Body Mass Index In Patients Research Articles

Analysis of Breast Aesthetic Revision Procedures after Unilateral Abdominal-based Free-flap Breast Reconstruction: A Single-center Experience with 1251 Patients.

A retrospective review of all unilateral abdominal-based free-flap breast reconstructions performed from 2000 to 2014 was undertaken at a tertiary academic center. Overall, 1251 patients were included in the analysis. The average number of breast revision procedures was 1.1 ± 0.9, and 903 patients (72.2%) underwent at least one revision procedure. Multiple logistic regression analysis demonstrated that younger age, higher body mass index, and prior oncologic surgery on the reconstructed breast were factors associated with increased likelihood of undergoing a revision procedure. The probability of undergoing at least one revision increased by 4% with every 1-unit (kg/m2) increase in a patient's body mass index. Multiple Poisson regression modeling demonstrated that younger age, prior oncologic surgery on the reconstructed breast, and bipedicle flap reconstruction were significant factors associated with undergoing a greater number of revision procedures. Most patients who undergo unilateral autologous breast reconstruction require at least one additional operation to optimize their breast aesthetic results. Young age and obesity increase the likelihood of undergoing additional operations. These findings can aid reconstructive microsurgeons in counseling patients and establishing patient expectations prior to their undergoing microvascular breast reconstruction.

Prevalence of medically induced psychological trauma and its influence on women's health.

The aim of the present study was three-fold. One, to assess the prevalence of medical traumatization in outpatients of a gynecologic department; two, to analyze the relationship of medical traumatization with adverse childhood events; and three, to investigate the extent to which medical traumatization affects the health outcomes of woman. Between January and September 2022, a prospective cross-sectional study recruited patients of a gynecologic outpatient clinic at St. Gallen Cantonal Hospital in Switzerland. Medical trauma was a self-reported item. The presence of adverse childhood events was assessed using the Childhood Trauma Questionnaire. The severity of post-traumatic stress was evaluated using the Impact of Event Scale Revised questionnaire. In total, 227 patients were recruited. Medical trauma was reported by 20% of the interviewees and it was strongly associated with obesity (A= 0.005). Undergoing surgery was most commonly the source of psychological distress (5.7%) followed by delivery (4.8%), pregnancy loss (4.8%), and cancer diagnosis (4.0%). Yet, fewer than 1% of the patients reached the threshold suggesting post-traumatic stress disorder. We found no relationship between the medical trauma, adverse childhood events, cardiovascular disease, or substance abuse. The presence of medical trauma was associated with the patient's body mass index (calculated as weight in kilograms divided by the square of height in meters).

Developing Subcutaneous Emphysema, Pneumothorax and Pneumomediastinum after Arthroscopic Shoulder Surgery under General Anesthesia: A Case Report

The use of arthroscopic shoulder surgery for diagnosis and treatment is increasing. Although some complications may occur during the operation, subcutaneous emphysema, pneumomediastinum and pneumothorax are rare complications. In this case, we present a patient who developed subcutaneous emphysema, pneumomediastinum and pneumothorax. A 53-year-old female patient presented with right shoulder pain for 8 months. The patient's body mass index is 20. Additional diseases are rheumatoid arthritis (RA) and vertigo. There was no other systemic disease or comorbidity. She was assigned an American Society of Anesthesiologists (ASA) score of 2. Arthroscopic rotator cuff repair was planned. She was operated under general anesthesia (GA). Subcutaneous emphysema, pneumothorax and pneumomediastinum developed at 6 hours after this surgery. The patient was discharged without any complaints on the 6th day of follow-up. No problem was detected in the follow-up of the patient. After shoulder arthroscopy under GA, subcutaneous emphysema, pneumothorax and pneumomediastinum can occur due to the procedure itself, the pleural and alveolar trauma, the endotracheal intubation or extravasation of irrigation fluid during shoulder arthroscopy. In our case, it was not possible to determine the exact cause. However, it is important to keep in mind that subcutaneous emphysema, pneumothorax and pneumomediastinum can occur after arthroscopic shoulder surgery. Although shoulder arthroscopy is a safe procedure, surgeon familiarity with the risk factors for this complication and close monitoring can aid in its identification and allow for appropriate treatment.

P591 Negative impact of high body mass index on the efficacy of anti-TNFα agents in patients with Inflammatory Bowel Disease

Abstract Background Anti-tumor necrosis factor (TNF)-α agents are a therapy of choice in the induction and maintenance treatment of inflammatory bowel disease (IBD). Unfortunately, their efficacy varies. Some IBD patients are primary non-responders and many will experience a secondary loss of response. However, we do not yet have good predictors of their efficacy. Obesity, which prevalence increases worldwide, is also increasingly found in IBD population. Some studies suggest an association between obesity and poorer response to anti-TNFα therapy in IBD patients, although with conflicting results. The aim of this study is to assess the impact of patients’ body mass index (BMI) on the efficacy of anti-TNFα agents in IBD and if there is difference according to the route of administration (intravenous (IV) vs subcutaneous (SC)) or the type of disease (Crohn’s disease (CD) vs ulcerative colitis (UC)). Methods We retrospectively collected data from 188 patients with IBD, aged ≥ 18 years, treated with a first anti-TNFα agent started in our center between January 2002 and December 2020 to avoid missing data. A lack or loss of response to anti-TNFα therapy was defined by the need to optimize or change the treatment or by the initiation of any intercurrent treatment (steroid therapy, hospitalization, or surgery). Frequency of the event and time to its occurrence were analyzed and compared according to BMI using uni- and multivariate logistic regression models and survival curves (Kaplan-Meier), represented by BMI categories (<18.5; 18.5-25; 25-30 and ≥ 30 kg/m²). Results In this cohort of 188 patients (143 CD, 43 UC, 2 Indeterminate Colitis), 8% were obese. We observed that the higher the patient’s BMI, the earlier the risk of optimization or change of treatment (HR=1.043, p=0.045). Association was even stronger for obese patients (HR=2.13, p=0.018). After adjustment for IBD type and administration route, association with obesity persisted. Two other characteristics - female gender (HR=1.56, p=0.012) and higher CRP (HR=1.14, p=0.021) – were associated with earlier optimization or treatment change. Similarly, analysis of survival curves showed a significant difference in time to optimization or change of treatment between BMI categories in patients with CD (p=0.02) but not in those with UC (p=0.87). No association was found between BMI and need for intercurrent treatment. Conclusion This study confirms an association between higher BMI – specifically obesity - and an earlier loss of efficacy of a first anti-TNFα treatment, regardless of IBD type or route of drug administration. Prospective studies with analysis of trough levels are required for a better understanding of the mechanisms involved in the response to anti-TNFα therapy in IBD obese patient.

Radiation Exposure and Surgical Outcomes after Antegrade Sclerotherapy for the Treatment of Varicocele in the Paediatric Population: A Single Centre Experience.

Antegrade sclerotherapy (Tauber) effectively treats varicocele. However, fluoroscopy exposes young males to ionizing radiation. We aimed to evaluate radiation exposure and surgical outcomes after the Tauber procedure. We retrospectively analysed data from 251 patients. Dose area product (DAP) and fluoroscopy time were recorded. The effective dose was calculated with the PCXMC software. Descriptive statistics and linear regression tested the association between clinical predictors and radiation exposure. Median (IQR) age and body mass index (BMI) were 14 (13-16) years and 20.1 (17.9-21.6) kg/m². Five (2.1%) patients developed clinical recurrence and two (0.81%) developed complications. Median fluoroscopy time and DAP were 38.5 (27.7-54.0) s and 89.6 (62.5-143.9) cGy*cm2. The effective dose was 0.19 (0.14-0.31) mSv. Fluoroscopy time was higher in patients with collateral veins (41 (26-49) s vs. 36 (31-61) s, p = 0.02). The median amount of sclerosing agent (SA) used was 3 (3-4) ml. DAP was higher when SA > 3 mL was used (101.4 (65-183) cGy*cm2 vs. 80.5 (59-119) cGy*cm2; p < 0.01). At univariable linear regression, age, BMI, operative time and SA > 3 mL were associated with higher DAP (all p < 0.01). At multivariable linear regression, only BMI (beta 12.9, p < 0.001) and operative time (beta 1.9, p < 0.01) emerged as predictors of higher DAP, after accounting for age and SA > 3 mL. The Tauber procedure is safe and associated with low effective doses. Operative time and the patient's BMI independently predict a higher radiation dose.

The Influence of Body Mass Index on Radiation Dose and Exposure Time in Fluoroscopic Guided Hip Injections - A Comparative Analysis of Two Approaches.

Intra-articular hip injections (IHI) are routinely performed for both diagnostic and therapeutic purposes. The procedure can be performed via either an anterior or a lateral approach with fluoroscopic guidance being widely practised. There is a risk of radiation exposure associated with fluoroscopy assisted IHI. This may be influenced either by the surgical approach or the patient's body mass index (BMI) or both. This study was undertaken to compare the relationships of the respective approaches to BMI, fluoroscopic exposure time (FET) and radiation dose (RD). A retrospective study was conducted comprising 74 patients who underwent IHI with 37 patients in each group (anterior and lateral). Patients were assessed pre-operatively and post operatively for any complications. The intra-operative radiation dose, fluoroscopic exposure time and BMI data were collected and analyzed. The mean age of the patients in anterior and lateral groups was 61.18±14.08 and 67.21±14.39 years respectively. No complications were noted in either group. However, there was a significant increase in FET (P=0.002) and RD (P<0.001) in patients with BMI ≥ 30. In the lateral group, this trend was markedly noted with increase in FET (P<0.001) and RD (P<0.001) in patients with BMI ≥ 30. On the other hand, in the anterior group there was no statistically significant increase in FET (P=0.155) and only a moderate increase in RD (P=0.020) in patients with BMI ≥ 30. Both anterior and lateral approaches to fluoroscopic guided IHI are equally safe in terms of complications involved. There is statistically significant increase in both radiation dose and fluoroscopic exposure time in patients with BMI ≥ 30. This is more pronounced in lateral approach. The anterior approach is most effective in reducing both radiation dose and fluoroscopic exposure time, more so in patients with BMI of 30 and above.

Optimization of 201Tl Dosage in a Simultaneous Acquisition Rest 99mTc/Stress 201Tl Dual-Isotope Myocardial Perfusion Single-Photon Emission Computed Tomography with Semiconductor Gamma Camera.

Background: The use of 201Tl in myocardial perfusion single-photon emission computed tomography (SPECT) is predominantly not recommended because of the higher radiation exposure of 201Tl compared to 99mTc agent. However, the advent of new gamma cameras with semiconductor detectors has made it possible to reduce the 201Tl dose and lower radiation exposure. In our hospital, the dose of 201Tl is adjusted according to the patient's body mass index (BMI), with 50 MBq for BMI<25 and 74 MBq for BMI≥25. The dose of 201Tl during simultaneous acquisition dual-isotope myocardial perfusion SPECT (MPS; stress 201Tl and rest 99mTc agent) exceeds 9 mSv/examination when 74 MBq of 201Tl is administered. In order to further reduce the radiation dose, optimization of the 201Tl dose was investigated. Methods: Two hundred and eighty consecutive patients who underwent stress MPS using simultaneous acquisition dual-isotope protocol (SDI protocol) for the estimation of ischemic heart disease were included. Patients with prior myocardial infarction were excluded. Correlations between BMI and acquisition time were determined in patients receiving 50 MBq (n=154) or 74 MBq (n=126) of 201Tl. In addition, linear regression analysis was used to determine the slope and intercept to derive a linear functional equation, and the theoretically optimal 201Tl dose was evaluated. Results: The correlation coefficient between BMI and acquisition time in the 201Tl 50 MBq group was 0.532 (P< 0.00001) and in the 201Tl 74 MBq group was 0.478 (P<0.00001), both showing a positive correlation. Linear regression analysis yielded two equations: y=0.52x-0.32 (201Tl 50 MBq group) and y=0.41x-0.69 (201Tl 74 MBq group). Linear function equation results indicated that patients with BMI between 25 and 30 could be examined within approximately 15 minutes with 50 MBq of 201Tl. Conclusion: Considering examination efficiency, a single acquisition time of less than 15 minutes is ideal. Theoretically, patients with BMI less than 30 could be examined within approximately 15 minutes with 50 MBq of 201Tl.

Aripiprazole Used to Treat Capgras Syndrome in an Adolescent Diagnosed With Autism.

This report discusses the emergence, clinical appearance, and treatment of the rare entity Capgras syndrome (CS) in an adolescent diagnosed with autism. After a brief introduction to the CS, we conduct a detailed description of the case and review, after a search on the PubMed database, the known pathophysiology, psychiatric disorders associated with the onset of this syndrome, and the management of CS. Capgras syndrome generally emerges during the course of delusional disorder, schizophrenia, or mood disorders, and for reasons such as neurological, infectious, or endocrinological diseases, drug intoxications, or deprivation. We encountered no previous reports of CS developing during the course of autism. There are no prospective studies concerning the treatment of the syndrome. However, antipsychotic drug use is primarily recommended in treatment. Antipsychotic drug therapy was therefore planned for the treatment of delusion, a psychotic symptom, in this case. The atypical antipsychotic aripiprazole was used based on the presence of accompanying diagnosis of autism, and the patient's body mass index and age. A relatively high dose of aripiprazole was required for the first psychotic attack in our patient. However, a good level of response was achieved within the expected time frame. In addition, no marked adverse effects were observed. Aripiprazole seems to be an effective and well-tolerated antipsychotic drug in the treatment of CS accompanying autism.

The association of metabolic risk factors with ischemic heart disease and heart failure in Saudi Arabia - A cross sectional study.

Cardiovascular diseases (CVDs) are the leading non-communicable cause of morbidity and mortality worldwide. This study aimed at determining the association of metabolic risk factors with ischemic heart disease (IHD) and heart failure (HF). A cross-sectional study including 104 participants was conducted in three major hospitals between October 2020 and October 2021. All adult patients of either gender, over the age of 35, attending the CVD screening program at the family medicine clinics of the hospitals were included in the study. The physician collected demographic details, history of CVD, diabetes or hypertension, and current medication. Each patient's body mass index (BMI) was calculated, electrocardiogram (ECG) and blood tests were done. Univariate and multivariate logistic regressions were checked. The mean age of the participants was 47.6 (SD = 13.5) years. Diabetes and hypertension had increased odds of IHD by 129 (CI = 6.20 - 2698.42, P = 0.002) and 195 (CI = 13.87 - 2743.11, P < 0.001) times, respectively. Diabetes mellitus (Chi2 = 11.93, P < 0.001) and hypertension (Chi2 = 14.74, P < 0.001) had significant association with HF. Dyslipidemia was significantly associated with IHD (OR = 12.41, CI = 1.15 - 134.12, P = 0.038) and high-grade HF (OR = 14.91 CI = 3.61 - 61.40, P < 0.001). Age, dyslipidemia, diabetes, hypertension, and left ventricular hypertrophy have significant association with IHD or HF among the study population.

Association of hypertension, hyperlipidemia, obesity, and demographic risk factors with breast cancer in Bangladeshi women.

In recent years, breast cancer incidences and related deaths have been rising among Bangladeshi women and will be a major threat by 2040. So, conducting more population-based studies is crucial. This case-control study was designed to quantitatively evaluate potential risk factors for breast cancer. In this population-based case-control study, 52 random breast cancer cases and 59 matched healthy controls, aged between 25 and 70 years, were included. The breast cancer patient samples were collected from the National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh, from December 2021 to February 2022. The study was conducted fully following the Declaration of Helsinki guidelines. The collected socio-demographic data and blood samples of the study participants were analyzed. Chi-square analysis was used to compare study characteristics between cases and controls, Odds ratios (ORs) with 95% confidence intervals (CIs) were derived by univariate-logistic regression, and models were adjusted where necessary for study characteristics. Summary demographic characteristics of the 111 study participants suggested that higher age: (≥45): [OR 4.38, 95% CI (1.94-9.89), P value <.001], height: (<1.5 m): [OR 3.01, 95% CI (1.12-8.12), P value .029], low-incomes: [OR 6.83, 95% CI (2.11-22.05), P value .001], and illiteracy: [OR 12.65, 95% CI (3.49-45.79), P value .0001] showed significant correlations with breast cancer. The patient's body mass index (BMI) (≥30) indicated an association with breast cancer: [OR 3.91, 95% CI (1.00-15.31), P value .05]. The lipid profile: [triglycerides (TG): OR = 3.20, 95% CI (1.36-7.53), P value .008; TG/high-density lipid (HDL): OR = 8.82, 95% CI (2.81-27.68), P value <.001; and a lowered HDL: OR = 3.32, 95% CI (1.38-7.98), P value .007], hypertension: [systolic: OR 4.32, 95% CI (1.71-10.93), P value .002; and diastolic: OR 7.32, 95% CI (2.51-21.34), P value <.001], and gastric issues: [OR 6.07, 95% CI (2.00-18.37), P value .001], all showed significant association with breast cancer. The ER- breast cancer subtype was significantly associated with the overweight (OW) group (P value .046) whereas the PR-patients were significantly higher in the normal BMI group (P value .013). Results from this study might aid in the prevention, management, and raising of awareness against the specific risk factors among Bangladeshi women in near future.

Incidence of VTE in Pregnant Women with Sickle Cell Gene Mutation(s): A Retrospective Database Analysis

Purpose/Objective(s): The leading cause of pregnancy-associated mortality in Western countries is venous thromboembolism (VTE) with an absolute incidence of 0.025 to 0.1 percent in the general pregnant population. Noubiap et al reported that sickle cell disease (SCD) patients had a significantly higher risk for VTE (pooled OR 4.4, 95%CI 2.6-7.5, p < 0.001), deep vein thrombosis (DVT) (OR 1.1, 95% CI 1.1-1.2, p < 0.001) and pulmonary embolism (PE) (pooled OR 3.7, 95% CI 3.6-3.8, p < 0.001) as compared to patients without SCD [1]. Although sickle cell trait (SCT) and SCD have an increased risk for VTE, the incidence of VTE during pregnancy has not been documented. Our primary objective was to record a composite incidence of VTE among pregnant patients with SCT/SCD. Material/Methods: A retrospective, cross-sectional analysis including pregnant patients with SCT and SCD was conducted at our tertiary care academic medical center. Data was collected between January 2011 and December 2020. Adult women up to 51 years old with hemoglobin electrophoresis proven SCT and SCD were included. Risk factors for VTE such as the patient's body mass index (BMI), COVID status, family history of VTE, and smoking history were included in the analysis. ANOVA and Chi-square tests were used for analysis and to calculate a composite incidence, odds ratio, confidence interval, and p-value. A p-value of <0.05 was considered statistically significant. Data was analyzed using the SAS system. Results: A total of 139 pregnant SCT/SCD patients were included for analysis, out of which, the majority of the patients were SCT (84/139, 60.4%). The mean age at pregnancy was 26.42 (standard deviation 5.72). The type of VTE included DVT 58.3% (14/24) and PE 41.7% (10/24). At our facility, the incidence rate of VTE in pregnancy for SCT/SCD was 17% as compared to 0.025 to 0.1% in the general population. There was no statistically significant difference in the odds of developing VTE between SCD and SCT (OR= 1.09, 95% CI [.45, 2.63]). Only 2.16% of patients had positive COVID infection, as most of the collected data predated the pandemic. Almost one-third of the patients were smokers (45/139) and only 2.88% (4/139) had a family history of VTE. BMI was divided into BMI <30 (38.13%, 53/139) and BMI >30 (61.87%, 86/139). Obesity (OR= 1.03, 95% CI [.4166, 2.56]) and COVID status (OR=2.45, 95% CI [.21, 28.23]) were not found to be significant in our population of patients. Patients with a family history of DVT had a greater odd of developing VTE (OR=50.70, 95% CI [2.63, 977.88]), although the sample may not provide a precise representation of the population mean. Conclusion: Currently, ASH guidelines recommend a conservative approach to VTE prophylaxis unless research suggests benefits [2]. Our analysis found a 17% incidence of pregnancy-associated VTE in our SCT/SCD patients, which is drastically higher than the general population. With such a significant increased incidence in this patient population, especially with current racial disparities in African American maternal mortality rates, more research should be conducted to evaluate the need for thromboprophylaxis/treatment. Additionally, evaluation for specific SCT/SCD guidelines and recommendations to decrease pregnancy-related VTE and mortality rates should be discussed.

APPLICATION OF DATA MINING FOR PREDICTION OF LONG COVID ON COVID-19 SURVIVAL WITH FEATURE SELECTION AND NAÏVE BAYES METHOD

Since it was declared a global pandemic in March 2020, Corona Virus Disease (Covid-19) has become the world's attention, a lot of research has focused on all things related to Covid-19. Covid-19 is an infectious disease caused by the acute respiratory syndrome Corona virus 2 (SARS-CoV-2). Several studies have shown that the symptoms of COVID-19 persist for a long period of time even though they have been declared cured of Covid-19, this is known as Long Covid. Complaints that are often experienced by patients who progress to Long Covid are fatigue, headaches, coughs, runny noses, sleep disturbances and even shortness of breath. Several risk factors for the occurrence of Long Covid include age, gender, patient congenital disease, condition during acute infection, ethnicity and the patient's Body Mass Index (BMI). To anticipate the occurrence of long covid, it is necessary to have a risk prediction system for the occurrence of long covid in covid-19 patients, this aims to anticipate and prepare for early handling and prevention efforts for covid-19 patients who are at risk of experiencing long covid. Prediction of the risk of long covid can be done by classifying long covid risk factors by utilizing data mining. The purpose of this study is to classify symptom data and patient history, so that data patterns can be obtained that can be used as predictions to estimate the risk of the occurrence of Long covid-19 in Covid-19 survivors. This study uses the Naïve Bayes classification method by classifying data based on the Long covid risk factor and the feature selection information gain method which is used as a technique in attribute selection to optimize the nave Bayes algorithm. The results of this study have a real contribution to the development of science and technology. The concept of the resulting prediction data pattern can be used as a reference in developing early detection of the risk of the occurrence of Long Covid.

Dysplastic hips demonstrate increased joint translation at higher body mass index.

To determine which radiographic measures used to define the severity of hip dysplasia are associated with hip joint translation and to investigate relationships between position, body mass index, and joint translation. This is a cross-sectional retrospective study evaluating 10 validated radiographic measures of dysplasia on weight-bearing AP pelvis and supine 45-degree bilateral Dunn radiographs of 93 young adults with symptomatic hip dysplasia presenting to a single academic institution between October 2016 and May 2019. We determined the difference between standing and supine measurements for each hip and the correlation of each measure with the patient's body mass index. Femoral head extrusion index was 2.49% lower on supine X-ray (p = 0.0020). Patients with higher body mass index had higher center gap distance (p = 0.0274), femoral head extrusion (p = 0.0170), and femoral head lateralization (p = 0.0028) when standing. They also had higher Tönnis angle (pstanding = 0.0076, psupine = 0.0121) and lower lateral center-edge angle (pstanding = 0.0196, psupine = 0.0410) in both positions. The difference in femoral head lateralization between standing and supine positions increased with higher body mass index (p = 0.0081). Translation of the hip joint with position change is demonstrated by decreased femoral head extrusion index on supine X-ray. Patients with higher body mass index had more dysplastic hips, as measured by five of six radiographic outcomes of dysplasia, and experienced more translation with weight-bearing, reflected by increased femoral head lateralization.

Respiratory-gated 18F Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance Imaging in Evaluation of Primary Gastric Lesions and Gastric Lymph Nodes in Patients with Gastric Cancer

AimsTo evaluate the added value of respiratory-gated positron emission tomography (PET) in 18F fluorodeoxyglucose (FDG) PET/magnetic resonance imaging (MRI) in the visual and semi-quantitative assessment of primary gastric lesions and gastric lymph nodes for patients with gastric cancer. Materials and methodsIn total, 102 upper abdominal respiratory-gated and whole-body 18F FDG PET/MRI of 88 patients with gastric cancer were evaluated visually and semi-quantitatively. For 41 patients who underwent surgery, histopathological and PET findings were compared. Three PET images were obtained from upper abdominal PET data: non-Q static (non-QS) PET from all counts, respiratory-gated Q static (QS) PET from counts in the end-expiration phase of breathing, shortened 4 min (S4min) PET that was reconstructed to obtain similar counts to QS PET. The semi-quantitative parameters (standardised uptake values, metabolic tumour volume, total lesion glycolysis) of primary lesions for each PET image, the sizes of primary lesions and the patient's body mass index were recorded. According to lymph node stations, the presence and numbers of positive lymph nodes and visual scores of lymph nodes for each PET image were recorded. ResultsThe patients with smaller gastric lesions (≤30 mm) or higher body mass index (>30) had significantly higher standardised uptake value percentage changes in QS PET compared with non-QS PET (all P < 0.05). The third (lesser curvature), fourth (greater curvature) and sixth (infra-pyloric) lymph node stations had significantly higher visual scores in the QS PET than in the others. The fourth lymph node station had a significantly higher number of FDG-positive lymph node in the QS PET than in the non-QS and the whole-body PET images. In the fourth station, sensitivity, positive predictive value, negative predictive value and accuracy increased in the QS PET compared with the others. ConclusionRespiratory-gated PET/MRI was found to be significantly superior in the evaluation of especially the fourth lymph node station, smaller gastric lesions and in the patients with a higher BMI compared with the non-respiratory-gated PET images.

The Effect of Body Mass Index on the Degree of Renal Interstitial Fibrosis and Tubular Atrophy - A Retrospective Case-Control Study

IntroductionThe degree of interstitial fibrosis and tubular atrophy (IFTA) seen on kidney biopsy has long been used to judge the chronicity of kidney disease to predict renal disease outcomes and prognosis. It is an essential component incorporated in many renal disease prognostic classification systems on the native and renal allograft. The impact of increased body mass index on the body metabolism, and the human vascular system, including the functional unit of the kidney, the nephron, is well-addressed in the literature. In this study, we focus on evaluating the degree of IFTA concerning the patient's body mass index (BMI).MethodAll the specimens of nephrectomies performed in King Abdulaziz University Hospital for adults from January 2010 to February 2021 were evaluated for this study. A total of 125 cases were selected for the study. The glass slides were pulled and assessed for the degree of IFTA. The demographic data, and the patient's BMI, were collected from the hospital records.ResultsSubjects with high BMI showed a 1.62 (OR: 1.62, 95% CI: 0.62, 4.22) and 1.52 (AOR: 1.52, 95% CI: 0.56, 4.13) increased risk of high IFTA score compared with those with normal BMI. This study has proved that only at a BMI of 25 or more will there be a measurable, independent effect on the degree of IFTA.ConclusionAlthough a small number of hospital-based populations limits this study, it could prove the increased severity of IFTA in patients with high BMI. Its result may act as a spark that will drive extensive population-based studies that more precisely delineate the relationship between BMI and the degree of IFTA on different levels.

Evaluation of the Factors Influencing on Intraoperative Difficulty Scores of Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair.

Background: Inguinal hernias are the leading surgical diseases in the world. There are different surgical procedures reported for the treatment. Some problems are thought to be encountered when performing laparoscopic surgery in these patients, such as risk of severe complications and the prolonged operative duration. Aim: The objective of this study was to specify the complexity of the transabdominal preperitoneal (TAPP) procedure by using an intraoperative scoring system and examine the scores with these patients' predictive factors. Materials and Methods: A prospective study was conducted in patients who underwent inguinal hernia surgery with TAPP. Previous lower abdominal surgery, previous (open) hernia surgery, body mass index (BMI), type of hernia, duration of the surgery, scoring the difficulty of the operation in five various stages using the visual analog scale (VAS) score (1. Mobilizing the peritoneum/dissection of the inferior peritoneal flap. 2. Dissection of internal ring or vas deference or hernia sac. 3. Visualization of Cooper's ligament. 4. Mesh placement. 5. Peritoneal closure.) and the time of discharge were recorded. Results: In this study, 137 patients were included. "BMI" and "previous lower abdominal surgery" have significantly higher scores, time of surgery, and hospital stay compared with other risk factors (P < .005). Conclusion: This study showed that patient's BMI and previous lower abdominal surgery could create technical difficulty with the TAPP procedure, but it is not necessary to avoid this laparoscopic technique because of these situations and can be performed safely.

A Retrospective, Single-Center Study of Technical-Procedural Factors Affecting Radiation Dose During Prostatic Artery Embolization.

IntroductionThis study aims to evaluate the effect of technical-procedural factors on radiation dose during prostatic artery embolization (PAE).MethodsThis was a single-center, retrospective study of 59 patients with benign prostatic hyperplasia (BPH) who underwent prostatic artery embolization from March 2020 to September 2021. Computed tomography angiography (CTA) was performed for vascular planning prior to PAE in all patients. The effect of the following techniques on the dose area product (DAP) of PAE was evaluated: application of low-dose protocol (LDP) for digital subtraction angiography (DSA), reduction of oblique projections by performing PAE of at least one pelvic side utilizing anteroposterior projections only (AP-PAE), utilization of “roadmap” technique instead of DSA for the delineation of pelvic arterial anatomy (RDMP-PAE), and cone-beam CT (CBCT). The impact of the patient’s body mass index (BMI) on DAP was also calculated. The effective dose (ED) of PAE and pre-PAE CTA was calculated from DAP and from dose length products, respectively, using appropriate conversion factors.ResultsFor the entire study population (n = 59), the mean DAP of PAE was 16,424.7 ± 8,019 μGy‧m2. On simple regression analysis, LDP, AP-PAE, and RDMP-PAE significantly contributed to DAP reduction during PAE (30% (p = 0.004), 26.7% (p = 0.013), and 31.2% (p = 0.004), respectively). On multiple regression, LDP and AP-PAE maintained their significant effect (p = 0.002 and p = 0.006, respectively). CBCT was associated with a not statistically significant increase in DAP (10.1%) (p = 0.555). The ED of CTA represented 21.2% ± 10.6% of the ED of PAE.ConclusionOf the four studied factors, LDP, AP-PAE, and RDMP-PAE proved to be relatively simple and widely available techniques that could limit radiation exposure of both the operators and the patients during PAE. The contribution of planning CTA to the overall radiation exposure of patients undergoing PAE appears to be not negligible.

Persistent lipedema pain in patients after bariatric surgery: a case series of 13 patients.

Lipedema often remains undiagnosed in patients with obesity, leading to mismanagement of treatment. Because of this, despite remarkable weight loss after bariatric surgery and decreases in hip and abdomen circumference, some patients show only small decreases in circumference of the extremities and report persistent limb pain. The goal of this work is to raise awareness of lipedema coincident with obesity, mistakenly diagnosed as obesity alone, in order to ensure the correct diagnosis of the condition and to achieve better treatment outcomes for people with lipedema and coincident obesity. CG Lympha Clinic, Cologne, and Ernst von Bergmann Clinic, Potsdam. From clinical records, we identified 13 patients who were diagnosed with lipedema only after undergoing bariatric surgery. We describe the course of their pain before and after bariatric surgery, focusing on the long-term progression of symptoms accompanying the disease. Lipedema cannot be cured by bariatric surgery, and although the patients in this study lost an average of more than 50 kg of weight, they displayed no improvement in the pain symptoms typical of lipedema. Because of the different etiologies of lipedema and obesity, lipedema requires its own specific treatment. Patients suffering from obesity should always be assessed for pain and lipedema. If coincident lipedema is diagnosed, we suggest that bariatric surgery only be performed first if diet and exercise have failed, the patient's body mass index is >40 kg/m2, and the patient has been informed of the possible persistence of pain. Lipedema, like a coincident disease, must be additionally treated conservatively or preferably surgically. This optimized treatment may help to better manage patient expectations after weight loss.

Prevalence of Viral Hepatitis and its Variable Outcome Among Diabetic Patients

Objective: Evaluation of the clinical and biochemical characteristics among diabetes and non-diabetic individuals suffering from acute viral hepatitis is the focus of this particular research. Study Design: Prospective/Observational study Place and Duration: Social Security Teaching Hospital Ferozepur Road Lahore. April, 2021 to Sep, 2021 Methods: This research includes 140 individuals of acute viral hepatitis. Cases in the study ranged in age from 20 to 72 years old. Following signed and informed permission, demographic information, such as a patient's BMI (Body Mass Index), dwelling address, and educational status, were gathered. Patients were divided into two categories. 70 non-diabetic patients were included in group A and 70 diabetic patients with acute viral hepatitis were in group B. In both groups, smoking history was caculated. Both groups of patients had their clinical and biochemical indicators monitored throughout their hospitalization. Analysis was performed by using SPSS 24.0. Results: In current study males were significantly higher in numbers than females with p value 0.005. In both groups, hepatitis E was the most prevalent cause, followed by B and A. There were considerably greater mean blood bilirubin levels in diabetics than in nondiabetics, as well as lower ALT and albumin levels. Diabetic patients spent an average of 22.5±7.45 days in the hospital compared to 11.4±6.45 days for non-diabetic patients, with a p value of 0.03. Group B had a death rate of 4 (5.7%), due to liver failure, whereas group A had no mortality. Conclusion: In the present study, we found that diabetes patients with acute viral hepatitis had lower levels of ALT, higher levels of bilirubin, a larger risk of liver failure, and longer hospital admissions than non-diabetic patients with the same condition. Except this death rate in diabetic patients was 5.7%. Keywords: Clinical Outcomes, Diabetes, Mortality, Acute Viral Hepatitis

Querying the significance of patient position during computerized tomography on the reliability of pre-percutaneous nephrolithotomy planning.

Computerized tomography (CT) is considered indispensable in percutaneous nephrolithotomy (PCNL) planning. We aimed to define the reliability of pre-PCNL CT for planning renal access by assessing renal positional changes between supine and prone CTs. CT urographies (CTU) of 30 consecutive patients were reviewed for distances upper pole (UP)-diaphragm, UP-diaphragm attachment, renal pelvis (RP)-lateral body wall, RP- posterior body wall, and lower pole (LP)- anterior-superior iliac spine (ASIS). The posterior and lateral renal axes angles were also calculated. The most consistent overall movement in transition from prone to supine was backward rotation, as demonstrated by a decrease in distance UP-posterior body wall (p = 0.010) and increase in the posterior renal angle (p < 0.0001). This finding correlated with the patient's body mass index (BMI) (p = 0.029). The left kidney was more mobile than the right one, moving significantly for five of the measured parameters compared to the right kidney which moved significantly for only two parameters. The UP-diaphragm distance of the left kidney correlated with age (p = 0.014), the RP-lateral wall distance correlated with previous abdominal surgery (p = 0.006), and the RP-posterior wall distance with BMI (p = 0.017). On the right, the UP-diaphragm distance correlated with gender (p = 0.002) and the lateral renal rotation was smaller (p = 0.046). Kidneys present significant mobility between supine and prone positions. CT assessment should be performed in the position expected during surgery and should be interpreted with caution, while a real-time imaging modality should be used in the operating room.