Postoperative analgesic efficacy of nefopam after anorectal surgery: a retrospective observational study

Objective: To examine the effectiveness of nefopam on postoperative pain control after anorectal surgeries. Methods: We retrospectively reviewed the electronic medical records of patients who underwent anorectal surgeries from January 2019 to March 2022 at two medical centers. The data were divided into nefopam and conventional groups. The primary outcome was the number of patients who requested additional opioids in the 24-h postoperative period. The secondary outcomes were numeric rating pain scores (NRPS) within a 24-h postoperative period and analgesic drugs-related side effects. Results: Eighty-seven patients in the conventional group and 60 in the nefopam group were recruited. The nefopam group reported less additional opioid consumption than the conventional group in all dimensions of analysis, including overall, adjusted to anesthetic techniques and types of surgery. However, these did not reach statistical significance (P = 0.093). Only patients in the nefopam group who underwent hemorrhoidectomy under TIVA or spinal anesthesia significantly required fewer additional opioids (P = 0.016, 60% mean difference). Similarly, the 24-h postoperative morphine consumption was lower in the nefopam group (mean difference = -3.4, 95%CI: 0.72,6.08). Furthermore, significantly lower NRPS were reported in the nefopam group during the 12-18 h postoperative period (P = 0.009). On the other hand, analgesic drugs related side effects were similar in both groups. Conclusions: The administration of nefopam after major anorectal surgery is beneficially evident in reducing postoperative opioid requirements. (AU)

Association of high sensitivity C-reactive protein concentrations and metabolic syndrome among Thai adults.

Background: Limited information is available regarding associations of metabolic syndrome with C-reactive protein (CRP) concentrations among Asian populations. Objective: Investigate the association of high sensitivity CRP (hsCRP) concentrations and metabolic syndrome among Thai adults. Methods: This cross-sectional study was comprised of 467 Thai participants (209 men and 258 women) receiving annual health check-up. Spearman’s rank correlation coefficients were used to assess the associations between metabolic parameters (age, waist circumference, blood pressure, triglycerides, HDL-C, fasting plasma glucose, fasting insulin and uric acid) with hsCRP concentrations for men and women, respectively. Multivariable logistic regression procedures were used to estimate the risk (odds ratios (OR), and 95% confidence intervals (CI) of metabolic syndrome according to low, moderate, and high hsCRP concentrations (<1.0, 1.0-3.0, and >3.0 mg/L, respectively). Results: Measures of adiposity and fasting insulin were positively and significantly correlated with hsCRP concentrations among women with and without metabolic syndrome. Similar associations were observed among men without metabolic syndrome. After controlling for confounders, moderately elevated hsCRP concentrations were associated with a 2.38-fold increased risk of metabolic syndrome (OR=2.38, 95%CI=1.20-4.72) among men. Men with high hsCRP concentrations had a 5.45-fold increased risk of metabolic syndrome (OR=5.45, 95%CI=2.24- 13.27) when compared with those who had low hsCRP concentrations. The corresponding OR for women with moderately elevated and high hsCRP concentrations were 4.92 (OR=4.92, 95%CI=2.34-10.35) and 11.93 (OR=11.93, 95%CI=5.54-25.72), respectively. Conclusions: These findings are consistent with the literature suggesting a role of hsCRP as a biomarker for metabolic syndrome.

Risk of dyslipidemia in relation to level of physical activity among Thai professional and office workers.

We completed a cross-sectional study of 1,608 Thai participants (536 men and 1,072 women) receiving annual health check-ups to evaluate the relation between physical activity levels and fasting serum concentrations of total cholesterol (TCH), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), and the total cholesterol: high density lipoprotein-cholesterol (TCH:HDL-C) ratio. Physical activity levels were assessed using a self-administered questionnaire administered at the time of blood collection. After controlling for confounders, men who reported high physical activity levels had on average a 3.42 mg/dl higher (p = 0.020) in HDL-C concentrations, when compared to men who reported low physical activity levels. Higher mean HDL-C concentrations were also observed for women who reported high physical activity levels, when compared with their less active counterparts (4.24 mg/dl, p = 0.004). TG concentrations were 30.92 mg/dl lower in men (p = 0.029) and 12.83 mg/dl lower in women (p = 0.003) who had high physical activity levels when compared with less active individuals. Men who reported high physical activity levels, compared with those who reported low physical activity levels, had a 59% reduction in risk for hypertriglyceridemia (OR = 0.41, 95% CI: 0.24-0.70). The corresponding OR for women was 0.43 (95% CI: 0.21-0.88). No association was found between physical activity levels and TCH concentrations. Overall, these data suggest that habitually active men and women are less likely to have hypertriglyceridemia and low HDL-C concentrations. The favorable effects of physical activity on lipid and lipoprotein concentrations are consistent with the evidence documenting the cardiovascular health benefits of physically active lifestyles.

Prevalence of metabolic syndrome among professional and office workers in Bangkok, Thailand.

OBJECTIVE: To estimate the prevalence of metabolic syndrome (MetS) among Thai professional and office workers and to compare the prevalence with other populations. MATERIAL AND METHOD: The authors conducted a cross-sectional study of 1,339 professional and office workers (535 men and 804 women) who participated in the annual health examinations at the Mobile Health Checkup Unit of King Chulalongkorn Memorial Hospital in Bangkok, Thailand during the period of August through December 2001. MetS was defined using the modified NCEP ATP III criteria. Chi-square tests were used to evaluate differences in distribution of covariates for affected and unaffected patients. RESULTS: The prevalence of MetS among Thai professional and office workers was 15.2% and approximately 3 times more common among men than women (25.8% vs. 8.2%). Men and women with MetS were older (p < 0.05) and were less well-educated (p < 0.05) than those without MetS. The three most common metabolic abnormalities in men were high blood pressure (45.0%), BMI > or = 25 kg/m2 (40.7%) and hypertriglyceridemia (38.7%). Among women, high blood pressure (22.8%), BMI > or = 25 kg/m2 (20.9%) and low HDL-Cholesterol (18.4%) were the most common metabolic abnormalities noted. CONCLUSION: The prevalence of MetS in this cohort of Thai professional and office workers was as high as those observed in developed countries. These findings emphasize the urgent need to develop strategies for the detection, treatment, and prevention of MetS. Such efforts will contribute to attenuating the incidence of cardiovascular disease and diabetes.

Prevalence and risk factors of hypercholesterolemia among Thai men and women receiving health examinations.

The purpose of our study was to evaluate risk factors for hypercholesterolemia and correlates of serum lipid concentrations in Thai men and women. A cross-sectional study was conducted in 1392 patients (380 men and 1012 women) who received health examinations during July 1999 - February 2000 at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Serum total cholesterol (TC), triglyceride (TG) and high density lipoprotein- cholesterol (HDL-C) concentrations were determined using standard procedures. Logistic and linear regression procedures were used to assess the association of several covariates with risk for hypercholesterolemia. The results reveal that the prevalences of hypercholesterolemia (TC > or =200 mg/dl) among men and women were 66.8% and 66.0%, respectively. Among men, hypercholesterolemia was associated with older adults (OR = 3.26), and previous alcohol consumption (OR = 2.05). Risk factors for women included advanced age (OR = 3.19), and a family history of dyslipidemia (OR = 1.59). Serum TC and TG were positively associated with age and previous alcohol consumption among men. Among women, TC and TG were strongly associated with age, body mass index (BMI) and family history of dyslipidemia. In men and women, HDL-C was inversely associated with BMI. More emphasis should be placed on understanding the epidemiology of hypercholesterolemia and other dyslipidemias in Thai men and women. More information regarding risk factors will aid in the development of effective health promotion and disease prevention efforts.

Risk factors of hypertension and correlates of blood pressure and mean arterial pressure among patients receiving health exams at the Preventive Medicine Clinic, King Chulalongkorn Memorial Hospital, Thailand.

OBJECTIVE: The purpose of the present cross-sectional study was to determine the relevance of several risk factors for hypertension in a Thai population. MATERIAL AND METHOD: The authors used multiple linear regression to identify factors that influenced systolic blood pressure(SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP) in a study of 1,398 patients. RESULTS: Hypertensive risk factors were similar among men and women. Increased age, body mass index (BMI), and low educational attainment, were statistically significant risk factors for hypertension in men. For example, overweight men (BMI = 25.0-29.9 kg/m2) were 1.88 times more likely to be hypertensive (OR = 1.88, 95%CI = 1.02-3.47) as compared with men who had a normal BMI (20.0-24.9 kg/m2). Obese men (> or = 30.0 kg/m2) had an increased risk, but this association was not significant (OR = 1.40, 95%CI = 0.34-5.69). Similar risk factors were identified among women. Overweight women had a 1.74-increased risk for hypertension (OR = 1.74, 95%CI = 1.13-2.69). The corresponding risk was increased 3-fold among obese women (OR = 3.05, 95%CI = 1.76-5.29). Among men, age and BMI were positively associated with increased SBP, DBP and MAP Men > or = 60 years of age had an increase in SBP (beta = 18.89, p < 0.001), DBP (beta = 5.53, p < 0.001), and MAP (beta = 9.89, p < 0.001) values as compared with the referent group (< 40 years). Similar associations were noted among women. CONCLUSION: Hypertension risk factors observed in this Thai population are similar to those found in Western populations. Prospective studies are needed to evaluate rigorously causal relationships between risk factors and hypertension.