Comparing anti-hepatitis B antibody level in Iranian obese or overweight with non-obese cases

Background: There is a controversy about the relation between anti-hepatitis B [anti-HBs] antibody level and obesity. We designed this study to compare the vaccine efficacy in obese/overweight and non-obese cases

Methods: In this cross-sectional study, 242 obese/overweight and 85 non-obese individuals were participated. Cases were selected from a referral clinic for obesity and a referral hepatology clinic, both in Tehran, Iran

Results: Obese cases had lower percentage of liver diseases [66.9% vs. 100%, P<0.001] but higher hepatitis B vaccination history [74.9% vs. 51.2%, P<0.001]. Median+/-inter-quartile range of anti-HBs titer in obese cases was significantly lower than controls [48.5+/-194.5 vs. 100+/-557.6, P=0.012]

Conclusion: The level of anti-HBs surface antigen antibody's titer in obese cases without liver disease is lower than control group. Therefore, a suitable strategy is needed to overcome this problem, which can be the use of longer needles for vaccination

comparison between two different prophylactic doses of unfractionated heparin for deep venous thrombosis prevention in laparoscopic bariatric surgery

Deep Venous Thrombosis [DVT] is a major risk of morbidity and mortality in morbid obese patients underwent bariatric surgery. There are some controversies in different kind of prophylactic strategies for DVT in laparoscopic bariatric surgeries. Unfractionated heparin [UFH] is an available and reversible anticoagulant used for DVT prophylaxis. This study aimed to compare clinical results of two different dosage regimes of unfractionated heparin for short term prophylaxis of DVT after bariatric surgery. 139 patients with morbid obesity who underwent laparoscopic bariatric surgery [laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic gastric banding] were evaluated in two groups: group A received 5000 IU unfractionated heparin q12h and group B received the same dose but q8h [preliminary dose received before induction of anesthesia followed by 2 or 3 times daily]. All patients were evaluated by physical examination and Doppler ultra sound for DVT before and 10 days after surgery. There was no statistically significant difference between two groups in venous thrombosis. No thrombotic events were observed before and after operations. There were no heparin induced thrombocytopenia and no meaningful difference between two groups in postoperative bleeding. This study showed that in combination with non-pharmacologic methods for prevention of thromboembolic events, both regimes of UFH prophylaxis had similar clinical effects

Management of thoracic empyema: review of 112 cases

To review our experience in treatment of patients with thoracic empyema at a teaching hospital chart of patients were retrospectively reviewed over a 72-month period. A total of 112 patients [94 men, 18 women, mean age: 39, range: 6-89 years] underwent therapeutic procedures for thoracic empyema between 2001-2006. The causes of empyema included parapneumonic empyema [60.7%], thoracic trauma [20.5%], surgical procedures [7.1%] and seeding from an extra-pulmonary source [11.7%]. Multiloculated empyemas were documented in 45 patients [40%]. Insertion of chest tube was the first procedure in 103 patients [92%]. Nineteen patients [17%] were treated by thoracotomy, ten patients [8.9%] had fibrinolytic therapy, eight patients [7.2%] underwent video assisted thoracic surgery [VATS] and sixteen patients [14.3%] had subsequent radiologic-guided drainage. Thoracotomy-Decortication was successful in 90% of patients undergoing surgery and the least successful intervention was tube thoracostomy alone. Twelve of 112 patients [10.7%] died in the hospital including one patient in the thoracotomy group. Long-term follow-up was available in 67 patients including all of patients requiring surgery and fibrinolytic therapy. Thirty four patients [50%] obtained complete functional recovery. Simple drainage as the first procedure for the treatment of thoracic empyema has a high failure rate. Selection of a therapeutic option should be based on age, underlying disease, stage of the empyema, state of the loculation, local expertise and availability. Surgical procedures such as VATS or thoracotomy are recommended as the first procedure in elderly patients and advanced empyema