Diabetes mellitus in the young in Srinagarind Hospital.

We studies 151 case of diabetes in the young (age at first visit < or = 35 yrs) from January 1982 to June 1990. We classified the 151 cases into non-insulin dependent diabetes mellitus (NIDDM) (38.4%), malnutrition-related diabetes mellitus (MRDM) (36.4%), insulin-dependent diabetes mellitus (IDDM) (9.9%), secondary diabetes mellitus (2.6%) and unclassified category (12.6%). MRDM can be further classified into 2 groups: 22.5 per cent were fibrocalculous pancreatic diabetes (FCPD) and 13.9 per cent were protein deficient pancreatic diabetes (PDPD). Abdominal roentgenography were performed in 103 cases (68.2%) and pancreatic calcification were found in 34/103 (33%). Farming occupation (p = 0.001), abdominal pain (p = 0.005), male sex (p = 0.0015) and cataracts (p = 0.02) were statistically more common in MRDM comparing to NIDDM and IDDM taken together. There were no statistically significant differences in history of alcohol consumption and raw cassava intake between both groups. Family history of diabetes mellitus were more common in NIDDM comparing to IDDM and MRDM.

A prevalence survey of lipids abnormalities of rural area in Amphoe Phon, Khon Kaen.

A population survey in 13 villages and 3 sub-districts of a rural area in Amphoe Phon, Khon Kaen showed that mean cholesterol and high density lipoprotein cholesterol (HDL-C) level were 163.0 +/- 35.3 and 29.6 +/- 9.1 mg/dl respectively which is very low compared to Bangkok and other affluent countries. The cholesterol level in females was higher than in males (male 158.0 +/- 33.2, female 166.6 +/- 36.4) and the HDL-C level in males was higher (30.2 +/- 9.0 vs 29.1 +/- 9.2). The cholesterol level increased with age and obesity while HDL-C decreased with obesity. The prevalence of hypercholesterolemia and low HDL-C was 3.0 and 74.9 per cent respectively. The diet of the survey population was high in carbohydrate (80% of calories) and fat intake was very low (8% of calories). The factors which were associated with high cholesterol levels were age, female sex, obesity and increased fat intake while those of low HDL-C were obesity and being a farmer. The low fat intake may explain for the low total cholesterol, HDL-C HDL-C/cholesterol ratio observed in our population compared to other studies.

An analytic cross sectional study of anemia in rural area, Amphoe Phon, Khon Kaen.

Anemia is a major public health problem in Thailand with the estimate prevalence of 25 per cent. The last survey of the prevalence of anemia was done in 1979, so we performed another survey to observe the trend of change in prevalence of anemia in Khon Kaen. We conducted a community survey by multistage random sampling. In a population aged 30-65 years in 13 villages in Amphoe Phon. The mean hematocrit level was 40.1 +/- 5.1 per cent (42.8 +/- 4.6% in males, 38.1 +/- 4.5% in females). The prevalence of anemia (Hct < 39% in males, < 36% in females) was 22.2 per cent (16.4% in males, 26.4% in females). The mean level of hematocrit of patients admitted for elective surgery in Srinagarind Hospital was 38.6 +/- 5.5 per cent which was significantly lower than in the rural area (P < 0.001) and the prevalence of anemia was 25.9 per cent. The prevalence of anemia increased with age and decreased with high education and body mass index. Comparing to the data in 1979, the prevalence in males increased from 13.9 to 16.4 per cent and from 23.3 to 26.4 per cent in females. The prevalence of anemia in Khon Kaen is still high and has increased compared to the data in 1979, and thus, remains a major public health problem.

Vascular complications in noninsulin dependent diabetes mellitus (NIDDM) in Srinagarind Hospital, Khon Kaen.

We prospectively conducted a hospital based study to determine the prevalence of vascular complications in NIDDM and their risk factors. Using standard protocol for interviewing, physical examination and laboratory investigations, we studied 207 patients from the diabetic clinic and medical outpatient department (ratio 3.9:1) by systematic sampling. The prevalence of hypertension, coronary heart disease cerebrovascular disease, peripheral and large vessel disease was 22.2, 22.2, 8.2, 21.3 and 34.8 per cent respectively. We found that the prevalence of small vessel disease, retinopathy and nephropathy was 34.3, 25.1 and 12.5 per cent respectively. The complications were slightly higher in females and increased with duration of diabetes. By univariate and logistic regression analysis, we found that the risk factors of large vessel disease were body mass index, diastolic blood pressure, duration of diabetes and for small vessel disease were duration of diabetes and high uric acid.

Abnormal glucose tolerance and blood pressure in Khon Kaen.

To quantify the association of abnormal glucose tolerance with hypertension, a population based study was carried out in subjects aged 30-65 years with oral glucose tolerance and blood pressure measurement compared with clinic based known diabetics. In males, subjects with diabetes (newly diagnosed and clinic based) had increased systolic and diastolic blood pressure with clinical significance compared to normal. The diastolic blood pressure in diabetic males was higher than normal but was not different from IGT. In females, the differences were observed between normal vs IGT, and diabetes. The differences were independent of age and obesity. The prevalence of hypertension also increased in diabetic patients, especially for systolic hypertension.

A study of unit cost of routine investigations in Srinagarind Hospital.

We have used the step up allocation accounting method to determine the actual costs of complete blood count, urinalysis, chest radiograph and electrocardiogram. We found that the actual costs were quite different from the price set up by the hospital. The actual cost were much higher than the price for the complete blood count and urinalysis and much lower for the chest radiographs and especially for electrocardiogram. We propose that in performing economic analysis involving all these investigations, the actual cost should be used instead of the price.

The prevalence and risk factors of hypertension in population aged 30-65 years in rural area, Amphoe Phon, Khon Kaen.

The prevalence of hypertension in a population aged 30-65 years in a rural area in Amphoe Phon, Khon Kaen was 18 per thousand (22 per thousand in males and 16 per thousand in females). The prevalence of isolated systolic hypertension was 5 per thousand (10 per thousand in males and 2 per thousand in females). The risk factors of blood pressure elevation were age, body mass index, level of development of village and non farmer occupation.

The impact of routine preoperative chest X-ray in Srinagarind Hospital, Khon Kaen.

We conducted a prospective study of 1,013 consecutive patients who were scheduled for elective surgery in Srinagarind Hospital to determine the prevalence of abnormal chest X-rays and the change in management. Chest X-ray abnormalities were detected in 19.4 per cent (181/933) and lead to management change in 3.6 per cent (34/933). Fifty out of 933 had tuberculosis like lesions and 59 had cardiomegaly. By using Mantel-Haenzel chi-square and logistic regression, age greater than or equal to 45 years old was the most important predictors of the abnormalities found. Other predictors were cough and productive sputum. There was no statistical difference of the intraoperative and postoperative complications among the patients aged less than 45 years who had normal and abnormal chest X-rays. A preoperative chest X-ray may be useful as a routine evaluation only in those aged greater than or equal to 45 years.

Movement disorder in hypothyroidism: a case report.

A case of primary hypothyroidism with hemichoreoathetoid movement was presented. After thyroid hormone replacement therapy for a few weeks, the movement disorder decreased dramatically. This abnormal movement may be one of the neurological manifestations of hypothyroidism.