scholarly journals Coccydynia – could age, trauma and body mass index be independent prognostic factors for outcomes of intervention?

2018 ◽  
Vol 100 (1) ◽  
pp. 12-15 ◽  
Author(s):  
P Kodumuri ◽  
S Raghuvanshi ◽  
R Bommireddy ◽  
Z Klezl

Introduction The aetiology of coccydynia can be multifactorial, with several associated factors such as obesity, female gender and low mood. The long-term results of operative interventions, such as manipulation under anaesthesia and coccygectomy are variable, ranging from 63–90%. Materials and methods Our aim was to identify whether age, trauma and body mass index (BMI) were independent prognostic factors in coccydynia treatment. All patients who presented to the Royal Derby Hospital with a primary diagnosis of coccydynia between January 2011 and January 2015 who had injections, manipulation under anaesthesia or coccygectomy were included. We used patient-reported satisfaction score as the primary outcome measure. We hypothesised that patients with preceding history of trauma and with high BMI (> 25) would be less satisfied. We divided patient BMI into four groups, following World Health Organization guidelines: group A (18.5–24.9), group B (25–29.9), group C (30–39.9) and group D (> 40). Results A total of 748 patients were diagnosed with coccydynia. Of these, 201 patients had 381 injections, 40 had 98 manipulations under anaesthesia and 9 had coccygectomy. Mean age was 46.4 years; 26% of patients had trauma to the coccyx. The mean time to follow-up was 7.3 months. We found a statistically significant difference (P = 0.03) between satisfaction scores in groups B and D. Patients who had trauma improved significantly (P = 0.04). The odds ratio calculation of coccygectomy and BMI revealed a higher risk of coccygectomy in Group A. Discussion This is the first study to establish BMI and trauma as independent prognostic factors for coccydynia treatment. Our hypothesis that patients with higher BMI would have lower satisfaction levels has been proven true.

2019 ◽  
Vol 70 (10) ◽  
pp. 2168-2177
Author(s):  
Ellen Moseholm ◽  
Marie Helleberg ◽  
Håkon Sandholdt ◽  
Terese L Katzenstein ◽  
Merete Storgaard ◽  
...  

Abstract Background Exposures to human immunodeficiency (HIV) and antiretroviral therapy in utero may have adverse effects on infant growth. Among children born in Denmark and aged 0–5 years, we aimed to compare anthropometric outcomes in HIV-exposed but uninfected (HEU) children with those in children not exposed to HIV. Methods In a nationwide register-based study we included all singleton HEU children born in Denmark in 2000–2016. HEU children were individually matched by child sex, parity, and maternal place of birth to 5 singleton controls born to mothers without HIV. Weight-for-age z (WAZ) scores, length-for-age z (LAZ) scores, and weight-for-length or body mass index–for–age z scores were generated according to the World Health Organization standards and the Fenton growth chart for premature infants. Differences in mean z scores were analyzed using linear mixed models, both univariate and adjusted for social and maternal factors. Results In total, 485 HEU children and 2495 HIV-unexposed controls were included. Compared with controls, HEU children were smaller at birth, with an adjusted difference in mean WAZ and LAZ scores of −0.29 (95% confidence interval [CI], −.46 to −.12) and −0.51 (95% CI, −.71 to −.31), respectively (both P ≤ .001). Over time, there was a trend toward increasing WAZ and LAZ scores in HEU children, and there was no significant difference in adjusted WAZ scores after age 14 days (−0.13 [95% CI, −.27 to .01]; P = .07) and LAZ scores after age 6 months (−0.15 [95% CI, −.32 to .02]; P = .08). Conclusion Compared with a matched control group, HEU children were smaller at birth, but this difference decreased with time and is not considered to have a negative effect on the health and well-being of HEU children during early childhood.


Author(s):  
Karim G. Sabeh ◽  
Victor H. Hernandez ◽  
Wayne B. Cohen-Levy ◽  
Alvin Ong ◽  
Fabio Orozco ◽  
...  

AbstractA common patient concern after total knee arthroplasty (TKA) is the ability to kneel. Kneeling may have a substantial impact on the patients' ability to perform many activities of daily living, occupations, and hobbies. The purpose of this study was to quantify the percentage of patients able to kneel after TKA after 2 years and to evaluate preoperative patient characteristics that influence the patient's perceived ability to kneel after TKA such as obesity, occupation, and hobbies. We retrospectively assessed a cohort of 404 patients who underwent primary TKA with patellar resurfacing. We assessed the impact of patient hobbies, occupation, employment status, and body mass index (BMI) on the kneeling capacity and patient-reported satisfaction. Univariate analysis was performed using Fisher's exact test, and multivariate analysis was performed using logistic regression with multiple imputations. A total of 404 patients were included. Sixty percent of patients were unable to kneel after TKA. Males (p < 0.001) and patients with occupations or hobbies requiring kneeling (p < 0.05) were more likely to kneel after surgery. We identified an inverse relationship between BMI and the ability to kneel. No correlation was found between duration and frequency of kneeling relative to patient-reported ease or difficulty with kneeling. Patient-reported factors that prevented patients from kneeling were pain, physical inability, and fear of damaging the prosthesis. Patient education may be helpful in improving patient expectations about kneeling after surgery. A small but significant difference in subjective patient satisfaction was observed when comparing patients able to kneel with those unable to kneel.


2019 ◽  
Author(s):  
Rudy Londile Mathebula ◽  
Eric Maimela ◽  
Thembelihle Samuel Ntuli

Abstract Background: The rates of non-communicable diseases (NCD’s) appear to be increasing in HIV infected people as compared to non-HIV infected people and this will have major implications for clinical care. The aim of the current study was to profile selected cardiovascular disease risk factors among HIV patients on ART in Bushbuckridge sub-district. Methodology: The current study followed a quantitative cross-sectional study design using a questionnaire which was adapted from World Health Organization STEPwise approach to Surveillance (WHO STEPS). Participants were HIV infected people on ART and data was entered into a computer software Microsoft excel, then imported to Stata 12 for analysis. Results: The overall prevalence of overweight at the initiation of ART amongst the participants was 18.1% and obesity was 11.5% as compared to the time of the study which was 21.4% overweight and 19.6% obese. The average time of ART initiation to study period was 3.6 years. The study findings revealed a significant difference (p-value 0.006) between the baseline and current body mass index at time of study for females. Hypertension was found to be having a significant difference (p-value 0.026 and 0.038) between the baseline and current body mass index at time of study for males and females respectively. The overall prevalence of hypertension was found to be 34.6%, overweight was 21.4% obesity was 19.6%. The overall prevalence of abnormal waist circumference was 31.9% and females had a higher prevalence of 42.5% as compared to 4.4% of males. The overall prevalence of smoking 10.8% and alcohol consumption was 21.7%. Males were 22.5 times more likely to be smokers than females (p<0.001) and older people were found to be 0.3 times less likely to consume alcohol as compared to young people. Conclusion: The high levels of selected risk factors for NCDs among adults on ART in the current study area suggest an urgent need for health interventions to control risk factors in an era of HIV with an aim of reducing multiple morbidity of chronic diseases. occurrence of NCDs and their risk factors with an aim to achieve positive effects of the long-term anti-retroviral therapy (ART).


2020 ◽  
Author(s):  
Rudy Londile Mathebula ◽  
Eric Maimela ◽  
Thembelihle Samuel Ntuli

Abstract Background: The rates of non-communicable diseases (NCD’s) appear to be increasing in human immunodeficiency virus (HIV) infected people as compared to non-HIV infected people and this will have major implications for clinical care. The aim of the current study was to profile selected cardiovascular disease risk factors among HIV patients on anti-retroviral therapy (ART) in Bushbuckridge sub-district. Methodology: The current study followed a quantitative cross-sectional study design using a questionnaire which was adapted from World Health Organization STEPwise approach to Surveillance (WHO STEPS). Participants were HIV infected people on ART and data was entered into a computer software Microsoft excel, then imported to Stata 12 for analysis. Results: The overall prevalence of overweight at the initiation of ART amongst the participants was 18.1% and obesity was 11.5% as compared to the time of the study which was 21.4% overweight and 19.6% obese. The average time of ART initiation to study period was 3.6 years. The study findings revealed a significant difference (p-value 0.006) between the baseline and current body mass index at time of study for females. Hypertension was found to be having a significant difference (p-value 0.026 and 0.038) between the baseline and current body mass index at time of study for males and females respectively. The overall prevalence of hypertension was found to be 34.6%, overweight was 21.4% obesity was 19.6%. The overall prevalence of abnormal waist circumference was 31.9% and females had a higher prevalence of 42.5% as compared to 4.4% of males. The overall prevalence of smoking 10.8% and alcohol consumption was 21.7%. Males were 22.5 times more likely to be smokers than females (p<0.001) and older people were found to be 0.3 times less likely to consume alcohol as compared to young people. Conclusion: High levels of selected risk factors for NCDs among adults on ART in the current study area suggest an urgent need for health interventions to control risk factors in an era of HIV with an aim of reducing multiple morbidity of chronic diseases. occurrence of NCDs and their risk factors with an aim to achieve positive effects of the long-term ART.


Author(s):  
S shanthi ◽  
. Shambhavi

Introduction: Nutritional issues are typically encountered throughout the treatment of cancer. Cancer cachexia is usually recognised as not only reduced bodily function and quality of life, but also poor positive outcome in patients. Naturally, Body Mass Index (BMI) is frequently used for determining nutritional status of a patient. Intervening nutritional problems of the patient leads to better prognosis. It is necessary to identify patients at-risk earlier and provide effective nutritional interventions. Aim: To determine the level of BMI and evaluate the effect of nutritional therapy on BMI and find its association with demographic characteristics. Materials and Methods: This was a quasi-experimental interventional trial conducted among 100 patients admitted in the hospital with a diagnosis of head, neck and breast cancers. Parameters assessed were baseline proforma, weight and height which were measured and BMI was calculated (BMI=kg/m2 in which kg is a individuals weight in kilograms and m2 is their height in meters squared) and classified as per World Health Organisation (WHO) guidelines. Results: Before nutritional intervention 20% and 26% of patients were underweight in the experimental and control group respectively, whereas after 21 days 18% in experimental and 32% in control were underweight. Z score for post-test level of BMI in the experimental and control group were 2.125 and 2.34, respectively is greater than the tabulated value (Z=1.96 at p-value=0.05 level of significance), hence there was a significant difference between post-test level of BMI in the experimental and control group. High protein high caloric whole food was significant. Conclusion: Investigators concluded from the present study that nutrition therapy can help to maintain or improve the nutritional status among patients on cancer treatment.


2020 ◽  
Vol 33 ◽  
Author(s):  
Lucas Simões Arrebola ◽  
Rogério Teixeira de Carvalho ◽  
Vitória Cristina de Oliveira Lima ◽  
Karen Alexandra Neregato Percivale ◽  
Vanessa Gonçalves Coutinho de Oliveira ◽  
...  

Abstract Introduction: Patellofemoral Pain Syndrome is characterized by retro-patellar and peripatellar pain during squatting, kneeling and running whose intensity can be related to Body Mass Index (BMI). Objective: To evaluate the relationship between overweight, pain and function in women with Patellofemoral Pain Syndrome (PFPS). Method: Cross-sectional observational study of fifty-four women with PFPS assessed in the period between January and December 2015, in the physiotherapy outpatient clinic of a tertiary hospital in the city of São Paulo. To verify the variables of pain at rest, at effort and function, the Numerical Pain Rating Scale (NPRS) and the Kujala Anterior Knee Pain Scale (AKPS) were used. The participants were divided into two groups, according to the BMI categories defined by the World Health Organization (WHO): Group 1, composed of women with normal BMI (18-24.9 kg/m²), with 36 patients, and group 2 composed of overweight women (25-29.9 k/m²), with 18 patients. Comparison between groups of pain at rest and effort and AKPS were performed using Student's t-test and Mann-Witney with statistical significance p < 0,05. Results: There was no statistically significant difference between groups for the pain at rest and effort and for AKPS. Conclusion: BMI does not impact pain intensity and function in women with PFPS.


2013 ◽  
Vol 2 (2) ◽  
pp. 16 ◽  
Author(s):  
Shalom Nwodo Chinedu ◽  
Olubanke O. Ogunlana ◽  
Dominic E. Azuh ◽  
Emeka E.J. Iweala ◽  
Israel S. Afolabi ◽  
...  

<em>Background</em>. Anthropometric measures have been widely used for body weight classification in humans. Waist circumference has been advanced as a useful parameter for measuring adiposity. This study evaluated the correlation between body mass index (BMI) and waist circumference and examined their significance as indicators of health status in adults.<br /><em>Design and Methods.</em> The subject included 489 healthy adults from Ota, Nigeria, aged between 20 and 75 years, grouped into early adulthood (20-39 years), middle adulthood (40-59 years) and advanced adulthood (60 years and above). Weight, height and abdominal circumference were measured. BMI was calculated as weight kg/height2 (m2) and World Health Organization cut-offs were used to categorize them into normal, underweight, overweight and obese.<em></em><br /><em>Results</em>. Abnormal weight categories accounted for 60 % of the subjects (underweight 11 %, overweight 31%, and obese 18%). The waist circumference of overweight and obese categories were significantly (P&lt;0.05) higher than the normal weight category. There was no significant difference between waist circumference of underweight and normal subjects. The correlation coefficient values of BMI with waist circumference (r=0.63), body weight (r=0.76) and height (r=-0.31) were significant (P&lt;0.01) for the total subjects.<br /><em>Conclusions</em>. The study indicates that waist circumference can serve as a positive indicator of overweight and obesity in the selected communities; however, it may not be used to determine underweight in adults. Regular BMI and waist circumference screening is recommended as an easy and effective means of assessing body weight and in the prevention of weight related diseases in adults.<br />


Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1901
Author(s):  
Antonios Gounaris ◽  
Rozeta Sokou ◽  
Martha Theodoraki ◽  
Eleni Gounari ◽  
Polytimi Panagiotounakou ◽  
...  

Introduction: The effects of “aggressive” neonatal feeding policies of very preterm neonates (VPN) and the risk of metabolic syndrome later in life remain questionable. We aimed to evaluate the effect of our “aggressive” nutrition policies of VPN during hospitalisation on body mass index (BMI) at ages 2 and 8 years. Materials and Methods: Eighty four VPN, who received “aggressive” nutrition during hospitalisation in an effort to minimise postnatal growth restriction (PGR) (group A), and 62 term neonates, as controls (group B), were enrolled in the study. Group A was further divided in four subgroups depending on the type (A1: fortified expressed breast milk and preterm formula; A2: exclusively preterm formula) and quantity of milk received (A3: maximum feeds 180–210 mL/kg/day; A4: maximum feeds 210 and up to 260 mL/kg/day). BMI was calculated at ages 2 and 8 years and plotted on the centile charts. Results: There was no significant difference in BMI between groups A and B at 2 and 8 years, respectively, in both absolute BMI values and their centile chart distribution. There was no significant difference in BMI at 2 and 8 years either between subgroups A1 and A2 or between subgroups A3 and A4. Conclusions: “Aggressive” and individualised feeding policy for VPN did not affect the BMI and obesity rates at ages of 2 and 8 years in our study population. The type and quantity of milk feeds had no impact on their BMI at school age. Further larger studies are needed to confirm our results.


2020 ◽  
Vol 32 (4) ◽  
pp. 523-532 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Mohamad Bydon ◽  
John Knightly ◽  
Mohammed Ali Alvi ◽  
Anshit Goyal ◽  
...  

OBJECTIVEDischarge to an inpatient rehabilitation facility or another acute-care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to healthcare costs. In this era of changing dynamics of healthcare payment models in which cost overruns are being increasingly shifted to surgeons and hospitals, it is important to better understand outcomes such as discharge disposition. In the current article, the authors sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis who underwent a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes among patients with grade I spondylolisthesis were evaluated. Nonroutine discharge was defined as those who were discharged to a postacute or nonacute-care setting in the same hospital or transferred to another acute-care facility.RESULTSOf the 608 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute-care facility). Compared to patients who were discharged to home, patients who had a nonroutine discharge were more likely to have diabetes (26.3%, n = 15 vs 15.7%, n = 86, p = 0.039); impaired ambulation (26.3%, n = 15 vs 10.2%, n = 56, p < 0.001); higher Oswestry Disability Index at baseline (51 [IQR 42–62.12] vs 46 [IQR 34.4–58], p = 0.014); lower EuroQol-5D scores (0.437 [IQR 0.308–0.708] vs 0.597 [IQR 0.358–0.708], p = 0.010); higher American Society of Anesthesiologists score (3 or 4: 63.2%, n = 36 vs 36.7%, n = 201, p = 0.002); and longer length of stay (4 days [IQR 3–5] vs 2 days [IQR 1–3], p < 0.001); and were more likely to suffer a complication (14%, n = 8 vs 5.6%, n = 31, p = 0.014). On multivariable logistic regression, factors found to be independently associated with higher odds of nonroutine discharge included older age (interquartile OR 9.14, 95% CI 3.79–22.1, p < 0.001), higher body mass index (interquartile OR 2.04, 95% CI 1.31–3.25, p < 0.001), presence of depression (OR 4.28, 95% CI 1.96–9.35, p < 0.001), fusion surgery compared with decompression alone (OR 1.3, 95% CI 1.1–1.6, p < 0.001), and any complication (OR 3.9, 95% CI 1.4–10.9, p < 0.001).CONCLUSIONSIn this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included older age, higher body mass index, presence of depression, and occurrence of any complication.


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