Infertility treatment outcome in sub groups of obese population

<p>Abstract</p> <p>Background</p> <p>Obesity is a common disorder with a negative impact on IVF treatment outcome. It is not clear whether morbidly obese women (BMI >= 35 kg/m2) respond to treatment differently as compared to obese women (BMI = 30–34.9 kg/m2) in IVF. Our aim was to compare the outcome of IVF or ICSI treatments in obese patients to that in morbidly obese patients.</p> <p>Methods</p> <p>This retrospective cohort study was conducted in a tertiary care centre. Patients inclusion criteria were as follows; BMI ≥ 30, age 20–40 years old, first cycle IVF/ICSI treatment with primary infertility and long follicular pituitary down regulation protocol.</p> <p>Results</p> <p>A total of 406 obese patients (group A) and 141 morbidly obese patients (group B) satisfied the inclusion criteria. Average BMI was 32.1 ± 1.38 kg/m2 for group A versus 37.7 ± 2.99 kg/m²for group B. Patient age, cause of infertility, duration of stimulation, fertilization rate, and number of transferred embryos were similar in both groups. Compared to group A, group B had fewer medium size and mature follicles (14 vs. 16), fewer oocytes collected (7 vs. 9) and required higher doses of HMG (46.2 vs. 38.5 amps). There was also a higher cancellation rate in group B (28.3% vs. 19%) and lower clinical pregnancy rate per started cycle (19.9% vs. 28.6%).</p> <p>Conclusion</p> <p>In a homogenous infertile and obese patient population stratified according to their BMI, morbid obesity is associated with unfavorable IVF/ICSI cycle outcome as evidenced by lower pregnancy rates. It is recommended that morbidly obese patients undergo appropriate counseling before the initiation of this expensive and invasive therapy.</p

Mesures rapportées par les patients : Depression, Anxiety and Sleep Disturbance in Vitiligo Patients Participating in the ComPaRe e-cohort : Dépression, anxiété et troubles du sommeil chez les patients atteints de vitiligo participant à l'e-cohorte ComPaRe

Among all skin diseases, vitiligo, a chronic acquired auto-immune depigmenting disease, is considered as the most common cause of disfiguration with a 0.5%-2% worldwide prevalence. Cut-offs of the severity assessment tools has not yet been established to reflect the patient’s improvement and for the treatment’s effectiveness. Furthermore, affection of visible areas in vitiligo has been associated with higher impact on the psychological health of the patient. While different studies emphasize on the psychological impact of the chronic diseases, comparative studies between chronic skin diseases and chronic non skin diseases are still lacking.The objectives of this research were, first to show that face involvement is a good proxy for assessing the perception of global severity among vitiligo patients and to determine the minimal clinically important difference (MCID) of a patient-reported outcome measure in vitiligo; the Self-Assessment Vitiligo Extent Score (SAVES). Second, to determine correlates of depression, anxiety and quality of sleep among vitiligo patients, in addition to comparing these psychological morbidities in vitiligo to non-cutaneous chronic diseases (diabetes and hypertension).This is a retrospective cross-sectional study in the context of the ComPaRe e-cohort. Among invited patients, 540 vitiligo, 633 diabetic, and 1153 hypertensive patients filled in electronically the initial questionnaire which included socio-demographic characteristics and lifestyle habits. The severity of vitiligo was assessed using the Self-Assessment Vitiligo Extent Score (SAVES). In order to determine the minimal clinically important difference (MCID), the SAVES was collected during the initial registration and a second collection was performed one year after with the global assessment scale used as an anchor. In addition, patient-reported outcomes measures including ED-5Q questionnaire, Patient Health Questionnaire 7 (PHQ-7), General Anxiety Disorder 9 (GAD-9) and Pittsburgh Sleep Quality Index (PSQI) were collected.Using the distribution based methods; the MCID and MDC were respectively equal to 7.935% and 7.864% BSA, while the Receiver Operating Characteristic (ROC) analysis revealed an MCID of 0.247% BSA increase of the total SAVES in worsened patients while an MCID equal 0.217%BSA decrease of the SAVES was determined for improved patients. Involvement of hands was not significantly associated with perceived change, while an increase in facial severity was significantly correlated with the patient’s perception of deterioration (OR= 7.428; 95%CI: 1.206, 45.761; p=0.031).The prevalence of depression in vitiligo (28.1%), diabetes (30.8%) and hypertension (29.6%) was not statistically different. Furthermore, 21.3% of vitiligo patients were anxious; while significantly higher mean GAD score was seen among vitiligo patients compared to diabetics. A significant difference in the mean PSQI was observed between vitiligo patients (7.21±4.05) and hypertensive (8.45±4.33), but not diabetic patients.To conclude, our findings highlight the importance of developing a new scale for assessing repigmentation of the face is of high interest as patients’ perception of their facial patches is of most importance compared to other body parts. Ultimately, this global impression of severity could correlate with an improved quality of life. Lastly, dermatologists are encouraged to consider these data because the findings of PRO instruments are critical to assisting clinicians and patients to make informed decisions regarding any intervention. Moreover, a severity measurement scale should be developed in order to compare the impact of disease severity on the psychological morbidities and on quality of life among patients with cutaneous and non-cutaneous chronic diseases.Parmi toutes les maladies de la peau, le vitiligo, une maladie dépigmentante chronique, auto-immune, est considérée comme la cause la plus fréquente de défiguration avec une prévalence mondiale de 0,5% à 2%. Cependant, les seuils des outils de mesure n’ont pas été déterminés pour refléter l’amélioration du patient et l’efficacité du traitement. En outre, l’affection des zones visibles dans le vitiligo a été associée avec un impact substantiel sur l’état psychologique des patients. Bien que différentes études mettent l’accent sur l’impact psychologique des maladies chroniques, des études comparatives entre les maladies chroniques de la peau et les maladies chroniques non cutanées font encore défaut. Les objectifs de cette recherche étaient, premièrement de montrer que l’atteinte du visage est un bon paramètre pour évaluer la perception de la sévérité globale chez les patients atteints de vitiligo et de déterminer la différence minimale cliniquement pertinente (MCID) du Self-Assessment Vitiligo Extent Score (SAVES). Deuxièmement, de déterminer les corrélats de la dépression, l’anxiété et la qualité du sommeil chez les patients atteints de vitiligo, en plus de comparer ces morbidités psychologiques dans le vitiligo aux maladies chroniques non-cutanées (diabète et hypertension). Il s’agit d’une étude transversale rétrospective dans le contexte de la cohorte électronique ComPaRe. Parmi les patients invités, 540 patients atteints de vitiligo, 633 diabétiques et 1153 hypertendus ont répondu électroniquement le questionnaire initial, évaluant les caractéristiques sociodémographiques. La gravité du vitiligo a été évaluée à l’aide des SAVES. Afin de déterminer le MCID, le SAVES a été recueilli lors de l’enregistrement initial et une deuxième collecte a été effectuée un an après, en plus d’une échelle globale d’évaluation de l’étendu du vitiligo. De plus, des mesures reportés par les patients; la qualité de vie (questionnaire ED-5Q), Patient Health Questionnaire 7 (PHQ-7) pour la dépression, General Anxiety Disorder 9 (GAD-9) pour l’anxiété et Pittsburgh Sleep Quality Index (PSQI) pour la qualité du sommeil ont été collectées. Les méthodes basées sur la distribution ont montré un MCID et un MDC de 7,935 % et 7,864 % de surface corporelle, tandis que l’analyse de la courbe des caractéristiques receveur-opérateur a révélé une valeur du MCID de 0,247 % de la surface corporelle chez les patients aggravés, et de 0,217 % de la surface corporelle chez les patients améliorés. Une augmentation de la gravité faciale était significativement corrélée à la perception de détérioration du patient (OR = 7,428; IC à 95%: 1,206, 45,761; p = 0,031) La prévalence de la dépression dans le vitiligo, le diabète et l’hypertension n’était pas statistiquement différente. En outre, le score moyen GAD était significativement plus élevé chez les patients atteints de vitiligo par rapport aux diabétiques. Une différence significative de la moyenne du PSQI a été observée entre les patients atteints de vitiligo (7,21±4,05) et les patients hypertendus (8,45±4,33), mais pas les patients diabétiques. Pour conclure, le développement d’une nouvelle échelle pour évaluer la repigmentation du visage est d’un grand intérêt car la perception des patients concernant les tâches du visage est de plus grande importance par rapport à d’autres parties du corps. En fin de compte, cette impression globale de gravité pourrait être corrélée à une amélioration de la qualité de vie. En plus, nos résultats soulignent l’importance de développer une nouvelle échelle commune de mesure de la gravité afin de pouvoir comparer l’impact de la gravité de la maladie sur les morbidités psychologiques et sur la qualité de vie dans les maladies chroniques cutanées et non cutanées

Mesures rapportées par les patients : Depression, Anxiety and Sleep Disturbance in Vitiligo Patients Participating in the ComPaRe e-cohort : Dépression, anxiété et troubles du sommeil chez les patients atteints de vitiligo participant à l'e-cohorte ComPaRe

Parmi toutes les maladies de la peau, le vitiligo, une maladie dépigmentante chronique, auto-immune, est considérée comme la cause la plus fréquente de défiguration avec une prévalence mondiale de 0,5% à 2%. Cependant, les seuils des outils de mesure n’ont pas été déterminés pour refléter l’amélioration du patient et l’efficacité du traitement. En outre, l’affection des zones visibles dans le vitiligo a été associée avec un impact substantiel sur l’état psychologique des patients. Bien que différentes études mettent l’accent sur l’impact psychologique des maladies chroniques, des études comparatives entre les maladies chroniques de la peau et les maladies chroniques non cutanées font encore défaut. Les objectifs de cette recherche étaient, premièrement de montrer que l’atteinte du visage est un bon paramètre pour évaluer la perception de la sévérité globale chez les patients atteints de vitiligo et de déterminer la différence minimale cliniquement pertinente (MCID) du Self-Assessment Vitiligo Extent Score (SAVES). Deuxièmement, de déterminer les corrélats de la dépression, l’anxiété et la qualité du sommeil chez les patients atteints de vitiligo, en plus de comparer ces morbidités psychologiques dans le vitiligo aux maladies chroniques non-cutanées (diabète et hypertension). Il s’agit d’une étude transversale rétrospective dans le contexte de la cohorte électronique ComPaRe. Parmi les patients invités, 540 patients atteints de vitiligo, 633 diabétiques et 1153 hypertendus ont répondu électroniquement le questionnaire initial, évaluant les caractéristiques sociodémographiques. La gravité du vitiligo a été évaluée à l’aide des SAVES. Afin de déterminer le MCID, le SAVES a été recueilli lors de l’enregistrement initial et une deuxième collecte a été effectuée un an après, en plus d’une échelle globale d’évaluation de l’étendu du vitiligo. De plus, des mesures reportés par les patients; la qualité de vie (questionnaire ED-5Q), Patient Health Questionnaire 7 (PHQ-7) pour la dépression, General Anxiety Disorder 9 (GAD-9) pour l’anxiété et Pittsburgh Sleep Quality Index (PSQI) pour la qualité du sommeil ont été collectées. Les méthodes basées sur la distribution ont montré un MCID et un MDC de 7,935 % et 7,864 % de surface corporelle, tandis que l’analyse de la courbe des caractéristiques receveur-opérateur a révélé une valeur du MCID de 0,247 % de la surface corporelle chez les patients aggravés, et de 0,217 % de la surface corporelle chez les patients améliorés. Une augmentation de la gravité faciale était significativement corrélée à la perception de détérioration du patient (OR = 7,428; IC à 95%: 1,206, 45,761; p = 0,031) La prévalence de la dépression dans le vitiligo, le diabète et l’hypertension n’était pas statistiquement différente. En outre, le score moyen GAD était significativement plus élevé chez les patients atteints de vitiligo par rapport aux diabétiques. Une différence significative de la moyenne du PSQI a été observée entre les patients atteints de vitiligo (7,21±4,05) et les patients hypertendus (8,45±4,33), mais pas les patients diabétiques. Pour conclure, le développement d’une nouvelle échelle pour évaluer la repigmentation du visage est d’un grand intérêt car la perception des patients concernant les tâches du visage est de plus grande importance par rapport à d’autres parties du corps. En fin de compte, cette impression globale de gravité pourrait être corrélée à une amélioration de la qualité de vie. En plus, nos résultats soulignent l’importance de développer une nouvelle échelle commune de mesure de la gravité afin de pouvoir comparer l’impact de la gravité de la maladie sur les morbidités psychologiques et sur la qualité de vie dans les maladies chroniques cutanées et non cutanées.Among all skin diseases, vitiligo, a chronic acquired auto-immune depigmenting disease, is considered as the most common cause of disfiguration with a 0.5%-2% worldwide prevalence. Cut-offs of the severity assessment tools has not yet been established to reflect the patient’s improvement and for the treatment’s effectiveness. Furthermore, affection of visible areas in vitiligo has been associated with higher impact on the psychological health of the patient. While different studies emphasize on the psychological impact of the chronic diseases, comparative studies between chronic skin diseases and chronic non skin diseases are still lacking.The objectives of this research were, first to show that face involvement is a good proxy for assessing the perception of global severity among vitiligo patients and to determine the minimal clinically important difference (MCID) of a patient-reported outcome measure in vitiligo; the Self-Assessment Vitiligo Extent Score (SAVES). Second, to determine correlates of depression, anxiety and quality of sleep among vitiligo patients, in addition to comparing these psychological morbidities in vitiligo to non-cutaneous chronic diseases (diabetes and hypertension).This is a retrospective cross-sectional study in the context of the ComPaRe e-cohort. Among invited patients, 540 vitiligo, 633 diabetic, and 1153 hypertensive patients filled in electronically the initial questionnaire which included socio-demographic characteristics and lifestyle habits. The severity of vitiligo was assessed using the Self-Assessment Vitiligo Extent Score (SAVES). In order to determine the minimal clinically important difference (MCID), the SAVES was collected during the initial registration and a second collection was performed one year after with the global assessment scale used as an anchor. In addition, patient-reported outcomes measures including ED-5Q questionnaire, Patient Health Questionnaire 7 (PHQ-7), General Anxiety Disorder 9 (GAD-9) and Pittsburgh Sleep Quality Index (PSQI) were collected.Using the distribution based methods; the MCID and MDC were respectively equal to 7.935% and 7.864% BSA, while the Receiver Operating Characteristic (ROC) analysis revealed an MCID of 0.247% BSA increase of the total SAVES in worsened patients while an MCID equal 0.217%BSA decrease of the SAVES was determined for improved patients. Involvement of hands was not significantly associated with perceived change, while an increase in facial severity was significantly correlated with the patient’s perception of deterioration (OR= 7.428; 95%CI: 1.206, 45.761; p=0.031).The prevalence of depression in vitiligo (28.1%), diabetes (30.8%) and hypertension (29.6%) was not statistically different. Furthermore, 21.3% of vitiligo patients were anxious; while significantly higher mean GAD score was seen among vitiligo patients compared to diabetics. A significant difference in the mean PSQI was observed between vitiligo patients (7.21±4.05) and hypertensive (8.45±4.33), but not diabetic patients.To conclude, our findings highlight the importance of developing a new scale for assessing repigmentation of the face is of high interest as patients’ perception of their facial patches is of most importance compared to other body parts. Ultimately, this global impression of severity could correlate with an improved quality of life. Lastly, dermatologists are encouraged to consider these data because the findings of PRO instruments are critical to assisting clinicians and patients to make informed decisions regarding any intervention. Moreover, a severity measurement scale should be developed in order to compare the impact of disease severity on the psychological morbidities and on quality of life among patients with cutaneous and non-cutaneous chronic diseases

Food safety culture in food companies amid the Lebanese economic crisis and the Covid-19 pandemic

The challenges to food safety in Lebanon are many and have worsened due to the Covid-19 pandemic and the Lebanese economic crisis. Against a backdrop of loosely enforced food laws and regulations, a cross-sectional study was carried out in 23 Lebanese food companies on 204 participants using a validated online food safety culture self-assessment tool consisting of 28 indicators. Food safety motivation, burnout/job stress and conscientiousness and their impact on food safety culture were also investigated. Overall, the perceived food safety culture was “good” with a mean value of 119.1 over 140 (equivalent to 4.3/5). A young workforce, the female gender, a science background, and a university degree were associated with a higher food safety culture. The food safety culture score was also perceived higher among participants who attended food safety trainings, and among those working at the managerial level and in the quality department. In addition, the results showed that the food safety culture was significantly better in companies exporting their goods than companies with no international market exposure (121.6 vs 118.1). Moreover, Food safety motivation (mean score 4.1/5) and conscientiousness (3.5/5) were moderately associated with a positive food safety culture. However, the low burnout/job stress scores (2.8/5) may exhibit a negative impact on the food safety culture and could be related to several consequences caused by the Lebanese economic crisis and the Covid-19 pandemic. Further studies are to be conducted to understand better the causal effects relationship

The influence of socio-demographic factors on patterns of thyme and thyme products consumption: the case of a Mediterranean country

Thyme intake assessment is gaining significance because thyme is becoming a global staple food and its use has been on the rise. In our study, a food frequency questionnaire (FFQ) was developed to assess thyme intake in Lebanon. Out of the total 1555 adult participants, 1523 persons (97.9%) consumed at least one thyme product among the14 assessed thyme-containing products. The mean consumption of thyme products was estimated to be 425.5 g/day, providing an estimated 31.4 g/day of thyme. Thyme pie had the highest mean intake (72.5 g/day) and represented the highest thyme contribution (10.4 g/day) among all thyme products, while crackers with thyme had the lowest mean intake (3.7 g/day) and the lowest thyme contribution (0.2 g/day). The mean consumption values for thyme products were significantly different between participants of different genders, age categories, socio-economic and demographic levels. This study highlighted the importance of a food frequency questionnaire as a tool for data collection about the consumption patterns

The relationship between hypovitaminosis D and metabolic syndrome: a cross sectional study among employees of a private university in Lebanon

Abstract Background The prevalence of low vitamin D status and metabolic syndrome is increasing globally and in Lebanon. The objectives of this study are to assess the prevalence of metabolic syndrome (MetS) and its components (elevated triglycerides, low HDL, abdominal obesity defined by high waist circumference, hypertension, impaired fasting blood glucose) and investigate the association between serum 25-hydroxyvitamin D (25(OH)D) concentrations and MetS and its components among a sample of Lebanese adults. Methods A cross-sectional study was carried out on Notre Dame University employees. A background questionnaire, a short-form of the International Physical Activity Questionnaire and a food frequency questionnaire were administered. Participants were invited to the nutrition laboratory to gather data on anthropometric (height, waist circumference, weight, body composition and body mass index) and biochemical measurements (serum vitamin D, triglycerides, HDL and fasting blood glucose). Vitamin D status was assessed according to the Institute of Medicine cut-offs (inadequate or adequate: 25(OH)D < or ≥ 50 nmol/L).The definition of the Third Report of the National Cholesterol Education Program was used to identify individuals who had MetS. The data were analyzed using the SPSS version 22. P < 0.05 was considered statistically significant. Results A total of 344 participants (age range of 20 to 74 years) were included in the study. The prevalence of MetS was 23.5%. Among MetS components, central obesity was the most prevalent condition (50.6%), while the least prevalent was impaired fasting blood glucose (20.3%). The odds of having MetS were found to be 2.5 (95% CI 1.3–4.7) higher among those with inadequate vitamin D status, than among those with adequate vitamin D status while controlling for important confounders (age, marital status, education level, income, medical morbidity, smoking and percent body fat and gender). Among the components of MetS, only hypertriglyceridemia (OR: 2.4, 95%CI: 1.3–4.2) and low HDL (OR: 1.8, 95% CI: 1.0–3.0) were associated with inadequate vitamin D status while controlling for important confounders. Conclusions Early identification and control of risk factors for cardiovascular diseases in the primary care level is needed, particularly among adults who have low vitamin D status, are obese, and have low income level

Facial involvement is reflective of patients’ global perception of vitiligo extent

Background The involvement of visible areas in vitiligo has been found to be correlated with increased psychiatric morbidity. Although multiple tools have been developed to assess vitiligo, no cutoff for improvement or worsening of vitiligo from a patient’s perspective has been established. Objectives To determine the minimal clinically important difference (MCID) of the Self-Assessment Vitiligo Extent Score (SA-VES) in patients with vitiligo and to evaluate, from the patient’s perspective, the importance of the change in the involvement of visible areas (face and hands) in patients’ overall perception of disease worsening or improving. Methods This was a cross-sectional study in the context of the ComPaRe e-cohort. Adult patients with vitiligo were invited to answer online questionnaires. They completed the SA-VES twice, 1 year apart. In addition, patients answered a 5-point Likert anchor question aimed at assessing their perception of the evolution of the extent of their vitiligo. The MCID was calculated using distribution- and anchor-based approaches. Using ordinal logistic regression, the change of vitiliginous lesions on the face or hands was compared to the overall extent of vitiligo (patches on all body areas). Results In total, 244 patients with vitiligo were included in the analyses; 20 (8%) were found to have an improvement in their vitiligo. The MCID in worsened patients was equal to a 1.3% body surface area [95% confidence interval (CI) 1.01–1.43] increase in the SA-VES. For participants with improved vitiligo, the MCID was equal to a decrease in total SA-VES of 1.3% (95% CI 0.867–1.697). Patients’ perceptions of change in their vitiligo was increased sevenfold when it affected the face vs. the rest of the body. Conclusions Changes in the facial SA-VES were highly correlated with patients’ impressions of the extent of vitiligo. © The Author(s) 2023. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved

Aflatoxin B1 in Rice: Effects of Storage Duration, Grain Type and Size, Production Site, and Season

ABSTRACT: Our study evaluated aflatoxin B1 (AFB1) levels in packed rice marketed in Lebanon and determined the exposure to this toxin from rice consumption. A total of 105 packed white, parboiled, and brown rice bags were collected. Enzyme-linked immunosorbent assay was used to measure AFB1. A comprehensive food frequency questionnaire was completed by 500 participants to determine patterns of rice consumption and, subsequently, the exposure levels to AFB1 from rice consumption in Lebanon. AFB1 was detected in all rice samples (100%). The average concentration ± standard deviation of AFB1 was 0.5 ± 0.3 μg/kg. Contamination ranged between 0.06 and 2.08 μg/kg. Moisture content in all rice samples was below the recommended percentage (14%). Only 1% of the samples had an AFB1 level above the European Union limit (2 μg/kg). Brown rice had a significantly higher AFB1 level than white and parboiled rice (P = 0.02), while a significant difference was found between both collections for the same brands (P = 0.016). Packing season, packing country, country of origin, presence of a food safety management certification, grain size, and time between packing and purchasing had no significant effect. Exposure to AFB1 from rice consumption in Lebanon was calculated as 0.1 to 2 ng/kg of body weight per day