Association of Combined TCF7L2 and KCNQ1 Gene Polymorphisms with Diabetic Micro- and Macrovascular Complications in Type 2 Diabetes Mellitus

Background@#Vascular complications are the major morbid consequences of type 2 diabetes mellitus (T2DM). The transcription factor 7-like 2 (TCF7L2), potassium voltage-gated channel subfamily Q member 1 (KCNQ1), and inwardly-rectifying potassium channel, subfamily J, member 11 gene (KCNJ11) are common T2DM susceptibility genes in various populations. However, the associations between polymorphisms in these genes and diabetic complications are controversial. This study aimed to investigate the effects of combined gene-polymorphisms within TCF7L2, KCNQ1, and KCNJ11 on vascular complications in Thai subjects with T2DM. @*Methods@#We conducted a case-control study comprising 960 T2DM patients and 740 non-diabetes controls. Single nucleotide polymorphisms in TCF7L2, KCNQ1, and KCNJ11 were genotyped and evaluated for their association with diabetic vascular complications. @*Results@#The gene variants TCF7L2 rs290487-T, KCNQ1 rs2237892-C, and KCNQ1 rs2237897-C were associated with increased risk of T2DM. TCF7L2 rs7903146-C, TCF7L2 rs290487-C, KCNQ1 rs2237892-T, and KCNQ1 rs2237897-T revealed an association with hypertension. The specific combination of risk-alleles that have effects on T2DM and hypertension, TCF7L2 rs7903146-C, KCNQ1 rs2237892-C, and KCNQ1 rs2237897-T, as genetic risk score (GRS), pronounced significant association with coronary artery disease (CAD), cumulative nephropathy and CAD, and cumulative microvascular and macrovascular complications (respective odds ratios [ORs] with 95% confidence interval [95% CI], comparing between GRS 2–3 and GRS 5–6, were 7.31 [2.03 to 26.35], 3.92 [1.75 to 8.76], and 2.33 [1.13 to 4.79]). @*Conclusion@#This study demonstrated, for the first time, the effect conferred by specific combined genetic variants in TCF7L2 and KCNQ1 on diabetic vascular complications, predominantly with nephropathy and CAD. Such a specific pattern of gene variant combination may implicate in the progression of T2DM and life-threatening vascular complications.

Association of Combined TCF7L2 and KCNQ1 Gene Polymorphisms with Diabetic Micro- and Macrovascular Complications in Type 2 Diabetes Mellitus

Background@#Vascular complications are the major morbid consequences of type 2 diabetes mellitus (T2DM). The transcription factor 7-like 2 (TCF7L2), potassium voltage-gated channel subfamily Q member 1 (KCNQ1), and inwardly-rectifying potassium channel, subfamily J, member 11 gene (KCNJ11) are common T2DM susceptibility genes in various populations. However, the associations between polymorphisms in these genes and diabetic complications are controversial. This study aimed to investigate the effects of combined gene-polymorphisms within TCF7L2, KCNQ1, and KCNJ11 on vascular complications in Thai subjects with T2DM. @*Methods@#We conducted a case-control study comprising 960 T2DM patients and 740 non-diabetes controls. Single nucleotide polymorphisms in TCF7L2, KCNQ1, and KCNJ11 were genotyped and evaluated for their association with diabetic vascular complications. @*Results@#The gene variants TCF7L2 rs290487-T, KCNQ1 rs2237892-C, and KCNQ1 rs2237897-C were associated with increased risk of T2DM. TCF7L2 rs7903146-C, TCF7L2 rs290487-C, KCNQ1 rs2237892-T, and KCNQ1 rs2237897-T revealed an association with hypertension. The specific combination of risk-alleles that have effects on T2DM and hypertension, TCF7L2 rs7903146-C, KCNQ1 rs2237892-C, and KCNQ1 rs2237897-T, as genetic risk score (GRS), pronounced significant association with coronary artery disease (CAD), cumulative nephropathy and CAD, and cumulative microvascular and macrovascular complications (respective odds ratios [ORs] with 95% confidence interval [95% CI], comparing between GRS 2–3 and GRS 5–6, were 7.31 [2.03 to 26.35], 3.92 [1.75 to 8.76], and 2.33 [1.13 to 4.79]). @*Conclusion@#This study demonstrated, for the first time, the effect conferred by specific combined genetic variants in TCF7L2 and KCNQ1 on diabetic vascular complications, predominantly with nephropathy and CAD. Such a specific pattern of gene variant combination may implicate in the progression of T2DM and life-threatening vascular complications.

Concurrence of myasthenia gravis and thyroid disorders: A retrospective database study / Journal of the ASEAN Federation of Endocrine Societies

@#<p style="text-align: justify;"><strong>INTRODUCTION</strong><strong>:</strong> Both myasthenia gravis (MG) and autoimmune thyroid diseases (AITDs) are autoimmune diseases. Graves'disease (GD) is the most common AITD reported to be associated with MG. Currently, there is limited data on prevalence and clinical features/outcomes of MG in various thyroid diseases in a large database report.</p><p style="text-align: justify;"><strong>METHODOLOGY:</strong> A total of 872 patients with MG and 97,251 patients with thyroid disorders had been recorded by the tertiary hospital database. The study period was between 1997 and 2017. Patients with a thyroid disorder and MG were identified by the ICD-10-CM code. Clinical courses of MG accompanied by thyroid disorders were studied.</p><p style="text-align: justify;"><strong>RESULTS:</strong> During the 20-year study period, there were 872 patients with MG and 97,251 patients with thyroid disorders. In the group with thyroid disorders, 28,886 patients (29.70%) had GD, 1,612 patients (1.66%) had Hashimoto's thyroiditis, 13,172 patients (13.54%) had toxic goiter and 53,581 patients (55.10%) had nontoxic goiter. 97 patients had been diagnosed with both MG and thyroid disorders. Among the four types of thyroid disorders, the rate of MG was highest in HT group (9.92/1,000 HT patients). There were four significant factors among four groups of thyroid disorders including age of onset of thyroid disease (p 0.004), MG classification (ppp 0.034). Among the four groups of thyroid disorders, patients with MG and HT were diagnosed with thyroid disease at the youngest age (27 years) compared with other thyroid diseases. Additionally, the MG patients with HT also had the highest proportion of MG class 4-5 a/b (7 patients, 43.75%), received prednisolone treatment (15 patients, 93.75%), received immunosuppressants (9 patients, 56.25%), received IVIG or PLEX (5 patients, 31.30%), and had thymoma (6 patients, 46.15%).</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> MG is most prevalent in patients with HT. Patients with both MG and HT had more severe MG status and had higher rate of thymoma.</p>

Who should be checked for hepatitis C virus infection in endemic areas?

OBJECTIVE@#To find additional factors suggestive of hepatitis C virus (HCV) infection in the general population by using data from a hepatitis virus survey.@*METHODS@#This study collected data of HCV infection from a hepatitis virus survey. The survey was conducted in 13 provinces in the northeast Thailand in 2014 and 2015. During the survey, a blood test was performed to screen for HCV. A questionnaire was also distributed to all participants asking about baseline characteristics, risk factors for HCV infection, and daily life activities. Risk factors for HCV infection were executed.@*RESULTS@#There were 2112 participants for the survey. Of those, 110 participants (5.21%) tested positive for HCV infection. After adjustment by multivariate logistic regression, three factors were significantly associated with HCV infection, namely male gender, age, and family history of liver cancer. The adjusted ORs and 95% CI of these factors were 3.14 (1.50, 6.56), 3.78 (1.12, 12.76), and 2.28 (1.08, 4.80), respectively.@*CONCLUSIONS@#Male gender, increasing age, and family history of liver cancer are predictors of HCV infection in endemic areas. Males with a family history of liver cancer in their first-degree relatives should be tested for HCV infection regardless of symptoms.

Thrombolysis in ischaemic stroke in rural North East Thailand by neurologist and non-neurologists

Background & Objective: Acute ischemic stroke (AIS) has been shown to be effectively treated with thrombolytic therapy. Thailand and other developing countries have limited stroke specialists to prescribe this treatment. Data regarding stroke outcomes in AIS patients who received thrombolytic therapy prescribed by neurologists compared with non-neurologists are limited. Methods: This was a large, multicenter, retrospective study conducted in 9 hospitals across the northeastern part of Thailand. The inclusion criteria were AIS patients who were admitted and treated with thrombolytic therapy between January 2010 and December 2012. Patients were categorized into two groups by physician specialty; neurologist and non-neurologist. Clinical outcomes and in-hospital mortality were compared between the groups. Results: There were 915 AIS patients who participated in the study; 175 patients were treated by the non-neurologists (19.1%). The mean age of all patients was 64 years and 55.1% were men. The median onset to needle time in both groups were similar at 180 minutes. The National Institutes of Health Stroke Scale (NIHSS) at discharge were significantly higher in neurologist group than non-neurologist group (NIHSS 6 vs 3, p value 0.03). The in-hospital mortality was also higher in neurologist group (9.5% vs 4.0%; p value 0.02). Conclusions: Non-neurologists may be able to thrombolyze AIS patients safely and effectively.

Who should be checked for hepatitis C virus infection in endemic areas?

Objective To find additional factors suggestive of hepatitis C virus (HCV) infection in the general population by using data from a hepatitis virus survey. Methods This study collected data of HCV infection from a hepatitis virus survey. The survey was conducted in 13 provinces in the northeast Thailand in 2014 and 2015. During the survey, a blood test was performed to screen for HCV. A questionnaire was also distributed to all participants asking about baseline characteristics, risk factors for HCV infection, and daily life activities. Risk factors for HCV infection were executed. Results There were 2 112 participants for the survey. Of those, 110 participants (5.21%) tested positive for HCV infection. After adjustment by multivariate logistic regression, three factors were significantly associated with HCV infection, namely male gender, age, and family history of liver cancer. The adjusted ORs and 95% CI of these factors were 3.14 (1.50, 6.56), 3.78 (1.12, 12.76), and 2.28 (1.08, 4.80), respectively. Conclusions Male gender, increasing age, and family history of liver cancer are predictors of HCV infection in endemic areas. Males with a family history of liver cancer in their first-degree relatives should be tested for HCV infection regardless of symptoms.

Seizures at the emergency department in Thailand and risk factors for recurrent seizures

Background: Seizure is a common neurological presenting symptom at the emergency department (ED). Recurrent seizure may result in an overcrowded ED and affect morbidity. Factors associated with recurrent seizure in Thailand or other developing countries are limited. Methods: Clinical features of adult patients who presented with seizure at the ED, Ramathibodi Hospital, Mahidol University, Thailand were retrospectively reviewed. Factors associated with recurrent seizure were identified by multivariate logistic regression analysis. Results: During the study period, there were 65,586 patients who visited the ED. Of those, there were 156 seizure patients who were identified for analysis. The mean (S.D.) age of all patients was 47.44 (19.80) and males accounted for 41.67%. There were 40 patients who had recurrent seizures (25.64%). There were 10 significant factors associated with recurrent seizure at the ED. Of those, seven factors had a positive association with recurrent seizure; the top three factors were seizure attacks >4 times prior to ED visit, age >70 years and cerebral infarction, while the other three factors were negatively associated (history of antiepileptic drugs, brain surgery and alcohol consumption). Conclusions: Recurrent seizure at the ED may be related to seizure history prior to the ED visit, age, cause of seizure, and co-morbid conditions.

Clinical characteristics and treatment outcomes of patients with Brugada syndrome in northeastern Thailand

<p><b>INTRODUCTION</b>Brugada syndrome (BrS) is a common genetic cause of sudden cardiac arrest (SCA) due to polymorphic ventricular tachycardia and ventricular fibrillation. The current recommended therapy for high-risk BrS patients is the use of an implantable cardioverter defibrillator (ICD). The present study aimed to report the clinical characteristics and treatment outcomes of BrS patients in northeastern Thailand.</p><p><b>METHODS</b>Patients who were diagnosed with BrS or had a Brugada electrocardiogram (ECG) between 2005 and 2012 at Khon Kaen University's hospitals were enrolled in the present study. Patients' clinical characteristics, ECG type, laboratory results and treatment were reviewed.</p><p><b>RESULTS</b>A total of 90 eligible patients were enrolled. Of these, 79 (87.8%) patients were symptomatic--65 (82.3%) had documented SCA and 14 (17.7%) had unexplained syncope. The remaining 11 (12.2%) patients were asymptomatic with Brugada ECG. A majority of the patients enrolled were born in northeastern Thailand. The mean age of the symptomatic patients was 44.49 ± 8.55 years. Among the symptomatic patients, a majority were male (n = 77, 97.5%) and 23 (29.1%) patients had a family history of SCA. Almost all BrS patients who were symptomatic (96.2%) received ICD treatment for secondary prevention. The number of patients who received appropriate ICD therapy was 4.2 times of those who received inappropriate shocks. Only 3 (3.8%) symptomatic BrS patients refused ICD treatment.</p><p><b>CONCLUSION</b>Clinical characteristics did not distinguish between symptomatic BrS patients and asymptomatic patients with Brugada ECGs. The clinical characteristics and treatment outcomes for the symptomatic BrS patients with SCA and unexplained syncope were similar. Among the BrS patients implanted with secondary prevention ICD in Northeastern Thailand, nearly one-third had received appropriate ICD therapy, far exceeding the incidence of device-related complications and inappropriate therapy.</p>

Clinical manifestations and outcomes of Guillain Barré syndrome after diphtheria and tetanus vaccine (dT) during a diphtheria outbreak in Thailand: A Case series

Four cases of Guillain-Barré syndrome (GBS) after diphtheria and tetanus vaccine (dT) during diphtheria outbreak in Thailand are reported. Three cases had an age over 60 years, and developed GBS after the second dose of dT vaccine. Two cases received intravenous immunoglobulin and had improvement after treatment. The autoantibodies or anti-ganglioside antibodies are believed to be the possible explanation of GBS associated with vaccination. Data regarding post-dT vaccine GBS are limited in Asian populations particularly on clinical presentation and outcomes.

Clinical Manifestations of Eosinophilic Meningitis Due to Infection with Angiostrongylus cantonensis in Children

Eosinophilic meningitis, caused by the nematode Angiostrongylus cantonensis, is prevalent in northeastern Thailand, most commonly in adults. Data regarding clinical manifestations of this condition in children is limited and may be different those in adults. A chart review was done on 19 eosinophilic meningitis patients aged less than 15 years in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. Clinical manifestations and outcomes were reported using descriptive statistics. All patients had presented with severe headache. Most patients were males, had fever, nausea or vomiting, stiffness of the neck, and a history of snail ingestion. Six patients had papilledema or cranial nerve palsies. It was shown that the clinical manifestations of eosinophilic meningitis due to A. cantonensis in children are different from those in adult patients. Fever, nausea, vomiting, hepatomegaly, neck stiffness, and cranial nerve palsies were all more common in children than in adults.

A Recombinant Matrix Metalloproteinase Protein from Gnathostoma spinigerum for Serodiagnosis of Neurognathostomiasis

Neurognathostomiasis is a severe form of human gnathostomiasis which can lead to disease and death. Diagnosis of neurognathostomiasis is made presumptively by using clinical manifestations. Immunoblotting, which recognizes antigenic components of molecular mass 21 kDa and 24 kDa in larval extracts of Gnathostoma spinigerum (Gs 21/24), has high sensitivity and specificity for diagnosis of neurognathostomiasis. However, only very small amounts of the Gs 21/24 antigens can be prepared from parasites harvested from natural or experimental animals. To overcome this problem, we recently produced a recombinant matrix metalloproteinase (rMMP) protein from G. spinigerum. In this study, we evaluated this rMMP alongside the Gs 21/24 antigens for serodiagnosis of human neurognathostomiasis. We studied sera from 40 patients from Srinagarind Hospital, Khon Kaen University, Thailand, with clinical criteria consistent with those of neurognathostomiasis, and sera from 30 healthy control adults from Thailand. All sera were tested for specific IgG antibodies against both G. spinigerum crude larval extract and rMMP protein using immunoblot analysis. The sensitivity and specificity for both antigenic preparations were all 100%. These results show that G. spinigerum rMMP protein can be used as an alternative diagnostic antigen, in place of larval extract, for serodiagnosis of neurognathostomiasis.

Detection of Gnathostoma spinigerum Antibodies in Sera of Non-Traumatic Subarachnoid Hemorrhage Patients in Thailand

Gnathostoma spinigerum can cause subarachnoid hemorrhage (SAH). The detection of specific antibodies in serum against G. spinigerum antigen is helpful for diagnosis of neurognathostomiasis. There is limited data on the frequency of G. spinigerum infection in non-traumatic SAH. A series of patients diagnosed as non-traumatic SAH at the Srinagarind Hospital, Khon Kaen University, Thailand between January 2011 and January 2013 were studied. CT or MR imaging of the brain was used for diagnosis of SAH. Patients were categorized as aneurysmal subarachnoid hemorrhage (A-SAH) or non-aneurysmal subarachnoid hemorrhage (NA-SAH) according to the results of cerebral angiograms. The presence of specific antibodies in serum against 21- or 24-kDa G. spinigerum antigen was determined using the immunoblot technique. The detection rate of antibodies was compared between the 2 groups. Of the 118 non-traumatic SAH patients for whom cerebral angiogram and immunoblot data were available, 80 (67.8%) patients had A-SAH, whereas 38 (32.2%) had NA-SAH. Overall, 23.7% were positive for specific antibodies against 21- and/or 24-kDa G. spinigerum antigen. No significant differences were found in the positive rate of specific antibodies against G. spinigerum in both groups (P-value=0.350).

Isolated bulbar palsy with anti-GM3 and GT1b antibodies

Isolated acute bulbar palsy has been described as one of the more rare variants of Guillain-Barré syndrome. IgG anti-ganglioside antibodies are associated with axonal subtypes of Guillain-Barré syndrome as well as Fisher syndrome. However, IgG against GM3 and GT1b in relation to bulbar palsy is uncommon. In this case report, we describe a 64 year-old male patient presenting with isolated bulbar weakness and generalized hyporeflexia without limb weakness. Serological testing for antiganglioside antibodies was positive for IgG anti-GM3 and -GT1b, suggesting the association of these antibodies with isolated bulbar palsy.

Is the Thailand epilepsy service adequate to help patients?

Background: Epilepsy is a common disease but to achieve successful seizure control in developing countries is still a challenge. This study aimed to investigate the epilepsy services in Thailand. Methods: This was a survey by questionnaires on epilepsy service sent to 1,033 public hospitals all over Thailand. Results: The response rate was 54.1%. The results show that most of physicians that provide care for persons with epilepsy were General Practitioners (91.5%). Epileptologists and Neurologists accounted for only 11.1% and 14.4%. There were only 52 EEG, 54 CT Scan, and 6 MRI instruments in the entire country of 65 million. Standard antiepileptic drugs (AEDs) were widely available, phenobarbital (99.9%), phenytoin (96.0%), carbamazepine (97.9%), and valproic acid (89%) of institutions. The availability of new AEDs were: gabapentin (77.6%), topiramate (63.9%), levetiracetam (46.0%), lamotrigine (45.3%), pregabalin (33.6%), were also available in 77.6%, 63.9%, 46.0%, 45.3%, 33.6%, vigabatrin (14.5%), and oxcarbazepine (14.3%) of institutions. Intravenous AEDs used for status epilepticus patients include phenytoin (54.2%), phenobarbital (33.9%), and sodium valproate (12.1%). Therapeutic drug monitoring could be done in 45.7% of the responding hospitals. Conclusion: There is limited human and material resources for the care of epilepsy in Thailand. There is a need to develop a model of epilepsy care that is appropriate with the limited resources in the country.

The efficacy of topiramate in status epilepticus, experience from Thailand

Background: Oral topiramate is a broad-spectrum antiepileptic drug. There is limited documented data on its use in refractory convulsive and non-convulsive status epilepticus. Methods: A retrospective study of the clinical characteristics and responses of patients diagnosed as status epilepticus treated with topiramate at the Srinagarind Hospital, Khon Kaen University from 2001-2010. Results: There were 8 patients included in this study, 6 patients were convulsive status epilepticus and 2 patients were non-convulsive status epilepticus. The most common cause was stroke seen in 4 patients. Oral topiramate successfully controlled status epilepticus in 7 out of 8 patients with no serious adverse events. Of these 7 patients, status epilepticus was controlled after initial loading and re-loading of oral topiramate in 3 and 4 patients, respectively. In two patients with hepatitis, oral topiramate was successful after failure with benzodiazepine. The initial loading dose of topiramate in most cases was 400 mg with a maintenance dose of 100 mg/day. Conclusion: Oral topiramate has the potential to treat both convulsive and non-convulsive status epilepticus after failing the fi rst antiepileptic drug. Further study with larger number of patients is needed to confi rm this.

Health related behaviors survey of the medical organization, Srinagarind hospital, Faculty of Medicine, Khon Kaen University

Background: Physicians and dentists are the health personnel that need high investment and long production process. The life expectancy of medical doctors was varied between 61.1 and 86.5 years old and dentists was varied between 51.3 and 75.4 years old. Health related behavior might play an important role to health status and life expectancy.  Objective: To study health related behavior of physicians and dentists who are the member of the medical organization, and work at  Srinagarind hospital. Study design: A cross-sectional descriptive  studySetting: Srinagarind hospitalMethod: The physicians and dentists who are the members of the medical organization, and work at Srinagarind hospital were given a self-administrated questionnaire during June 31st- Oct 30th, 2004. The questionnaire had 5 compartments as follows: general information, occupational history, health status data, life style pattern and occupation-related hazards.Result: Two hundred and six  out of 519 numbers (39.7%) Completed the questionaires. The male: female ratio was nearly 1:1. The mean age of responder was 38.1 + 8.6 years old.  Sixty  five percent were highly pleased with their own occupation. The mean monthly income of physicians was 72,483.00 baht (median 30,000 Baht). The average working hour was 42.5 + 24.8 hours per week. Most of the cases slept 6-8 hours per day. The four most common diseases were allergy (19.6%), hypertension (5.4%), heart disease (1.6%) and Diabetes Millitus(1.1%), respectively. 8.2% of the respondents  noticed history of doze during driving while 7.1% experienced traffic accident. Regarding personal behaviors; 20.0% had history of alcohol drinking, 2.7% presented cigarette smoking and 10.2% had ever played government raffle. Most of the cases (80.6%) took care themselves while having ill. However, only 52.2% of respondents attended annual health check-up program. In addition, half of cases 48.9%  exercised less than 2 days per week. In cases of stress management, 36% watched television, while 30% read  books. Subgroup analysis of 22 dentists revealed that 72.7% of them were highly pleased with their own occupation. The mean monthly income of dentists was 58,500.00 Baht. The average working hour was 34.9 + 5.7  hours per week. Most of the cases slept 6-8 hours per day. The three most common diseases were allergic disease (13.6%), hypertension (4.5%), and diabetes mellitus (4.5%), respectively.  9.1% of the respondents  noticed history of doze during driving while 4.5% experienced traffic accidents. Regarding personal behaviors, 13.6% had history of alcohol drinking, 9.1% presented cigarette smoking. Most of the cases (40.9%) took care themselves in terms of illness. However, 3 in 4 of responders attended annual health check-up program. In addition, one-third of cases (36.4%) exercised less than 2 days per week. In cases of stress management, 40.9% watched television, while 27.3% read  books.   Conclusion:  The physicians and dentists who are the members of the medical organization and work at Srinagarind hospital were highly satisfied with their own profession. The average earning was good. The health statuses were similar to the physicians and the dentists in the other part of Thailand. However, the attitude in health promotion was low. 

Clinical outcome of hypertensive treated at hypertension clinic, Srinagarind hospital

Background: Hypertension clinic, Srinagarind hospital has established since April 2003. Our aims are to teach medical students in taking care of hypertensive patients and give a comprehensive and holistic care for hypertensive. We would like to evaluate patients’ characteristics and outcome of treatment in our clinic that will be baseline data to and improve our service.Objective: To assess clinical outcome of hypertensive treated at hypertension clinic, Srinagarind hospital.Design: Descriptive studySetting: Hypertension clinic, Srinagarind hospital, Khon Kaen, ThailandPopulation: Patients diagnosed as hypertension and treated at hypertension clinic, Srinagarind hospital for at least one year.Sampling: 100 cases by simple random sampling from 200 populationsTool: Record form and out-patient department recordAnalysis: Descriptive statistics and analytical statisticsResults: There were 100 persons enrolled, 62 female. The mean ages were 59 +17.7 and 57.4 + 10.6 years old in female and male, respectively. The average duration after diagnosis as hypertension was 4.5 years. The mean BMI and mean abdominal circumference in male were 27.2 + 0.6 kg/m2 and 94.8 + 0.8 centimeters, respectively. In female group, both variables were 26.3 + 0.9 kg/m2 and 92.9 + 5.6 centimeters, respectively.  The three most common anti-hypertensive drug uses were ACEI (38%), hydrochlorothiazide (35%), and beta blocker (35%). Side effects were found in 18 patients; ACEI induced cough (10%) was the most common one. Good control of hypertension was achieved in 92 patients with one or two medications. Left ventricular hypertrophy was the most common complication in our studied cases, 20 cases. According to International Diabetes Federation (IDF, 2005) criteria, there were 54 cases met metabolic syndrome criteria. Diabetes mellitus or impaired fasting glucose (IFG) was found in 45 cases.  Conclusion: The control rate of hypertensive patients treated at hypertension clinic, Srinagarind hospital was 92% with one or two antihypertensive drugs. Half of cases were associated with metabolic syndrome and/or diabetes mellitus or IFG.Keywords: outcome, hypertension clinic, essential hypertension

Clinical Outcome of Hypertensive Treated at Hypertension Clinic, Srinagarind Hospital

Background: Hypertension clinic, Srinagarind hospital has established since April 2003. Our aims are to teach medical students in taking care of hypertensive patients and give a comprehensive and holistic care for hypertensive. We would like to evaluate patients’ characteristics and outcome of treatment in our clinic that will be baseline data to and improve our service.Objective: To assess clinical outcome of hypertensive treated at hypertension clinic, Srinagarind hospital.Design: Descriptive studySetting: Hypertension clinic, Srinagarind hospital, Khon Kaen, ThailandPopulation: Patients diagnosed as hypertension and treated at hypertension clinic, Srinagarind hospital for at least one year.Sampling: 100 cases by simple random sampling from 200 populationsTool: Record form and out-patient department recordAnalysis: Descriptive statistics and analytical statisticsResults: There were 100 persons enrolled, 62 female. The mean ages were 59 +17.7 and 57.4 + 10.6 years old in female and male, respectively. The average duration after diagnosis as hypertension was 4.5 years. The mean BMI and mean abdominal circumference in male were 27.2 + 0.6 kg/m2 and 94.8 + 0.8 centimeters, respectively. In female group, both variables were 26.3 + 0.9 kg/m2 and 92.9 + 5.6 centimeters, respectively.  The three most common anti-hypertensive drug uses were ACEI (38%), hydrochlorothiazide (35%), and beta blocker (35%). Side effects were found in 18 patients; ACEI induced cough (10%) was the most common one. Good control of hypertension was achieved in 92 patients with one or two medications. Left ventricular hypertrophy was the most common complication in our studied cases, 20 cases. According to International Diabetes Federation (IDF, 2005) criteria, there were 54 cases met metabolic syndrome criteria. Diabetes mellitus or impaired fasting glucose (IFG) was found in 45 cases. Conclusion: The control rate of hypertensive patients treated at hypertension clinic, Srinagarind hospital was 92% with one or two antihypertensive drugs. Half of cases were associated with metabolic syndrome and/or diabetes mellitus or IFG.Keywords: outcome, hypertension clinic, essential hypertension 

Undergraduate students’ knowledge and understand of occupational medicine at Khon Kaen University

Background: Occupational medicine and occupational health were taught in 20 hours through out our whole 6 years curriculum. From a survey done in the year 2001, our 6th year medical students had low confidence when diagnosing occupational diseases. Since the year 2002, a teaching session at a factory setting was added for the 5th year medical students.Objective: To assess the knowledge and understanding of occupational medicine among 6th medical school students in the year 2004.Study design: Descriptive studyMethod: The 6th year medical students were given a self-administrated questionnaire. The data collected were general information and specific knowledge and understanding about occupational medicine.Result: There was 62% response rate. 86% of the respondents understood the role of doctor toward occupational medicine at an average level. 63% were not confident about the diagnosis of occupational disease. 70% emphasized on history taking for the diagnosis of occupational disease. 52% do not know the correct funding source for the workers’ compensation however they knew better than the study done in 2002. 84% knew that doctors were required to write a sick leave certificate only. 53% of the students knew the correct procedure for writing a medical opinion for the claim form. Nevertheless, some thought that doctor should evaluate the workplace as well. In addition the students are aware of the occupational health and safety principles while working at hospitals.Conclusion: When compare with the previous study, our students’ understanding about the doctors’ role in occupational medicine remain the same as compared with the earlier study. However, the student had more ability to emphasize on the history taking for the diagnosis.