Body Mass Index In Patients Research Articles

Surgeon and staff radiation exposure in minimally invasive spinal surgery: prospective series using a personal dosimeter.

The level of radiation awareness by surgeons and residents in spinal surgery does not match the ubiquity of fluoroscopy in operating rooms in the United States. The present method of monitoring radiation exposure may contribute to the current deficiency in radiation awareness. Current dosimeters involve a considerable lag from the time that the surgical team is exposed to radiation to the time that they are provided with that exposure data. The objective of the current study was to assess the feasibility of monitoring radiation exposure in operating room personnel during lateral transpsoas lumbar interbody fusion (LLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) procedures by using a wearable personal device with real-time feedback. Operating room staff participating in minimally invasive surgical procedures under a single surgeon during a 6-month period were prospectively enrolled in this study. All radiation dose exposures were recorded for each member of the surgical team (surgeon, assistant surgeon, scrub nurse, and circulating nurse) using a personal dosimeter (DoseAware). Radiation doses were recorded in microsieverts (μSv). Comparisons between groups were made using ANOVA with the Tukey post hoc test and Student t-test. Thirty-nine patients underwent interbody fusions: 25 underwent LLIF procedures (14 LLIF alone, 11 LLIF with percutaneous screw placement [PSP]) and 14 underwent MI-TLIF. For each operative scenario per spinal level, the surgeon experienced significantly higher (p < 0.035) average radiation exposure (LLIF: 167.9 μSv, LLIF+PSP: 424.2 μSv, MI-TLIF: 397.9 μSv) than other members of the team, followed by the assistant surgeon (LLIF: 149.7 μSv, LLIF+PSP: 242.3 μSv, MI-TLIF: 274.9 μSv). The scrub nurse (LLIF: 15.4 μSv, LLIF+PSP: 125.7 μSv, MI-TLIF: 183.0 μSv) and circulating nurse (LLIF: 1.2 μSv, LLIF+PSP: 9.2 μSv, MI-TLIF: 102.3 μSv) experienced significantly lower exposures. Radiation exposure was not correlated with the patient's body mass index (p ≥ 0.233); however, it was positively correlated with increasing patient age (p ≤ 0.004). Real-time monitoring of radiation exposure is currently feasible and shortens the time between exposure and the availability of information regarding that exposure. A shortened feedback loop that offers more reliable and immediate data would conceivably raise the level of concern for radiation exposure in spinal surgeries and could alter patterns of behavior, leading to decreased exposures. Further studies are ongoing to determine the effect of real-time dosimetry in spinal surgery.

Relationship of Major Depression with Body Mass Index and Salivary Cortisol

IntroductionDepression is one of the most incapacitating psychiatric diseases that disturb life of millions of people round the globe. Its major causes include stressful life events, bereavement, social abuses or certain biological and genetic factors with complex causal mechanisms. Higher salivary cortisol levels for a long period lead to dyslipidemias which increase body mass index (BMI), elevate adiposity and waist-to-hip ratio (WHR). Such individuals with high quartiles of BMI have considerably higher risk of major depressive disorder. The aim of this study was to establish a correlation between major depression, BMI and salivary cortisol.MethodsThis cross-sectional analysis was accomplished in the Physiology Department, Sheikh Zayed Federal Postgraduate Medical Institute, Lahore as well as in Punjab Institute of Mental Health, Lahore, Pakistan, over a period of six months. A total of 60 participants aged between 18 and 60 years were included in this study; they were divided equally into two groups as normal healthy individuals with no physical or mental illness and severely depressed groups. The patients were categorized as cases of severe depression on outdoor clinical assessment and further confirmed by ICD-10. Patient’s BMI was estimated by measuring height in meters (m) and weight in kilograms (kg), and then dividing weight with square height. Early morning saliva samples were collected. Estimation of cortisol levels in saliva was done through ELISA. SPSS version 20.0 (IBM Corp., Armonk, NY) was used to analyze the data and p ≤ 0.05 was considered statistically significant.ResultsThe mean BMI in normal healthy group was 22.02 ± 4.21, while the mean BMI in severely depressive group was 24.64 ± 3.58. The difference was statistically significant (p = 0.012). The mean salivary cortisol level was significantly raised in patients with major depression (2.23 ± 1.69 nmol/L) in contrast to healthy normal individuals (1.46 ± 0.91 nmol/L), with p-value = 0.031.ConclusionBMI and depression has a very noteworthy correlation and there is a remarkable link between raised salivary cortisol, greater BMI and development of major depression.

Arterial attenuation in individualized computed tomography pulmonary angiography injection protocol adjusted based on the patient's body mass index

Background:The aim of this study was to optimize computed tomography pulmonary angiography (CTPA) protocols with regard to improve vascular attenuation without increasing contrast media (CM) volumes. Therefore, we compared the standard CTPA protocol to an individualized contrast media injection protocols adjusted for the patient's body mass index (BMI).Materials and Methods:Two groups of 295 patients with suspected pulmonary embolism (PE) have been receiving CTPA. Group 1 received a standard protocol without taking patient's BMI into account. Group 2 received a CTPA scan, where dose and flow rate of CM injections were adjusted for the patient's BMI. Images were retrospectively analyzed by drawing regions of interests in defined positions in the superior vena cava, descending aorta, the pulmonary main trunk as well as the left and right lower lobe arteries. Intravascular attenuation, contrast volumes, and flow rates were compared using unpaired t-tests. Furthermore, a qualitative image analysis was performed by two experienced readers blinded for the protocol used for image acquisition to evaluate the image quality and arterial attenuation.Results:Patient's BMI was similar in both the groups (27.5 ± 1.5 kg/m2 vs. 28.4 ± 2.1 kg/m2; P = 0.67). Contrast volumes were lower (54.2 ± 4.8 ml vs. 55 ml; P < 0.05), and flow rates (4.1 ± 0.3 ml/s vs. 3.5 ml/s; P < 0.05) were significantly higher in the individualized protocol. The qualitative image analysis yielded an agreement on diagnostic interpretability in the individualized and standard group of 49% and 51% (95% Wilson confidence interval for mean), respectively.Conclusion:An individualized CTPA protocol based on the patient's BMI reduced the contrast media volume and led to an increased pulmonary artery enhancement improving image quality, particularly in the evaluation of the peripheral pulmonary arteries. Thus, contrast media volumes in CTPA should be adjusted for the patient's BMI.

Outcomes of Autologous Hematopoietic Stem Cell Transplantation Depending on Body-Mass Index in Patients with Multiple Myeloma

Introduction. About ten years ago, the International Agency for Research on Cancer corroborated the association of obesity with the risk of cancers of the gastrointestinal tract, breast, endometrium and kidney. In a report published in 2016, eight cancer types were added in this list, including multiple myeloma (MM). Aim of the study. To study the impact of obesity on the efficacy of autologous hematopoietic stem cell transplantation (auto-HSCT) in MM patients. Materials and methods. 99 MM patients (37 males, 62 females), aged from 27 to 66 years (median 54) underwent auto-HSCT in 2016-2017 were enrolled in the study. The diagnosis was made according to IMWG criteria (2014). Induction therapy included bortezomib-containing regimens in all patients (first-line therapy), immunomodulatory drugs were used in 21 % of the patients (second-line therapy). Before auto-HSCT complete response (CR) was documented in 49% of the patients, very good partial response (VGPR) was achieved in 51% of the patients. After induction chemotherapy, patients received melphalan 200 mg/m2 (95% of the patients) and melphalan140 mg/m2 (5% of the patients with dialysis-dependent renal failure) before undergoing auto-HSCT. A standardized body-mass index (BMI) was calculated before performing the transplantation. The median follow-up period since the auto-HSCT was 22 months. Progression-free survival (PFS) was assessed for a period of 3 years after autologous HSCT. Survival curves were constructed using the Kaplan-Meier method. Statistical analysis was done using Statistica 10. Results. A normal body weight (a BMI &amp;lt;25 kg/m2) was documented in 22% of the patients, an overweight status (a BMI between 25 and 29, 9 kg/m2) was established in 53% of the patients. Obesity (a BMI &amp;gt; 30 kg/m2) was diagnosed in 25% of the MM patients. When analyzing the PFS, it was revealed significant differences depending on the body-mass index of the patients. Thus, in patients with a normal BMI the 3-year PFS rates was significantly higher (Cox's F-test, p&amp;lt;0,05) and was 69% versus 45% and 33% in the group of patients with overweight or obese, respectively (fig.1). Conclusion. Obesity has reached epidemic proportions globally. It is important to identify the factors that raise the risk of MM progression. Our study confirmed the hypothesis of the negative impact of obesity on the results of the treatment of MM patients. All patients achieved a good response - CR or VGPR before auto-HSCT. The analysis of the 3-year PFS rates demonstrated, that the results of autologous HSCT in MM patients suffering from obesity was significantly worse than the same results in patients with normal body weight (3-year PFS 33% vs. 69%, p&amp;lt;0,05). Obesity is a modifiable risk factor; shifting a patient's behaviour after diagnosis could reduce their risk of progression, changes in lifestyle and diet can improve the treatment outcomes in MM patients. Disclosures No relevant conflicts of interest to declare.

Evaluation of Thyroid Hormone Replacement Dosing in Overweight and Obese Patients After a Thyroidectomy.

Background: Initiation of thyroid hormone replacement (THR) after a total thyroidectomy has traditionally relied on the weight of the patient, regardless of the patient's body mass index (BMI). Current literature suggests that THR in obese patients differs from nonobese patients. This can lead to overdosing of levothyroxine (LT4) and delay in achievement of euthyroid state. Methods: We retrospectively identified patients on THR after total thyroidectomy with a benign postoperative diagnosis. Patients who achieved euthyroidism with THR were included in the analysis. Patient demographic and THR dosing information was collected. Regression analysis was performed to identify appropriate THR dosing at varying BMIs. This study aimed to evaluate the appropriate dosing of THR in overweight and obese patients. Results: Our cohort consisted of 114 patients achieving euthyroidism while on THR. Mean age was 55 years (range 28-77 years) with 84% females. Of the 114 patients, the number of patients with a BMI less than 25, 25-29, 30-34, 35-39, and greater than 40 were 26 (23%), 33 (29%), 23 (20%), 19 (17%), and 13 (11%), respectively. Of the entire cohort, a mean of 50 weeks elapsed after surgery to achieve euthyroidism, with no significant difference between the BMI categories (p = 0.58). In obese patients (BMI >30), 35% were overdosed with LT4 on initial dosing. The cohort lost a mean of 3 kg until euthyroidism was achieved, with no significant difference in the weight loss based on BMI category (p = 0.61). Patients with a higher BMI did require a higher dose (mcg) of LT4 to achieve euthyroidism (p < 0.01), but the dose was significantly lower in relation to their weight (mcg/kg) (p < 0.01). The LT4 dose required to achieve euthyroidism based on the previously mentioned BMI categories were 1.76, 1.47, 1.42, 1.27, and 1.28 mcg/kg. Conclusion: The current weight-based dosing of THR inappropriately overdoses overweight and obese patients. A more appropriate formula for THR titration should consider both the weight and BMI of the patient.

946 Factors Leading to Discordance Between Vibration-Controlled Transient Elastography and Liver Biopsy in Patients With Non-Alcoholic Fatty Liver Disease

INTRODUCTION: Vibration-Controlled Transient Elastography (VCTE) or Fibroscan® is used for the non-invasive assessment of liver fibrosis. However, liver biopsy remains the gold standard for diagnosis due to potential inaccuracies of VCTE including, the patient's body mass index and interobserver variance. Therefore, we examined simple lab parameters and patient related factors that might contribute to this discordance, in patients with Non-Alcoholic Fatty Liver Disease (NAFLD). METHODS: Patients were identified using appropriate ICD 9 and 10 coding for NAFLD. We included patients 18 years and older who underwent a VCTE (both the M and XL probe) and liver biopsy within 6 months of each other. Electronic medical records were reviewed manually to extract data. Variables of interest included VCTE liver stiffness measurement (LSM), VCTE fibrosis score and biopsy fibrosis stage according to the NASH CRN Scoring System. Only valid VCTE results (IQR &lt; 30 and with 10 valid readings) were included. Discordance was defined a difference of more than 2 fibrosis stages between VCTE and biopsy results. Mann-Whitney U test was used to compare continuous variables, Fischer’s exact test to compare categorical variables and multivariate analysis for logistic regression. RESULTS: 109 patients with fatty liver on imaging and elevated transaminases without other types of liver disease underwent a Fibroscan and a subsequent biopsy. In 52% of patients (57/109) the Fibroscan overestimated fibrosis by 2 stages. In univariate analysis, discordance was associated with BMI (36 vs 32.9), ALT (45 vs 72), Fibroscan IQR (17.24 vs 13.5), FIB-4 Score (1.65 v/s 2.25), and NAFLD Activity Score (2.33 vs 3.36), (P value &lt; 0.05 for all). In multivariate analysis, BMI was the only factor independently associated with discordance (P &lt; 0.05). CONCLUSION: Although multiple factors may lead to discordant results for the stage of fibrosis between VCTE and liver biopsy, our results indicate that a higher BMI is the major factor for this discordance with the XL probe. These data also suggest that a stepwise approach combining a noninvasive scoring system and VCTE should be explored as an alternative approach to improve the accuracy of noninvasive methods and minimize the need for liver biopsy in NAFLD patients.

Relation between body mass index and position of chest examination as a function of entrance surface dose

X-ray is ionic radiation which is now a necessity in the health sector as a tool in establishing diagnosis. Calculation of exposure doses in patients generally only considers gender and age, but from a theoretical point of view, energy absorption will be greater with increasing thickness of material. The thickness of the material in terms of chest examination using X-rays is indicated by position of the examination where the lateral examination makes the material exposed to radiation thicker than the posterioranterior or anteriorposterior examination position, as well as the patient's body mass index. Therefore, the relationship between the position of examination and body mass index to the entrance surface dose is the topic of this study. Analysis of chest examination data in several patients with various examination positions and different body mass indices showed an increase in entrance surface dose with increasing body mass index and examination position. The highest entrance surface dose was observed in patients with lateral examination positions, as well as in patients with large body mass indexes.

Evaluation of image quality and radiation dose in low tube voltage coronary computed tomography angiography.

BACKGROUNDCoronary computed tomography angiography (CCTA) is an important modality in diagnosis of coronary artery disease (CAD). Owing to the fact that computed tomography (CT) examinations are performed using ionizing radiation; applying radiation dose-reduction strategies seems to be necessary. Lowering tube voltage (in kV) according to the patient’s body mass index (BMI) or weight is an approach that is investigated by many researchers. The goal of this study was to evaluate the impact of low tube voltage CCTA on radiation dose and image quality in order to decrease radiation dose in selected patients who meet inclusion criteria of the introduced protocol.METHODSPatients with clinical indications of CCTA who met inclusion criteria were classified in two groups randomly. Imaging of two groups was performed using 120 kV and 100 kV, respectively. Subjective and objective parameters of image quality and radiation dose of two groups were measured. Afterward, data were analyzed by appropriate statistical tests using SPSS software.RESULTSWhile differences in image quality between two groups were not significant, radiation dose of patients who underwent 100 kV CCTA was significantly lower than the other group. Effective doses (EDs) of first and second groups were 22.30 ± 5.48 mSv and 13.82 ± 2.00 mSv, respectively (P < 0.001).CONCLUSIONLowering tube voltage in non-obese patients is an effective and practical approach to radiation dose reduction without missing image quality that should be considered especially for female patients.

Tibial tubercle avulsion fracture according to different mechanisms of injury in adolescents: Tibial tubercle avulsion fracture.

Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported. The purpose of this study was to evaluate any differences according to the mechanisms of injury in adolescents with tibial tubercle avulsion fracture.Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. Seven patients (low-stress group) had a spontaneous fracture during running without definite trauma. Twenty-three patients (high-stress group) experienced pain during jumping and landing, or definite trauma. The mechanisms of injury, age, height, weight, body mass index (BMI), BMI percentile, fracture type, as well as any complication, such as limitation of motion and deformity related to the physeal arrest, were compared between groups.There was no definite difference in age, fracture type, and surgical outcomes between groups. There was no patient with significant early physeal arrest in both groups. The weight (P = .02), BMI (P = .03) and BMI percentile (P = .01) in low-stress group were higher than those in high-stress group. In low-stress group, 6 patients’ BMIs were in the 97th percentile, and 1 patient's BMI was in the 5th percentile.Extreme BMI may be a risk factor for tibial tubercle avulsion fractures in adolescents during running without definite trauma. However, there was no difference in the final outcome according to injury mechanisms.

Effect of surgeon experience and bony pelvic dimensions on surgical performance and patient outcomes in robot-assisted radical prostatectomy.

To evaluate the effects of surgeon experience, body habitus, and bony pelvic dimensions on surgeon performance and patient outcomes after robot-assisted radical prostatectomy (RARP). The pelvic dimensions of 78 RARP patients were measured on preoperative magnetic resonance imaging and computed tomography by three radiologists. Surgeon automated performance metrics (APMs [instrument motion tracking and system events data, i.e., camera movement, third-arm swap, energy use]) were obtained by a systems data recorder (Intuitive Surgical, Sunnyvale, CA, USA) during RARP. Two analyses were performed: Analysis 1, examined effects of patient characteristics, pelvic dimensions and prior surgeon RARP caseload on APMs using linear regression; Analysis 2, the effects of patient body habitus, bony pelvic measurement, and surgeon experience on short- and long-term outcomes were analysed by multivariable regression. Analysis 1 showed that while surgeon experience affected the greatest number of APMs (P<0.044), the patient's body mass index, bony pelvic dimensions, and prostate size also affected APMs during each surgical step (P<0.043, P<0.046, P<0.034, respectively). Analysis 2 showed that RARP duration was significantly affected by pelvic depth (β=13.7, P=0.039) and prostate volume (β=0.5, P=0.024). A wider and shallower pelvis was less likely to result in a positive margin (odds ratio 0.25, 95% confidence interval [CI] 0.09-0.72). On multivariate analysis, urinary continence recovery was associated with surgeon's prior RARP experience (hazard ratio [HR] 2.38, 95% CI 1.18-4.81; P=0.015), but not on pelvic dimensions (HR 1.44, 95% CI 0.95-2.17). Limited surgical workspace, due to a narrower and deeper pelvis, does affect surgeon performance and patient outcomes, most notably in longer surgery time and an increased positive margin rate.

Quality of MBSAQIP data: bad luck, or lack of QA plan?

National clinical registries are commonly used in clinical research, quality improvement, and health policy. However, little is known about methodological challenges associated with these registry analyses that could limit their impact and compromise patient safety. This study examined the quality of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MSBASQIP) data to assess its usability potential and improve data collection methodologies. We developed a single flat file (n = 168,093) using five subsets (Main, BMI, Readmission, Reoperation, and Intervention) of the 2015 MBSAQIP Participant User Data File (PUF). Logic and validity tests included (1) individual profiles of patient's body mass index (BMI) changes over time, (2) individual patient care pathways, and (3) correlation analysis between variable pairs associated with the same clinical encounters. 8888 (5.3%) patients did not have postoperative weight/BMI data; 20% of patients had different units for preoperative and postoperative weights. Postoperative weight measurements ranged between - 71 and 132% of preoperative weight. There were 325 (3.7%) hospital readmissions reported on the day of or day after MBS. The self-reporting of "emergency" vs. "planned" interventions did not correlate with the type of procedure and its indication. Up to 20% of data could potentially be unused for analysis due to data quality issues. Our analysis revealed various data quality issues in the 2015 MBSAQIP PUF related to completeness, accuracy, and consistency. Since information on where the surgery was performed is lacking, it is not possible to conclude whether these issues represent data errors, patient outliers, or inappropriate care. Including automated data checks and biomedical informatics oversight, standardized coding for complications, additional de-identified facility and provider information, and training/mentorship opportunities in data informatics for all researchers who get access to the data have been shown to be effective in improving data quality and minimizing patient safety concerns.

Nurses' practices in the preparation and administration of intramuscular injections in mental health: A cross-sectional study.

Intramuscular injections (IMIs) remain a frequent practice in mental health. Few studies have examined the issue of nurses' practices concerning IMI in this domain, and none considered specifically hygiene. Finally, no study appears to have looked at emergency situations and their possible influence on practices. The principal objective of our study was to assess the practices associated with IMI in mental health, especially the hygiene-related practices. The secondaryobjectives were as follows: 1) to assess the practices for the preparation and administration of IMI in mental health for criteria other than hygiene and 2) to determine whether professional experience and emergency situations influence these practices. Single-centre cross-sectional study in a psychiatric Hospital and adherence to the STROBE guidelines. The participating nurses all worked with inpatients, and all volunteered for the study. A self-administered questionnaire was sent to all participants. The questionnaire included questions about knowledge and practices associated with IMI, some considered in two different situations: emergencies and planned injections. The distribution of the responses was tested by the chi-squared test or Fisher's exact test, as appropriate, or by McNemar's chi-squared test or Friedman's nonparametric chi-squared test for matched data. Response rate was 48.6%. Overall, 81% of nurses reported correct handwashing before preparation, 87.5% responded that the dorsogluteal site is currently recommended for IMI, and 74.6% that they did not know the "Z track" technique. In planned injections, 58.7% reported that the choice of needle was determined, at least in part, by the patient's body mass index. In emergency situations, adherence to guidelines was less frequent for all types of practices. This study shows the need to improve practices for the frequently used procedure of IMI among mental health nurses. Better professional education appears necessary to develop optimal practices, especially in emergency situations.

Study of the Anti-Diuretic Hormone (ADH) on End Stage Renal Failure Disease (ESRD) Pre-Hemodialysis in Iraqi Patients

Chronic renal disease (CRD) is a pathophysiologic process with multiple etiologies, resulting in the inexorable attrition of Nephron number and function and frequently leading to end-stage renal disease (ESRD). In turn, ESRD represents a clinical state or condition in which there has been an irreversible loss of endogenous renal function, of a degree sufficient to render the patient permanently dependent upon renal replacement therapy (dialysis of transplantation) in order to avoid life threatening uremia, reflecting a dysfunction of all organ systems as a result of untreated or under treated acute or chronic renal failure. The current study was involved 80 patients, the age range within 25-70 years, selected sample of patients who attend Iraqi center of kidney dialysis, Baghdad Teaching Hospital and Al-Yarmok Teaching Hospital. All the patient's body mass index [BMI] were measured serum anti diuretic hormone ADH was assessed using enzyme linked immunosorbent kit [Elisa] while urea, creatinine, albumin, hemoglobin were determined by spectrophotometer (PD-303), and sodium, potassium, chloride were determined by Electrolyte analyzer 9180.These patients were divided in two group B (40 patients) as pre dialysis with ESRD, and group A (40) healthy control. Results showed non-significant elevations in ADH levels in the patient group compared with the control group, while highly significant increase in urea, creatinine and albumin levels in in the patient group compared with the control group, also highly significant decrease in hemoglobin comparing with the control group. Also, it was observed non-significant decrease in sodium, non-significant increase in potassium and highly significant increase in chloride when comparing with the control group.&#x0D;

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No Differences in Outcomes Scores or Survivorship of Unicompartmental Knee Arthroplasty Between Patients Younger or Older than 55 Years of Age at Minimum 10-Year Followup.

Although patients who have undergone unicompartmental knee arthroplasty (UKA) report improvements in functional outcomes, orthopaedic surgeons tend to avoid UKA in younger patients due to implant survivorship concerns. As a result, few studies specifically have examined the outcomes of patients 55 years and younger. Is there a difference between two cohorts of patients: those 55 years and younger and those 56 years and older who underwent UKA in terms of: (1) functional outcomes scores, (2) quality-of-life scores, and (3) implant survivorship free from all-cause revision. Between 2004 and 2007, 100 patients 55 years and younger underwent UKA at one institution. Of those, three (3%) died, and 13 (13%) were lost to followup before the 10-year minimum required for this study, leaving 84 patients available for propensity score matching. During that same period, 343 patients older than 56 years underwent UKA; 48 (14%) died, and 59 (17%) were lost to followup before 10 years, leaving 236 patients available in that group for potential inclusion. After propensity score matching to account for confounding preoperative variables (surgeon, patient's body mass index, and sex), the patients were divided into two groups based on age: (1) 55 years and younger, (2) 56 years and older. There were 71 patients in each group, with minimum followup of 10 years. The mean age in the group of patients 55 years and younger was 52 years (range, 45-55 years) and that of the older patients was 64 years (range, 56-80 years). The mean (range) followup in both groups was 13 years (range, 11-15 years). Patient functional outcomes, quality of life scores, and implant survivorship were assessed for both groups of patients. To detect a minimum clinically important difference of 5 points in the Oxford Knee Score (OKS), a sample size of at least 68 patients in each group would be required to achieve a power of 0.95. With the numbers available, there were no differences between patients 55 years and younger and those 56 years and older in terms of OKS (18 ± 6 versus 20 ± 8, mean difference -1.8; 95% CI, -4.1 to 0.5; p = 0.133) and Knee Society Knee Score (84 ± 16 versus 79 ± 21, mean difference 4.7; 95% CI, -1.8 to 11.2; p = 0.157) at 10 years postoperatively. With the numbers available, there were no differences between patients 55 years and younger and those 56 years and older in terms of the physical component summary (PCS) (47 ± 10 versus 48 ± 11, mean difference -0.4; 95% CI, -4.0 to 3.2; p = 0.827) and the mental component summary (MCS) (52 ± 12 versus 51 ± 12, mean difference 1.4; 95% CI, -2.6 to 5.4; p = 0.491) of the SF-36 at 10 years postoperatively. Finally, we found no differences with the numbers available between patients 55 years and younger and those 56 years and older in terms of survivorship free from all-cause revision at a minimum of 10 years followup (both groups had the same 10-year revision-free rate of 0.96; 95% CI, 0.91-1.00). Because we found few differences between patients 55 years and younger and those older than that in terms of functional outcomes, quality of life, and implant survivorship after UKA, we believe that appropriately selected younger patients should not be excluded from the potential benefits of undergoing UKA, especially in the hands of high-volume surgeons. Level III, therapeutic study.

Application of iodine contrast agent optimization protocol with fixed injection time in triple-rule-out CT examination of chest pain

To investigate the feasibility of using optimized protocol of iodine contrast agent with fixed injection time in triple-rule-out CT examination of acute chest pain patients. A prospective study was conducted. The patients who underwent triple-rule-out CT examination of acute chest pain at the Second Hospital of Shanxi Medical University from September 2017 to June 2018 were enrolled. According to the patient's body mass index (BMI), they were divided into BMI ≤ 23 kg/m2 group and BMI > 23 kg/m2 group. The patients in each group were subdivided into two subgroups according to the random number table, and they were given two iodine contrast injection protocols with fixed injection time (14 s). Protocol 1 was performed with 55 mL of total iodinated contrast media: iodinated contrast media was first injected at 5.0 mL/s for 8 s, followed by the same contrast media injection at 2.5 mL/s for 6 s, finally followed by injection of 40 mL of saline at a rate of 2.5 mL/s. Protocol 2 with 60 mL of total iodinated contrast media: iodinated contrast media was first injected at 5.0 mL/s for 10 s, followed by the same contrast media injection at 2.5 mL/s for 4 s, finally followed by injection of 40 mL of saline at a rate of 2.5 mL/s. The primary and objective evaluation was conducted on the image quality of the patients' blood vessels in different segments. The primary score, CT value and contrast-to-noise ratio (CNR) of the pulmonary artery, coronary artery, aorta and total effective radiation dose for the examination were recorded. A total of 92 patients were enrolled in the analysis. There were 44 patients in BMI≤ 23 kg/m2 group, in which 22 patients received in protocol 1 and protocol 2, 48 patients in BMI > 23 kg/m2 group, in which 24 patients in protocol 1 and protocol 2, respectively. There was no significant difference in the effective radiation dose between the two subgroups receiving different injection protocols in different BMI groups (mSv: 6.7±1.1 vs. 6.5±0.8 between protocol 1 and protocol 2 in BMI ≤ 23 kg/m2 group; 7.8±1.0 vs. 8.0±1.1 between protocol 1 and protocol 2 in BMI > 23 kg/m2 group, both P > 0.05). In BMI ≤ 23 kg/m2 group, the CT value, CNR and primary scores of pulmonary artery images in patients receiving protocol 2 were significantly higher than those receiving protocol 1 [CT value (HU): 584±110 vs. 472±86 for main pulmonary artery, 561±93 vs. 467±78 for left pulmonary artery, 555±91 vs. 472±83 for right pulmonary artery; CNR: 24.2±7.5 vs. 18.7±4.6 for main pulmonary artery, 23.2±6.8 vs. 18.6±4.8 for left pulmonary artery, 22.9±6.7 vs. 18.8±4.7 for right pulmonary artery; primary score: 4.0 (4.0, 4.0) vs. 3.5 (3.0, 4.0), all P < 0.05]; and there was no statistically significant difference in the primary or objective evaluation of coronary artery or aortic image quality between the two protocols. In BMI > 23 kg/m2 group, the CT value, CNR and primary scores of coronary artery and aortic images in patients receiving protocol 2 were significantly higher than those receiving protocol 1 [CT value (HU): 369±63 vs. 315±61 for proximal right coronary artery (RCA), 388±63 vs. 323±63 for proximal left coronary artery (LCA), 328±83 vs. 272±51 for ascending aorta, 348±82 vs. 272±49 for aortic arch; CNR: 15.0±4.6 vs. 12.3±4.7 for proximal RCA, 15.7±3.8 vs. 12.8±5.2 for proximal LCA, 13.2±5.3 vs. 10.4±4.1 for ascending aorta, 14.1±5.3 vs. 10.4±3.9 for aortic arch; primary score: 4.0 (3.0, 4.0) vs. 3.0 (3.0, 4.0) for coronary, 4.0 (3.0, 4.0) vs. 3.0 (2.0, 4.0) for aorta; all P < 0.05]; and there was no statistically significant difference in the primary or objective evaluation of pulmonary artery image quality between the two protocols. The effective radiation dose of triple-rule-out CT examination of acute chest pain is relatively low. The low-dose iodine contrast agent application program with fixed injection time can meet the needs of clinical diagnosis of triple-rule-out CT examination of acute chest pain patients. For patients with BMI ≤ 23 kg/m2, both protocols 1 and 2 can obtain excellent image quality; in order to avoid the influence of superior vena cava artifacts, protocol 1 is recommended. For patients with BMI > 23 kg/m2, application protocol 2 can obtain stable, excellent image quality that is more suitable for clinical applications.

PENGARUH PUASA RAMADHAN TERHADAP INDEKS MASSA TUBUH PASIEN DIABETES MELITUS TIPE-2

Ramadan fastingis donefor one full month, must be done every Muslim Ummah including those suffering from chronic diseases such as Diabetes Mellitus, did not eat and drink during 13,5-14 hours. At the time off as ting that there will be changes such as: activity, diet, hours of work, activities at night as tarawih prayer and tadarus. Aim: odetermine the effect of Ramadan fasting on body mass indexin patients with type 2 diabetes mellitus. Methods: A prospective longitudinal study of the fasting month of Ramadan until the end of the fasting Ramdhan on 19 patients who had been diagnosed with type 2 diabetes at Adam Malik Hospital. The data collected by taking blood sample sat the beginning and end of the fasting of Ramadan fasting. Data were analyzed using paired T-test, wilcoxon. Results: Of the 19 patients with type 2 diabetes, as many as 13 respondents (68.4%) male sex with a mean age of 57.26 years. Statistical tests performed showed me significant value in BMI, Waist Circumference. Conclusion: There are significant value of BMI, Waist Circumference and blood fasting glucosain patients with type 2 diabetes before and after Ramadan fasting

Body composition and arterial stiffness in pediatric patients with chronic kidney disease.

This study investigated the impact of body composition in the arterial stiffness of children with chronic kidney disease (CKD). Fat mass (FM), fat tissue index (FTI), fat-free mass (FFM), fat-free tissue index (FFTI), and FFTI/FTI were measured in 26 patients and 25 healthy controls by bio-impedance analysis. Data on patient's body mass index (BMI) for height-age, serum albumin, glomerular filtration rate (GFR), blood pressure status, and pulse wave velocity (PWV) were collected in patients. Patients presented lower levels of FM and FFM compared to healthy controls (p = 0.04 and p = 0.055 respectively). In patient group, BMI height-age z-score was positively correlated to FTI (r2 = 0.574, p < 0.001) and FFTI (r2 = 0.338, p = 0.001) and negatively correlated to FFTI/FTI (r2 = 0.263, p = 0.007). Serum albumin was positively correlated only with FFM among body composition data (r2 = 0.169, p = 0.037). PWV z-score was positively correlated to FFTI (r2 = 0.421, p = 0.006) and inversely correlated to FFTI/FTI ≥ 2.5 (r2 = 0.317, p = 0.003). Patients with FFTI/FTI ≥ 2.5 presented lower levels of PWV regardless the need for antihypertensive treatment. Serum albumin ≥ 3.8mg/dl and FFTI/FTI ≥ 2.5 were independently associated with a lower risk for high PWV, after adjustment for age, sex, and GFR (OR 0.009, 95% CI 0.000-0.729 and OR 0.039, 95% CI 0.002-0.680). All underweight [2 (7.7%)] and overweight [4 (15.4%)] patients presented high PWV. Among normal weight patients, FFTI/FTI ratio ≥ 2.5 was significantly associated with lower PWV z-score (p = 0.013). Both underweight and overweight are associated with arterial stiffness. Targeting FFTI/FTI ≥ 2.5 could be protective against cardiovascular disease in normal weight children.

Intensification of Weight Loss with the Ketogenic Diet during the Management of a Super Obese: Case Study

Obesity is a chronic disease referred to as a world epidemic. Superobesus management is challenging and requires multidisciplinary follow-up. In this case report, the patient had an initial body mass index (BMI) of 110 kg/m² associated with comorbidities such as type 2 diabetes (T2DM). Initial clinical management was performed with changes in lifestyle, through hypocaloric and ketogenic diet, associated with several antiobesity drugs and the introduction of light physical activity. After a total loss of about 140 kg using only clinical measures, the patient's BMI still remained above 40 kg/m², with indication for bariatric surgery. Patient performed Roux-en-Y gastric bypass (RYGB) with greater safety due to previous important weight loss. After the surgery, the patient evolved to the reversion of type T2DM associated with a psychosocial and quality of life improvement.

Do anthropometrical indices correlate with pulse oximetry among children attending a private hospital in Enugu?

Background: Pulse oximetry remains the most common investigation in pediatric cardiology as it acts as a window to unravel most abnormalities in cardiac functions and structure. Objectives: The objective of this study was to determine what is actually the normative pulse oximetry reading among children and to determine if anthropometry has any effect on pulse oximetry. Methodology: A cross-sectional prospective study in which pulse oximetry readings were ascertained among healthy children attending a private clinic in Enugu over a 3-year period. Data Analysis: Data were analyzed using Stata 10 software (STATA 10, College Station, Texas, USA: Stata [Corp]) Means and 95% confidence intervals were calculated for all the individuals. The level of statistical significance was considered P < 0.05. Results: A total of 349 individuals were recruited consecutively. The median value of oxygen saturation (SpO2) was 98% (93%–99%). Females had a significantly higher SpO2 than the males (Wilcoxon-Mann–Whitney test, Z = 2.064, P = 0.04). There was a positive correlation between the SpO2 and age, weight, and height of the patients. Of these anthropometry, height is the most correlated with SpO2. On the other hand, there was a negative correlation between SpO2 and heart rate of the subjects (rho = −0.1845, P = 0.0005). There was no correlation between SpO2 and patient's body mass index (BMI). Conclusion: The normal oximetry reading among children in this study is 98% with a positive correlation with age, weight, and height and a negative correlation with heart rate but no correlation with patient's BMI.