Body mass index and quality of bowel preparation: real life vs. clinical trials

Background and study aims: Obesity is a recognised risk factor for poor bowel preparation in retrospective studies whilst corresponding data in prospective trials are marginally reported. Aims are to evaluate the relation between body mass index [BMI] and preparation quality in retrospective and interventional prospective settings and within a single centre

Patients and methods: Data from a recent colorectal cancer screening registry were retrospectively analysed for the relation between BMI and adequacy of preparation. Patients were categorised as underweight [BMI < 20 kg/m2], normal [20-25 kg/m2], overweight [25-30 kg/m2], and obese [>30 kg/m2]. Data from a recent prospective colon preparation trial were similarly analysed

Results: 541 registry patients were included. Multivariate analysis showed BMI to be an independent risk factor for inadequate preparation. Obesity was associated with odds ratio [OR] of 5.3 [95% confidence interval [CI] 1.4-19.8; p = 0.01] compared to normal BMI. A significant difference was also noted in underweight but otherwise healthy individuals [OR = 11.1, 95% CI 2-60; p = 0.005]. In the prospective study of 195 patients, obese patients had comparable rates of inadequate preparation to normal-weight individuals [OR = 0.7, 95% CI 1.1-3.96; p = 0.68]. Underweight patients had a significantly worse preparation compared to normal BMI individuals [OR = 8, 95% CI 1.1-58; p = 0.04]

Conclusions: In real life, bowel preparations in obese individuals have a lower quality in comparison to normal individuals. This finding is not replicated in clinical trials. This discrepancy is likely the result of focused patient education suggesting that this is primarily a dietary compliance phenomenon. Underweight individuals appear to have worse quality of preparation independent of study design or setting

Association between payer mix and costs, revenues and profitability: a cross-sectional study of Lebanese hospitals

This study aimed to examine the association between the payer mix and the financial performance of public and private hospitals in Lebanon. The sample comprised 24 hospitals, representing the variety of hospital characteristics in Lebanon. The distribution of the payer mix revealed that the main sources of revenue were public sources [61.1%], out-of-pocket [18.4%] and private insurance [18.2%]. Increases in the percentage of revenue from public sources were associated with lower total costs and revenues, but not profit margins. An inverse association was noted between increased revenue from private insurance and profitability, attributed to increased costs. Increased percentage of outof-pocket payments was associated with lower costs and higher profitability. The study provides evidence that payer mix is associated with hospital costs, revenues and profitability. This should initiate/inform discussions between public and private payers and hospitals about the level of payment and its association with hospital sector financial viability

Comparative study between the concentration of interleukin-6 in peritoneal fluid and in serum of patients with endometriosis

Our purpose was to compare the level of interleukin- 6 in peritoneal fluid with that in serum in patients with and without endometriosis undergoing laparoscopic procedures and to set a value for Interleukin 6 as a marker for endometriosis in the serum and peritoneal fluid of patients diagnosed laparoscopically to have endometriosis and correlate it with the stage of the disease. The present study was conducted at the period starting from March 2002 to October 2003 in the laparoscopy unit, Ain Shams University Maternity hospital. Fifty patients underwent laparoscopy were recruited in this case control cross-sectional study. These patients were divided into two groups. Group I included thirty patients diagnosed to have endometriotic lesions by means of laparoscopy and histopathologic confirmation. Group II included twenty patients diagnosed laparoscopically to have no visible gynecological lesions [e.g. women undergoing laparoscopic tubal ligation]. These patients were subjected to full history taking with special regard to symptoms suggestive of endometriosis, full general, abdominal and local examination for signs of endometriosis, laparoscopic visualization and staging of endometriosis according to the criteria of the revised American Fertility Society classification system, testing for serum and peritoneal fluid Interleukin-6 using the BioSource International ELISA. [Enzyme linked immunosorbent assay], and histopathologic confirmation of peritoneal endometriotic lesions. Interleukin- 6 was significantly higher among female patients diagnosed to have endometriosis than in control patients both in serum and peritoneal fluid. Also, our study revealed a highly significant direct correlation between the level of serum and peritoneal fluid IL-6 among women with endometriosis. A significant direct correlation between the level of IL-6 with the grade of endometriosis among cases was found both in serum and peritoneal fluid IL-6. However, no significant correlation was found between the grade of endometriosis and pain among the cases group. Increased peritoneal fluid levels of interleukin-6 in patients with active red endometriosis may relate to endometriosis-associated infertility and to the pathogenesis of endometriosis