Prevalence of metabolic syndrome and its relationship to weight in the Thai population.

BACKGROUND: Although the prevalence of the metabolic syndrome (MetS) has been well-documented in Western Caucasian populations, there are few studies in non-Caucasian populations. The objectives of the present study were to estimate the prevalence of MetS and to find an optimal BMI cut-off value for defining obesity in the Thai population. MATERIAL AND METHOD: A sample of 307 men and 295 healthy women aged between 20 and 90 years (average age of 45 years) who came for a health check-up clinic in Khon Kaen, a northeast province of Thailand, were studied. The present study was conducted between 2003 and 2004. The modified ATP III criteria were used to estimate the age-and-sex specific prevalence of MetS, in which a BMI of > or = 27 kg/m(2) for men and 25 kg/m(2) for women were used in place of waist circumference. In the Thai population, these BMI cut-offs were equivalent to a percent body fat of 25% and 35% in men and women respectively. RESULTS: The overall prevalence of MetS was 15%, with no significant differences between men (15.3%) and women (14.6%). In men, the prevalence increased from 9.5% among the 20-39 age group to 24.7% among the 50+ age groups. In women, the respective prevalence was 7% and 29.5%. When BMI was removed from the classification ofMetS, the overall prevalence of "MetS-without-BMI" (still defined by the presence of at least 3 abnormalities) in both men and women was 7.8%. However the prevalence of MetS-without-BMI increased with higher BMI levels: among those with BMI < 25, the prevalence was 4.6% in men and 5.0% in women; among those with BMI > or = 25, the prevalence was 13% in men and 16% in women. CONCLUSION: The prevalence of MetS in this semi-rural Thai population was 15%, which is as common as in Caucasian populations. In the Thai population, obesity was a major component of MetS.

Infective endocarditis in hypertrophic cardiomyopathy--mural and aortic valve vegetations: a case report.

Hypertrophic cardiomyopathy (HCM) is infrequently complicated by infective endocarditis (IE). The authors report the case of a 46-year-old woman developing IE in asymptomatic HCM. Blood cultures were positive for Streptococcus viridans. Echocardiography demonstrated: 1) a mobile (1.2 x 1 cm2) vegetation attached to the septal endocardium at the site of contact between the mitral valve leaflet and the hypertrophic septum; 2) two large (2.7 x 1.7 cm2 and 1.6 x 1.1 cm2) vegetations at NCC and RCC respectively of aortic valve, causing moderate valve regurgitation, and, 3) a mural (1 x 0.8 cm2) vegetation on the posterior wall of the left ventricle. On the third day of hospitalization, the patient underwent aortic valve replacement and removal of the vegetations. Antibiotics were continued for another four weeks. The patient recovered and follow-up was uneventful. Thus, chronic endocardial trauma of the septum, a common finding in HCM with outflow tract obstruction, may provide a fertile nidus for the development of vegetation, which in turn would play the major role in the pathogenesis of IE.

Congenital aortocaval fistula to the superior vena cava: a case report.

Various systemic arteriovenous fistulas have been described. The arteriovenous fistula arising from the ascending aorta and draining separately into the superior vena cava is very uncommon. The authors report a case of congenital aortocaval fistula to the superior vena cava in a 22 year-old woman in whom the fistula was closed successfully.

Clinical outcome of native valve infective endocarditis in Khon Kaen: 1990-1999.

OBJECTIVE: To compare the survival of infective endocarditis (IE) patients following different treatment strategies and to determine the predictors of patient survival. BACKGROUND: IE is a life-threatening infectious disease that is often difficult to manage. Studies on long-term outcome are limited. METHOD: Data on 152 patients with IE from 1990 to 1999 were collected from two hospitals. The main outcome is death after definite diagnosis of native valve IE. RESULTS: The overall case fatality rate was 38 per 100 patient-years. Survival curves showed better survival for patients treated with surgery compared with patients treated medically (p <0.0001). Survival rate at year 1 was 72 per cent for surgically treated patients and 33 per cent for medically treated patients. Five-year survival rates were 66 per cent and 27 per cent in the two groups, respectively. Based on Cox proportional hazards regression analysis, surgery to be an independent predictor of survival (relative risk [RR] = 0.23; 95% confidence interval [CI] 0.14 to 0.39, p < 0.0001), while the presence of congestive heart failure (RR = 2.55; 95% CI 1.61 to 4.02, p < 0.0001), and being male (RR = 1.76; 95% CI 1.04 to 2.82, p <0.05) were independent predictors of mortality. CONCLUSION: Patients with native valve endocarditis have a high long-term mortality rate. The most common types of cardiac death are post-operative and sudden death. Surgical treatment was the preventive factor of mortality.

Infective endocarditis: prevalence, characteristics and mortality in Khon Kaen, 1990-1999.

OBJECTIVE: To update the prevalence, characteristics and mortality of infective endocarditis in a tertiary care hospital in Khon Kaen, Thailand. BACKGROUND: Numerous studies have shown that the prevalence and course of infective endocarditis remain unchanged inspite of the advance in treatment, diagnosis and of prophylactic recommendations. METHOD: The authors identified 160 patients from 1990-1999 with 86 per cent definite and 14 per cent possible endocarditis based on the Duke criteria. Data were collected from two tertiary care hospitals. RESULTS: The prevalence was 4 patients per 1,000 hospital admissions. The mean age of the 106 male and 54 female patients was 39+/-16 years. Twenty-four percent of the patients had no previously known heart disease. Native valve endocarditis was present in 95 per cent and prosthetic valve endocarditis was diagnosed in 5 per cent. Infective endocarditis was located on the aortic valve in 42 per cent, the mitral valve in 43 per cent, both mitral and aortic valves in 9 per cent and the tricuspid valve in 8 per cent. The infective organism was identified in only 62 per cent of cases. Streptococci was the most common in 43 per cent, followed by Staphylococci in 16 per cent. During the first month after admission, 45 per cent of the patients underwent surgery. In-hospital mortality was 25 per cent. CONCLUSION: Despite improved diagnostic techniques and aggressive surgical therapy, infective endocarditis remains a serious problem associated with a high mortality in Khon Kaen.