Tag Archives: obesity

The Complication Rates of Oral Anticoagulation Therapy in Deep Venous Thrombosis

DOI: 10.2478/amma-2019-0012

The objective of the current study is to evaluate the complication rates (embolic and hemorrhagic events) in deep venous thrombosis (DVT) patients on different types of oral anticoagulation therapy (OAC): direct oral anticoagulant therapy and vitamin K antagonist therapy.
Methods: A number of 62 DVT patients were included and divided in two groups, depending on the type of oral anticoagulation therapy administered. The first group was composed of patients treated with direct oral anticoagulant treatment (Dabigatran, Rivaroxaban) and the second group was composed of patients treated with vitamin K antagonist (Acenocumarol). General data, including BMI and comorbidities were noted. Embolic and hemorrhagic events were noticed.
Results: in the first group of patients (DOAC therapy), a number of 34 patients were included (14 of them with BMI higher than 25 kg/m2 and 14 with concomitant atrial fibrillation), while the second group comprised of 28 patients treated with VKA (21 of them with a high BMI and only 3 of them with atrial fibrillation). After a mean period of 36 months of anticoagulant therapy, complications were present in 17 patients, hematuria (8 episodes) and pulmonary embolism (4 cases) were the most frequent, with no difference regarding the treatment applied. Conclusion: No statistically significant difference was encountered regarding embolic and hemorrhagic event rates in our deep vein thrombosis patients.

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Ultrasound Guidance Versus Peripheral Neurostimulation for Brachial Plexus Block Anesthesia with Axillary Approach and Multiple Injection Technique

DOI: 10.1515/amma-2017-0025

Introduction: There are several approaches for brachial plexus anesthesia: supraclavicular, infraclavicular, interscalenic and axillary. Out of these, the axillary approach is considered to be the safest because of the low risk of lesioning the adjacent structures, low risk of phrenic nerve blockade or of producing an iatrogenic pneumothorax. The block can be performed by one single injection at the site, by two injections or by several injection, among each nerve of the plexus. Ultrasound was introduced in regional anesthesia since 1978, being used initially as an auxiliary method to peripheral neurostimulator.
Objectives: The evaluation of ultrasound efficiency as an auxiliary method for brachial plexus block performance, in terms of success rate, vascular punctures. The influence of obesity on performing time, total duration of the block, and success rate of brachial plexus block.
Material and method: Prospective, randomized study which enrolled adult patients, scheduled for surgical emergency or elective surgical intervention on upper limb with brachial plexus block by axillary approach, using either the peripheral nerve stimulation or the ultrasound guidance.
Results: We enrolled 160 patients, grouped in two sets- the ultrasound group= 82 patients (US) the neurostimulation group = 78 patients (NS). Vascular punctures were statistically significant different p= 0, 04. The success rate was not influenced by the obesity.
Conclusions: Ultrasound guidance makes axillary brachial plexus block safer, we can recommend ultrasound guidance as routine for axillary brachial plexus block. The obese patient can beneficiate by both methods of brachial plexus blockage.

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Body Mass Index and the Relationship with Chronic Kidney Disease in a Tertiary Care Hospital in Romania

DOI: 10.1515/amma-2016-0016

Obesity and chronic kidney disease are epidemic size. Chronic kidney disease (CKD) appears to be more common in obese, although interrelation is not supported by all authors. Aim: The aim of the study was to investigate the effects of overweight and obesity on glomerular filtration rate (GFR) and the relationship between body mass index (BMI) and other risk factors for CKD.
Methods: This is a cross-sectional study on 627 patients admitted in a Nephrology Department between January 2007 – December 2011. Patients were divided according to eGFR in a CKD group and a non-CKD group. Patients were divided based on BMI in: normal (<25 kg/m2), overweight (≥ 25 kg/m2 and ≤30 kg/m2) and obese (>30 kg/m2). Demographical, clinical and laboratory data (serum creatinine, lipid parameters, etc) were used for the statistical analysis. The relationship between BMI (as a marker of obesity and overweight), glomerular filtration rate and other possible risk factors for chronic kidney disease was studied.
Results: 43.70% patients were obese and 33.17% overweight. CKD prevalence was 58.69%. Logistic regression analysis showed that systolic blood pressure was the main determinant of CKD in our patients.
Conclusion: Lack of association between BMI and CKD was demonstrated in our study.

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Association Between Sleep Disorder and Increased Body Mass Index in Adult Patients

DOI: 10.1515/amma-2016-0015

Introduction and objectives. Obesity is a public health issue, with increasing prevalence and incidence all over the world. Diet and exercise applied in obesity treatment are not always as effective as expected, as there are many other determining factors which can lead to obesity. One of these modifiable factors seem to be sleep disorder. The objective of our study was to test the positive association between the presence of sleep disorder and increased body mass index (BMI).
Material and method. 84 patients were screened in a descriptive cross-sectional study. Each patient completed the adjusted 7 items University of Toronto Sleep Assessment Questionnaire (SAQ©). Each affirmative answer was accounted 1 point. The total score was calculated. Mild sleep disorder was considered at 4-5 points, severe sleep disorder at 6 – 7 points. Body mass index (BMI) was calculated for each patient by the formula weight (Kg)/squared height (m2). We considered increased BMI values greater than 25 kg/m2. The association between the sleep disorder and increased BMI was statistically tested.
Results. We interviewed 84 patients, 32 (38%) men (average age 54 +/- 6.63) and 52 (62%) women (average age 50 +/- 5.26). Mild sleep disorder was present in 36 patients, and severe sleep disorder in 25 patients. We noticed association between sleep disorder and increased BMI (p=0.0064, RR=2.925, 95% CI 1.16-7.36). We observed the risk for increased BMI dependent on the sleep disorder severity.
Conclusions. Sleep disorder is a potentially modifiable risk factor which can be included in obesity therapeutic approach and management. Early diagnosis and treatment of sleep disorder is important in obesity prevention.

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The Role of Acanthosis Nigricans in Identifying Clinical and Metabolic Features of the Metabolic Syndrome in Obese Children

Background: Acanthosis nigricans (AN) is a dermatologic marker of hyperinsulinemia and has been linked with metabolic syndrome in adults. In children, the relationship between AN and different components of the metabolic syndrome has received mixed research results. We investigated whether the clinical and metabolic profile of obese children with AN was different from those without AN.
Material and methods: We studied retrospectively the observation charts of children who were evaluated in our clinic for obesity and/or anomalies of glucose metabolism from January 1st 2005 to December 31st 2009. The study population consisted of 52 children. The analyzed data included: age, sex, body mass index (BMI), the presence or absence of AN, systolic and diastolic blood pressure, the results of the oral glucose tolerance test, triglycerides and high-density lipoprotein (HDL) cholesterol levels, baseline insulin, the homeostatic model assessment: insulin resistance (HOMA-IR), glicated hemoglobin. We divided our study population into two groups according to the presence or absence of AN. We used One-Way ANOVA to evaluate the clinical and metabolic differences between the two study groups.
Results: We found significant differences between the two groups for BMI, systolic and diastolic blood pressure, triglycerides, HDL cholesterol, baseline insulin and HOMA-IR.
Conclusions: Our study shows that AN seems to be linked with most of the features of the metabolic syndrome in children. The relationship of AN and anomalies of glucose metabolism need further testing.

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Nutritional Status Assesment in Overweight and Obese Children

Background: Obesity represents the abnormal/excessive accumulation of fat in adipose tissue. Anthropometry takes a person’s body measurements, especially for use on a comparison or classification basis to establish his/her nutritional status. Nutritional condition also includes clinical examination and laboratory findings. Our aim was to assess the nutritional status in a group of obese children versus normal-weight children.
Material and methods: Our prospective study, conducted between October 1, 2010 and April 15, 2011, included a study group with 20 obese children and a control-group with 35 healthy children; we performed antropometric measurements, we calculated some anthropometric indices and performed laboratory tests, abdominal ultrasound and real-tyme elastography; statistical analysis involved Graph PadPrisma and Graph Pad InStat Demo programme; Student’s t test and correlation coefficient Pearson were used.
Results: Children weight and weight-for-age z-score significantly differed between the study-group and controls, at each age group, stature and height-for-age z-score was not significantly different. Medium upper-arm circumference (MUAC) had higher values than Body Mass Index, (BMI), while Tricipital Skin-fold (TSF) recorded the highest values, reflecting the fat deposits of obese children (in controls these indices were between -2SD and +2SD). The laboratory findings were generally within normal limits; total cholesterol values were higher in obese and triglycerides were incresed in a part of children in which they were determined. Liver elasticity was lower in obese than in the control-group.
Conclusion: Overweight alters the nutritional status, disturbs lipid metabolism and decreases the elasticity of the liver, highlighting the risks related to obesity and the importance of prevention and treatment of this disorder.

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Obesity and Insulin Resistance Status: The Impact of Using Different International Growth Standards in Romanian Children

Introduction: Worldwide, childhood obesity is on the rise. A lot of debate exists within the scientific community regarding the best way to define overweight and obesity in different populations. Currently, three sets of growth references are in use internationally: the 2007 World Health Organization (WHO) growth standards, the International Obesity Task Force (IOTF) reference, and the 2000 Center for Disease Control and Prevention (CDC) growth charts. We examined the impact of using these international growth references on diagnosing obesity in a group of overweight and obese Romanian children. Afterwards, we evaluated the relationship between diagnosed obesity and insulin resistance status.
Material and method: We studied retrospectively the observation charts of children who had their insulin levels tested in our hospital’s laboratory between January 1st 2008 and December 31st 2009. The study population consisted of 76 children. We analyzed: age, gender, body mass index (BMI), the homeostatic model assessment: insulin resistance (HOMA-IR). We divided the children into two categories according to their HOMA-IR values. We used each of the standards and grouped the study population into two BMI groups: overweight and obese. We used One-Way ANOVA to evaluate the differences between the three definitions.
Results: We found significant differences between the WHO and the IOTF and CDC references. The WHO standards identified the least overweight children with insulin resistance.
Conclusions: Our study shows that using WHO growth standards may be the proper method to diagnose obese children. A large populational study is needed to establish the proper growth references for our population.

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Obesity and Metabolic Syndrome as Risk Factors of Colorectal Polyps and Colorectal Cancer

Purpose: Obesity and metabolic syndrome, each represent one of the risk factors in colon cancer and colon polyps. We have studied the association between obesity, metabolic syndrome and the risk of developing colorectal cancer and colorectal polyps.
Materials and methods: Our study refers to patients with mucosal modifications at the level of the colon, hospitalized and investigated through colonoscopy in the Gastroenterology Clinic 1, Tîrgu Mureș between 2008–2011.
Results: There were 324 patients with colorectal cancer and colorectal polyps, compared with 345 control patients investigated in the same hospital. In the study group, 69 patients (21.29%) were overweight (BMI 25–29.99 kg/m2) and 71 patients (30.90%) were obese (BMI> 30 kg/m2), compared with the control group, where 53 patients (15.36%) were overweight and 32 patients (9.26%) were obese. There was a significant association between obesity and risk for colorectal cancer and colorectal polyps: BMI >30 kg/m2 – OR = 2.89, CI: 1.64–5.10. We also observed a significant increase in the risk for colorectal polyps and colorectal cancer in parallel with the increase of the number of metabolic syndrome components: 1 component – OR = 1.55, CI: 1.09–2.20; 2 components OR = 2.42, CI: 1.54–3.81; 3 components OR = 2.37, CI: 1.16–4.81; 4 or more components OR = 5.27, CI: 1.07–25.85.
Conclusions: The results of our study showed that obesity and metabolic syndrome are associated with an increased risk for the development of colorectal polyps and colorectal cancer.

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Obesity and Calcium Oxalate Renal Stones

Introduction: Kidney stones are a major cause of morbidity. The lifetime prevalence of symptomatic renal stones is approximately 10% in men and 5% in women. The rate of backsliding for calcium oxalate stones is 10% in one year, 30% in 5 years and 50% in 10 years. Urine pH is one of the important factors for urinary stone formation.
Material and methods: We studied 283 renal stone formers (131 men, 152 female), divided according to their BMI (body mass index) in normal body weight (BMI <25 kg/m2), overweight (BMI 25–30 kg/m2) and obese (BMI >30 kg/m2).
Results: Urine pH is inversely related to BMI among patients with urolithiasis (higher BMI will have lower urine pH). The mean urine pH of the normal body weight, overweight, and obese groups was 6.1, 5.5 and respectively 5.7 (p <0.0001).
Conclusions: Obesity is associated with both hypercalciuria and with proteinuria, demonstrated factors in the etiology of urolithiasis, and urinary pH is inversely related to BMI in patients with urinary stones.

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The Results of ARFI (Acoustic Radiation Force Impulse) Elastographic Assessment of Liver Aspect and NAFLD (Non-alcoholic Fatty Liver Disease) in Pediatric Obese Patients Compared to Normal-weight Children

Background: The incidence of obesity has dramatically increased in the last few years, and associated disorders such as non-alcoholic fatty liver disease (NAFLD) constitute a serious threat. The objective of our study was to assess the liver aspect of obese children and adolescents by real-time elastography, ARFI-technique, compared to the liver aspect of normal-weight children.
Methods: Eighty-six children, aged 3–18 years, admitted to the County Emergency Clinical Hospital of Tîrgu Mureș between 15 September 2010 and 15 April 2012, were recruited for the study. They were included in two groups: 39 overweight/obese children and 47 normal-weight healthy controls. We evaluated the liver-tissue elasticity by measuring the Shear Wave Velocity (SWV), globally and separately for segments 1 and 8 in order to detect possible differences beetween them, knowing that the caudate-lobe has it’s own vasculature; we also evaluated biochemical parameters (transaminases, etc). Correlations between SWV and laboratory tests were established using non-parametric Spearman correlation test.
Results: In healty children in the 1st segment SWV was 1.012±0.31 m/s, smaller than in the 8th segment, 1.342±0.32 m/s (p = 0.0316). For obese children, SWV was higher in the 8th segment 1.982±0.85 m/s compared to the 1st segment 1.325±0.27 m/s (p <0.0001). Globally in obese children, the SWV was 1.746±0.49 m/s, significantly higher than in healthy children, 1.080±0.27 m/s (p = 0.0023). Positive statistical correlations have been established between SWV and aspartate-aminotransferase in obese (r = 0.61, Pearson correlation p = 0.025), with no statistically significant differences for other laboratory findings.
Conclusion: Elastographic evaluation of liver alterations in obesity by ARFI-method shows higher SWV, which could be translated in fibrosis and necroinflammatory activity. According to our study, these alterations in liver tissue affect mainly the right lobe of the liver.

 

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