Health Related Quality of Life among Saudi Undergraduate Students with Different Categories of Body Mass Index

Background : Health related quality of life (HRQoL) is a critical indicator of one’s perception of health and well-being. Theobjective of the study was to assess and compare HRQoL among undergraduate students at different categories of bodymass index. Method: 140 undergraduate students at the mean age 19 ±0.70 years were randomly assigned into underweight<18.5 kg/m2 [n= 37: 26.4%], normal-weight 18.5-24.9 kg/m2 [n= 31: 22.1%], obese ≥30.00 kg/m2 [37: 26.4%] and obeseclass III ≥40.00 kg/m2 [n=35: 25%] groups. HRQoL was also measured using CDC HRQOL-14. Results: SRH-good resultswere as the following: underweight students 87%, normal weight 94%, obese 73% and obese-III 57%. The activity limitationdays were observed more among obese and obese-III category expressing lack of sleep, worrisome and depression.Underweight and obese category students exhibited less energetic days. Conclusion: HRQoL was low among obese andobese class III students. Normal weight category students exhibited better SRH-good. Obese class had more unhealthy dayswith regard to physical and mental issues and reported more days of activity limitation due to pain, depression and lack ofsleep. Obese students had greater impairments in emotional problems.

Epidemiology of type 2 diabetes: Indian scenario.

India leads the world with largest number of diabetic subjects earning the dubious distinction of being termed the "diabetes capital of the world". According to the Diabetes Atlas 2006 published by the International Diabetes Federation, the number of people with diabetes in India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken. The so called "Asian Indian Phenotype" refers to certain unique clinical and biochemical abnormalities in Indians which include increased insulin resistance, greater abdominal adiposity i.e., higher waist circumference despite lower body mass index, lower adiponectin and higher high sensitive C-reactive protein levels. This phenotype makes Asian Indians more prone to diabetes and premature coronary artery disease. At least a part of this is due to genetic factors. However, the primary driver of the epidemic of diabetes is the rapid epidemiological transition associated with changes in dietary patterns and decreased physical activity as evident from the higher prevalence of diabetes in the urban population. Even though the prevalence of microvascular complications of diabetes like retinopathy and nephropathy are comparatively lower in Indians, the prevalence of premature coronary artery disease is much higher in Indians compared to other ethnic groups. The most disturbing trend is the shift in age of onset of diabetes to a younger age in the recent years. This could have long lasting adverse effects on nation's health and economy. Early identification of at-risk individuals using simple screening tools like the Indian Diabetes Risk Score (IDRS) and appropriate lifestyle intervention would greatly help in preventing or postponing the onset of diabetes and thus reducing the burden on the community and the nation as a whole.

Estimating cancer survival in developing countries. Use of reply-paid post cards to augment follow-up information.

Survival from cancer is one of the indices to evaluate cancer control activities. Reliability of survival estimates depends to a large extent on the completeness of follow-up information available for patients in the study group. Loss to follow-up (LFU) is one of the potential problems introduced in follow-up of cancer patients. An attempt is made to improve the follow-up system for reducing the LFU of cancer patients by repeatedly sending reply-paid post cards for the LFU patients. A total of 353 ovarian cancer patients registered at the Regional Cancer Centre, Trivandrum during a three year period and followed-up to a total of five years showed 67 percent loss to follow-up. The five-year survival rate of this group calculated using Kaplan-Meier method under the assumption that the LFU's occurred at random was 75 percent. Efforts to improve the follow-up rate for the study population were made through the simple and cost effective method of postal enquiry which resulted in a reduction of 63 percent of losses to follow-up. Incorporation of this information in the data brought about a revised five-year survival estimate of 55 percent. The reply paid post card system was found to be effective in obtaining useful follow-up data. The result shows that LFU can be reduced by better design of survival study.

Cutaneous malignant melanoma--clinical epidemiology and survival.

Melanoma of the skin is rare in the Asian population. However, this malignancy results in a high mortality due to the inadequacies in the referral pattern and management. India is one of the low incidence regions of the world. Cancer registries in India report that the age specific incidence rates for cutaneous malignant melanoma (CMM) are less than 0.5 per 1,000,000. There are only few reports in the literature on CMM in the Asian population. The Regional Cancer Centre at Trivandrum registers about 6000 new cancer cases per year and CMM forms 0.5% of them. This paper presents the clinical epidemiology and survival of 79 cases of CMM registered in the hospital cancer registry during the period 1985-90. The peak age frequency was in the 7th decade. The male:female ratio was 1.6:1. All cases had undergone a surgical manipulation in a peripheral centre, before being referred to this centre. This has posed limitation in staging and in deciding the extends of surgical excision. The overall 5-year survival rate was 25.2% (95% confidence intervals, or, CI, 14%-38%). CMM in the low incidence regions may have a different aetiology and needs to be addressed in epidemiological studies.

Pseudomyxoma peritonei: a report of eight cases.

OBJECTIVE: To assess the effectiveness of surgical treatment for pseudomyxoma peritonei. DESIGN: Retrospective analysis. SETTING: Referral center. PATIENTS: Eight patients with pseudomyxoma peritonei, five with mucinous tumors of the ovary and three with mucoceles of the appendix. INTERVENTION: All patients underwent cytoreductive surgery with removal of source i.e. panhysterectomy with appendicectomy in 5 and appendicectomy in 3. Systemic chemotherapy was used in 6 and systemic plus intraperitoneal chemotherapy in one case. RESULTS: Over 18 to 86 months' follow up, two patients died (at 18 and 24 mo) and 2 are alive with recurrence. Recurrence occurred only in those with inadequate clearance of mucinous material at the initial operation. The remaining 4 patients are free of disease. CONCLUSION: Aggressive surgical therapy with-chemotherapy is effective in providing long-term relief or cure in pseudomyxoma peritonei.

Prevention and early detection of oral, breast and cervical cancers: a practical approach in Indian context.

Cancer has emerged as a major killer disease in India. One-third of the total cancer load is constituted by oral, breast and uterine cervix cancers. Considerable knowledge is available on control strategies on these 3 major cancers and this can be transformed into the community through the individual health care practitioners. Oral cancer is preventable and both the precancerous and invasive lesions can be picked up easily by examination of the oral cavity. The occurrence of breast cancer in the country is on the increase. The poor survival rate indicates the impact of the major proportion of advanced cancer. An effective strategy comprising breast self-examination, examination by a physician and a mammography test, is described. Cancer of the uterine cervix is the commonest malignancy among females in several regions in India. An effective and definitive method is available in the form of Pap smear for the control of cervical cancer. An organised community screening programme is not economically viable at present. However, routine per speculum examination should be undertaken and this can result in clinical downstaging of cancer. Women above the age of 40 years should undergo regular Pap smear screening. Broad guidelines are presented for an opportunistic screening.

Survival in multiple myeloma in Kerala.

BACKGROUND. The reported incidence of multiple myeloma in India ranges from 0.5 to 1.2 per 100,000 but there have been few studies on the effect of treatment of this condition. We, therefore, analysed the clinical profile of patients in Kerala with myeloma, the treatment given and the factors affecting survival. METHODS. Case records of 142 patients with multiple myeloma treated at the Regional Cancer Centre, Trivandrum, between 1984 and 1989 were reviewed and abstracted. Chemotherapy (using melphalan and prednisolone) and radiotherapy were the treatment modalities. Survival analysis was done using the Kaplan-Meier estimates and multivariate analysis of factors affecting survival was performed using Cox's proportional hazards regression model. RESULTS. The mean age of the patients was 61 years and 90 were males. Bone pain and pallor were the most common presenting symptoms and the median survival was 30 months. A combination of melphalan and prednisolone was found to be well tolerated and achieved a survival rate of 62% at 5 years. Hemibody irradiation was beneficial in a small group of patients. On a multivariate analysis, Bence-Jones proteinuria, melphalan and prednisolone combination chemotherapy and response to treatment at 6 months were the most significant factors affecting survival. Socioeconomic status did not seem to influence survival. CONCLUSIONS. Melphalan and prednisolone chemotherapy achieves prolonged survival in myeloma. Radiotherapy can relieve symptoms and in a small group of patients hemibody irradiation can achieve prolonged remission. Further studies are required to identify the subgroups in which certain treatments are most effective in improving survival.