Walaa Ali Elwakil
@faculty of medicine
Faculty of medicine
Alexandria University
RESEARCH, TEACHING, or OTHER INTERESTS
Rehabilitation, Rheumatology
Scopus Publications
Scopus Publications
Yasser El Miedany, Maha El Gaafary, Mathias Toth, Sami Bahlas, Waleed Hassan, Safaa Mahran, Mohammed Hassan Abu-Zaid, Ali El Miedany, and Walaa Elwakil
Springer Science and Business Media LLC
Abstract Background Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) frequently overlap, with each disease potentially presenting as a manifestation of the other. The strong relationship between PMR and GCA raises the question of whether it is a “co-occurrence of different diseases” or a “common spectrum of inflammatory diseases.” The objectives of the current study were to assess the applicability of using ultrasound (US) and clinical data as a monitoring tool to identify PMR patients with subclinical GCA and determine possible predictors of GCA among PMR patients. Results One hundred eight PMR patients and 62 GCA patients were included in this study. The study found that 20.4% of the PMR cohort had subclinical GCA, which later progressed to classical GCA, while 31.5% experienced a PMR relapse. The presence of intimal media thickening of the temporal/axillary artery at baseline was a very early predictor of GCA development; the OGUS score was significantly higher in the PMR group who developed GCA than the standard GCA cohort (p < 0.01). Conclusion The key finding of this study is the incorporation of the concept that vascular inflammation mainly precedes the classical clinical manifestations. Routine screening for subclinical GCA in PMR patients should be considered as part of standard care for PMR patients. Physicians should be attentive to the presence of mural inflammatory changes at the time of diagnosis and monitoring of the ultrasound composite scores in the follow-up course.
Yasser El Miedany, Hala Lotfy, Maha El Gaafary, Naglaa Gadallah, Annie Nasr Mehanna, Safaa Mahran, Waleed Hassan, Mohammed Hassan Abu-Zaid, Samar Abdelhamed Tabra, Mohamed Mortada,et al.
Springer Science and Business Media LLC
Abstract Background The incidence of osteoporosis in children has increased dramatically during the last decade. This has been attributed to better survival rates of children living with chronic disorders, the increased use of medications known to have a negative impact on the children’s bones, and the increased preference for indoor activities and sedentary life in healthy children. Recent advances in pediatric osteoporosis definition, along with a lack of management recommendations or national consensus on its diagnosis and treatment, have led to a wide range of approaches being implemented to manage this illness. The aim of this work was to develop an optimal evidence-based consensus, target-oriented, on-steered therapeutic approach for children with osteoporosis. Based on 15 key clinical questions, a qualitative literature evaluation was conducted to provide evidence-based recommendations for the treatment of pediatric osteoporosis. An expert panel of 14 pediatric osteoporosis specialists conducted a Delphi survey. The level of evidence for each element was assessed using the Oxford Centre for Evidence-based Medicine (CEBM) System, when available, and/or based on the expert panel’s personal experience. All recommendations with an agreement rate of 75% or higher were included. Results Thirty-six recommendations, categorized into 13 domains, had evidence 4 or 5 and consequently were included in the Delphi survey. This was assessed online and a response rate of 82.4% was achieved. Delphi 2 round revealed that all the recommendations achieved 75% or more level of agreement and therefore have been accepted and included in this management recommendations. Based on that an algorithm showing an approach to pediatric osteoporosis management and maintenance of therapy has been developed. Conclusion For the management of children with osteoporosis, consulting a pediatric bone specialist is strongly advised, either by referral or by advice. This is extremely relevant because children are uniquely capable of recovering spontaneously or with the assistance of medication. This includes also vertebral fractures reshaping. Consequently, there is a huge opportunity to improve bone mass accretion and thus musculoskeletal health in children with osteoporosis.
Yasser El Miedany, Mathias Toth, Susan Plummer, Maha Elgaafary, Safaa Mahran, and Walaa Elwakil
Springer Science and Business Media LLC
Abstract Background With a focus on promoting healthy aging, the Egyptian Academy of Bone and Muscle Health followed a structured guideline development process to create the Egyptian 24-h movement clinical guideline for adults aged 18 to 50. This guideline is in continuation with the earlier published 24-h movement guidelines for children and older adults. Online databases (PubMed, Embase, and Cochrane Library) were searched for relevant peer-reviewed studies that met the a priori inclusion criteria. Results A large body of evidence was used to inform the guidelines as a total of 56 studies met the inclusion criteria. Leveraging evidence from the review of the literature led to the development of 30 statements answering the 7 key questions. Recommendations were also given for specific conditions including inactivity or insufficiently active adults, chronic conditions disability as well as pregnancy and postpartum. Based on this, the final guideline was developed providing evidence-based recommendations for a “Healthy 24-h day”, based on the integration of resistance training, aerobic activity, balance and flexibility activity, sleep pattern, and sedentary behavior. Conclusion The developed guidelines are meant to help in the decision-making process and are intended for use by adults both nationally and internationally; also, for endorsement by the policymakers. The developed 24-h movement guidelines provide specific targets for each movement behavior, towards which adult Egyptians can work to achieve better health.
Yasser El Miedany, Hala Lotfy, Laila Abdel Ghaffar, Maha El Gaafary, Safaa Mahran, Susan Plummer, Waleed Hassan, Mohamed Hassan Abu-Zaid, and Walaa Elwakil
Springer Science and Business Media LLC
Abstract Background The Egyptian Academy of Bone and Muscle Health in collaboration with the Egyptian College of Pediatric Rheumatology have identified two indicators to ensure optimum health outcomes among children: one is developmentally and nutritionally appropriate healthcare, and the second is the availability of an effective transition of care model from pediatric care to adult health services. Currently, there is no national guidelines on transition of care for children and adolescents with osteoporosis and metabolic bone disease. To close this gap, this work was carried out to develop the Egyptian guidelines for transition model of care. Results The final recommendation included 12 specific domains. These included the following: targeted population, transition age, transition readiness, patient-targeted care, and disease-specific knowledge, patient education, and optimum model for the transition of care, transition referral, management approach, high quality of care, documentation, and recent service approaches as well as standards and quality indicators. All the overarching principles and most voters agreed with the 12 amended recommendations. Conclusion Transitional care is the term used to describe services that seek to bridge this care gap. Based on the best available data and professional judgment, these consensus-based recommendations guide ways to achieve optimal outcomes in transitional care for adolescents with osteoporosis and metabolic bone disorders. Though focussed on transition of care of bone and muscle health, this article can be the bases for transition services for children with other chronic conditions. This could be used as a blueprint for additional national or internationally healthcare transition policies.
Y. El Miedany, Hala Lotfy, Laila A.G. Hegazy, Maha Elgaafary, Safaa Mahran, Susan Plummer, and Walaa Elwakil
Springer Science and Business Media LLC
Abstract Background The objectives of this work were as follows: (1) to develop holistic recommendations for physical activity, sleep, sedentary behaviours and eating habits adapted to children and adolescent life stage (5–17 years) and targeting optimal metabolic cycle and achieving energy balance; (2) to provide evidence-based information that can be used by the government, policy makers, healthcare professionals, community, schools as well as families to endorse active, healthy, living in apparently healthy children and youth aged 5–17 years, and as a base for monitoring the activities, particularly the physical ones, on the people level. The Egyptian Academy of Bone and Muscle Health followed an established guideline development process to create the Egyptian 24-h movement clinical guideline for children and adolescents. 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 41 studies met the inclusion criteria. Leveraging evidence from the review of the literature led to the development of 11 key questions covering 8 domains. Fifteen statements focus on the overall identified targets through integration of the movement activities and eating behaviour. Results revealed a major change in the previous basic understandings as it shifts away from segregated into integrated movement behaviour and dietary habit paradigm. Based on this, the final guideline was developed providing evidence-based recommendations for a “Healthy 24-h day”, for Egyptian children and adolescents. Conclusion The 24-h composition of movement behaviours has principal implications for health at all ages. The developed guideline provides an up-to-date evidence-based recommendation towards a holistic approach for favourable daily life activities and adopts a feasible perspective by outlining these activities within a 24-h period. In addition, eating and dietary elements have been included to complete the energy cycle. Children and adolescents who meet the 24-h movement guidelines generally report more favourable health indicators than those who do not.
Yasser El Miedany, Maha Elgaafary, Naglaa Gadallah, Safaa Mahran, Mohammed Hassan Abu-Zaid, Waleed Hassan, and Walaa Elwakil
Springer Science and Business Media LLC
Abstract Background Gender differences in the diagnosis and treatment of osteoporosis is a relatively common phenomenon, particularly amongst those patients under 80 years of age presenting with fragility fractures. The clinical implications of these findings are that strategies, which tend to focus on osteoporosis management in women, should also pay enough attention to osteoporosis in men. However, there have been questions whether there is a gender difference when setting intervention thresholds for osteoporosis management. This work was carried out aiming to determine the fracture probabilities calculated by FRAX at which therapeutic intervention in older men and women can be considered. Results Assessment of fracture risk probability thresholds in men revealed that for hip fractures, ROC was 0.754 (95% CI: 0.69–0.817). The sensitivity was 80.5% for threshold probabilities of 2.5%. For the major osteoporosis fracture, ROC was 0.828 (95% CI: 0.694–0.963). The sensitivity was 87.5% for threshold probabilities of 10%. Assessment of fracture risk probability threshold in women ROC was 0.760 (95% CI: 0.691–0.83). The sensitivity was 76.1% for threshold probabilities of 3%. For major osteoporosis fracture, ROC was 0.848 (95% CI: 0.784–0.912). The sensitivity was 87.3% for threshold probabilities of 15%. Conclusion Operational aspects of osteoporosis management should consider gender specific fracture thresholds. Interventional thresholds were found to be different in men compared to women. This helps to optimise fracture prevention in older men.
Yasser El Miedany, Mathias Toth, Susan Plummer, Maha El Gaafary, Safaa Mahran, and Walaa Elwakil
Springer Science and Business Media LLC
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.
Yasser El Miedany, Maha El Gaafary, Safaa Mahran, Naglaa Gadallah, Atef Abdel Azim, Waleed Hassan, Mohammed Hassan Abu-Zaid, Radwa H. Shalaby, Samar abd Alhamed Tabra, and Walaa Elwakil
Springer Science and Business Media LLC
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.
Yasser El Miedany, Maha El Gaafary, Naglaa Gadallah, Safaa Mahran, Mohamed Hassan Abu-Zaid, Waleed Hassan, and Walaa Elwakil
Springer Science and Business Media LLC
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).
Walaa Elwakil, Hussein Elmoghazy Sultan, Marwa Hassan, Mohamed Elshafei, and Esraa Hammad
Springer Science and Business Media LLC
Abstract Background Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. It is clinically presented by nocturnal pain, paresthesia, and weakness in the distribution of the median nerve. However, extra-median symptoms may develop in some patients, particularly those with mild to moderate CTS. This raised the assumption of possible concomitant ulnar nerve entrapment at the wrist, or Guyon's canal syndrome (GCS). The aim of this study is to evaluate functional and structural changes that may take place in the ulnar nerve at the wrist in those patients. Methods This is a retrospective case–control study that included forty patients with mild to moderate CTS and 40 matched subjects as a control group. Electrophysiological evaluation was done for all the participants in addition to measuring median and ulnar nerves sonographic parameters in the form of median cross-sectional area (m-CSA) at the level of pisiform bone, median flattening ratio (m-FR), median swelling ratio (m-SR), the difference between m-CSA at the inlet of the carpal tunnel and m-CSA at the distal third of the pronator quadratus (Δ m-CSA), as well as the ulnar cross-sectional area (u-CSA) at the same level. Results The u-CSA was larger in the patients relative to the control (5.23 ± 1.21 mm2 versus 3.28 ± 0.64 mm2). It did not correlate with m-CSA. However, a statistically significant correlation was demonstrated between u-CSA and median motor conduction parameters (P ≤ 0.001). Conclusion Although patients with mild to moderate idiopathic CTS may have normal electrophysiological parameters of the ulnar nerve, ultrasonographic evaluation is valuable to detect early ulnar nerve structural changes, which appear to be likely due to concomitant distal ulnar nerve entrapment at the Guyon’s canal, which may contribute to the development of extra-median symptoms in those patients.
Yasser El Miedany, Walaa Elwakil, Mohammed Hassan Abu-Zaid, and Safaa Mahran
Springer Science and Business Media LLC
AbstractTrabecular bone score (TBS) is a grayscale textural assessment resulting from a computed evaluation of pixel gray-level variations in previously obtained lumbar spine DXA images. It is an index of bone microarchitecture correlated with parameters of bone strength. Higher values of TBS indicate a better microarchitecture, whereas lower values indicate a degraded microarchitecture. TBS can be used alongside Fracture Risk Assessment tool “FRAX” and bone mineral density (BMD) to enhance the assessment of fracture risk and to inform treatment initiation and monitoring. A systematic review was carried out aiming to update the evidence on the clinical use of the TBS in the management of both primary and secondary osteoporosis. Results revealed that in both primary and secondary osteoporosis, TBS enhances the prediction of fracture risk, and when adjust with BMD and clinical risk factors, it is able to inform the decision-making process regarding initiating osteoporosis therapy and the choice of anti-osteoporosis medication. Evidence also implies that TBS provides valuable adjunctive information in monitoring osteoporosis therapy. In conclusion, this work provides an up-to-date evidence-based review and recommendations which informs the utility of trabecular bone score in standard clinical practice.
Yasser El Miedany, Maha El Gaafary, Naglaa Gadallah, Safaa Mahran, Nihal Fathi, Mohammed Hassan Abu-Zaid, Samar abd Alhamed Tabra, Radwa H. Shalaby, Belal Abdelrafea, Waleed Hassan,et al.
Springer Science and Business Media LLC
Walaa Elwakil, Maha El Gaafary, and Yasser El Miedany
Springer Science and Business Media LLC
Yasser El Miedany, Maha El Gaafary, Naglaa Gadallah, Walaa Elwakil, Waleed Hassan, Nihal Fathi, Mohammed Hassan Abu-Zaid, Samar abd Alhamed Tabra, Radwa H. Shalaby, and Safaa Mahran
Springer Science and Business Media LLC
Abstract Purpose (1) This was a multi-center, cross-sectional, observational study. Both old men and postmenopausal women over 50 years old who were admitted with an osteoporotic fracture (whether hip fracture or major osteoporosis) were consecutively recruited for this work and managed under the Fracture Liaison Service. All the patients were assessed for their sarcopenia risk (SARC-F), fracture risk (FRAX), and fall risk (FRAS) as well as functional disability (HAQ). The aim was to assess the prevalence of sarcopenia risk among older adult Egyptians presenting with fragility fractures. (2) To identify the relation between sarcopenia risk with the risk of falling as well as sustaining a fragility fracture. Results Two hundred and thirty-six patients (69 males, 167 females) were included in this work. The mean age was 70.1 (SD = 9.2) years. The prevalence of sarcopenia was 69.7%. The sarcopenia risk score was positively correlated with the FRAX score (p = 0.01). The prevalence of high sarcopenia risk was 78% of the patients presenting with a high 10-year probability of major osteoporosis fracture as well as a 10-year probability of hip fracture. The sarcopenia risk score was positively correlated with the increased fall risk (p = 0.01) as scored by the FRAS scale. There was a significant relation (p < 0.05) between the functional disability score and the SARC-F score. This was persistent when assessed in relation to fall risk. Conclusion This study highlighted the high sarcopenia risk in the patients presenting with fragility fractures. Identification of patients at increased risk of sarcopenia should be a component of the standard practice.
Yasser El Miedany, Mohammed Hassan Abu-Zaid, Maha El Gaafary, Mona Mansour, Mohamed Elwy, Deborah Palmer, Nihal Fathi, Waleed Hassan, Mohamed Mortada, Mervat Eissa,et al.
Springer Science and Business Media LLC
Abstract Background Despite the recent advances in the management of inflammatory arthritis, a considerable proportion of arthritis patients remain symptomatic. This cohort has recently been identified as ‘difficult to treat’ (D2T). In view of the limited evidence base, management of these patients has been a challenge particularly in view of its associated significant economic health burden. A better understanding of the D2T may help recognise or develop new therapeutic targets and facilitate earlier intervention in the disease course to prevent the progression of such condition. The aim of this work is to address the unmet needs in the management of D2T arthritis and develop a comprehensive approach towards the identification and proper assessment of those patients. Results At the completion of round 3 Delphi process, a total of 20 items were obtained and divided into 5 domains. From 88.9 to 100% of respondents agreed with the recommendations (ranks 7–9). All 20 of the clinical standards that the scientific committee identified were agreed upon in terms of wording, recommendation grade, and level of evidence (i.e. 75% of respondents strongly agreed or agreed). Conclusion D2T inflammatory arthritis remains a relevant clinical challenge, despite the endorsement of the treat-to-target approach and the availability of a broad range of targeted arthritis medications. This study provided a comprehensive definition of the condition to facilitate the identification of this patients’ group. It also highlighted the goals and principles aiming at providing an effective framework for D2T assessment, closely monitor and set up a strategy to intervene in standard clinical practice.
Yasser El Miedany, Mona M. Hasab El Naby, Mohammed Hassan Abu-Zaid, Safaa Mahran, Mervat Eissa, Heba Gamal Saber, Samar Abdalhamed Tabra, Rehab Ali Ibrahim, Salwa Galal, and Walaa Elwakil
Springer Science and Business Media LLC
Abstract Background Despite the associated high prevalence of morbidity and mortality, osteoporotic fragility fractures remain underdiagnosed and undertreated. Furthermore, those who sustain a fragility fracture are at imminent risk of sustaining subsequent fractures. Post-fracture care (PFC) programs are systematic, coordinated care programs that recognize, evaluate, and manage older adults who sustained a fragility fracture with the goal of managing all the risk factors and preventing succeeding fractures. Main text This work was carried out to outline the PFC program adopted in Egypt and its applicability in standard clinical practice. A review of literature was conducted to identify an evidence-informed PFC strategies and protocols, which outlines the optimal manner to manage older adults living with fragility fractures. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist was used to guide the reporting of this review. Based on this, a PFC integrated model of care based on a patient-centered approach has been developed aiming to optimize the outcomes. Conclusion This manuscript described the integrated model of care adopted in Egypt to provide care for older adults presenting with fragility fractures. This will pave the way to standardize patient identification and management. Additionally, to prevent occurrence of subsequent fractures and to enhance equity of care for patients with fragility fracture and osteoporosis, expansion of such service to rural and remote areas is highly recommended.
Yasser El Miedany, Maha El Gaafary, Naglaa Gadallah, Riad Sulimani, Nadia S. AlAli, Ziad Alzoubi, Atef Abdel Azim, Nizar Abdulateef, Gemma Adib, Mohamed Elwy,et al.
Springer Science and Business Media LLC
Abstract Background Dual-energy X-ray absorptiometry (DXA) is an important diagnostic test for bone mass status. The aim of this work was to set the standards for structured reporting of DXA measurements in adults within the context of fracture and fall risk assessment. Results Two rounds of Delphi were completed. The first Delphi round had a 68% response rate, while round two had a 100% response rate. After round 2, a total of 28 items were obtained, which were classified into three domains. The percentage of people who agreed with the recommendations (ranks 9–7) ranged from 76.5 to 100%. The wording of all 19 clinical standards determined by the scientific committee was agreed upon (i.e., 75% of respondents strongly agreed or agreed). Conclusion The DXA scan report is an independent document that contains sufficient information to enable optimal osteoporosis management advised by an experienced healthcare professional. Setting up quality standards for DXA scans not only supports healthcare professionals reporting/interpreting bone densitometry but also meets the parameters outlined in national as well as international guidelines or recommendations for the optimal management of osteoporosis and subsequent prevention of low trauma fractures.
Yasser El Miedany, Maha El Gaafary, Naglaa Gadallah, Safaa Mahran, Nihal Fathi, Mohammed Hassan Abu-Zaid, Samar abd Alhamed Tabra, Radwa H. Shalaby, Belal Abdelrafea, Waleed Hassan,et al.
Springer Science and Business Media LLC
Abstract Mini abstract This work studies the direct cost of hip fractures in Egypt. The direct cost was calculated based on the incidence of hip fracture in Egypt retrieved from the national database. The result of this work raises red flags to the policy makers in Egypt that such fragility fractures are preventable, should appropriate approaches be implemented. Background This study provides an analysis for the healthcare system in Egypt. It was carried out to assess the direct annual cost incurred to the Egyptian healthcare system in 2023 as a result of fragility hip fractures in older adult Egyptians. Results The direct costs of hip fractures incurred during the first year after the injury were estimated at 1,969,385,000 Egyptian pounds (US $63,734,142.4). Time from fracture to surgery was 2.2 + 0.5 days. The average hospital stay after hip fracture surgery was 5.2 + 2.6 days. 4.5% of patients died after surgery, on average 2.3 + 0.4 months. After being discharged from the hospital, all patients needed home care. Conclusion Hip fractures have a significant clinical and financial impact on patients and the healthcare system. This study raises red flags for the healthcare policy makers in Egypt, as the financial burden due to the direct costs of hip fractures justifies extensive prevention programs for osteoporosis and fragility fractures. There is an urgent need to implement diagnostic approaches and validated management protocols for bone health disorders and its associated fractures in Egypt.
Yasser El Miedany and Walaa Elwakil
Springer Science and Business Media LLC
Abstract Background There is an evidence-practice gap in osteoarthritis (OA) management which has caused several patients living with the disease are receiving suboptimal medical care. Though there are several guidelines and treatment recommendations published, there is a real need to operationalise such evidence-based guidelines and facilitate their implementation by healthcare professionals in their local health systems Main text This work was carried out to outline a patient-centred multidisciplinary osteoarthritis care programme for knee and hip joint osteoarthritis that is applicable in standard clinical practice. A scoping review was conducted to identify an evidence-informed osteoarthritis management strategy, which outlines the optimal manner to treat patients living with osteoarthritis and can be implemented by healthcare professionals. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR) checklist was used to guide the reporting of this review. Based on this, a “Model of Care” based on a patient-centred approach with shared decision-making to enhance the timely consideration of all treatment options (including non-pharmacological, pharmacological therapies, psychotherapy, rehabilitation as well as surgery) has been developed aiming to optimise the outcomes. The goals and principles have been identified as well as the key performance indices. An algorithm for the multidisciplinary management of osteoarthritis has been developed. Conclusion The developed osteoarthritis care programme (OACP) provided a “Model of Care” for people living with OA which can be implemented in standard practice. The results will give insight into the features, performance, results, and outcome measures assessed. It will also guide future research towards how “Model of Care” can be patient-centred and tailored to the individual medical status.
Yasser El Miedany, Safaa Mahran, and Walaa Elwakil
Springer Science and Business Media LLC
AbstractBackgroundMusculoskeletal 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 textThe 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.ConclusionMany 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.
Mona El-Sebaie and Walaa Elwakil
Springer Science and Business Media LLC
Abstract Background Sarcopenia is a syndrome characterized by a progressive decline in muscle mass and strength, with subsequent deterioration of functional performance and increased morbidity and mortality. Its emergence may be associated with disorders that are not limited to the elderly. The multifactorial nature of sarcopenia is a major barrier to diagnosis. Several risk factors contribute to the development of sarcopenia, including age, gender, and amount of physical activity. Additionally, the pathophysiology of sarcopenia involves inflammatory conditions, endocrinal dysfunction, and metabolic alterations. Several studies have proposed numerous molecules that may be linked to the pathogenesis of sarcopenia and could be useful in the future; however, there is an unmet need to discover a sensitive, reliable, and cost-effective biomarker of muscle aging. Main text The objective of this research is to highlight different biomarkers of sarcopenia that reflect its multifactorial pathophysiology. A narrative review was carried out through a series of literature searches in the database MEDLINE/PubMed focusing on sarcopenia biomarkers. The following search terms were used: “sarcopenia,” “osteosarcopenia,” “muscle ageing,” “muscle failure,” “sarcopenic obesity,” “weakness,” “biomarkers,” “frailty,” “comorbidity,” “functional disability,” and “inflamm-aging.” The studies were observational and peer-reviewed. They were all carried out at a referral center, hospital, or in the community. The articles chosen all contained information about sarcopenia. Case reports and articles that did not assess people's muscle aging and sarcopenia were not considered. Conclusion Despite the availability of numerous functional, imaging, and biological sarcopenia markers, the inherent limitations of the assessment tools make it difficult to objectively measure the various sarcopenia domains. A valid and reliable biomarker of sarcopenia has yet to be identified. The identification of “gold standard” evaluation techniques that should be systematically used is also impacted by the variability of the populations to be assessed. In this context, the establishment of an international consensus adopting a multi-biomarker approach may be of utmost importance to tackle the different aspects of this multifactorial health-related problem.
Yasser El Miedany, Maha El Gaafary, Naglaa Gadallah, Safaa Mahran, Waleed Hassan, Nihal Fathi, Mohammed Hassan Abu-Zaid, Samar abd Alhamed Tabra, Radwa H. Shalaby, and Walaa Elwakil
Springer Science and Business Media LLC
Walaa Elwakil, Mohamed Imam, Marwa Hassan, Waleed Elsaadany, and Omnia Gaber
Springer Science and Business Media LLC
Abstract Background There is growing evidence of the valuable role of multimodal intraoperative neurophysiological monitoring (IONM) during spine and spinal cord surgeries, as it provides an opportunity to recognize functional changes of the neural elements, usually in the reversible stage, during complex surgical manipulations. Therefore, it may reduce the risk of postoperative neurological dysfunction and improve functional outcomes. The aim of the current study was to evaluate the efficacy of multimodal IONM for preventing and predicting iatrogenic neurological dysfunction during spinal cord and spine surgeries. Results Significant alerts had occurred in 9 out of 24 patients; however, all the changes were reversible and did not contribute to postoperative clinical deterioration. Only one case got worsened in the early postoperative follow-up period, with stable intraoperative monitoring. Conclusion Intraoperative monitoring is a valuable tool in spine and spinal cord surgeries. Combined transcranial motor-evoked potential (TcMEP), somatosensory-evoked potential (SSEP), and spontaneous electromyography (EMG) monitoring may prevent permanent motor deficit and enhance the postoperative outcomes.
Y El Miedany, M El Gaafary, M Toth, D Palmer, Ayman Ali, S Bahlas, S Mahran, W Hassan, MH Abu-zaid, S Saber,et al.
Elsevier BV
Yasser El Miedany, Maha El Gaafary, Naglaa Gadallah, Safaa Mahran, Nihal Fathi, Mohammed Hassan Abu-Zaid, Samar abd Alhamed Tabra, Radwa H. Shalaby, Belal Abdelrafea, Waleed Hassan,et al.
Springer Science and Business Media LLC