Glimepiride in type 2 diabetes mellitus Thai patients.

This study aimed to confirm the efficacy of glimepiride given once daily in the treatment of Thai type 2 diabetic patients and to find out the optimum dosage for Thai patients. The patients were enrolled at the diabetic clinics of 5 hospitals (Rajavithi, Chulalongkorn, Pramongkutklao, Siriraj and Theptarin Hospitals). All patients started glimepiride 1 mg once daily and escalated to 2, 3, 4 and until 6 mg every 4 weeks if fasting plasma glucose (FPG) exceeded 140 mg/dL. Subjects were 60 females and 29 males with an average age of 52.2 +/- 10.0 years. Mean BMI was 25.5 +/- 3.8 kg/m2. Fifty seven patients (64.0%) were drug naïve and thirty two patients (36.0%) had been previously treated with oral hypoglycemic agents. Seventy three per cent of the drug naïve and 37 per cent of the previously treated patients could be controlled with 1-2 mg of glimepiride once daily. At the twelfth week of treatment, mean fasting plasma glucose decreased from 224.6 to 156.6 mg/dL (30% reduction) and mean HbA1c decreased from 10.0 to 7.5 per cent (25% reduction). At the end of the study 49.4 per cent of the patients had HbA1c < 7.0 per cent, 21.3 per cent had HbA1c 7.0-8.0 per cent and 29.3 per cent had HbA1c > 8.0 per cent. Adverse events that were probably or possibly related to the drug were reported in 5 patients (5.6%). Three of them were hypoglycemia and two patients had skin rash. All hypoglycemic episodes were mild. Glimepiride was indicated to be safe. There were no clinically significant changes in clinical laboratory values, physical examinations and vital signs. In conclusion, glimepiride was efficacious and safe in type 2 diabetes Thai patients and 1-2 mg of glimepiride appeared to be a sufficient dose for most newly diagnosed type 2 diabetic patients.

Study of plasma hormones and lipids in healthy elderly Thais compared to patients with chronic diseases: diabetes mellitus, essential hypertension and coronary heart disease.

Simultaneous measurements of serum estradiol, testosterone, cortisol, prolactin, total cholesterol (TC), high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC) and triglycerides in Thai men and postmenopausal women aged over 50 years were carried out in four groups of subjects: healthy controls, and patients with essential hypertension, non-insulin dependent diabetes mellitus (NIDDM), and coronary heart disease. Hypertriglyceridemia and hypercholesterolemia were found more often in patients with essential hypertension than in patients with other diseases. Low levels of HDLC with high TC/HDLC and LDLC/HDLC ratios occurred more frequently in coronary heart disease patients. Hypertensive men had the highest plasma estradiol levels while men with coronary heart disease had the least testosterone levels compared with men with the other two diseases. Decreased testosterone and/or increased estradiol may have an adverse effect on lipid profiles in elderly men. However, neither the sex hormones, cortisol, nor prolactin, appeared to have any influence on serum lipids and lipoproteins in elderly women. These findings in the Thai population are consistent with those previously reported in other populations.

Pulmonary dirofilariasis in a patient with multisystem Langerhans cell histiocytosis--the first reported case in Thailand.

Despite a high prevalence of canine dirofilariasis, there is no case of pulmonary dirofilariasis reported from Thailand. We herein report a case of multisystem Langerhans cell histiocytosis who had an incidental pulmonary dirofilariasis found at the time of autopsy as a solitary nodule at the periphery of the right lower lobe. This is the first reported case in Thailand. Association between pulmonary dirofilariasis and Langerhans cell histiocytosis has not been described before in the literature.

Behavior in self-care of the foot and foot ulcers in Thai non-insulin dependent diabetes mellitus.

A cross sectional study was conducted to examine behavior in self-care of the foot and foot ulcers in Thai non-insulin dependent diabetic patients. Fifty-five patients with foot ulcers (ulcer group; 42 females and 13 males) and 110 patients without foot ulcers (control group; 83 females and 27 males) were evaluated for self foot-care behavior using a questionnaire consisting of questions about foot inspection, foot cleaning, nail-care, and the use of footwear which possessed a total score of 20. The results showed that a mean total self foot-care score of the ulcer group was significantly lower than that of the control group (14.50 +/- 3.35 vs 15.74 +/- 2.31; p < 0.01). The patients with foot ulcers had lower mean scores in all of the four self foot-care categories than did those without foot ulcers. However, only the difference in foot cleaning score was statistically significant (7.35 +/- 0.21 vs 7.88 +/- 0.11; p < 0.05). A univariate analysis has shown that the risk of developing foot ulcers was significantly associated with a total self foot-care score of less than 15 with an odd ratio of 2.6 and a 95 per cent confidence interval of 1.3-5.6. Regarding the behavior in self foot ulcer-care, 45.5 per cent of the diabetic patients with foot ulcers had neglected them and 54.5 per cent had inappropriately cared for their ulcers. In conclusion, Thai non-insulin dependent diabetic patients with foot ulcers understood less about self foot-care practice than did those without foot ulcers. Incorrect self foot-care behavior particularly foot cleaning is associated with an increased risk of foot ulceration. In addition, diabetic patients should be advised about the correct self-care of their feet and foot ulcers in order to prevent foot ulceration and its complications.

Angiotensin converting enzyme gene polymorphism in healthy Thais and patients with non-insulin dependent diabetes mellitus.

Insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene has been shown to be associated with various cardiovascular disorders in diabetic and non-diabetic patients. Its association with the development of non-insulin dependent diabetes mellitus (NIDDM) has been raised. This study was aimed to examine I/D polymorphism of ACE gene in healthy Thai subjects and patients with NIDDM. The I/D ACE genotypes were determined by polymerase chain reaction technique. Healthy unrelated subjects were 151 males and 147 females, 17-70 year old (mean +/- SD = 37.5 +/- 10.4). The unrelated diabetic patients were 42 males and 66 females, 20-79 years of age (mean +/- SD = 54.7 +/- 12.0). In healthy subjects, the ACE genotypes were DD 10.1 per cent, ID 39.2 per cent and II 50.7 per cent. Diabetic patients had similar distribution of ACE genotypes. The frequency of I and D alleles in diabetic patients was 0.69 and 0.31, similar to 0.70 and 0.30, respectively, in healthy subjects (p = 0.69). The frequency of I and D alleles in healthy Thai subjects was similar to the Japanese (I = 0.66 & D = 0.34) but different from Caucasians (I = 0.44-0.46 & D = 0.54-0.56). We conclude that I/D ACE gene polymorphisms may possess a racial difference. The similar frequency of both alleles in diabetic patients and healthy subjects suggests that there is no association between I/D polymorphism of ACE gene and diabetes mellitus in Thai individuals.

The efficacy and safety of gliquidone in Thai diabetics.

This study was aimed to evaluate the efficacy and safety of gliquidone, the latest available sulphonylurea, as a monotherapy for patients with non-insulin dependent diabetes millitus (NIDDM). Ninety patients attending diabetic clinics of Siriraj, Rajavithi and Pramongkutklao Army Hospitals were recruited in study. They were 21 males and 69 females, 27-82 years old (mean +/- SD = 52.3 +/- 11.2 years). The diabetic duration varied from newly diagnosed to 18 years (mean +/- SD = 1.5 +/- 2.8 years). Four weeks washout period was applied to 40 patients who had been treated with oral hypoglycemic agents. Before initiation of therapy, fasting venous blood samples were obtained for determination of fasting plasma glucose (FPG), Hemoglobin A1 (HbA1), lipid profile, chemistry profile and complete blood count (CBC). The starting dose of gliquidone was 15-60 mg by mouth once or twice daily. The dosage was adjusted every 4 weeks. FPG, HbA1 and lipid profile were assessed every 4 weeks. Blood chemistry profile and CBC were monitored at 4 weeks after treatment and at the end. After 12 weeks of therapy, FPG and HbA1 significantly declined from 220.8 +/- 55.5 mg/dl and 11.3 +/- 2.6 per cent to 159.1 +/- 38.6 mg/dl and 9.2 +/- 1.4 per cent, respectively (p < 0.001). A small but statistically significant decrease in serum total cholesterol from 229.3 +/- 46.9 to 219.8 +/- 40.7 mg/dl (p < 0.01) as well as serum low density lipoprotein cholesterol from 150.2 +/- 43.7 to 142.2 +/- 42.1 mg/dl (p < 0.05) were observed. Serum triglyceride and high density lipoprotein cholesterol did not significantly alter. Clinical follow-up, blood chemistry profile and CBC did not indicate any adverse reactions from gliquidone therapy. We concluded that gliquidone is an effective oral hypoglycemic agent for treating patients with NIDDM. Adverse effects were not experienced by this group of patients.

Efficacy of using basal plasma adrenocorticotropic hormone-radioimmunoassay (ACTH-RIA) level in the identification of the cause of Cushing's syndrome.

Basal (8.00 a.m.) plasma ACTH-radioimmunoassay (ACTH-RIA) levels were studied in 32 cases of endogenous Cushing's syndrome (17 Cushing's disease, 13 adrenocortical tumors, and 2 ectopic ACTH syndrome) and 11 normal volunteers. There were overlaps in the ranges of plasma ACTH-RIA levels among patients with Cushing's disease, adrenocortical tumors, and normal volunteers but not ectopic ACTH syndrome. By using different plasma ACTH-RIA levels as cut-off points in differentiating ACTH-dependent from ACTH-independent Cushing's syndrome, the level of 30 pg/ml had the highest diagnostic efficacy with a 94.7 per cent sensitivity, a 84.6 per cent specificity and a 90.6 per cent diagnostic accuracy.

Effects of alpha-glucosidase inhibitor (acarbose) combined with sulfonylurea or sulfonylurea and metformin in treatment of non-insulin-dependent diabetes mellitus.

The effects of alpha-glucosidase inhibitor (acarbose) were studied in 36 patients with non-insulin-dependent diabetes mellitus (NIDDM), aged 34-67 years with a mean duration of diabetes of 8.8 +/- 0.9 years. They were poorly controlled with diet plus sulfonylurea alone or plus sulfonylurea combined with metformin drugs. Acarbose, 100 mg three times daily, was additionally given to these patients for six months. Results showed small but significant decreases (P < 0.001) in postprandial blood glucose level. Glycosylated hemoglobin level was lowered significantly (P < 0.001) and was normalised (level of < 8%) in 17 per cent of the patients. Fasting serum triglycerides level decreased significantly (P < 0.01), whereas, no significant changes in serum total cholesterol and HDL cholesterol levels were seen. Body weight also decreased significantly (P < 0.001) at the end of acarbose trial. Flatulence was the major side effect of acarbose found in 42 per cent of the patients but it was well-tolerated and may be transient and self-limited. We concluded that the addition of acarbose to the therapeutic regimens of diet therapy plus sulfonylurea or plus sulfonylurea combined with metformin drugs led to significant improvement of glycemic control. Acarbose may be a safe and valuable adjunct to diet and sulfonylurea and metformin treatments in obese, poorly-controlled patients with NIDDM.

Sertoli-cell-only syndrome: a case report.

A 20-year-old male presented with a small hydrocoele in the left scrotal sac, bilateral small testes, and azoospermia with normal secondary sexual characteristics. Chromosome study revealed 46,XY. The results of hormonal and histopathological studies were consistent with Sertoli-cell-only syndrome.

Complete heart block complicating hyperthyroidism: a case report.

Complete heart block developed in a 29-year-old man with hyperthyroidism and acute febrile illness. The definite cause of acute febrile illness was unknown. The results of bacteriological and viral studies were negative. Endomyocardial biopsy revealed no evidence of carditis which is the common cause of heart block. All the abnormalities resolved completely after the fever subsided and the patient was treated with an antithyroid drug. Available information indicates that a high degree of heart block can sometimes occur in hyperthyroidism in either the presence or absence of additional factors which can independently impair atrioventricular conduction. This course of events which occurred in this patient suggest that complete heartblock may have been the direct manifestation of the hyperthyroid state, however, the acute febrile illness may have been an aggravating factor in the development of abnormal atrioventricular conduction.