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http://www.webmedcentral.com/images/Header_Logo.giftext/html2024-03-26T03:11:15+01:00http://www.webmedcentral.com/Dr. Ezzuddin A OkmiDeterminants of the influence of calorie labels displayed on menus in restaurants and cafes among Adults in Saudi Arabia, 2023: a cross-sectional study
http://www.webmedcentral.com/article_view/5829
Introduction
Obesity is one of the leading risk factors for many chronic diseases. It is ranked as forth fourth most common risk factor for NCDs. In the European Region Overweight and obesity affect about 60% of adults according to World Health Organization(1)
The obesity prevalence in Saudi Arabia is 35% which is three times higher than the global prevalence. )2)
The Global Burden of the Diseases report stated that the health effects of high Body mass index (BMI) accounted for about 4 million deaths and 120 million disability-adjusted life-years worldwide in 2015. Moreover, the report found approximately two-thirds of the deaths that were related to high BMI. (3)
Calorie labeling in restaurants and cafes is an important way that provide customers with the informed knowledge that can help them choose healthier food choices. (4)
Some evidence demonstrates calorie restriction causes a 5–10% loss of weight. (5) In 2014, a study conducted in the UK, found that Calorie labeling may decrease weight by about 3.5 kg over 36 weeks. (6)
Therefore, investigating the factors that can determine the influence of using calorie information is very important in reducing the prevalence of obesity which is considered a leading risk factor for chronic diseases in Saudi Arabia. Although there are studies conducted on the effects of using Calorie labeling and lifestyle among the general adult population worldwide (4-18), the number of studies on the influence of calorie information utilization in the KSA is scant. Thus, our study is very important to determine the effects of factors related to sociodemographic and lifestyle , on the influence of Calorie labels displayed on menus in restaurants and cafes among the adult population in KSA, Saudi Arabia, 2023
We want to detect the determinants of the influence of Calorie labeling and how this influence can be predicted based on sociodemographic and lifestyle factors.
text/html2023-07-10T03:19:34+01:00http://www.webmedcentral.com/Dr. Esther Una CidonA short review of results with palbociclib in a real world daily clinic
http://www.webmedcentral.com/article_view/5826
Background: Palbociclib (P) was the first cyclin-dependent kinase 4/6 (CDK4/6) inhibitor approved for ER+/HER-2 negative advanced breast cancer patients. Neutropenia is commonly observed.
Aim: We carried out a review of our data to provide a real-world experience of the results and toxicities associated with this therapy in our population of patients.
Patients and methods: Retrospective review of ER positive metastatic breast cancer patients treated with Palbociclib at the University Hospital Dorset.
Results: 64 women included. All had received P in combination either with L (46) or F (18). Median age 63 years old (36-84). 30 patients (46.8%) required dose adjustments, with 19 of them (63.6%) requiring this during the first 3 months of treatment (early dose adjustment). 9 patients (out of 64, 154.06%) required a second dose adjustment. No discontinuation due to toxicities. Adverse events as expected; only one case of repeated thromboembolic events was reported.
At the time of collecting these data, with a m follow up of 33 months, the mPFS was 26 months with P + L and 15m with P + F. And mOS was not reached in any of the combinations.
36 patients were alive with P+L (78.2%) and 10 had died (21.7%). With P+F, 12 were alive (66.7%) and 6 (33.3%) had died.
32 patients had progressed at the time of data cut-off. 13 with P+F and 19 with P+L.
Conclusion: Although we will continue to follow these patients to get final conclusions, our data are in line with other real life studies showing benefits with these combinations with expected toxicities. text/html2023-07-06T01:48:58+01:00http://www.webmedcentral.com/Dr. Felix I Woke MD, Ph.DTravel Clinic and 10 Travel Checklist: One Health Medical Center Pretoria CBD 0123224541
http://www.webmedcentral.com/article_view/5825
Introduction: International travel can be exciting but poses health challenges peculiar to an individual or country. Travel consultation is advisable before setting off to a new city or country. The steps taken for a safe trip begin with preparations from home to the mode of travel and the travel destination and continue until a safe return home. However, the trip's impact remains with the traveller for years after return in the form of chronic diseases acquired during the sojourn (for example, lime disease) to any traumatic events experienced during travel (as in post-traumatic stress disorder). Conditions in the country of travel, including climatic conditions, common diseases, type of food available and activities during travel are important determinants of the health precautions and care needed. Hiking, horse riding, marathons and swimming all require different precautions. The following health advice applies to most travellers.
Discussion: The 10 Travel Check-list
1. Water: Water is an inevitable need of a traveller. Travellers interact with water in different ways and hence can acquire water-related diseases. Examples of ways travellers can acquire water-related diseases are; Water-borne (Amoebic Dysentery and Cholera), waster-bath (Typoid, yaws and relapsing fever), water-bred (Malaria, Yellow Fever and Trypanosomiasis) and water-based (Schistosomiasis and Dracunculus). These diseases are prevalent in areas of the world without pipe-borne water. Suggested ways to prevent water-related diseases are; brushing teeth and drinking only boiled/bottled water. Avoid ice made from un-boiled tap water. Drink only sealed carbonated beverages, beer, and wine (Pimazoni-Netto & Zanella, 2014). Other ways of preventing these diseases are; avoiding swimming in rivers and stagnant water and staying away from pools of water around living areas.
2. Food: Reduce the risk of gastrointestinal infections by avoiding unpeeled fruits or fruits not peeled by others. Avoid raw vegetables, unpasteurized ("raw") dairy products, raw meat, fish, shellfish and other unfamiliar food. Exercise caution while eating unknown meals because of the danger of diarrhea and allergic diseases.
3. Communicable Diseases: In certain areas, insects (mosquitoes, flies, fleas, bugs, and lice) and arthropods (ticks and mites) can transmit serious diseases like yellow fever and malaria. Avoid bites by using insect repellants, treated mosquito nets, long sleeve shirts and trousers. Reduce time spent outdoors, stay on the last floor of the hotels, and check skin regularly for insect bites. Avoid walking bare-footed; avoid stagnant waters, dogs, cats and pets. Practice safe sex always (HIV and other STIs).
4. Vaccines & Prophylaxis: Some countries have specific diseases that may require vaccination by law, like Yellow Fever which occurs in most tropical areas of the world, and travellers from these areas or returning from these areas must possess proof of vaccination before entering the country of destination. Other vaccines for the safety and convenience of the traveller are also important and can prove invaluable (like Typhoid, Pneumococcal, Meningitis, and Cholera, Hepatitis A). Some diseases require prophylaxis; a good example is malaria (Walldorf et al. 2017). Most common travel diseases have vaccines available in SA; please consult and enquire about all the compulsory and recommended vaccines for the destination country.
5. Medical Insurance: Medical insurance may or may not provide cover at the travel destination- Medical insurance must be engaged before travel if unsure. Travel insurances are also available at most travel agencies.
6. Emergency Medications: Travellers must take some emergency medications during travel; for example, medications for diarrhoea, pain, allergy and vomiting (Bobroff, 2010). Identify the closest health facility on arrival at the destination and write down emergency numbers for the country, including police, fire and ambulance services.
7. Chronic Health Problems: Discuss chronic health problems with a treating doctor before travel. Extra medication or treatment adjustment may be needed. Medications should be in the hand luggage for access and safety. Persons with chronic diseases may require adjustments in treatment and eating habits (e.g. Diabetes) and may be susceptible to new health problems and complications during travel with exposure to new food (Pimazoni-Netto & Zanella, 2014). Generally, stick to known food items and use new products sparingly
8. Medical Problems Associated with Air, Water and Road Travel: The mode of transport may be associated with peculiar health problems. Air travel-related problems include jet lag, motion sickness, ear, lung and sinus barotraumas, leg clots and problems with low oxygen pressure (lung disease and heart attacks) (Das & Suma, 2008). It is advisable to contact the hostess immediately if anyone feels sick during a flight. During road travel, all road safety measures must be taken to avoid accidents and an international driver's license is required to drive in the destination country. Avoid or take care with outdoor activities with the risk of accidents during travel. The activities must consider the driver's age, health status and chronic medication side effects. For a visitor in a new destination, risky activities must be avoided, especially those that may lead to accidents and hospitalization.
9. During Travel: Sit comfortably, loosen tight clothing and take a walk/stretch every 2hrs of flight (Ker & Kerr, 2002). It is important to have chronic medications within reach, as adherence to prescribed medications must continue unless advised otherwise by a health professional.
10. The Returned Traveler: A returned traveller with a flu-like illness, fever, diarrhoea, and headache must consult immediately. Travel diseases may manifest acutely in hours like Barotrauma, Jetlag and Pulmonary embolism (Gorbach, 2010). They can present sub-acutely in days like Malaria, Lyme disease, Babesiosis, hemorrhagic fever and diarrhea diseases. It can also take months or years to manifest, like schistosomiasis and Falciparum Malaria (Mwaiswelo et al., 2020). A returned traveller presenting with fever and diarrhoea must consult and volunteer the travel history so that investigations can focus on the common diseases in the country of travel.
Conclusion: While travelling is a good exercise for families, partners and friends, it is, however, important that all must return in good health. Travel health starts with anticipation and planning for the possible condition at the travel destination, and such planning can only be possible with a clear understanding of the possible health needs of the traveller, epidemiology of common diseases and health peculiarities of the destination of choice; this is the services One Health Travel Center, and other travel clinics offer to all travellers to ensure a safe and enjoyable stay in whichever destination chosen.
References
Bobroff, L.B. (2010) 'Remembering to take your diabetes medications', EDIS, 2010(6). doi:10.32473/edis-fy1206-2010.
Das, K.V. and Suma, T.K. (2008) 'Motion sickness, problems due to air travel and road accidents', Textbook of Medicine, pp. 106–106. doi:10.5005/jp/books/10921_21.
Gorbach, S.L. (2010) 'Diarrhea in a returned traveler from Mexico', Infectious Diseases, pp. 1154–1155. doi:10.1016/b978-0-323-04579-7.00257-4.
Kerr, A. and Kerr, K. (2002) 'Sit-to-stand and sit-to-walk',Physiotherapy, 88(7), p. 437. doi:10.1016/s0031-9406(05)61283-7.
Mwaiswelo, R.O.et al., (2020) 'Sickle cell disease and malaria: Decreased exposure and asplenia can modulate the risk from Plasmodium falciparum', Malaria Journal, 19(1). doi:10.1186/s12936-020-03212-w.
Pimazoni-Netto, A. and Zanella, M.T. (2014) 'Diabetes guidelines may delay timely adjustments during treatment and might contribute to clinical inertia', Diabetes Technology & Therapeutics, 16(11), pp. 768–770. doi:10.1089/dia.2014.0092.
Walldorf, J.A. et al. (2017) 'Lessons learned from emergency response vaccination efforts for cholera, typhoid, yellow fever, and ebola', Emerging Infectious Diseases, 23(13). doi:10.3201/eid2313.170550.
'Infestations, insect bites and stings' (2003) Roxburgh's Common Skin Diseases, 17Ed, pp. 66–78. doi:10.1201/b13512-9. text/html2023-06-30T02:35:54+01:00http://www.webmedcentral.com/Dr. Loay K HassounehNA
http://www.webmedcentral.com/article_view/5819
text/html2023-01-15T04:36:15+01:00http://www.webmedcentral.com/Dr. Deepak GuptaWorth Investigating Futuristic Potential For Patient Education Regarding Sugammadex Especially If Patient Is Self-Paying, Peripartum, Postmenopausal, Or Transgender Woman
http://www.webmedcentral.com/article_view/5814
American Society of Anesthesiologists (ASA) has apparently recommended sugammadex use over neostigmine use by anesthesia providers to antagonize maybe most of their patients' neuromuscular blockade [1]. This may make sugammadex use the norm rather than the exception because although dosing and redosing of sugammadex may warrant quantitative neuromuscular blockade monitoring, sugammadex may still be better than neostigmine even in the absence of quantitative neuromuscular blockade monitoring. Therefore, besides patient awareness about unintended pregnancy risk among reproductive age patients on hormonal contraception (low doses of estrogen and progesterone) [2], perioperative patient education may have to futuristically investigate to potentially inculcate patient awareness about maybe exorbitant copay among patients with inadequate insurance coverage and maybe withdrawal symptoms among patients on gender affirming hormone therapy (very high doses of estrogen with or without progesterone) and hormone replacement therapy (high doses of estrogen with or without progesterone) [3-7]. Although it may appear that sugammadex use may not be unsafe for pregnant patients presenting for non-obstetric surgeries [8] and lactating mothers presenting for postpartum surgeries, it may still be worth investigating systemically in postpartum clinics during first postpartum visits whether postpartum mind spectrum [9-10] transiently changes/fluctuates over blues-depression-psychosis scale when patients had received sugammadex during their cesarean sections because during basic research among pregnant rats [11], postpartum behavioral changes among rats could not rule out sugammadex effect on steroidal hormones as changed behaviors’ cause. Moreover, until sugammadex has a generic version approved for use in the United States (US) [12], ASA may have essentially recommended Bridion® (Merck & Co., Inc., Rahway, New Jersey, US) [13] use over neostigmine use. Anesthesia providers in Europe may not have to weigh in their conflicts of interest while following ASA recommendations because they may have an approved generic version of sugammadex available at hand as an alternative [14]. However, in good conscience for patient safety, ASA couldn't delay their recommendations anymore by waiting for US Food and Drug Administration (FDA) to approve a generic version of sugammadex in US [15]. Henceforth, after getting information from their pharmacies about the current billable patient charges for sugammadex, it may seem prudent for anesthesia providers to preoperatively educate their patients who are going to receive neuromuscular blockade with rocuronium or vecuronium that they are very likely to receive sugammadex perioperatively and thus may potentially owe hundreds of dollars as their copay for sugammadex which may be somewhat buffered by discount coupons and patient assistance programs if any available [16] unless Bridion® soon emulates the path of already transparently reimbursable Exparel® (Pacira Pharmaceuticals, Inc., Parsippany, New Jersey, US) [17-18]. Additionally, as ASA recommendations to anesthesia providers clearly support sugammadex use over neostigmine use, they may have an option to provide a copy of ASA recommendations [19] as patient education template to prepare them for sugammadex non-coverage by their healthcare insurance providers who can then potentially re-negotiate their copay for sugammadex. Cost concerns with sugammadex use may be raised by healthcare facilities as well [20]. However, by their sheer size and number, they may be way better-equipped to negotiate with their pharmaceutical vendors about costs of procuring sugammadex and with their patients' third-party payers about charges billed for sugammadex as compared to individual non-Veteran patients pleading with their healthcare insurance providers about copay for sugammadex. Summarily, although ASA practice guidelines may have overlooked patient education about sugammadex, it may become necessary with almost universal use of sugammadex in patients especially when healthcare facilities' investment into and anesthesia providers' acceptance for quantitative neuromuscular monitoring may lag behind easier administration of sugammadex to antagonize neuromuscular blockade among patients.