Therapeutic immunoglobulin should be dosed by clinical outcome rather than by body weight in obese patients

Introduction: Prevalence of obesity is 30 % in the Czech Republic and is expected to increase further in the future. This disease complicates surgical procedures but also the postoperative period. The aim of our paper is to present the surgical technique called hand-assisted laparoscopic nephrectomy (HALS), used in surgical management of kidney cancer in morbid obese patients with BMI >40 kg/m2. Methods: The basic cohort of seven patients with BMI >40 undergoing HALS nephrectomy was retrospectively evaluated. Demographic data were analyzed (age, gender, body weight, height, BMI and comorbidities). The perioperative course (surgery time, blood loss, ICU time, hospital stay and early complications), tumor characteristics (histology, TNM classification, tumor size, removed kidney size) and postoperative follow-up were evaluated. Results: The patient age was 38−67 years; the cohort included 2 females and 5 males, the body weight was 117−155 kg and the BMI was 40.3−501 kg/m2. Surgery time was 73−98 minutes, blood loss was 20−450 ml, and hospital stay was 5−7 days; incisional hernia occurred in one patient. Kidney cancer was confirmed in all cases, 48–110 mm in diameter, and the largest removed specimen size was 210×140×130 mm. One patient died just 9 months after the surgery because of metastatic disease; the tumor-free period in the other patients currently varies between 1 and 5 years. Conclusion: HALS nephrectomy seems to be a suitable and safe surgical technique in complicated patients like these morbid obese patients. HALS nephrectomy provides acceptable surgical and oncological results.

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Kosen-cha, a Polymerized Catechin-Rich Green Tea, as a Potential Functional Beverage for the Reduction of Body Weight and Cardiovascular Risk Factors: A Pilot Study in Obese Patients

Biological and Pharmaceutical Bulletin ◽

10.1248/bpb.b19-00921 ◽

2020 ◽

Vol 43 (4) ◽

pp. 675-681 ◽

Cited By ~ 1

Author(s):

Yasufumi Katanasaka ◽

Yusuke Miyazaki ◽

Yoichi Sunagawa ◽

Masafumi Funamoto ◽

Kana Shimizu ◽

...

Keyword(s):

Risk Factors ◽

Body Weight ◽

Cardiovascular Risk ◽

Pilot Study ◽

Cardiovascular Risk Factors ◽

Green Tea ◽

Obese Patients

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Assessing Safety and Efficacy of Lean Body Weight-Based intravenous Heparin Dosing in Obese and Morbidly Obese Patients

CHEST Journal ◽

10.1378/chest.2254192 ◽

2015 ◽

Vol 148 (4) ◽

pp. 1010A ◽

Cited By ~ 1

Author(s):

Rachel Park ◽

Scott Chelemer ◽

Jason Varghese ◽

Cheryl Leddy ◽

Lewis Rose

Keyword(s):

Body Weight ◽

Lean Body Weight ◽

Morbidly Obese ◽

Obese Patients ◽

Safety And Efficacy ◽

Intravenous Heparin

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IV fosphenytoin in obese patients

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000322 ◽

2016 ◽

Vol 7 (1) ◽

pp. 45-52 ◽

Cited By ~ 2

Author(s):

Sarah L. Clark ◽

Megan R. Leloux ◽

Ross A. Dierkhising ◽

Gregory D. Cascino ◽

Sara E. Hocker

Keyword(s):

Body Weight ◽

Adverse Events ◽

Vital Signs ◽

Drug Distribution ◽

Retrospective Chart Review ◽

Current Method ◽

Liver Function Tests ◽

Excess Body Weight ◽

Obese Patients ◽

Bonferroni Adjustment

AbstractBackground:Previous studies evaluated the disposition of IV phenytoin loading doses and found that obese patients had increased drug distribution into excess body weight, larger volumes of distribution, and longer half-lives when compared to their nonobese counterparts. We assess the safety and efficacy of fosphenytoin loading doses in patients with different body mass indices (BMIs).Methods:A retrospective chart review was conducted in 410 patients who received fosphenytoin. Patients were divided into 2 groups: BMI <30 (nonobese) and BMI ≥30 (obese). Patient demographics, fosphenytoin dose administered in mg/kg body weight, renal and liver function tests, fosphenytoin drug levels, and pre- and post-fosphenytoin administration vital signs were collected to assess for adverse events. Necessity of additional antiepileptic loading doses was used as a surrogate for clinical efficacy.Results:The median dose of fosphenytoin administered was 19 mg/kg (interquartile range 15–20). The most frequently encountered adverse event was hypotension, which occurred in 39% of the cohort. Using a Bonferroni adjustment for multiple comparisons, there were no differences in adverse events between the 2 groups. The need for additional antiepileptic loading doses was not different between the 2 groups (p = 0.07).Conclusions:The incidence of adverse events and the need for repeat loading antiepileptic medications was similar between the 2 groups. From our findings, the patients in our study did not receive empiric loading dose adjustments and the current method of loading fosphenytoin achieves similar outcomes, regardless of the patient's BMI.

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POS0358 EVALUATION OF THE EFFECT OF mTOR EXPRESSION ON THE CLINICAL MANIFESTATIONS OF KNEE OSTEOARTHRITIS IN OBESE AND NORMAL WEIGHT PATIENTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3287 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 409.2-409

Author(s):

E. Strebkova ◽

E. Tchetina ◽

L. Alekseeva

Keyword(s):

Body Weight ◽

Knee Pain ◽

Mammalian Target Of Rapamycin ◽

Clinical Manifestations ◽

Normal Weight ◽

Womac Pain ◽

Obese Patients ◽

Normal Body ◽

Knee Oa ◽

Normal Body Weight

Background:Currently, a large number of molecular biological and genetic markers are known to be involved in the development of osteoarthritis (OA). The mammalian target of rapamycin (mTOR) signaling pathway is responsible for chondrocyte proliferation, cartilage matrix production, and cell growth. OA is characterized by increased mTOR synthesis, which is accompanied by an increase in proliferative activity and destruction of chondrocytes. Obesity is an important factor in the progression of knee OA. The study of mTOR expression in patients with OA and obesity is an urgent task in the development of personalized OA therapy.Objectives:To determine the expression of mTOR in patients with knee OA in combination with obesity and normal body weight. To evaluate the effect of mTOR on the clinical manifestations of OA in patients with different body mass index (BMI).Methods:The study included 73 female patients aged 45-65 y.o. with Kellgren-Lawrence stage II-III knee OA. The patients were divided into 2 groups: group 1 (n=50) with obesity (BMI > 30 kg / cm2) and group 2 (n=23) with normal or increased body weight (BMI < 30 kg/cm2). The average age of patients with obesity is 56.5 ± 5.87 years, without obesity - 58.7 ± 5.43 years. Clinical manifestations were evaluated by a WOMAС. RNA was isolated from the patients ‘ blood samples, which was used to determine the expression of mTOR.Results:Patients with knee OA with and without obesity did not differ in age. OA develops at an earlier age in obese patients, than in non-obese patients (p < 0.001). Patients from 1 group had a high BMI > 30 kg/m2 at the onset of OA. Obese patients had more severe knee OA is significantly more often detected: Kellgren-Lawrence stage III was determined in 10% of obese patients and in 4.35% - without obesity (p < 0.001). Significantly higher values of the WOMAC index pain, stiffness, joint functional failure, and total WOMAC were observed in obese patients (p = 0.006, p = 0.039, p = 0.037, and p = 0.014, respectively). Obese patients had higher VAS pain scores (p < 0.05) compared to patients with a lower BMI. Obese patients had a higher mTOR expression (p < 0.05) of 8.02±8.62, compared to non-obese patients. High mTOR expression was associated with VAS knee pain (r=0.78; p < 0.05) and WOMAC pain (r=0.89; p<0.05) in obese patients (Table 1).Table 1.Correlation of m-TORParametersmTOR (1 group, n=50)mTOR (2 group, n=23)Body weightр > 0,05р > 0,05Pain (VAS)r=0,78; р<0,05p = 0,07; r = 0,45Pain (WOMAC)r=0,89; р<0,05р > 0,05Total WOMACр > 0,05р > 0,05Conclusion:Our study showed that patients with obesity and knee OA have higher rates of mTOR expression, compared to patients with normal body weight. High mTOR expression correlates with the severity of knee pain in obese patients. Thus, the evaluation of mTOR expression in obese patients and knee OA plays an important role in predicting the severity of clinical manifestations of OA, and may influence the choice of personalized therapy tactics for such patients.Disclosure of Interests:None declared

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Comments on the updated recommendations of the American College of Rheumatology (ACR) for the treatment of gout. Lifestyle (part 2)

Modern Rheumatology Journal ◽

10.14412/1996-7012-2021-2-83-88 ◽

2021 ◽

Vol 15 (2) ◽

pp. 83-88

Author(s):

M. S. Eliseev

Keyword(s):

Body Weight ◽

Food Habits ◽

The Other ◽

Obese Patients ◽

American College Of Rheumatology ◽

The Russian Federation ◽

The One ◽

Effective Drugs ◽

First Time

Updated ACR recommendations for the treatment of gout concerning lifestyle are discussed. Factors related to a lifestyle, above all food habits, for many years were of leading importance in the treatment of patients with gout, even after application of effective drugs. The authors of the updated ACR recommendations for the first time offered to reconsider the role of environmental factors in the genesis of gout and objectively assess the possibility of its non-drug treatment. On the one hand, regardless of the activity of the disease, the need for restrictions of the alcohol, purine-rich products and fructose-containing beverages, as well as the decrease of body weight in obese patients and vitamin C usage unviability are confirmed. On the other hand, these recommendations are conditional. Their new version of ACR recommendations is significantly different from both its previous version and other international and national recommendations, including recommendations on the diagnosis and treatment of gout used in the Russian Federation.

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Adjusted versus actual body weight dosing of 4-factor prothrombin complex concentrate in obese patients with warfarin-associated major bleeding

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-018-1771-6 ◽

2018 ◽

Vol 47 (3) ◽

pp. 369-374 ◽

Cited By ~ 7

Author(s):

Keaton S. Smetana ◽

Rachel Ziemba ◽

Casey C. May ◽

Michael J. Erdman ◽

Edward T. Van Matre ◽

...

Keyword(s):

Body Weight ◽

Actual Body ◽

Major Bleeding ◽

Prothrombin Complex Concentrate ◽

Obese Patients ◽

Actual Body Weight

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Distribution volume, metabolic clearance and plasma half disappearance time of exogenous luteinizing hormone releasing hormone in normal women and women with obesity and anorexia nervosa

Acta Endocrinologica ◽

10.1530/acta.0.0960001 ◽

1981 ◽

Vol 96 (1) ◽

pp. 1-6 ◽

Cited By ~ 13

Author(s):

Kazumasa Chikamori ◽

Fumie Suehiro ◽

Toshiki Ogawa ◽

Kei Sato ◽

Hiroyoshi Mori ◽

...

Keyword(s):

Body Weight ◽

Anorexia Nervosa ◽

Normal Subjects ◽

Distribution Volume ◽

Metabolic Clearance ◽

Obese Patients ◽

Metabolic Clearance Rate ◽

Provocation Tests ◽

Disappearance Time ◽

Normal Women

Abstract. Synthetic LRH was infused into normal women and women with obesity and anorexia nervosa to determine the distribution volume (DV), metabolic clearance rate (MCR) and half disappearance time (t½) of plasma LRH. In normal women, the DV of LRH was 12.1 ± 0.9 (mean ± se) l, the MCR was 1478.9 ± 39.8 ml/min (28.5 ± 1.2 ml/min/kg body weight) and the initial t½ was 5.6 ± 0.4 min. In obese patients the DV (20.6 ± 1.5 l) was significantly higher than that in normal subjects (P < 0.005), but the MCR and t½ were not significantly different from those in normal subjects. In patients with anorexia nervosa the DV and MCR were 6.5 ± 1.1 l and 621.8 ± 110.5 ml/min (17.9 ± 2.4 ml/ min/kg body weight), respectively, which were both significantly lower than those in normal subjects (P < 0.02), while the t½ (7.3 ± 0.1 min) was longer than in normal subjects (P < 0.02). These data suggest that 1) the abnormal responses of some hormones to provocation tests observed in obese patients and patients with anorexia nervosa should be evaluated in consideration of changes in the DV and metabolic clearance of hormones in these conditions, and 2) in patients with anorexia nervosa changes in MCR and t½ may reflect low metabolism of LRH.

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