post-transplantation: An initiative of Egyptian Academy of Bone Health

The aim of this study was to reach a consensus on an updated version of the recommendations for the diagnosis and Treat-to-Target management of osteoporosis that is effective and safe for individuals with chronic kidney disease (CKD) G4-G5D/kidney transplant. Delphi process was implemented (3 rounds) to establish a consensus on 10 clinical domains: (1) study targets, (2) risk factors, (3) diagnosis, (4) case stratification, (5) treatment targets, (6) investigations, (7) medical management, (8) monitoring, (9) management of special groups, (10) fracture liaison service. After each round, statements were retired, modified, or added in view of the experts' suggestions, and the percent agreement was calculated. Statements receiving rates of 7-9 by more than 75% of experts' votes were considered as achieving consensus. The surveys were sent to an expert panel ( = 26), of whom 23 participated in the three rounds (2 were international experts and 21 were national). Most of the participants were rheumatologists (87%), followed by nephrologists (8.7%), and geriatric physicians (4.3%). Eighteen recommendations, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7-9) ranged from 80 to 100%. Consensus was reached on the wording of all 10 clinical domains identified by the scientific committee. An algorithm for the management of osteoporosis in CKD has been suggested. A panel of international and national experts established a consensus regarding the management of osteoporosis in CKD patients. The developed recommendations provide a comprehensive approach to assessing and managing osteoporosis for all healthcare professionals involved in its management. [Abstract copyright: Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.

One musculoskeletal health: towards optimizing musculoskeletal health in Egypt—how to be a bone and muscle builder by the Egyptian Academy of Bone Health and Metabolic Bone Diseases

Abstract Background Musculoskeletal disorders are common problems that affect the elderly. They severely restrict mobility and dexterity, resulting in early retirement from work, lower levels of well-being, and reduced ability to participate in society. With the increase in life expectancy, the older populations are dreaming of active, painless, and independent lives in the face of functional limitations that are the result of various comorbidities with age progression. Main text The aim of the study is to highlight aging changes in the musculoskeletal system, risk factors that may have a negative impact on musculoskeletal, as well as strategies to optimize musculoskeletal health in the elderly. A narrative review was conducted through a series of literature searches in the database MEDLINE/PubMed focusing on musculoskeletal health. The search terms used were “muscle building,” “bone building,” “osteoporosis,” “osteopenia,” “sarcopenia,” “osteosarcopenia,” “fractures,” “falls,” “functional ability,” “nutrition,” “diet,” “obesity,” “comorbidity,” and “medication.” Data extraction was carried out by the investigators using a standardized data collection form with subsequent discussion among the authors. Peer-reviewed observational controlled and non-controlled studies (case–control and cohort studies) were selected. The data collected in the selected articles were all related to musculoskeletal health. Conclusion Many of the changes in the musculoskeletal system result more from disuse than from simple aging. Less than 10% of the Egyptian population participate in regular exercise, and the most sedentary group is older than 50 years of age. Long-term regular exercises may reduce the loss of bone and muscle mass and prevent age-associated increases in body fat

A randomized trial comparing the effects of electrical stimulation of the quadriceps muscle and decreased trigger sensitivity plus exercise breathing after discharge on mechanically ventilated patients with chronic obstructive pulmonary disease to those receiving standard care in terms of 30-day mortality, hospital readmission, and health-related quality of life

Background To compare the effectiveness of ES and TS plus exercise breathing after discharge on mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) to those receiving standard care in terms of 30-day mortality, hospital readmission, and health-related quality of life (HRQOL). Patients and methods The current study was a randomized controlled trial. It included 108 newly admitted patients with COPD to RICU, Chest Department, Assiut University Hospital, Egypt, between June 2018 and May 2020. They were divided into two groups: group I received the usual care plus ES and TS plus breathing exercise, and group II received the usual care alone. Thirty-day mortality, hospital readmission, and HRQOL assessed by MFR-28 were recorded and evaluated. Student t test, Mann–Whitney U test, χ2 test, and Fisher exact test were performed to analyze the data. Results A total of 108 patients with COPD were included. Early rehabilitation program (ES and TS) plus exercise breathing for patients with COPD in the ICU showed decreased 30-day mortality, decreased hospital readmission, and improved HRQOL as compared with patients with COPD who received usual care. Conclusion Patients with COPD who were treated with an early rehabilitation program (ES and TS) combined with exercise breathing had a better prognosis and a higher QOL. Clinical trial.gov The study was registered under NCT03253380

The health-related quality of life in stroke survivors: clinical, functional, and psychosocial correlate

Aim The aims of this study were to examine the health-related quality of life (HRQOL) in stroke survivors attending an outpatient rehabilitation clinic and to examine the relation between some clinical variables and HRQOL. Participants and methods Sixty-four stroke survivors were enrolled. Demographic data were obtained using a structured questionnaire. The functional level of the patients was assessed using the Barthel Index (BI). HRQOL was measured by the short-form 36 (SF-36) and the stroke-specific quality-of-life (SSQOL) scale. Results Our patients′ ages ranged from 42 to 95 years (mean 60.81 years), and men represented 81.2% of the participants. Low mean scores of all the eight domains of SF-36 were found. The 12 domains of SSQOL showed different degrees of deterioration in their means. Statistically significant differences between the means of the mobility level, and upper-limb and lower-limb voluntary control with the means of both SF-36 and SSQOL were found in favor of functional independency and full control of the limbs (P < 0.05). Voluntary control of the limbs and BI showed a significant positive correlation with both SSQOL and the physical component of SF-36. Multiple regression analysis showed that the BI score, the nature of stroke, and the comorbidities are the most significant predictors of SSQOL, with P values of 0.004, 0.013, and 0.047, respectively. Conclusion It was concluded that HRQOL is impaired in stroke survivors, and that the functional independency level is its most significant predictor. We recommend considering the assessment of HRQOL in stroke survivors undergoing rehabilitation management as it is more relevant to the patients

The development of the Egyptian 24-h movement guidelines for adults aged 50 years and older: an integration of sleep, sedentary behavior, and physical activity by the Egyptian Academy of Bone and Muscle Health

Abstract Background With the vision of healthy aging, the Egyptian Academy of Bone and Muscle Health followed an established guideline development process to create the Egyptian 24-h movement clinical guideline for adults aged 50 years and older adults. This guideline highlights the significance of movement behaviors across the whole 24-h day. Online databases (PubMed, Embase, and Cochrane Library) were searched for relevant peer-reviewed studies that met the a priori inclusion criteria. Results A total of 53 studies met the inclusion criteria. Leveraging evidence from the review of the literature led to the development of 27 statements answering the 5 key questions. Results revealed a major change in the previous basic understandings as it shifts away from focussing on a sole movement behavior to the combination of all the movement behaviors. Based on this, the final guideline was developed providing evidence-based recommendations for a “Healthy 24-Hour Day”, comprising a mix of light-intensity and moderate-to-vigorous-intensity physical activity, sleep, and sedentary behavior. Conclusion The developed guidelines are meant to help in the decision-making process and are intended for use by adults and older both nationally and internationally; also, for endorsement by the policy-makers. Dissemination and implementation efforts would impact positively on both health professionals and researchers and would also be useful to interested members of the public sector

Screening to prevent osteoporotic fractures in Egypt: a position statement of the Egyptian Academy of Bone Health

Abstract Background By 2030, approximately 22.6 million individuals in Egypt will be older than 50 years and prone to develop osteoporosis and are at risk of sustaining a fragility fracture. Osteoporotic fragility fractures, and in particular hip fractures, are associated with enduring pain, physical disability, poor quality of life, and loss of independence. Mortality rates are also high in this cohort of patients. Over the coming years, the potential preventable burden is likely to surge, particularly with the aging of the Egyptian population. The aim of this work was to determine the age onset of screening for risk of fragility fracture among Egyptians. Results A convincing evidence was found that fracture risk assessments are accurate and can be applicable in standard practice to identify individuals at high/very high risk of developing fragility fractures. A tremendous increase in the risk of fragility fracture at the age of 60 (RR = 33.5 for men and 20.2 for women). As interventions to either treat osteoporosis or to modify behavioral risk factors in terms of healthy eating and physical exercise would take years to change this risk, it was recommended to start screening for fragility fracture at the age of 50 for both men and women. Conclusion All Egyptian men and postmenopausal women 50 years of age or older should be evaluated/screened for their risk of sustaining a fragility fracture risk. The consequences of failing to identify and treat women and men who are prone to sustain a fragility fracture are considerable. In contrast to DXA scanning, screening with FRAX is cost-effective (time and effort required by patients and the health care system)

Association of IL-10–592 C > A /-1082 A > G and the TNFα -308 G > A with susceptibility to COVID-19 and clinical outcomes

Abstract Background Variation in host immune responses to SARS-CoV-2 is regulated by multiple genes involved in innate viral response and cytokine storm emergence like IL-10 and TNFa gene polymorphisms. We hypothesize that IL-10; -592 C > A and − 1082 A > G and TNFa-308 G > A are associated with the risk of SARS-COV2 infections and clinical outcome. Methods Genotyping, laboratory and radiological investigations were done to 110 COVID-19 patients and 110 healthy subjects, in Ismailia, Egypt. Results A significant association between the − 592 A allele, A containing genotypes under all models (p < 0.0001), and TNFa A allele with risk to infection was observed but not with the G allele of the − 1082. The − 592 /-1082 CG and the − 592 /-1082/ -308 CGG haplotypes showed higher odds in COVID-19 patients. Severe lung affection was negatively associated with − 592, while positive association was observed with − 1082. Higher D-dimer levels were strongly associated with the − 1082 GG genotype. Survival outcomes were strongly associated with the GA genotype of TNFa. -308 as well as AGG and AAA haplotypes. Conclusion IL-10 and TNFa polymorphisms should be considered for clinical and epidemiological evaluation of COVID-19 patients

The inter-relationship of the triad: osteoporosis, fracture risk, and obesity—a longitudinal multicenter analysis by the Egyptian Academy of Bone Health

Abstract Purpose To assess the relationship between the triad of obesity, fracture risk factors, and osteoporosis and its impact on fragility fractures. Results Osteoporosis was least prevalent (p < 0.001) among the obese patients in comparison to overweight and normal body mass index patients. On the other hand, history of risk of falling as well as history of fall(s) in the last year, sarcopenia, and functional disability were significantly more prevalent (< 0.01, 0.05, and 0.05 respectively) among the obese patient cohort. Conclusion Obesity was found to be associated with higher bone mineral density of the hip, lumbar spine, and distal forearm. This was significantly different in post-menopausal women, but not in men. Covariates such as sarcopenia, falls risk, and functional disability play an important factor in making the patient at high risk and prone to develop a fragility fracture