Conference on Medical Journals


 

First Regional Conference on Medical Journals in the WHO Eastern Mediterranean Region, Cairo, Egypt

___________________________________________________________________________

An important conference and workshop, the first of their kind, were held in Cairo, Egypt on medical journals.  The meeting was organized by World Health Organization (WHO) Regional Office of the Eastern Mediterranean Region (EMRO) in collaboration with the Saudi Medical Journal.  The Editor-in-Chief represented the journal in the conference and workshop.  The meetings were a great opportunity for exchanging experiences and for publicizing our journal.  The conference was well organized and attracted high-powered personalities and presentations.  One of the important results of the conference was the establishment of the Eastern Mediterranean Association of Medical Editors.  An important recommendation of the conference was to hold courses for editors and reviewers or regional biomedical journals. The good news is that the next conference and hopefully the first training course will be held in Riyadh, Saudi Arabia in the near future and will be hosted by the Saudi Medical Journal. The Editor-in-Chief urges all those interested to make the maximum of such important meetings and training. Our reviewers and interested readers would eventually be informed about developments in this regard. The following is an executive summary of the deliberations of the conference.  It is worth reading.*

Editor-in-Chief

___________________________________________________________________________


INTRODUCTION

The World Health Organization (WHO) Regional Office of the Eastern Mediterranean (EMRO) organized, in collaboration with the Saudi Medical Journal, the First Regional Conference on Medical Journals in Cairo, Egypt, from 7 to 9 October 2003. The conference was held at the premises of the Regional Office. It was preceded by a one-day workshop for editors of medical journals in the Region. The objectives of the conference were to:

·         review the current status of medical journal publishing in the Region;

·         assess the problems and constraints facing medical journals in the Region;

·         develop guidelines for quality of medical journal publishing in the Region;

·         develop and propose a code of ethics for medical journal publishing in the Region;

·         analyse trends in journals publishing in the Region;

·         promote collaboration and networking among editors of medical journals.

The opening session of the conference was addressed by Dr Salah Baghdadi, Director of Programme and Contracts Department, Medical Services, Armed Forces Hospital, Riyadh, on behalf of the Saudi Medical Journal. He noted the interest of the Saudi Medical Journal not only in being a medium for publishing articles, but as a means of education and academic leadership. The Conference was inaugurated by Dr Abdullah Assa’edi on behalf of Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean In his message to the conference Dr Gezairy noted that the convening of the Conference was a sign of recognition by the Regional Office of the role that the medical journal plays in promoting health research and in health care delivery. He said that health care professionals in the Region made more use of information provided by pharmaceutical companies and international journals than they did of locally produced health information, although it was estimated that over 400 medical journals are published in the Region. This raised important questions about, among other things, the extent to which journals reflected the health and biomedical research being conducted in the Region, the degree to which journals contributed to solving the health problems in the Region, and the seriousness with which academic and professional institutions regarded medical journal publishing. A major concern in the Region, said Dr Gezairy, was the under-representation of regional medical journals in the international literature. The conference was an effort to bring medical journals in the Region to the highest attention of researchers, academics, decision-makers and planners. The exchange of views, experience and sharing of future visions in the next few days would form a basis for a regional development plan for medical journals in the Region.

        Conference sessions covered the status of and trends in medical journal publishing in the Region, problems and constraints faced by medical editors, quality and ethical issues, and promoting networking and information dissemination.Four keynote presentations were made on: published research in the Eastern Mediterranean Region, a survey of medical journal publishing in the Region, equitable access to scientific and technical information in health, and quality of medical journals with special reference to the Eastern Mediterranean Health Journal. In addition 23 papers were presented on a wide range of subjects, reflecting the situation and trends in different countries of the Region and the commonality of problems faced by journal editors. Around 80 participants attended the conference from 19 countries of the Region and beyond. Participants included editors and staff of regional medical journals, as well as other interested participants from institutions in the Region.

CONCLUSIONS

The conference participants identified a need to improve skills of editors and reviewers of regional medical journals. Need to improve the quality of regional medical journals was noted and it was felt that better representation of the regional journals in the international indexing services would be instrumental in encouraging this. Communication between the editors of the Region was also felt to be vital to improving quality.

        The participants also agreed on the need to establish an association of medical editors in the Region. For this purpose, a coordination committee for the establishment of the Eastern Mediterranean Association of Medical Editors (EMAME) was convened. The committee will gather information and will contact and invite editors of all biomedical journals in the Region to participate in the association. The committee will develop a constitution and practice guidelines. It will also contact the World Association of Medical Editors (WAME) and the Forum for African Medical Editors (FAME) to inform them of their establishment as a sister association. A general assembly will be called for at the next conference to approve the constitution. The participants took special note of the establishment of FAME and acknowledged the work that it has accomplished so far in developing its constitution and editorial guidelines. The coordinating committee will contact the Chairman of FAME regarding building on its work in developing the EMAME constitution and guidelines. It was agreed that Dr Basim Yaqub will coordinate the function of the coordinating committee, and all members will contact their fellow editors in their parts of the Region (see below for contact details).

        The participants in the conference thanked the Regional Director and the WHO secretariat for organizing and facilitating the conference and pre-conference workshop, and for their support for the various initiatives outlined in the recommendations. They also thanked the Saudi Medical Journal and staff for their involvement in initiating and organizing the conference.

        The Saudi Medical Journal announced that it would publish the proceedings of the conference, including the full papers, as a supplement to its issue of January 2004 and offered to host the next conference and workshop in Riyadh in November 2004, in collaboration with WHO EMRO. A report of the meeting will be issued shortly by WHO EMRO.

RECOMMENDATIONS Member States

1.     Training courses for editors of regional biomedical journals and reviewers of such journals should be conducted on a continuing basis at national and regional level.

2.     Editors of regional medical journals should make efforts to fulfil the necessary criteria for inclusion in international indexing services and ensure that their journal is included in national and regional indexes.

3.     A regional association of medical editors should be established, and the details developed by the coordination committee for the establishment of the Eastern Mediterranean Association of Medical Editors (EMAME) for presentation at the next conference.

4.     Editors of regional medical journals should support the coordination committee for the establishment of the Eastern Mediterranean Association of Medical Editors (EMAME) by providing ideas and relevant information and informing other editors of its existence and the outcome of this conference.

5.     A second regional conference on medical journals should be held as soon as feasible and practical, and should again be preceded by a regional training workshop. Successive conferences should ensure that similar training opportunities are always included.

6.     Editors of regional medical journals should exchange existing training materials on medical editing and peer review through the facility of the EMRO portal so that national courses can be developed and/or enhanced.

7.     Editors of regional medical journals should develop, as a minimum, a web page for their journal in order to ensure journal details are available for capture on the internet. Efforts should then be made to develop their websites as resources permit.

WHO

8.     The Regional Office should support national and regional training activities for editors and reviewers of regional biomedical journals.

9.     The Regional Office should facilitate the improvement of regional representation in international indexing services through liaison with the services concerned.

10.   The Regional Office should create a listserv for medical editors in the Region to exchange information.

11.   The Regional Office should establish a portal for regional biomedical journals and a directory of regional medical editors to enhance exchange of information in the Region.

12.   The Regional Office should facilitate exchange and gift programmes between medical journals and libraries in the Region.

COORDINATING COMMITTEE AND CONTACT DETAILS

Ø       Dr. Ahmed J. Jamal, Chief Editor, Journal of the Bahrain Medical Society, e-mail: jbms@batelco.com.bh

Ø       Dr. Farhad Handjani, Editor-in-Chief, Journal of Medical Research/Journal of Yasuj University of Medical Sciences, e-mail: hanjanif@yahoo.com

Ø       Dr. Maqbool Jafary, Chief Editor, Pakistan Journal of Medical Sciences, email: drjafary@fascom.com

Ø       Dr.Basim Yaqub, Editor, Saudi Medical Journal, email: byaqub@smj.org.sa

Ø       Dr. Ahmed Said El Morsy, Chief Editor, Egyptian Journal of Histology,          Tel: +202 4848122

Ø       Dr. Youssif M. Kordofani, Editor, Juba Medical Journal, Tel: +249 11271136, Fax: +249 11780166

Ø       Ms. Jane Nicholson, Editor, WHO EMRO,

e-mail: nicholsonj@emro.who.int


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Conference executive summary



-0001-11-30

HYPOTHYROIDISM AND DYSARTHRIA


Case Report


HYPOTHYROIDISM PRESENTING WITH DYSARTHRIA

Kawther T. El-Shafie, MD Family and Community Medicine Department, College of Medicine, Sultan Qaboos University, Al-Khoud, Sultanate of Oman 

_____________________________________________________________________________________

إن مرض نقص إفراز نشاط هرمون الغدة الدرقية من أمراض الغدد واسعة الانتشار. ويتصف هذا المرض بأعراض وعلامات سريرية معينة. إن الأعراض التي يتصف بها تتمثل بالخمول ,والشعور بعدم تحمل البرد, ضعف في الذاكرة والقوة البدنية، نقص في الشهية للأكل، زيادة الوزن وجفاف الجلد. يقدم  فى هذا البحث  حالة امرأة في سن التاسعة والثلاثين تشكو من صعوبة في الكلام وهى الشكوى الرئيسية التى جاءت بها.

بعدالاستفسار عن أعراض أخرى، اتضح أنها تعاني من أعراض تنحصر في منطقة الفم والحنجرة مثل اختفاء قليل فى الصوت، عسرة بلع وتوقف التنفس أثناء النوم، مع الشخير. قد ثبت بالفحوصات المخبرية أنها تعاني من نقص شديد بنشاط الغدة الدرقية بالإضافة إلى وجود مضادات أجسام للغدة الدرقية بالدم.  وبعد تناولها لهرمون الثيروكسين، اختفت مشكلة عدم القدرة على الكلام وكل الأعراض الأخرى.  وبالتالي يمكن القول إن عدم القدرة على الكلام يمكن أن تكون الشكوى الرئيسية لمرض قصور الغدة الدرقية ويختفي  بتناول هرمون الثيروكين.

الكلمات المرجعية:  صعوبه النطق,ضعف نشاط الغده الدرقيه 

______________________________________________________________________________

Hypothyroidism is a common endocrine disorder with  characteristic clinical symptoms and signs. Typical symptoms of hypothyroidism are lethargy, cold intolerance, slowing of intellectual and motor activity, decreased appetite, weight gain, and dry skin. A 39-year-old female presented to the clinic with dysarthria as the chief symptom. Subsequent questions revealed that other symptoms were confined to the otolaryngeal region, which were episodes of mild dysphonia, dysphagia, sleep apnea, and snoring. Laboratory data revealed marked hypothyroidism and positive tests for antithyroglobulin and antimicrosomal antibodies. After administration of thyroxin, the dysarthria and the other symptoms rapidly disappeared. Dysarthria may be the presenting symptom of hypothyroidism and can be resolved after hormone replacement therapy.

Key Words:    Dysarthria Hypothyroidism, 

______________________________________________________________________________________


 

Correspondence to:

Dr. Kawther T. El-Shafie, Family and Community Medicine Department, College of Medicine, Sultan Qaboos University, P.O. Box 35, Al-Khoud 123, Sultanate of Oman


 

INTRODUCTION

Endocrine disorders may complicate, cause or mimic otolaryngologic disorders, some of which may be anatomical, due to an enlargement of the thyroid gland, while others are physiological, resulting from increased or decreased glandular activity.1 Hypothyroidism is characterized by the slowing of mental and motor activity, depression, constipation, cold intolerance menorrhagia, stiff muscles, carpal tunnel syndrome, sleep apnea, dry hair and skin, weight gain, snoring and a hoarse voice.1 Less common symptoms involve the heart, muscles, joints, and blood.2 Dysarthria as the presenting symptom of hypothyroidism has only been reported once before.3 Here, we present an unusual case of hypo-thyroidism presenting with dysarthria.

CASE REPORT

A 39-year-old female presented to the clinic with dysarthria of six months duration. She had noticed that she was developing a lisp. On further questioning, it was revealed that there had been episodes of dysphonea, snoring, sleep apnea, dysphagia and choking during eating or drinking.  Her past medical history was normal apart from one occasion of delayed recovery from anaesthesia during surgery for a fractured femur the year before. Clinical examination, including the central nervous system, was normal apart from a slightly puffy face. Her thyroid gland was not palpable. An otolaryngeal examination revealed no local cause for her problem. There was no abnormality in the movement of the tongue or pharygeal/palate muscles. A further neurological examination did not show any abnormality. Routine thyroid function tests showed a free thyroxin of < 5 pmol/L (normal 9.2-23.9 pmol/L), a thyroid stimulating hormone of 82.7 miu/L (normal 0.32-5.00 miu/L), antithyroglobulin antibodies were 1:320 u/ml (normal 1:40 u/ml), antiperoxidase autoantibodies of 1:1600 u/ml (normal 1:40 u/ml). Radioactive iodine uptake was low 0.18% (normal 1-4%). A complete blood count film was consistent with iron deficiency, a haemoglobin of 7grams   (normal 11-16 grams), low serum iron of 2 umol/L (normal 10-28 umol/L), increased red cell distribution width (RDW) of 17.2 (normal 11.6-13.7%). Other biochemical abnormalities were high serum cholesterol of 6.9 mmol/L (normal 3.6-6.8 mmol/L). High triglycerides of 2.5 mmol/L (normal 0.5-1.7 mmol/L). The Electroencephalo-gram (EEG) was normal.

        Based on these findings, hypo-thyroidism was diagnosed. In the light of the patient’s diagnosis, a second history was taken which showed that she suffered from other symptoms of hypothyroidism such as, dry skin, generalised weakness, excessive sleeping , hoarse voice, and menorrhagia. All of these symptoms were neither reported nor elicited.  After the administration of thyroxin, the symptoms rapidly improved. Two months after the initiation of therapy, the patient had no more dysarthria or other associated symptoms.

DISCUSSION

Dysarthria is a disturbance of articulation that may be caused by a neuromuscular lesion, or an abnormality of the vocal cords. The first may result from damage to the central or peripheral nervous system such as head trauma, brain stem infarction, bulbar palsy, motor neuron disease, peripheral neuropathy, Huntington’s Chorea, Parkinson’s disease, multiple sclerosis, myasthenia gravis, or muscle disease.4 The second may be attributable to congenital, traumatic, inflammatory, tumors, or post-operative lesions of the vocal cords. These causes were unlikely in this patient, because she showed no associated clinical      features of these diseases besides the normal neurological examination and investigations. Other causes such as  congenital or aquired storage disorders   such as amyloidosis, and such endocrine disorders as acromegaly or hypo-thyroidism,3 as in the presented case, may lead to an enlargement of one or more of the components of the vocal cords.5,6 The most likely cause for the dysarthria in this patient was hypothyroidism. This was supported by the abnormal thyroid functions and the response of the dysarthria to thyroxin.

        Dysarthria due to hypothyroidism had been reported only once previous to this case.3 The pathophysiology of dysarthria in hypothyroidism can be explained by edematous swelling of laryngeal and hypopharyngeal  structures in combination with macroglossia.3 It has been shown that macroglossia in hypothyroidism is caused by a thickening of the epithelial tissue.6 These changes can also explain the choking and the dysphagia which this patient experienced. Dysphagia  is also an unusual symptom of hypothyroidism. There have been a few reports of hypothyroidism responsible for secondary dysphagia.10-12 Her sleep apnea may also be a manifestation of hypothyroidism, most likely caused by edema and myopathy.7 Sleep apnea attributable to hypothyroidism is reversible with thyroxin replacement therapy.8 The episodic hoarseness of voice can also be explained by hypothyroidism,1 as well as the delayed recovery from anaethesia the year before, most probably the result of undiagnosed hypothyroidism.9,13,14 Unfortunately, thyroid function tests had not been performed on our patient at that time. Iron deficiency anemia in this patient was due to menorrhagia, which is one of the characteristic features of the disease.1 Hyperlipidaemia may also be due to hypothyroidism, a known association.1

        Clinical implication of the presented patient was that dysarthria may be the presenting symptom of hypothyroidism, even if other symptoms had been present for a long time. Hypothyroidism as the cause of dysarthria was confirmed with the discovery of additional symptoms in the patient’s history. Otolaryngeal symptoms should therefore be considered possible symptoms of hypothyroidism.15 Prompt recovery of dysarthria is expected  after hormone replacement therapy.

REFERENCES

1.     Wilson JD, Braunwald E. Harrison’s Principles of Internal Medicine (14th ed. New York: McGraw-Hill; 1998.

2.     Klein, Levey GS. Unusual manifestation of hypothyroidism. Arch Intern Med 1984; 144:123–8.

3.     Stollberger C, Finsterer F. Dysarthria as the leading symptom of hypothyroidism. American Journal of Otolaryngology2001; 22:70-2.

4.     Ackermann H, Wiles CM. Dysarthria and Dysphonia. In: Brandt T, Caplan LR, editors. Neurological disorders: course and treatment. San Diego(CA): Academic Press; 1996. pp 193-6.

5.     Finsterer J, Wogritsch C, Pokieser P, et al. Light chain myeloma with oropharyngeal amyloidosis presenting as bulbar paralysis. J Neurol Sci1997; 147: 205-8.

6.     Wittman AL. Macroglossia in acromegaly and hypothyroidism.Wirchow Arch A Pathol Anat 1977; 373: 353-60.

7.     Rosenow F, McCarthy V, Carusa CA. Sleep apnea in endocrine diseases. J Sleep Res1998; 7: 3-11.

8.     Strollo PJ Jr, Rogers RM. Obstructive sleep apnea. N Engl J Med 1996; 334: 99-104.

9.     Cone AM. Anesthesia in a patient with unusual myxoedema coma.   Anaesth Intensive Care 1994; 22 (3): 295-8.

10.   Reiss M. Dysphagia as a symptom of myxedema.Schweig Rundsch Med Prax 1998; 2987 (18):627-9.

11.   Wright RA, Penner DB. Myxedema and upper esophageal dysmotility.Dig Dis Sci 1981; 26(4): 376-7.

12.   Cohen SJ. Difficulty in swallowing as an early sign. Clin Pediatric 1971; 10(11):682.

13.   James ML. Endocrine diseases and anaethesia. A review of anae management in pitutary, adrenal and thyroid diseases. Anaethesia 1970;25(2):232-52.

14.   Holmes JL, Hooper MJ. B.W.R: Anaethesia for thyroid surgery. Anaeth Intensive care 1973; 1(3):218-25.

15.   Lucente FE. Endocrine problems in otolaryngology. Ann Otol Rhinol Laryngol 1973; 82 (1):131-7.


 


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Case report



-0001-11-30

PREVALENCE OF OBESITY


PREVALENCE OF OBESITY AMONG TYPE 2 DIABETIC PATIENTS IN AL-KHOBAR PRIMARY HEALTH CARE CENTERS

Kholood M. Mugharbel, FFCM,* Mowaffaq A. Al-Mansouri, FFCM†

* Al-Khobar Government Hospital, Al-Khobar † King Fahad Hospital, Jeddah

____________________________________________________________________

هدف الدراسة: معرفة مدى انتشار السمنة لدى مرضى السكري النوع الثاني لمراجعي المراكز الصحية الأولية بالخبرفى عيادات الأمراض المصغرة ) الضغط والسكري).

طريقة الدراسة: تم مراجعة الملفات الخاصة بالمرضىالمسجلين بمراكز الرعاية الصحية الأولية المختارة، من  تاريخ مايو2000م إلى اكتوبر 2001م

نتائج الدراسة: تم مراجعة 382  ملفا لمرضى السكري المراجعين لعيادات المراكز الصحية المختارة للدراسة، منهم 88.7%  يعانون من السكري النوع الثاني. على ضوء التقسيمات التى وضعت من منظمة الصحة العالمية للسمنة وجد أن 0.7% فقط من مرضى السكري يقع معدل كتلة الجسم تحت المعدل الطبيعي فقط وأن 21.8% لديهم معدل كتلة الجسم في المعدل الطبيعي. أما 2.31% يعانون من زيادة بالوزن ( معدل كتلة الجسم = 9.29- 25 كغم/ م2 ( وجدت السمنة لدى 39.9% من مرضى السكري النوع الثاني (معدل كتلة الجسم = 9.39- 30 كغم/ م2 ( والسمنة المفرطة لدى 6.3% ( معدل كتلة الجسم <40 كغم / م2  )

الاستنتاجات والخلاصة :ارتفاع معدل انتشار السمنة والسمنة المفرطة لدى مرضى السكري النوع الثاني يؤدي إلى مضاعفات خطيرة أخرى أوصت الدراسة بالاهتمام بتدريب الفريق الصحي لمتابعة المرضى المصابين. 

الكلمات المرجعية: السكري النوع الثاني، السمنة، المراكز الصحية.

____________________________________________________________________

Objectives: This study estimated the prevalence of obesity among Type 2 diabetic patients who are followed in mini clinics (hypertension, diabetes) in Primary Health Care Centers (PHCC) in Al-Khobar.

Methods: Retrospective study reviewing all diabetic patient files registered in PHC centers in the Al- Khobar area from May 2000 to October 2001.

Results: Of the 382 diabetic patients followed in PHC, 88.7% were type 2 diabetics, and according to WHO classification of obesity, 0.7% were underweight. Only 21.8% of type 2 diabetic patients were in their ideal range of body weight. While 31.2% were overweight (BMI in the range of 25.0-29.9 kg/m2), 39.9% of the type 2 diabetic patients were found to be obese (BMI= 30 - 39.9 kg / m2), and 6.3% had morbid obesity (BMI 40 kg / m2).

Conclusion: High prevalence of overweight and obesity in type 2 diabetics is associated with other serious complications. This study emphasizes the importance of training health care providers for the proper follow-up of patients.

Key Words: Type 2 diabetes, obesity, primary care.

___________________________________________________________________________

Correspondence to:

Dr. Kholood M. Mugharbel, Al-Khobar Government Hospital, P.O. Box 40117, Al-Khobar, Saudi Arabia


 

INTRODUCTION

The risk of diabetes mellitus increases independently with increasing age, obesity, and the lack of physical activity,1-6 and overall mortality rises with body mass index (BMI) level greater than 25 kg per m2.1

        Obesity is a complex disorder involving appetite regulation and energy metabolism, as the excess of body fat results from an imbalance of intake and expenditure.1Obesity is considered a major risk factor for type 2 diabetes.2-4 It has been found that the incidence of diabetes increases by a factor of 2-3 fold in obese individuals when obesity is defined as 120% of the ideal weight.7

        Obesity is a modifiable risk factor for Type 2 diabetes. It not only interferes with effective treatment of hyperglycemia, but also hypertension, dyslipidemia,8 cardio-vascular disease, cerbrovascular disease, hyperlipidemia, increased incidence of arthritis of the hands and knees, gallbladder disease, and sleep apnea. It is also related to chronic back pain and respiratory dysfunction.1,2 In addition to the increased risk of morbidity and mortality, obesity leads to various psychological stresses that vary from emotional distress to social stigmatization.1,2,4

Table 1: Classification of overweight and obesity by BMI*

Classification

Obesity class

Body Mass Index (kg/m2)

Underweight

-

18.5

Normal

-

18.5-24.9

Overweight

-

25.0-29.9

Obesity

I

30.0-34.9

Obesity

II

35.0-39.9

Extreme obesity

III

40

*Source: World Health Organization. Obesity: Preventing and managing the global epidemic. Report of WHO consultation of obesity. Geneva, 3-5 June 1997.

        Recent WHO classification of obesity is shown in Table 1, where the cut-off points of 25kg/m2 and 30kg/m2 are used to define overweight and obesity respectively.9,10

        This paper summarizes findings of type 2 diabetic patient files followed in the mini clinics (hypertension and diabetes) in Primary Heath Care Centers in Al-Khobar, Saudi Arabia.

 

METHODS

Data were collected randomly from 50% of the 10 primary health care centers (PHCC) in Al-Khobar. All the personal health files of the diabetic patients registered in these centers were studied and the required data such as weight, height BMI extracted by the investigator during an 18-month period (May 2000- October2001).

        World Health Organization's criteria for diabetes classification were used to group patients as Type 1 or Type 2 diabetes mellitus.5,6 Experienced nurses using standard techniques, measured height and weight. Body mass index (BMI) was calculated according to person’s weight in kilograms divided by the square of the person’s height in meters.10 Weight was recorded by the calibrated scale in PHCC; and height was taken in the same setting. The investigator revised this randomly.

        Data were entered into a personal computer using SPSS statistical package. A p-value of 0.05 or less was considered to represent statistical significance. Descriptive statistics and statistical tests were used as appropriate.

RESULTS

Ninety percent (90%) of the 382 diabetic patients registered and followed in the randomly selected PHCC were Type 2 diabetes. Recommended data were missing in 21.2% (81) of patients’ files.

        Table 2 shows the gender distribution of diabetic patients. Comparison between Types 1 and 2 diabetics showed that 88.9% of the male and 88.6% of female patients were Type 2, (p=<0.05).

Table 2: Gender distribution of the diabetic patients attending PHCC

Gender

Type 2

No. (%)

Type 1

No. (%)

Total

No. (%)

Male

176 (51.9)

22 (51.2)

198 (51.8)

Female

163 (48.1)

21 (48.8)

184 (48.2)

Total

339 (100)

43 (100)

382 (100)

    

        Comparison of BMI status among Type 2 and Type 1 diabetic patients attending PHCC (Table 3), showed a statistical significance (p=<0.05). Less than one percent (0.7% ) were underweight, while only 21.8% of Type 2 diabetics and 26.7% of Type 1 were within the normal range. There was a higher percentage of overweight Type 2 diabetic patients (32.1%) than Type 1 diabetics (23.3%), while there was no difference between obese diabetics Type 2 and Type 1 (46.2% and 43.3% respectively).

        Table 4 shows the distribution of BMI among male and female diabetic patients (p=<0.05). More than one quarter of the male patients and 16.3% of the females were in the normal BMI range while overweight males was higher (35.2%) than females (28.7%). It appears from the data that in all obesity classes, the percentage of female patients was higher.

DISCUSSION

Obesity is a condition in which excess body fat may put a person's health at risk. In adults, the risk of disease increases independently with increasing BMI and excess abdominalfat. Cardiovascular and other obesity-related disease risks increase significantly when BMI exceeds 25.0 kg per m2. The risk increases with the extent of obesity and those with a BMI 40 kg/m2 are at the highest risk.2,8

        In developed countries, 85% of all diabetics are Type 2 diabetics, and almost 100% are Type 2 in developing countries. This has been explained by the changes in life style and urbanization.3,9

Our study shows that of the total number of 382 diabetic patients who were followed in PHCC in the study area, 88.7% were Type 2 diabetics. Of these Type 2 diabetic patients, only 21.8% had BMI within the normal range while 32.1% were overweight; the percentage of male patients was higher (35.2%) than female patients (28.7%). Obesity was found in 39.9% of the patients (33.8% of the male patients 33.8% and 46.4% of the female patients). Extreme obesity was also higher in female patients (8.5%) than male patients (4.2%).   

Table 4: Body Mass Index (BMI) status among male and female Type 2 diabetics (p=<0.05)

BMI (kg/m2)

Type 2 diabetic patient

Male

No. (%)

Female

No. (%)

<18.5

0

0

18.5-24.9

38 (26.8)

21 (16.3)

25.0-29.9

50 (35.2)

37 (28.7)

30.0-34.9

35 (24.6)

47 (36.4)

35.0-39.9

13 (9.2)

13 (10.0)

40

6 (4.2)

11 (8.5)

Total

142 (100)

129 (100)

Table 3: Status among diabetic patients attending Primary Health Care Centers (p=<0.05)

Body Mass Index (Kg/m2)

Diabetic Patients

Total No. of

diabetic patients

Frequency %

Type 2

No. (%)

Type 1

No. (%)

<18.5

0

2 (6.7)

2

0.7

18.5-24.9

59 (21.8)

8 (26.7)

67

22.3

25.0-29.9

87 (32.1)

7 (23.3)

94

31.2

30.0-34.9

82 (30.3)

6 (20.0)

88

29.2

35.0-39.9

26 (9.6)

6 (20.0)

32

10.6

40

17 (6.3)

1 (3.3)

18

6.0

Total

271 (100)

30 (100)

301

100

        Different studies have documented that more than 80% of Type 2 diabetics are obese, and adult males with Type 2 diabetes are more likely to be obese than females.7,11

        In Arab societies, it has been found that the high prevalence of Non-insulin dependent diabetes mellitus (NIDDM) is associated with high prevalence of obesity.12In Bahrainis, the high rate of diabetes is associated with obesity, but not with overweight.13

        A study done on the Saudi diabetic population, showed that only 20% of Type 2 diabetic patients had normal BMI. Similar to our finding, 37% of the male patients, and 29.7% of the females were overweight. However, 20.7% of the male, and 39.3% of the female diabetic Type 2 patients were obese.13 Another study done on the general population of the Eastern Region showed that the prevalence of overweight was higher in males (21.62%) than in females (20.45%), but the reverse was found in obesity (female have higher BMI than males).14

        Results similar to ours were found in Yemeni diabetic patients, where the normal BMI was higher in female patients (22%) than in male patients (21%). However, more female patients (30%) were obese than male patients (28%).15

        The rapid changes in socioeconomic life in countries of the Middle East not excepting Saudi Arabia, with an imbalance between intake and reduced energy expenditure has brought in its wake a number of  health risks.11,13,16

        It has been recommended that screening for changes in BMI is a good indicator for the development of Type 2 diabetes.17Diabetic registration will reduce the latent complication of Diabetes. It has been documented that for most patients weight loss seems to be a desirable goal for the improvement of glycemic control, hyperlipidemia, and hypertension.18,19

        Public education about obesity and its consequences is strongly recommended. Ways to control and prevent obesity and overweight should be stressed and made known to people of all ages in the population. Education about diabetes mellitus and its complications could be presented in basic simple public lectures that stress the importance of the awareness of this health condition.

REFERENCES

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2.     Seidell JC. Effect of Obesity. Medicine International 1998; 20(10): 4-8.

3.     Kumar S, Barnett AH. Causes of non-insulin dependent diabetes mellitus. Medicine International 1997; July/August: 6-9.

4.     Khan NM, Hershey CO. Update on Screening for Type 2 Diabetes: the why, who, how, and what of testing and diagnosing. Postgraduate Medicine 2001; 109 (2): 27-34.

5.     American Diabetic Association: Screening for Diabetes (Position Statement). Diabetes Care 2001; 24(1): S21-S24.

6.     American Diabetic Association: Screening for Type II Diabetes (Position Statement). Diabetes Care 2000; 23 (1): S21-S24

7.     Rudy DR. Tzagourins M. Endocrinology. In: Rakel RE. Textbook of Family Practice. 4th edition. USA; WB Saunders Company 1990:1082-7.

8.     Crimmins CJ. Approach to the patient with obesity. In: Goroll AH. Primary care medicine 2nd edition. JB Lippinicott Company 1987: 941-951.

9.     Zimmet P. Diabetes - Definitions and Classification. Medicine International 1997; July/August: 1-3.

10.   World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation of Obesity. Geneva, 3-5 June 1997.

11.   Hillier TA, Pedula KL. Characteristics of an Adult Population with newly Diagnosed Type 2 Diabetes. Diabetes Care 2001; 24:1422-1527.

12.   AL-Mahroos F. Diabetes Mellitus. In: The Arabian Peninsula. Annals of Saudi Medicine 2000; 20(2):111-2.

13.   Al-Mahroos F, AL-Roomi K. Obesity Among Adult Bahraini Population: Impact of Physical Activity and educational level. Annals of Saudi Medicine 2001;21(3-4):183-7.

14.   El-Hazmi MAF, Warsy AS. Obesity and overweight in Type 2 Diabetics Mellitus patients in Saudi Arabia. Saudi Medical Journal 1999;20(2):167-72.

15.   Gunaid AA, El-Khally FMY, Hassan NAGM, Mukhtar ED. Demographic and Clinical Features of Diabetes Mellitus in 1095 Yemeni Patients. Ann Saudi Med 1997;17(4):402-9.

16.   El-Hazmi MAF, Warsy AS. Prevalence of Obesity in the Saudi Population. Ann Saudi Med 1997;17(3):302-6.

17.   El-Hazmi MAF, Warsy AS. Relationship between Obesity, overweight and plasma lipids in Saudis. Saudi Medical Journal 1999; 20(7):521-5.

18.   Looker HC, Knowler WC, Hanson RL. Changes in BMI and Weight Before and after the development of Type 2 Diabetes. Diabetes care 2001;24(11):1917- 22.

19.   Soran H. Oral hypoglycemic agents past, present, and future. Diabetes International 2000; l 10(3):77-80.


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