Intracapsular hip fractures have poorer nutritional status and more complications than trochanteric fractures: A retrospective study of 255 Thai patients.

Poor nutritional status which is found in many hip fracture patients may be one explanation for their increased morbidity and mortality. A retrospective study was performed to study the nutritional profile in Thai patients with hip fracture who had been admitted to Siriraj Hospital from January 2005 to March 2006. The parameter that was used to determine the nutritional profile was the level of albumin. The nutritional differences in hip fractures were assessed. The incidence of protein depletion was significantly higher in patients with trochanteric hip fractures than patients with intracapsular hip fractures. However, the average serum albumin level was significantly lower in patients with the intracapsular fractures than patients with trochanteric fractures. In addition, we found that a moderate level of malnutrition was related to post-operative complications in patients with the intracapsular hip fractures. Therefore, the higher complication rates in patients with intracapsular fractures than in patients with trochanteric fractures may be caused by the poorer nutritional status.

Open total talus dislocation: A case report.

Total dislocation of the talus is a rare and severe injury. We report a case of 18-year-old man who sustained a Gustilo type IIIA open total talus dislocation when he had a car accident. Immediate surgical debridement and putting the dislocated talus into an ankle mortise were accomplished under antibiotic coverage. The ankle was immobilized for 12 weeks, and weight-bearing was restricted for 3 months. At the 6-month follow-up, the patient had both ankle septic arthritis and avascular necrosis of the talus. After treatment with antibiotics for 8 months, the septic arthritis was resolved. Finally, at 12 month follow-up, the patient had a good plantigraded foot even though avascular necrosis of talus was presented.

Modification of platelet shape change parameter by oxidized lipoprotein from beta-thalassemia/Hemoglobin E.

BACKGROUND: Beta-thalassemia/Hemoglobin E (beta-thal/Hb E) is a congenital hemolytic anemia that is prevalent in Thailand Pulmonary arterial occlusion is the cause of morbidity and mortality in these patients. Abnormality of platelets has been implicated as pathogenesis of this condition. However the blood-borne factors that induce platelet activation are not identified Recently, oxidized low-density lipoproteins (ox-LDLs) had been identified in thalassemic blood. OBJECTIVE: Identify whether oxidized LDL is the blood bone factor that induce platelet activation in beta-thal/Hb E patients. MATERIAL AND METHOD: Platelet activation was measured by monitoring platelet shape change parameter using plasma-free human platelets. The shape change parameter was monitored following exposure to normal LDL, oxidized LDL, and thalassemic LDL. RESULTS: Oxidized LDL, but not the native LDL and thalassemic LDL, showed platelet activation activity. Oxidation of thalassemic LDL with copper give rise to oxidized LDL with platelet activating activity. However less copper was needed by LDL from splenectomized beta-thal/Hb E patients than those from nonsplencectomized beta-thal/Hb E patients. CONCLUSION: LDL from splenectomized beta-thal/Hb E patients is more susceptible for oxidation and gives rise to oxidized-LDL that plays an important role in thrombosis event in these patients.

Modification of platelet shape change parameter by modified phospholipids in oxidized LDL.

BACKGROUND: It is believed that the oxidatively modified lipoproteins play a critical role in activating platelets and is a contributing factor in the etiology of a number of cardiovascular-related diseases. OBJECTIVE: Identify the active component(s) of oxidized LDL that initiated shape change in plasma-free human platelets prepared by a gel filtration method Material and Method: Shape change parameter of platelets was monitored following exposure platelets to LDL, copper sulfate-oxidized LDL, and different types of lipids extracted of the corresponding LDL. RESULTS: Oxidized LDL, but not native LDL, increased the shape-change parameter in a concentration-dependent manner Specifically, phosphatidyl serine from oxidized LDL was responsible for this effect. CONCLUSION: Oxidized phospholipids generated during the oxidative modification of LDL are likely to be the active components responsible for changes in platelet function.

Protein depletion in Thai patients with hip fractures.

OBJECTIVE: Study the prevalence of protein depletion and determine the effect of protein depletion on postoperative complications. MATERIAL AND METHOD: A retrospective study was performed in 255 Thai elderly patients who had been admitted to Siriraj Hospital because of a fracture of the hip. The level of albumin was the parameter used to determine the degree of protein depletion. The effects of protein depletion that were examined were the length of hospital stay and the development of complications. RESULTS: Ninety-seven patients (44.5%) in the study group were in a protein-depleted state during the period of hospitalization. The patients who were protein-depleted had a higher prevalence of complications and tended to stay in the hospital longer, compared with the nonprotein-depleted patients. CONCLUSION: Thai elderly patients who sustain the trauma of a fracture of the hip should be managed appropriately for the intake of nutrients during the hospitalized period to improve their health status.