Abeer Hassan Elhaj

Primary female infertility is a complex, multifactorial reproductive disorder influenced by unmodifiable organic etiologies as well as modifiable behavioral and psychosocial factors. This narrative review synthesizes current molecular, cellular and endocrine evidence linking body composition, physical activity, dietary patterns and psychological distress to primary female reproductive dysfunction. We highlight specific physiological pathways, including hypothalamic Gonadotropin-Releasing Hormone (GnRH) pulsatility, the hypothalamic-pituitary-adrenal (HPA) axis, follicular microenvironment oxidative stress and peripheral insulin signaling. Furthermore, actionable clinical guidelines for preconception lifestyle modifications are provided alongside prioritized future research avenues. Routine evaluation of modifiable lifestyle parameters represents an essential component of comprehensive reproductive healthcare.

Introduction: Menstrual hygiene is a critical aspect of adolescent girls' health, yet it remains a neglected topic, particularly in rural areas. Poor menstrual hygiene practices can lead to various health complications, including urinary tract infections, reproductive tract infections, and emotional distress. This study aims to assess the knowledge and practices related to menstrual hygiene among school adolescent girls in a rural community in Pakistan. Objective: To evaluate the menstrual hygiene knowledge and practices of school- going adolescent girls in rural Pakistan. Methodology: This cross-sectional study was conducted at different rural communities of Punjab, Pakistan during June 2024 to December 2024. Data include 650 adolescent girls attending schools in a rural community. Data were collected using a structured questionnaire that assessed participants' knowledge about menstruation, menstrual hygiene practices, and sources of information.Descriptive statistics were used to analyze the data, and knowledge and practices were categorized into adequate and inadequate based on predefined criteria. Results: 58% of the girls had adequate knowledge about menstruation, while 42% had inadequate knowledge. In terms of practices, 62% of girls reported using sanitary pads, whereas 38% used cloths or other materials, with a significant number of them not changing the material regularly. A majority of the participants (62%, 403/650) used sanitary pads, while 38% (247/650) relied on cloths. Among the younger age group (<14 years), 85% (139/163) used cloths, highlighting a greater reliance on traditional materials among younger girls, which poses a higher risk of infections. Conclusion: There is a significant gap in menstrual hygiene knowledge and practices among adolescent girls in rural Pakistan. Improving access to menstrual hygiene products, education, and sanitation facilities are critical for improving menstrual health outcomes.Categories: Obstetrics/Gynecology, Public Health, Epidemiology/Public Health

Background: The risk of dying from chronic liver diseases (CLDs) is two to three times higher for patients with diabetes (DM). Nonalcoholic fatty liver disease (NAFLD) is the primary cause of this increased risk, which has an etiology unrelated to alcohol or viruses. Previous research reported that diabetes and CLD are related, since they influence each other. Aim: Estimation of the impact of diabetes (DM) on liver diseases (LD), and of the impact of liver diseases on DM among Egyptian and Saudi patients. It is a descriptive and prospective analytical study design. The investigation was carried out in Saudi Arabia and Egypt at gastroenterology outpatient clinics. Methods: Prospective data were collected through face-to-face patient interviews during clinic visits between June 2021 and June 2023. The interviews covered the patients’ basic characteristics and information on DM and LD. Certain laboratory tests were conducted on these patients, such as liver function, glucose level, lipid profile, INR, and prothrombin time. Results: The total of 2748 participants in this study included 1242 diabetic patients of both genders from Saudi Arabia and 1506 from Egypt. Most Saudis had between 10 and 20 years’ duration of DM (35.5%), with HbA1c (7–10%) values of 47.8%, while the Egyptian patients had >20 years’ duration of DM (39.8%), with HbA1c (7–10%) values of 49.8%. Regarding the impact of DM on the development of liver diseases, about 35.5% (Saudis) vs. 23.5% (Egyptians) had liver diseases due to DM, a significant difference (p-value = 0.011). Liver enzymes were increased in many of the Egyptian and Saudi patients (41.4% vs. 33%), while the presence of fatty liver (28.2% vs. 35.7%) and hepatocellular carcinoma (13.7% vs. 6.1%) were also significantly different (p-value = 0.047). While the impact of liver diseases on DM was observed more among Egyptian (59%) than among Saudi (46.4%) patients because of liver cirrhosis (HCV or HBV), known to be a reason for diabetes in Egyptians (27.9%) vs. Saudis (8.0%), a higher incidence of fatty liver leading to DM was observed in Saudis than in Egyptians (15.9% vs. 11.6%) (p-value = 0.000. Obesity was more prevalent among Saudi patients (63.8%) than among Egyptian patients (48.6%) (p-value = 0.019). Fewer Egyptians (about 65%) suffered from dyslipidemia than Saudis (about 80%). Higher INR and longer prothrombin times were observed in Egyptians (29.9% and 29.1%, respectively) than in Saudis (20.3% and 18.8%, respectively), with a significant difference between the two nations (p-value < 0.050). Conclusions: We may conclude that diabetes in most patients has a negative impact on the development of liver diseases (particularly fatty liver in Saudi patients). In addition, most liver diseases (liver cirrhosis) have a negative influence on the development of DM (more so in Egyptian patients). There is a link between DM and liver disease. In particular, liver cirrhosis and diabetes were found to influence each other. Therefore, correct medication, adherence to treatment, lifestyle modifications, successful cirrhosis control (in patients with liver diseases), and diabetic control (in diabetic patients) could lead to effective management of both diseases. The negative fallouts in the two cases were prompted by obesity, morbid eating, and poor quality of life.