RESUMEN
BACKGROUND: Obesity has emerged as a public health crisis in many populations including Egypt. Adipose tissue produces a number of adipokines, one of them is adiponectin which has attracted much attention because of its antidiabetic and antiatherogenic effects. OBJECTIVE: To determine the effect of a weight loss program on serum adiponectin level and insulin resistance among overweight and obese adult premenopausal females. STUDY DESIGN: A pre-postintervention study was carried out among 95 premenopausal overweight and obese females (body mass index ≥ 25 kg/m2) aged 20 to 40 years at the integrated health clinic affiliated to the High Institute of Public Health, Alexandria, Egypt, from February 2016 to February 2017. All participants underwent a weight loss program based on a reduced calorie balanced diet and advised to increase their physical activity. Dietary instructions and follow-up were done weekly throughout 16 weeks. Blood samples were collected to investigate serum adiponectin level and insulin resistance at the beginning and the end of the intervention. RESULTS: After 16 weeks, a significant decrease in body weight by 9.7% was associated with a significant increase in serum adiponectin from 13.3 ± 4.9 µg/ml to 18.5 ± 5.6 µg/ml. Both fasting insulin and insulin resistance had decreased significantly by 13.6% and 13.7%, respectively. CONCLUSION: A weight reduction program depending on a reduced calorie diet for 16 weeks was associated with a significant increase in total adiponectin level and reduction in insulin resistance. An emphasis on the importance of keeping normal weight through nutritional education and the promotion of healthy diets is recommended to reduce the risk of occurrence of insulin resistance, type 2 diabetes, and cardiovascular diseases.
RESUMEN
The target population was cases of oral and pharyngeal cancer in Alexandria and El Behira regions. Data were collected through all accessible archives. Data about quality of life (QoL) were collected through interviewing 171 subjects using the Arabic version of "Functional Living Interview Questionnaire for Cancer" (FLIC). It consists of 22 items translated into Arabic language, and was checked for reliability and validity. Only 12 questions were found suitable for use after testing the questionnaire. Responses are coded on a 7 point Likert scale. Questions included pain, psychic stress, and ability to work and do household activities. The initial scale's structure identified a two-factor model: functional including 6 questions, and psychological including 6 questions. The grand total score was calculated as the sum of responses to the 12 items. The total score of the scale range is 12 to 84 points. The median was used for demarcation between what was considered as "good" response, and what was considered as "poor" QoL. Quality of life displayed higher "good" frequencies among those 30-60 years old. Males, and rural cases expressed better QoL than females and urban. Married were of better QoL compared to single patients. The educated showed higher frequency of "good" compared to un-educated. Employees and professionals reported better QoL. Stage categories showed significant indirect correlation with QoL scores. The best QoL according to total or psychological mean scores was recorded for pharyngeal-otherwise (pharyngeal of a mysterious origin) or lip cases, while the worst were for the floor of the mouth. Lip cases showed the best QoL scores through the functional domain. According to treatment; surgery showed the best QoL, while chemotherapy showed the worst. When it came to chronic irradiation complications; those without complications expressed the best QoL. All those treatment complications showed significant associations with dichotomous leveling of QoL. Logistic regression showed that stage, late surgical complications, and response to treatment were the most important predictors of QoL.
RESUMEN
BACKGROUND: Medical errors in the emergency department (ED) are common, and proportion of preventable adverse events is among the highest for all areas of medical care. Some of the most common types of medical mistakes in ED include misdiagnosis, medication errors, surgery errors, nosocomial infections, laboratory test errors, and administrative errors. The present work aims to assess rate and identify contributing factors to miss and missed diagnoses at the ED of King Fahd Hospital of the University (KFHU) in Khobar, KSA. METHODS: It is a retrospective cohort study. Target population was medical records and database of inpatients admitted from the ED to the study hospital during the year 2007 and the study sample amounted to 441 cases. Accuracy of the diagnosis in the present study was assessed by comparing the degree of matching between ED diagnosis and the final discharge diagnosis using (ICD-9-CM) diagnostic codes. Accuracy of diagnosis was divided into four main categories: fully matched, partially matched, unmatched and symptoms& unspecific. However, missed diagnosis was defined as cases where the ED diagnosis was not documented in the ED sheet. RESULTS: Missed diagnosis represented (8.4%), fully/partially matched diagnosis was 62.3%, unmatched diagnosis was 10.7% and symptoms & unspecific diagnosis was (18.6%). Consultants experienced high percentage of fully/partially matched diagnosis (65.3%), while interns experienced high percentage of unmatched diagnosis (26.3%). The percentage of unmatched diagnosis at night shifts was relatively high 18.9%. Also, slightly more than one fifth of cases were diagnosed as symptoms & unspecific at evening shifts (21.2%). CONCLUSION AND RECOMMENDATIONS: Percentages of missed and unmatched diagnoses were relatively high. Also, percentage of unmatched diagnosis at night shifts and symptoms & unspecific diagnosis at evening shifts were high. The level of performance of interns was low in comparison to consultants leading to high percentage of unmatched diagnosis. Continuous medical education and training of ED physicians especially junior staff to continually improve their knowledge and skills, appropriate supervision of the medical staff to ensure competence, and proper manpower planning and recruitment to compensate for shortage of the ED medical staff especially at night shifts were highly recommended.
