Procjena spolnih razlika u tjelesnom sastavu i kondicijskom bodovanju u Odrasloj populaciji Saudijske Arabije pomoću analize bioelektrične impedancije

Obesity is a global problem that is reaching epidemic proportions. Body composition is an important parameter for humans because previous studies indicate high values of body fat as a predictor of mortality. The aim of the study was to assess gender differences in body composition and physical fitness in Saudi adult population. This epidemiological cross sectional study included 411 healthy adult Saudi subjects aged 18-72 years (mean } SD, 36.91}15.22). All participants underwent body composition analysis. Body composition was assessed by bioelectrical impedance analysis, with a commercially available body analyzer (InBody 3.0, Biospace, Seoul, Korea). Measurements included body weight, body mass index (BMI ), percent body fat, target weight, fat control, muscle control and fitness scoring based on target values. The mean BMI of the whole study population was 27.22}5.65 (median=26.80, range=15.6-55.4). The mean fitness score was 69.3}8.48 (median=71.0, range=29-99). Significant gender differences were observed in BMI,fitness score, percent body fat, and other parameters of body composition. In conclusion, the prevalence of obesity, percent body fat (%BF) and poor fitness is high in Saudi population with significant gender differences. In this regard, public awareness programs including exercise and diet teaching are required at large scale to cope up with the growing burden of obesity.Pretilost je globalni problem koji poprima epidemijske razmjere. Tjelesni sastav je važan parametar kod ljudi, jer prijašnja ispitivanja pokazuju da su visoke vrijednosti tjelesne masti predkazatelji smrtnosti. Cilj ove studije bio je procijeniti spolne razlike u tjelesnom sastavu i kondiciji u odrasloj saudijskoj populaciji. Ova epidemiološka poprečna studija obuhvatila je 411 odraslih osoba u dobi od 18 do 72 godine (srednja dob } SD, 36,91}15,22). Procjena tjelesnog sastava provedena je u svih ispitanika analizom bioelektrične impedancije pomoću tjelesnog analizatora dostupnog na tržištu (InBody 3.0, Biospace, Seoul, Koreja). Mjerila se tjelesna težina, indeks tjelesne mase, postotak tjelesne masti, ciljna težina, regulacija masti, regulacija mišića i bodovanje kondicije na osnovi ciljnih vrijednosti. Srednja vrijednost indeksa tjelesne mase za cijelu populaciju ispitanika bila je 27,22}5,65 (medijan=26,80, raspon=15,6-55,4), a srednja vrijednost kondicijskih bodova 69,3}8,48 (medijan=71,0, raspon=29-99). Značajne razlike prema spolu zabilježene su za indeks tjelesne mase, kondicijske bodove, postotak tjelesne masti i ostale parametre tjelesnog sastava. Ovi rezultati upućuju na visoku učestalost pretilosti, visokog postotka tjelesne masti i loše kondicije u saudijskoj populaciji, uza značajne razlike prema spolu. Zato su potrebni sveobuhvatni programi osvješćivanja populacije u tom smislu, uključujući izobrazbu u tjelovježbi i primjerenoj prehrani kako bismo se mogli nositi s rastućim teretom pretilosti

THE HIDDEN VALUE OF CLINICAL PHYSIOLOGY TESTS UTILITY IN MEDICAL PRACTICE FOR A BETTER UNDERSTANDING: A MESSAGE FOR THE DECISION MAKERS

Clinical physiology department in well-organized university hospitals has three important roles: 1) it can be considered the best link between the basic sciences that have been taught in the undergraduate curriculum and clinical practice. 2) several techniques are practiced in the clinical physiology department operating in close collaboration with other clinical specialties which are very helpful in providing health care such as Pulmonary Function Test, Electroencephalogram, Nerve Conduction Studies, Auditory Brainstem Response, Electrocardiogram, Exercise-based “stress tests,” etc. 3) it has a strong relation with research disciplines and its participation in this field cannot be neglected. The aim of this viewpoint is to unravel the hidden importance of the clinical physiology department and its utility in both basic sciences and clinical teachings, both for health care and research. Therefore, assuring clinical physiology as an independent part of the basic sciences physiology department with the decision-maker support could guarantee the survival and continuation of the link between undergraduate teaching and clinical practice. The practical sessions of the undergraduate curriculum should be updated so that students get knowledge of techniques utilized in their clinical careers. This is beyond the conventional theory bases irrelevant teaching curriculum. Recruitment of well-qualified and specialized specialists in clinical physiology techniques, technicians, and nurses who can perform and interpret these tests effectively as well as supplying the unit with modern and sophisticated equipment is of great value. Research funds have to be directed toward clinical physiology that can boost the development of medical evolution ahead

UTILITY OF SPIROMETRY IN ASSESSMENT OF UPPER AIRWAY OBSTRUCTIONS: THE NEGLECTED PARAMETERS

Upper airway obstructions represent a huge burden to the health care system due to its high morbidity and cost to the economic systems. Therefore, it is important to understand the physiological parameters used in diagnosis and prognosis of these diseases. Various physiological lung parameters should be examined simultaneously to make the precise diagnosis of upper airway obstruction. Relying on only one parameter and neglecting others might lead to misdiagnosis and subsequent mismanagement. The shape of the flow-volume loop, Forced Expiratory Flow at 50% of vital capacity/Forced Inspiratory Flow at 50% of vital capacity ratio (FEF-50%/FIF-50%), Forced Expiratory Volume in 1 second /Forced Expiratory Volume after 0.5 seconds (FEV1/FEV0.5), Empey index, and the refined version of the Expiratory Disproportion Index (EDI) are of great value in the diagnosis of different types of upper airway obstructions. The shape of the flow-volume loop changes earlier than other spirometrical parameters and is very useful in detecting early changes in upper airway diseases. This review was aimed to explain and simplify the role of pulmonary function tests and flow volume curve not only for pulmonologists, but also for surgeons, anesthesiologists, and ENT specialists who can utilize and implement usefully these tests in their clinical practice

Entrapment of medial plantar nerve [tarsal tunnel syndrome] in type 2 diabetes mellitus: An electrophysiological study

AbstractBackgroundWith increase in type 2 diabetes mellitus patients the complications of diabetes are being seen more frequently. Patients with diabetic neuropathy often present with distressing symptoms such as pain and burning sensation in the feet. Tarsal tunnel syndrome with electrophysiological changes may be a causative or contributing factor. The present study was designed to assess the presence and features of tarsal tunnel syndrome in diabetes mellitus patients.MethodIn this study a group of 10 normal volunteers were selected who had no neurological complaints or foot trauma. Another group of 33 patients having longstanding diabetes mellitus with complaints of pain, burning sensation and paraesthesia in the feet were selected for electrophysiological tests and median plantar nerve was studied.ResultsIn the present study we observed that 15 (45%) of diabetic cases showed abnormal findings e.g., prolonged distal motor latency, decreased amplitude of M-response, low or absent sensory response suggesting tarsal tunnel syndrome.ConclusionThis study shows that the tarsal tunnel syndrome may be present in a significant number of diabetic patients with subjective neuropathic symptoms in the feet. The tarsal tunnel syndrome should be kept in mind during the diagnostic workup and management of diabetes mellitus

Analysis of Toyota’s Marketing Strategy in the UK Market

This is a study on Toyota automobile industry, especially on Toyota GB Plc. The work mainly focuses on the strengths and weaknesses as well as the company’s way of keeping competitive advantage. The purpose of the study is to explore the marketing strategy of Toyota GB Plc. in UK market. It is an explorative study in nature. Both primary and secondary data are used to get the insights about the market. The study concludes with the understanding and recommendation of how Toyota’s marketing mix is contributing to obtain a substantial market share and brand image for its innovative technology. Key words: customer, marketing mix, strategy, innovatio

Analysis of Toyota’s marketing strategy in the UK market

Vol.5, No.20, 2013

Factors associated with month 2 smear non-conversion among category 1 tuberculosis patients in Karachi, Pakistan

Predictors of smear non-conversion at baseline can help identify cases at risk for failure of tuberculosis treatment. Retrospective data for smear-positive Category 1 patients in Karachi, Pakistan, was analyzed. Predictors of sputum conversion were determined using multiple logistic regression with sputum conversion as outcome variable and patient demographics, baseline weight, baseline sputum smear grade, case-finding approach as explanatory variables. Age ≥35 years, baseline sputum grade of 3+ were significantly associated with predicting sputum smear positivity at month 2 of treatment. Monitoring compliance to TB treatment should be considered amongst older patients and those with a high sputum grade at baseline

Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2):a multicentre observational cohort study

Background: Cerebral microbleeds are a potential neuroimaging biomarker of cerebral small vessel diseases that are prone to intracranial bleeding. We aimed to determine whether presence of cerebral microbleeds can identify patients at high risk of symptomatic intracranial haemorrhage when anticoagulated for atrial fibrillation after recent ischaemic stroke or transient ischaemic attack. Methods: Our observational, multicentre, prospective inception cohort study recruited adults aged 18 years or older from 79 hospitals in the UK and one in the Netherlands with atrial fibrillation and recent acute ischaemic stroke or transient ischaemic attack, treated with a vitamin K antagonist or direct oral anticoagulant, and followed up for 24 months using general practitioner and patient postal questionnaires, telephone interviews, hospital visits, and National Health Service digital data on hospital admissions or death. We excluded patients if they could not undergo MRI, had a definite contraindication to anticoagulation, or had previously received therapeutic anticoagulation. The primary outcome was symptomatic intracranial haemorrhage occurring at any time before the final follow-up at 24 months. The log-rank test was used to compare rates of intracranial haemorrhage between those with and without cerebral microbleeds. We developed two prediction models using Cox regression: first, including all predictors associated with intracranial haemorrhage at the 20% level in univariable analysis; and second, including cerebral microbleed presence and HAS-BLED score. We then compared these with the HAS-BLED score alone. This study is registered with ClinicalTrials.gov, number NCT02513316. Findings: Between Aug 4, 2011, and July 31, 2015, we recruited 1490 participants of whom follow-up data were available for 1447 (97%), over a mean period of 850 days (SD 373; 3366 patient-years). The symptomatic intracranial haemorrhage rate in patients with cerebral microbleeds was 9·8 per 1000 patient-years (95% CI 4·0–20·3) compared with 2·6 per 1000 patient-years (95% CI 1·1–5·4) in those without cerebral microbleeds (adjusted hazard ratio 3·67, 95% CI 1·27–10·60). Compared with the HAS-BLED score alone (C-index 0·41, 95% CI 0·29–0·53), models including cerebral microbleeds and HAS-BLED (0·66, 0·53–0·80) and cerebral microbleeds, diabetes, anticoagulant type, and HAS-BLED (0·74, 0·60–0·88) predicted symptomatic intracranial haemorrhage significantly better (difference in C-index 0·25, 95% CI 0·07–0·43, p=0·0065; and 0·33, 0·14–0·51, p=0·00059, respectively). Interpretation: In patients with atrial fibrillation anticoagulated after recent ischaemic stroke or transient ischaemic attack, cerebral microbleed presence is independently associated with symptomatic intracranial haemorrhage risk and could be used to inform anticoagulation decisions. Large-scale collaborative observational cohort analyses are needed to refine and validate intracranial haemorrhage risk scores incorporating cerebral microbleeds to identify patients at risk of net harm from oral anticoagulation. Funding: The Stroke Association and the British Heart Foundation

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020