How Does Iron Deficiency Anemia Impact Outcomes following Revision Total Hip Arthroplasty? / 대한고관절학회지

Purpose@#Studies have shown the prevalence of iron deficiency anemia (IDA) increasing worldwide, and currently the literature is limited on the impact of IDA on outcomes following revision total hip arthroplasty (RTHA). Therefore, the purpose of this study was to determine whether IDA patients undergoing RTHA have longer: 1) in-hospital lengths of stay (LOS); 2) medical complications; and 3) costs of care. @*Materials and Methods@#A retrospective query of a nationwide administrative claims database was performed. Using Boolean command operations, the study group consisted of all patients in the database undergoing RTHA with IDA; whereas, patients without IDA served as controls. To reduce the effects of confounding, study group patients were matched to controls in a 1:5 ratio by age, sex, and medical comorbidities yielding 92,948 patients with (n=15,508) and without (n=77,440) IDA undergoing revision THA. A P-value less than 0.001 was considered statistically significant. @*Results@#IDA patients were found to have significantly longer in-hospital LOS (5 days vs. 4 days, P<0.0001). Additionally, the study showed IDA patients were found to higher incidence and odds of (73.84% vs. 11.77%, OR 5.04, P<0.0001) 90-day medical complications. IDA patients also incurred high 90-day episode of care costs ($25,597.51 vs. $20,085.70, P<0.0001). @*Conclusion@#After adjusting for age, sex, and medical comorbidities this study of over 92,000 patients demonstrated IDA is associated with longer in-hospital LOS, complications, and costs of care. Future studies should compare the duration and severity of IDA on outcomes.

A Higher Altitude Is Associated with Increased Incidence of Infections following Primary Total Hip Arthroplasty / 대한고관절학회지

Purpose@#The purpose of this study was to evaluate whether patients undergoing primary total hip arthroplasty (THA) at a higher elevation have higher rates of: 1) in-hospital length of stay (LOS); 2) surgical site infections (SSIs); 3) periprosthetic joint infections (PJIs); and 4) costs. @*Materials and Methods@#The Medicare claims database was used to identify patients who underwent primary THA at an altitude higher than 4,000 feet (ft). High-altitude patients were matched to patients who underwent primary THA at an altitude less than 100 ft, yielding 24,958 and 124,765 patients respectively. Outcomes that were assessed included in-hospital LOS, SSIs, PJIs, and costs of care. A P-value less than 0.001 was considered statistically significant. @*Results@#Patients in the study group had significantly longer in-hospital LOS (4 days vs 3 days, P<0.0001). In addition, patients in the study group had a significantly higher incidence and odds of developing SSIs (1.16% vs 0.86%; odds ratio [OR], 1.34; P<0.0001) and PJIs (0.91% vs 0.58%; OR, 1.56; P<0.0001) within 90-days following the index procedure, compared to matched controls. Higher altitude patients incurred higher day of surgery ($16,139.76 vs $15,279.42; P<0.0001) and 90-day costs ($18,647.51 vs $16,401.62; P<0.0001). @*Conclusion@#This study demonstrated that primary THA procedures performed at an elevation higher than 4,000 ft are associated with longer in-hospital LOS, higher rates of SSIs, PJIs, and costs of care. Orthopedists and other healthcare professionals can use this information to provide adequate education for these patients regarding the potential complications that may occur following their procedure.

[ correlation between arterial blood gases and venous blood gases among the mechanically ventilated patients admitted in intensive care unit]

Background: While the arteriopuncture is a painful and relatively risky procedure and may be complicated by some problems, venopuncture required for assessing the venous blood gases [VBG] is an easier procedure with fewer complications. Considering the mentioned notion, substituting the VBG values for of ABG values can prevent such complications. This study was carried out with the aim of determining whether the VBG values can be replaced for ABG values in the management of mechanically ventilated patients admitted in ICU wards

Materials and Methods: This study was carried out on 102 patients admitted in ICU ward of Shahid Beheshti. After performing the Allen test, ABG was taken from radial artery of one hand and immediately VBG from the brachiocephalic vein of the other. The ABG and VBG indexes were calculated using a GEM3000 system. After the data collection and calculation of mean and standard deviation of all indexes, two methods were compared using paired t-test, subsequent correlation ratio and the linear regression model

Results: Among the 102 hospitalized patients 70 were males and the remaining 32 females. The results of comparing the ABG and VBG indexes in terms of Pearson-correlation coefficient and the relevant significant level were: pH [0.801, P<0.001]; PCO2 [0.835, P<0.001]; HCO[3] [0.768, P=0.369]; PO[2][0.287, P<0.001]; SaO2 [0.317, P<0.001]; BE [0.810, P<0.011]

Conclusion: While there was a significant correlation between the ABG and VBG indexes, but with the consideration of the power of correlation, the substitution of VBG for ABG is not recommended for mechanically ventilated patients

[Diagnostic value of pleural adenosine deaminase activity in discrimination of exudative from transudative effusion]

Background: the differentiation of pleural effusions as exudates or transudates is the first step in the diagnosis of pleural effusions. The aim of this study was to evaluate the usefulness of pleural adenosine deaminase [PADA], for separating transudative pleural effusion from exudative pleural effusion

Materials and Methods: using light's criteria, after careful evaluation of all relevant clinical and biochemical parameters of pleural fluid and serum, classically effusions were classified to transudative or exudative. The means and standard deviations of PADA, and pleural/serum ADA [P/S ADA] ratio were calculated for transudative and exudative effusions .The best cut-off values for each test were identified by using the receiver operating characteristic [ROC] curve

Results: we compared PADA levels between transudative and exudative patients with pleural effusion. According to the criteria used, 32 patients were included in the transudate group and 73 patients in the exudate group. Pleural fluid ADA levels were significantly lower in the transudate group than in exudate one [16.21 +/- 6.10 U/lit vs. 22.24 +/- 7.50 U/lit; P<0.001]. Also the mean pleural fluid/serum ADA ratio were [P<0.0001] lower in transudates as compared to exudates [0.76 +/- 0.32 vs. 0.91 +/- 0.26; P=0.021]. Using a cut-off point of 14.5 IU/L, the sensitivity and specificity of pleural ADA in the diagnosis of exudates was computed to be 84.7% and 48.3% respectively. At a cut-off point 0.75, pleural fluid/serum ADA ratio was found to have sensitivity and specificity of 73.2% and 65.5% , respectively

Conclusion: measuring PADA is suggested as a useful biochemical marker in differentiating between pleural exudates and transudates

Complicated parapneumonic effusion: Etiology and results of lung decortication

Parapneumonic effusion is a common accompaniment of bacterial pneumonia and mostly is resolved with medical management. We studied the etiology and possible underlying causes of complicated parapneumonic effusion and timing of pulmonary decortication. A descriptive study on 34 patients with postpneumonic empyema which required decortication carried out. Post surgical and post traumatic empyema were excluded. Patients' age ranged from 20 to 75 with a mean of 46 years. The most common clinical findings were fever [90%], pleural dull pain [80%], productive cough [73%] and dyspnea [70%]. PPD test was negative in all patients. In 78%, white cell count was normal; in remainder it was more than 10.000. Bacteriological findings were negative and acid fast bacilli were not detected. All patients underwent posterolateral thoracotomy and decortication and completely expansible lung was achieved. Tissue diagnosis after decorticating showed tuberculosis in 8 [24%] patients and necrotic tissue in remainder. Average medical management time and postoperative hospital stay were 38 +/- 2 and 6.7 +/- 2 days, respectively. Morbidity rates were acceptable and there was one late mortality. No recurrence was happened. In parapneumonic effusions not responding to standard treatment, tuberculosis must be considered, especially in addicted persons, positive family history and ESR > 100. In complicated parapneumonic effusion, early thoracotomy and full decortication is recommend because it is diagnostic, allows control of infection, releases the pulmonary entrapment, early discharge from hospital, need not further antibiotic administration and is cost benefit

Pulmonary alveolar microlithiasis

A 40-year-old male patient was referred with a history of exertional shortness of breath since a few years ago. Spirometric findings were consistent with a restrictive ventilatory defect. Plain chest radiographs showed sand-like opacities throughout both lungs predominantly in the lower zones. Computerized tomographic scan revealed diffuse bilateral calcified fine nodular pattern. The diagnosis of pulmonary alveolar microlithiasis was confirmed by transbronchial biopsy

[Distrubances in arterial blood gases exchanges in treated asthmatic patients]

This study was performed to investigate and study of arterial blood gases [ABG] in treated asthmatic patients with the age range of 18-74 years old in Kashan during the autumn and winter of 1999. The research was carried out descriptively on 122 referred patients [60 male and 62 female] whose diagnosis was confirmed one week after treatment with antiasthmatic drugs treatment was the same for all patients. Obtaining arterial blood samples from radial artery in sitting position and spirometry were done. The pressure of arterial oxygen value [Pa02] and the pressure of arterial C02 [PaC02] in the samples were determined and also the confidence interval was estimated. Pa02 value in treated male and female patients was 77.2 +/- 10.3 mmHg and 77.9 +/- 10.3 mmHgrespectively. The linear equation was as follows Pa02 =86.106-0.1933 xage [year]. PaC02 in treated asthmatic male and female patient was 37.7 +/- 1.96 mmHg and 37 +/- 2.61 mmHgrespectively. In treated asthmatic patients after 7 days of treatment, hypoxemia is a common complication which necessitates further supervision and monitoring after the occurrence of acute asthmatic attacks