Maha El Gaafary

Objective: This study aimed to establish age- and gender-stratified normative data for hand grip strength (HGS) in a population-based sample of healthy Egyptian adults and to analyze its relationship with various socio-demographic and anthropometric parameters. Methods: This cross-sectional study evaluated 2,247 healthy Egyptian participants (900 men, 1,347 women). HGS was measured in kilograms (kg) using a digital hand dynamometer following a standardized bilateral protocol. Anthropometric data (including BMI, hand size, and body circumferences) and socio-demographic characteristics (marital status and occupation) were collected. Data were stratified by age decade and gender for mean, confidence interval, and percentile reference allocation. Results: HGS exhibited highly significant gender dimorphism, with men demonstrating significantly higher strength than women across all age categories ( p < 0.001). In both sexes, HGS peaked in the 18–30-year age cohort, with men averaging 46.6 + 17.5 kg (Right) and women averaging 25.8 + 10.8 kg (Right). HGS showed a continuous, significant decline across successive age decades that was noticeably steeper in men (Right HGS vs. age: r = -0.580, p < 0.01) than in women (Right HGS vs. age: r = -0.184, p < 0.01), though women’s right HGS demonstrated a distinct stabilization plateau between ages 51 and 71+. Correlation analysis showed that HGS was positively linked to dominant hand size and calf circumference in both sexes ( p < 0.01). In men, weak but significant negative correlations were observed with BMI ( r = -0.144) and mid-arm circumference ( r = -0.103), whereas BMI and waist circumference had no statistically significant correlation with HGS in women ( p > 0.05). Socio-demographic stratification revealed that handgrip strength significantly varied by marital status and occupation ( p < 0.001), with single individuals and students achieving the highest baseline metrics. Conclusion: This study establishes the first comprehensive, age- and gender-stratified normative database and percentile reference values for HGS in an Egyptian cohort. These findings supply clinicians with a vital, population-specific diagnostic standard for risk-stratifying muscle wasting, frailty, and sarcopenia. The sharper age-related decline seen in men compared to the late-life plateau observed in women highlights distinct physiological trajectories that warrant further clinical investigation.

Background Purposeful SDM (PSDM) is a problem-based approach that emphasizes the multifaceted nature of SDM in response to different settings and contexts. Objective To evaluate the effectiveness of a novel approach utilizing patient decision aids in facilitating purposeful shared decision-making within the context of rheumatology care. Methodology This randomized controlled study included 431 patients diagnosed with inflammatory arthritis. The patients were randomized to receive management according to either the traditional standard care protocol (215 patients) or the purposeful shared decision-making (PSDM) approach (216 patients), which utilizes structured communication tools. At the end of 1 year of intensive therapy, 6 key outcomes were be assessed to measure the impact of PSDM: clinical remission, medication adherence, treatment cessation, patient motivation, multidisciplinary engagement (contact and utilization rates of the helpline facility), and comprehensibility. Results At 12 months of treatment, 84.3% of the PSDM group achieved treatment target scores, which was significantly higher than the control group, where 62.3% achieved the target. The patients’ adherence to anti-rheumatic therapy, as well as comprehensibility, was significantly higher (p < 0.1) in the PSDM group in comparison to the control group (p < 0.01). Patient motivation scores were significantly higher in the PSDM group (p < 0.01). The percentage of patients who contacted the help line from the control group was significantly higher, in contrast to the PSDM group (p < 0.01). Conclusion Using rheumatology-specific PSDM tools aids in improving patients’ knowledge and supporting communication with their clinicians on treatment benefits and risks. PSDM strategies may improve implementation of the treat-to-target approach. Addressing the variable modes of shared decision-making beyond weighing treatment options improves patients’ understanding of the disease. Key Points • Shared decision-making (SDM), a collaborative process where clinicians and patients jointly arrive at meaningful healthcare decisions. • Purposeful Shared Decision-Making (PSDM) is a problem-based approach that acknowledges the multifaceted nature of SDM, adapting its application to diverse settings, patient needs, and decision types. • A PSDM framework, supported by patient decision aids, demonstrably improves critical outcomes in patients with inflammatory arthritis and spondyloarthritis. • By fostering deeper patient understanding, increasing adherence, boosting motivation, and reducing reliance on external support, PSDM facilitates better disease control and patient empowerment.

Objective: 1. To develop a scoring system for the GCA Disease Activity 2. To validate the composite of the GCA Disease Activity Score (GCA-DAS). 3. To assess the GCA-DAS feasibility and effectiveness in the routine clinical setting for monitoring and assessment of treatment outcomes of GCA. Methods: The developed GCA-DAS includes acute temporal headache, visual deficit, physician global assessment of disease activity, patient global assessment of well-being, and ESR, rated on 0–10 scale. These variables have been identified as the main GCA outcome measures and criteria for improvement. Validation analyses were conducted on 124 patients and included assessment of construct validity, discriminant validity, and responsiveness to change. Results: The GCA-DAS was found to hold face and content validity, good construct validity, satisfactory internal consistency, appropriate dimensional structure, fair discriminative validity and strong responsiveness to clinically important change over time. The devised GCA-DAS was feasible and easily recorded in standard practice. This has been supported by the parallel significant improvement in the patients’ functional ability ( p < 0.001) and patient satisfaction (86.3%). Conclusion: The GCA-DAS was found to be a valid instrument for assessment of GCA disease activity and is potentially applicable in standard clinical care, observational studies, and clinical trials.

Objective: This study aimed to provide a comprehensive profile of the national pattern of systemic sclerosis (SSc) in Egypt.,Methods,This retrospective study included 354 SSc patients retrieved from the Egyptian cohort of the EUSTAR database. Data collected included demographics, modified Rodnan Skin Score (mRSS), SSc subsets, internal organ involvement, auto-antibody profile, acute phase reactants, and organ function tests (PFTs, ECHO, HRCT, and Nailfold Capillaroscopy [NFC]), Health Assessment Questionnaire (HAQ), and Living with Pulmonary Fibrosis Questionnaire (L-PF). Categorical variables were described as frequency and percentages, whereas continuous variables were described as mean and standard deviation or median and interquartile if skewed, together with the range of values encountered.,Results,The Egyptian cohort was overwhelmingly female (89.2%) with a mean age of onset of 32.6 years (± 13.5 SD). More than half presented with limited cutaneous SSc (53.1%). Mean skin disease severity was moderate (mRSS = 13.8 ± 10.6). Microvascular damage was severe, evidenced by a high prevalence of the active NFC pattern (47.8%) and frequent digital ulcers (56.7%).,Internal organ involvement was common: dysphagia (75.4%) and reflux (78.7%) were the most frequent GI symptoms. Interstitial Lung Disease (ILD) was diagnosed in 46.8% of assessed patients, predominantly showing a Ground-Glass Opacification (70.4%) pattern. Pulmonary Arterial Hypertension (PAH) was observed in 11.8% of tested individuals. Autoantibody profiles were notable for high positivity of both anti-Scl70 (51.0%) and anti-centromere (55.6%) among those tested. Inflammatory and muscular markers were often elevated (mean CRP = 6.7 mg/dL; mean CK = 164.3 U/L). Joint disease was significant, with a mean DAS28-ESR of 4.4 (+1.3).,Conclusion,This SSc cohort is characterized by a strong female predominance, a high rate of limited SSc, and significant systemic inflammation. The phenotype is dominated by severe microvascular manifestations and high rates of GI and pulmonary involvement. Analysis of autoantibodies may imply a specific serological profile.

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.

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.

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.

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.

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.