Change in Body Mass Index after Simultaneous Bilateral Total Knee Arthroplasty: Risk Factors and Its Influence on Functional Outcomes

BackgroundPrevious studies evaluating weight changes following total knee arthroplasty (TKA) were performed on heterogenous cohorts. However, no study has evaluated weight changes in a cohort of simultaneous-bilateral TKA (SB-TKA) patients. This study aimed to evaluate the prevalence of patients who lost or gained weight, determine if postoperative weight change influences functional outcome, and identify predictors of weight change after SB-TKA.MethodsProspectively collected registry data of 560 patients who underwent SB-TKA were reviewed. Patients were assessed preoperatively, at 6 months, and 2 years using the Knee Society Score, Oxford Knee Score, Short-Form 36, and range of motion. Change in body mass index (BMI) >5% was used to categorize patients into 3 groups: lost, maintained, or gained weight. Analysis of variance, Kruskal-Wallis test, and chi-squared test were used to compare functional outcomes between groups. Multivariable logistic regression evaluated predictors for postoperative weight changes.ResultsAt 2 years, 59% of patients maintained weight, 28% of patients gained weight, and 13% of patients lost weight. All groups experienced similar improvements in functional outcomes, rates of minimal clinically important difference attainment, and patient satisfaction (P > .05). Older patients were more likely to gain weight (P < .05). Patients with higher preoperative BMI were more likely to gain weight (P < .05) and less likely to lose weight (P < .05). Patients with greater preoperative comorbidities were less likely to lose weight (P < .05).ConclusionUp to 41% of patients experience significant weight changes after SB-TKA. Older patients with higher preoperative BMI were more likely to gain weight, while higher preoperative BMI with more comorbidities were less likely to lose weight following SB-TKA; however, postoperative weight changes do not appear to affect functional outcomes.Level of EvidenceIII, therapeutic study.     

Experiences of fatigue and self-management of Thai Buddhist cancer patients undergoing radiation therapy

The purpose of this study was to describe (a) the subjective feelings of fatigue of Thai Buddhist cancer patients undergoing radiation therapy (RT) and identify possible gender differences, (b) their beliefs about the main cause of fatigue, and (c) their ways of self-management for relief of fatigue. One hundred thirty-three voluntary and randomly selected patients, 55 men and 78 women, completed a questionnaire with a Thai version of the Revised Piper Fatigue Scale. After 1 week of treatment, the largest group (42.1%) of the patients had felt fatigue during the last few hours (from 1 to 5 hours). The patients perceived a mild level of fatigue, but the sensory/cognitive fatigue scores were high. Five categories of beliefs about the main cause of fatigue emerged: (a) receiving RT; (b) feelings of anxiety, depression, and fright/fear; (c) cancer; (d) long travel to hospital and long waiting time for RT; and (e) difficulty with sleep and weak body. For relief of fatigue, 5 categories of self-management emerged: (1) getting moral support from family and friends; (2) practicing religion, reciting prayers, doing merit, and meditating; (3) practicing self-care for symptomatic problems; (4) accepting the situation and doing the best of one's life; and (5) consulting with doctor and nurse. In conclusion, healthcare providers need to be concerned about RT patients' symptoms of fatigue, beliefs about causes of fatigue, and ways of self-management for relief of fatigue. They also need understanding of cultural and religious beliefs to plan holistic care.     

Hypotension,renal failure,and pulmonary complications in leptospirosis

During a recent outbreak of leptospirosis in northeastern Thailand, 148 patients with serologically diagnosed leptospirosis were seen in Loei hospital. The common serotypes were L. pyrogenes, and L. sejroe. Hypotension with a mean arterial pressure less than 70 mmHg upon admission or within 24 h after admission was observed in 94 patients or 64%. 30 patients had normal renal function; 30 patients had prerenal azotemia with mild pulmonary complication in 2; and 34 patients had acute renal failure. 29 patients with acute renal failure had pulmonary complications including pulmonary hemorrhage in 8, pulmonary edema in 3, acute respiratory distress syndrome (ARDS) in 14 and interstitial pneumonitis in 4. 54 patients had normal blood pressure. In this group 5 patients had acute renal failure; 16 had prerenal azotemia and 33 had normal renal function. Interstitial pneumonitis was noted in one patient with prerenal azotemia. Less renal complication and minimal pulmonary complication were seen in leptospirosis patients with normal blood pressure. The patients with normal renal function had no pulmonary complication. Good association existed between hypotension, renal failure and pulmonary complications.     

A lyophilized formulation to extend the shelf-life of tuberculin PPD

This study was aimed to develop a dry purified protein devirative (PPD) preparation to extend the shelf-life of tuberculin PPD. Five percent sucrose (S), 6.5% mannitol (M), 2.5% trehalose (T) or 0.3% Hemaccel (H) was added to each formulation. In vivo and in vitro analyses were carried out to determine the efficacy of the lyophilized products. In the in vivo test, the delayed type hypersensitivity (DTH) responses of the lyophilized preparations were compared to the liquid preparation (CL) after injection into BCG vaccinated guinea pigs. The preparations of H, M, T, and S generated DTH responses of 100, 90, 89, and 60%, as compared to the response of CL, respectively. There was no loss of tuberculin activity in the H formula. A statistically significant difference in activity was found between S and CL (p < 0.05). The cellular test for IFN-gamma secretions was performed using the whole blood of human subjects screened for DTH response to tuberculin PPD Mantoux tests. The detection of IFN-gamma secretions was done using ELISA and the efficacy was expressed in terms of percentage of IFN-gamma responses to the tuberculin antigens. The results of CL, H, M, T and S were 3.28, 10.40, 0.84, 1.52 and 1.29%, compared to mitogen stimulation, respectively. The lyophilized H, M and T formulations and the liquid CL were studied for their shelf-life stabiliy. Accelerated degradation was done by storing the samples at higher temperatures of 37 degrees C and 56 degrees C for 3, 6, 9 and 12 months. All the tuberculin PPD solutions were injected into BCG vaccinated guinea pigs at the end of each storage period and the activity of each solution was evaluated. The formulation with the Hemaccel as excipient gave a superior response than the others at the normal storage temperature of 40 micro C for 12 months. Therefore, Hemaccel provides protection for PPD activity. This supports the potential for the development of lyophilized tuberculin PPD with the addition of 0.3% Hemaccel to extend shelf life.     

Inhibition of P-glycoprotein activity and reversal of cancer multidrug resistance by <Emphasis Type="Italic">Momordica charantia</Emphasis> extract

Purpose Multidrug resistance (MDR) is known as a problem limiting the success of therapy in patients treated long term with chemotherapeutic drugs. The drug resistance is mainly due to the overexpression of the 170 kDa P-glycoprotein (Pgp), which causes a reduction in drug accumulation in the cancer cells. In this study, novel chemical modulator(s) from bitter melon (Momordica charantia L.) extracts obtained from leaves, fruits and tendrils were tested for their abilities to modulate the function of Pgp and the MDR phenotype in the multidrug-resistant human cervical carcinoma KB-V1 cells (high Pgp expression) in comparison with wildtype drug-sensitive KB-3-1 cells (lacking Pgp).Methods The KB-V1 and KB-3-1 cells were exposed to bitter melon extracts in the presence of various concentrations of vinblastine, and cytotoxicity was assessed by means of the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay. Relative resistance was calculated as the ratio of the IC₅₀ value of the KB-V1 cells to the IC₅₀ value of the KB-3-1 cells. Accumulation and efflux of vinblastine in KB-V1 and KB-3-1 cells were measured using a [³H]-vinblastine incorporation assay.Results The leaf extracts increased the intracellular accumulation of [³H]-vinblastine in KB-V1 cells in a dose-dependent manner, but extracts from the fruits and tendrils had no effect. By modulating Pgp-mediated vinblastine efflux, the leaf extracts decreased the [³H]-vinblastine efflux in KB-V1 cells in a dose-dependent manner, but not in KB-3-1 cells. Treatment of drug-resistant KB-V1 cells with bitter melon leaf extracts increased their sensitivity to vinblastine, but similar treatment of KB-3-1 cells showed no modulating effect. The fruit and tendril extracts did not affect the MDR phenotype in either cell line.Conclusion The leaf extracts from bitter melon were able to reverse the MDR phenotype, which is consistent with an increase in intracellular accumulation of the drug. The exact nature of the active components of bitter melon leaf extracts remains to be identified.     

Clinical study on the combined effect of capsaicin, green tea extract and essence of chicken on body fat content in human subjects

This study was conducted to assess the body fat content of free-living healthy human subjects taking a health supplement containing 0.4 mg capsaicin, 625 mg green tea extract (125 mg catechins and 50 mg caffeine) and 800 mg essence of chicken (CGTE). Subjects were advised to maintain their regular dietary habits and routine physical activity throughout study duration. Their body fat content was measured before and throughout the trial duration using a hand-grip body fat monitor. After 2 wk of supplementation with CGTE, the mean body fat percentage of males and female subjects was significantly less than the initial value (p < 0.05; t-test). 70.6%, of volunteers showed a trend for decreasing body fat content with 4 subjects showing a significant decrease in body fat content over time. The findings suggested that the effects were more prominent in subjects with higher initial body fat content. It was also demonstrated that the resting energy expenditure (REE) of the subjects taking the test samples were significantly increased in groups supplemented with CGTE, compared to placebo group. Thus, the combined thermogenic effect of capsaicin, green tea extract and essence of chicken could translate to a positive clinical effect by reducing approximately 460 g of body fat, following 2 wk of supplementation and the application of this natural health supplement for excess fat regulation, should be considered.     

Antihypertensive effect of BS 100–141, a new central acting antihypertensive agent

A double-blind comparison between BS 100–141 and placebo in 36 hypertensive patients of Thai or Thai-Chinese origin revealed that the preparation lowers the elevated blood pressure within the first week of treatment in most patients. The drug was relatively well tolerated and caused mild side effects only. After a sudden discontinuation of the drug, the blood pressure in four of the 19 patients increased within a few days to pretreatment values or slightly above. The occurrence of rebound hypertension cannot be excluded. Interruption of treatment, therefore, should be made gradually.