Good quality of life in severely obese total knee replacement patients: a case-control study.

BACKGROUND: The impact of obesity on total knee replacement (TKR) outcomes is unclear. Studies use different classifications of obesity and heterogeneous methods, making comparisons difficult. The aim of this study was to evaluate health-related quality of life (HRQL) preoperatively and at 12 months of follow-up in severe and morbidly obese patients with knee osteoarthritis and a control group of nonobese patients undergoing TKR. METHODS: Case-control study with 12 months follow-up. HRQL was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Sociodemographic variables, comorbidity, body mass index (BMI), degree of intra-operative difficulty (IOD), in-patient data, and postoperative medical data were collected. The effect size (ES) was measured for the different outcome measures. Comparison of the two groups after 12 months of follow-up was made using the t test. STUDY GROUP: sixty patients (88% women) with a mean age of 70.2 years (SD 6.7) and mean total WOMAC dimension score 61.4 (SD 16.7). CONTROL GROUP: 60 matched controls. There were 88% women, with a mean age of 71.7 years (SD 6.7), and a mean WOMAC score of 58.2 (SD 13.4). There were significant improvements in all WOMAC dimensions compared to baseline (p < 0.001) in both groups. There were no differences in WOMAC dimension scores between the two groups at 12 months. The study group had more IOD (p = 0.014) and more-severe complications in the follow up. CONCLUSIONS: Severe and morbidly obese and nonobese patients had similar change scores and TKR outcomes in terms of HRQL at 12 months after TKR. Obese patients had more intraoperative difficulties and more-severe postoperative complications.

Communicable diseases in the immigrant population attended to in a tropical medicine unit: epidemiological aspects and public health issues.

For geographical and historical reasons, Spain is receiving an increasing number of immigrants. The aim of this study was to evaluate some epidemiological aspects and the main public health issues of communicable diseases in Barcelona's immigrant population. From 2001 to 2004, a population of immigrants from tropical, subtropical regions and Eastern Europe was attended to in our centre. Each patient was offered a complete screening for tropical and common diseases. The prevalence and demographical characteristics of eight diseases with a potential risk of transmission in our setting were studied: latent and active tuberculosis, syphilis, human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), Chagas disease, Giardia intestinalis and Entamoeba histolytica/Entamoeba dispar. In all, 2464 immigrants mainly from sub-Saharan Africa were seen. Among the patients who underwent the screening, 46.5% had a positive tuberculin skin test (>or=10 mm), incidence of active tuberculosis was 324.7/100,000 immigrants in the period of the study, 6.4% had a positive syphilis serology, 7.7% had a positive HBsAg, 3.1% had a positive serology for HCV and 2.8% were HIV positive, 41 patients from Latin America with risk factors for American Trypanosomiasis were screened for Chagas disease by immunofluorescence assay and 34% had a positive result; 5.4% of stools parasitological tests were positive for G. intestinalis; 4.2% for E. histolytica/E. dispar. Communicable diseases in immigrant population could lead to emerging and re-emerging infections in the European Union with important issues for public health. European countries may have to establish guidelines for screening of infectious diseases in immigrants from low-income countries.