Salwa Tobar

Body image disturbance and surgical decision making in egyptian post menopausal breast cancer patients

BackgroundIn most developing countries, as in Egypt; postmenopausal breast cancer cases are offered a radical form of surgery relying on their unawareness of the subsequent body image disturbance. This study aimed at evaluating the effect of breast cancer surgical choice; Breast Conservative Therapy (BCT) versus Modified Radical Mastectomy (MRM); on body image perception among Egyptian postmenopausal cases.MethodsOne hundred postmenopausal women with breast cancer were divided into 2 groups, one group underwent BCT and the other underwent MRM. Pre- and post-operative assessments of body image distress were done using four scales; Breast Impact of Treatment Scale (BITS), Impact of Event Scale (IES), Situational Discomfort Scale (SDS), and Body Satisfaction Scale (BSS).ResultsPreoperative assessment showed no statistical significant difference regarding cognitive, affective, behavioral and evaluative components of body image between both studied groups. While in postoperative assessment, women in MRM group showed higher levels of body image distress among cognitive, affective and behavioral aspects.ConclusionBody image is an important factor for postmenopausal women with breast cancer in developing countries where that concept is widely ignored. We should not deprive those cases from their right of less mutilating option of treatment as BCT.

Study of some biomarkers in hair of children with autism

IntroductionAutism is a severe developmental disorder, which involves social withdrawal, communication deficits, and stereotypic repetitive behavior. The possible etiologies that precipitate autism symptoms remain controversial in many cases, but both genetic and environmental factors have been implicated. Mercury has gained much attention for a considerable period of time before other exacerbating or protective factors were suggested. The aim of this study was to investigate the relationship between autism and the level of some metals (namely mercury, lead, and copper) or zinc as a counteracting antioxidant element. MethodsThe study recruited 32 autistic children and 32 normal controls and all of them were subjected to KID-SCID, Childhood Autism Rating Scale (CARS), Stanford Binet intelligence test, and biochemical analysis of hair samples for the level of mercury, copper, lead and zinc. ResultsThere were highly significant differences between the level of these substances in the hair of children with autism compared with controls, positive correlation of CARS score with both mercury and copper, while intelligence quotient has significant negative correlation with the level of lead in the hair. The level of zinc does not correlate with either CARS score or intelligence quotient. ConclusionThese preliminary results suggest a complementary role for the studied elements in the pathogenesis of autistic disorder, which should be considered in the management plane.

Consanguinity associated with increased risk for bipolar I disorder in Egypt

We aimed to contrast rates of consanguinity among patients with bipolar I disorder (BP1) and controls in a population with customary consanguineous marriages (i.e., marriage between related individuals). Consanguinity increases risk for numerous monogenic and polygenic diseases. Whether the risk for BP1 increases with consanguinity has not been investigated systematically. Two independent studies were conducted in Egypt: (1) Case–control study 93 patients with BP1, 90 screened adult control individuals, and available parents. The inbreeding coefficient/consanguinity rate was estimated in two ways: using 64 DNA polymorphisms (“DNA‐based” rate); and from family history data (“self report”); (2) Epidemiological survey: total of 1,584 individuals were screened, from whom self‐reported consanguinity data were obtained for identified BP1 cases (n = 35) and 150 randomly selected, unaffected control individuals. DNA‐based consanguinity rates showed significant case–control differences (P = 0.0039). Self‐reported consanguinity rates were also elevated among BP1 patients in both samples (Study #1 OR = 2.66, 95% confidence intervals, CI: 1.34, 5.29; Study #2: OR = 4.64, 95% CI: 2.01, 10.34). In conclusion, two independent, systematic studies indicate increased consanguinity among Egyptian BP1 patients in the Nile delta region. Self‐reported estimates of consanguinity are bolstered by DNA‐based estimates, and both show significant case–control differences for BP1.

Reduced Fertility and Fecundity among Patients with Bipolar I Disorder and Schizophrenia in Egypt.

Objective To evaluate reproduction among patients with bipolar I disorder (BP1) or schizophrenia (SZ) in Egypt. Methods BP1 patients (n=113) were compared with community based, demographically balanced controls (n=124) and SZ patients (n=79, DSM-IV). All participants were evaluated using structured interviews and corroborative data were obtained from relatives. Standard indices of procreation were included in multivariate analyses that incorporated key demographic variables. Results Control individuals were significantly more likely to have children than BP1 or SZ patients (controls 46.8%, BP1 15.9%, SZ 17.7%), but the BP1-SZ differences were non-significant. The average number of children for BP1 patients (0.37±0.9) and SZ patients (0.38±0.9) was significantly lower than for controls (1.04±1.48) (BP1 vs controls, p<0.001; SZ vs controls, p<0.001). The frequency of marriages among BP1 patients was nominally higher than the SZ group, but was significantly lower than controls (BP1: 31.9% SZ: 27.8% control: 57.3%). Even among married individuals, BP1 (but not SZ) patients were childless more often than controls (p=0.001). The marital fertility, i.e., the average number of children among patients with conjugal relationships for controls (1.8±1.57) was significantly higher than BP1 patients (1.14±1.31, p=0.02), but not significantly different from SZ patients (1.36±1.32, p=0.2). Conclusion Selected reproductive measures are significantly and substantially reduced among Egyptian BP1 patients. The reproductive indices are similar among BP1 and SZ patients, suggesting a role for general illness related variables. Regardless of the cause/s, the impairment constitutes important, under-investigated disability.

Hepatitis C virus antibody titers associated with cognitive dysfunction in an asymptomatic community-based sample

ABSTRACT Background: Hepatitis C virus (HCV) infection is associated with cognitive dysfunction in clinic-based studies. The risk could be attributed to factors such as antiviral medications, substance abuse, or coincidental infection. Aim: The aim was to evaluate cognitive function in relation to HCV antibody titers in a community-based sample of asymptomatic individuals at low risk for substance abuse. Method: Adults were ascertained from a community in Mansoura, Egypt, where HCV is endemic (n = 258). Cognitive performance was evaluated using the Arabic version of the Penn Computerized Neurocognitive Battery. Substance abuse and psychopathology were also assessed. Antibodies to HCV and Toxoplasma gondii (TOX), a common protozoan that can affect cognition, were estimated using serological IgG assays. Results: The prevalence of HCV and TOX infection was 17.6% and 52.9%, respectively. HCV antibody titers were significantly associated with worse function in four cognitive tests for accuracy and three tests for speed, after adjusting for covariates (p < .05, beta coefficients, 2.1–3.2). TOX antibody titers were associated with impaired accuracy in one test. Conclusions: The association between HCV antibody titers and cognitive impairment is not mediated by antiviral treatment or substance abuse in this sample. Whether HCV has a causal role in the cognitive dysfunction should be investigated.

Practice effects distort translational validity estimates for a Neurocognitive Battery

Introduction: With the globalization of biomedical research and the advent of “precision medicine,” there is increased need for translation of neuropsychological tests, such as computerized batteries that can be incorporated in large-scale genomic studies. Estimates of translational validity are obtained by administering the test in the original and the translated versions to bilingual individuals. We investigated the translation of a neuropsychological battery from English to Arabic and how practice effects influence translational validity estimates. Methods: The Penn computerized neurocognitive battery (Penn CNB) includes tests that were validated with functional neuroimaging and provides measures of accuracy and speed of performance in several cognitive domains. To develop an Arabic version of the CNB, the English version was translated into Arabic, then back translated and revised. The Arabic and the original English versions were administered in a randomized crossover design to bilingual participants (N = 22). Results: Performance varied by cognitive domain, but generally improved at the second session regardless of the language of the initial test. When performance on the English and Arabic version was compared, significant positive correlations were detected for accuracy in 8/13 cognitive domains and for speed in 4/13 domains (r = .02 to .97). When the practice estimates using linear models were incorporated, the translational validity estimates improved substantially (accuracy, r = .50–.96, speed, r = .63–.92, all correlations, p = .05 or better). Conclusion: While crossover designs control for order effects on average performance, practice effects, regardless of language, still need to be removed to obtain estimates of translational validity. When practice effect is controlled for, the Arabic and English versions of the Penn-CNB are well correlated, and the Arabic version is suitable for use in research.

Arabic versions of the sleep timing questionnaire and the composite scale of morningness.

OBJECTIVES To develop Arabic versions of English language questionnaires to estimate morningness/eveningness and sleep variables. METHODS We translated the Composite scale of morningness (CSM) and the sleep timing questionnaire (STQ) [with added siesta questions] into Arabic; the Arabic versions were then back translated. The revised Arabic and the original English versions were next administered to bi-lingual Egyptians using a crossover design (n=25). The Arabic versions of both scales were subsequently administered to an independent Egyptian sample (n=79) and the siesta variables examined in relation to the CSM. RESULTS Satisfactory correlations were present between the English and Arabic versions for total CSM scores (Spearmans ρ=0.90, p<0.001). All but one of the STQ variables were significantly correlated (Spearmans ρ=0.45-0.88, p≤0.05). In the Arabic version, the frequency of siesta naps per week was significantly correlated with the total CSM score, with evening types taking more naps (Spearmans ρ=-0.23, p≤0.05). CONCLUSIONS Arabic versions of the STQ and CSM have been developed in Egypt, and are freely available. They can be used for behavioral research related to sleep and circadian function and can be adapted for use in other Arab speaking populations.

Egyptian children with autism spectrum disorders: risk factors and comorbidity in relation to disease severity

Background Autism spectrum disorders (ASDs) represent a group of neurodevelopmental disorders characterized by impaired reciprocal socialization and communication, often accompanied with stereotyped ritualistic behavior. To date, no clear data could explain the dramatic worldwide increase in the incidence of ASD during the last two decades. It is suggested that some environmental factors besides a genetic predisposition leads to the disease. In addition, the disease is known to be associated with other psychiatric comorbidities. Aim The current study aimed to assess the incidence of psychiatric comorbidity present in those children and to relate the findings to the severity of the disease. Patients and methods The current study included 40 children (27 boys and 13 girls), with ages ranging from 3 to 11 years, and diagnosed with ASDs on the basis of the DSM-IV-TR criteria. Patients were divided to three groups according to their score on Gilliam Autism Rating Scale: mild ASD (10 cases); moderate ASD (11 cases), and severe ASD (19 cases). Data were collected through clinical psychiatric interview, Mini International Neuropsychiatric Interview for children and adolescent (M.I.N.I. KID), the Gilliam Autism Rating Scale, Vineland Adaptive Behavior Scales, and a scale for measuring family socioeconomic status for health research in Egypt. Results The present study demonstrated that 72.5% of the cases presented in families with middle socioeconomic status, which are highly educated, the majority (80%) of parents of studied cases lacked consanguinity degree, while only 20% from them had consanguinity from first degree; the vast majorities (92.5%) of the cases were not presented with family history of autism. As regards comorbidity, 90% of the cases were associated with one or more comorbid conditions and the presence of more than one comorbidity usually associated with male sex and severe type of autism, 72.5% of studied cases suffered from comorbid tics (40% occurs in severe autism), 25% of cases presented with associated attention-deficit/hyperactivity disorder, 20% of cases suffered from oppositional defiant disorder (ODD) as comorbid conditions, 37.5% of studied cases had comorbid obsessive compulsive disorder (OCD), and 5% of cases suffered from comorbid general anxiety disorder. Conclusion From the current study it was concluded that boys, high and moderate socioeconomic states, consanguinity, positive family history represented conditions that are associated with an increased risk for autism and ASDs in Egyptian population. Presence of one or more of those risk factors in children with autism is usually associated with severe type of the disease and more associated comorbidities. Determining the contribution of these risk factors may improve detection, earlier treatment, and better prevention of the disease. Comorbid tics, attention-deficit/hyperactivity disorder, ODD, and OCD are most presented among boys, whereas comorbid general anxiety disorder is more presented in girls with autism. The most occurring coincidence of comorbidity is comorbid tics and OCD, followed by comorbid OCD and ODD. Those coincidences were associated with severe autism and male sex. We suggest future studies using large samples to confirm the finding of the present work.

Harassment-related maladaptive cognitions in a sample of Mansoura University students, Egypt

BackgroundDespite being a common problem with many psychiatric consequences, sexual harassment is an under-researched topic. The psychiatric consequences are reported to be related to the way the victim perceives different aspects of the situation. Hence, for cognitive behavior therapy, identification of maladaptive cognitions is of prime importance. Because of the scarcity of data on this topic in our culture, the current preliminary descriptive study aimed at identifying some cognitions about sexual harassment from female victims and their male peers (including harassers), reflecting the cultural views that have an impact on the victim’s reaction and the offender’s attitude. Materials and methodsA self-administered, anonymous questionnaire was specially designed and distributed online and personally among Mansoura University students. A total of 390 male and 354 female students responded. ResultsA significantly higher percentage of female students reported the presence of the problem, the presence of physical harassment, and described it as a serious problem. Regarding the causal attribution of sexual harassment, the most commonly reported cause by male students was the provocative dress of female students, although this factor was cited as a minor factor by female students. The main factor attributed by female students was decreased religious and moral values of the harasser. The significantly predominant feeling among male students (if their sisters had been harassed) was anger. Among female students, the most frequent feelings were disgust and insecurity. Aggression was clearly evident among female students in the form of a wish to hit or kill (61%) or at least curse (10%) the harasser. According to prior records, some of these cognitions can be potentially maladaptive but this must be verified through further research correlating them with different psychopathologies.