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Background and objective : There were many articles determined factors associated with microalbuminuria in type 2 diabetes. Some articles reported the same result, some articles reported difference. It was confusing which is to apply for prevention and health promotion in public health and clinical practice. The aim of this study was to determine factors associated with microalbuminuria in type 2 diabetes by meta-analysis.Methods : We performed our search using Ovid MEDLINE, Scopus, BMJ Clinical Evidence, ProQuest, Thai index medicus and Thai Medical index. The study design\ was an analytical cross sectional study and detection of microalbuminuria by quantitative technique, published during 1992 -2009. Criteria of quality assessment for publication composed of microalbuminuria classification and urine collection method. Heterogeneity assessment for the studies\’ results was the use of Cochran\’s 2.Results : Of 2,428 identified articles on electronic database, 17 articles were included for the analysis because of selection criteria and quality assessment criteria. The data was extracted and converted to be a standard measurement unit. Pooled effect estimates were obtained by using fixed effect and random effect meta-analysis. This study found that age, duration of diabetes, smoking, high blood pressure, high blood plasma glucose and dyslipidemia were the risk factors associated with microalbuminuria. But there is only HDL that expresses the protective factor of microalbuminuria (OR = 0.850, 95% CI = 0.748-0.966), p-value = 0.013).\ \ \ \ \ Conclusion : The health promotion program to prevent microalbuminuria in type 2 diabetes should be considered the behavioral optimization programming such as stop smoking programs, blood pressure control, blood glucose control and nutrition education.Keywords : microalbuminuria , diabetes, meta analysis
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Abstract How to Detect and Handle Confounding Factors Sirima Mongkolsomlit BSc, MSc Epidemiology* Jayanton Patumanond MD, DTM\&H, MSc Clin Trop Med, DSc Clinical Epidemiology** Petch Rawdaree MD, MSc Epidemiology, DLSHTM*** * Faculty of Public Health, Thammasart University. ** Faculty of Medicine, Chiangmai University. *** Department of Medicine, BMA Medical College and Vajira Hospital. When a researcher investigates the association between an exposure of factors and an occurrence of outcome, there are other influencing factors to the test result so called "confounding factors". Confounding factors may cause indistinct or inaccurate results of the study. Since statistical analysis cannot clear out the effect of confounders which have not been collected or being unidentified, it is crucial for the researcher to identify and control the impact of these confounding factors. In order to collect all essential data including any potential confounding factors, a thorough literature review prior to conducting a research is the first and important step. If confounders are identified, there are many approaches to deal with confounders: by randomization, restriction, or matching in the research design or methodology process; or by stratification or multivariable analysis in the statistical analysis process. Keywords: confounding factors, randomization, restriction, matching, stratification Vajira Med J 2010 ; 54 : 223-235
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Abstract Prevalence of T3 toxicosis and FT4 toxicosis in Thyrotoxic Patients Natee Munsakul MD Swangjit Suraamornkul MD Petch Rawdaree MD, MSc (Epid), DLSHTM Endocrinology Unit, Department of Medicine, BMA Medical College and Vajira Hospital Objective: To determine the prevalence of T3 toxicosis and FT4 toxicosis in thyrotoxic patients. Study design: Cross - sectional descriptive study. Subjects: Two hundred and ninety five newly diagnosed thyrotoxic patients were studied from January 1999 to September 2000 in BMA Medical College and Vajira Hospital. Methods:All patients were diagnosed by endocrinologists based on thyroid function tests. Age, sex, address, symptoms, signs, duration of symptoms before diagnosis, and thyroid function tests were recorded. The prevalence and correlation factors were analyzed by using SPSS for Windows program. Main outcome measures: Prevalence of T3 toxicosis and FT4 toxicosis, characteristic of the subjects such as age, sex, duration of symptoms before diagnosis. Results: From 295 subjects recruited, 19.3% were male and 80.7% were female. The prevalence of T3 toxicosis and FT4 toxicosis were 2% and 3.4% respectively. The diagnoses were Graves' disease 93.2%, toxic multinodular goiter 3.1%, toxic adenoma 2.7%, thyroiditis 0.3% and molar pregnancy 0.7%. Mean age of T3 toxicosis group, FT4 toxicosis group and the group that increased both T3 and FT4 were 31.4 + 11.4, 41.5 + 16.5, and 39.3 + 13.5 year respectively that were no statistically significant difference (p = 0.38). The duration of symptoms before diagnosis were 3.8 + 4.6, 2.4+2.8, and 2.9+2.8 months respectively that were no statistically significant difference (P= 0.79). Conclusion: The prevalence of T3 toxicosis and FT4 toxicosis in thyrotoxic patients were 2.0% and 3.4% respectively but there were no statistically significant difference. Key words: T3 toxicosis, FT4 toxicosis Vajira Med J 2001 ; 45 : 55 - 60
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Abstract Comparison of Two Chemotheropy Regimens (CHOP and COP) for Non-Hodgkin's Lymphoma Saowanee Chutipong MD Anchalee Boonyaritipong MD Petch Rawdaree MD Department of Medicine, BMA Medical College and Vajira Hospital Objective: To study efficacy of chemotherapy CHOP and COP in non-Hodgkin's lymphoma (NHL) by median survival time and mortality rate, Study design: Cohort study. Subjects: Eighty sevent patients of intermediate and high grade NHL who attend in hematology clinic, Department of Medicine, BMA Medical College and Vajira Hospital from January 1985 to March 2000. Methods: Follow up the patients who were intermediate and high grade NHL treated continuously by CHOP regimen (cyclophosphamide, doxorubicin, vencristine and prednisolone) every month in the first group. And the second groups were treated continuously by COP regimen (cyclophosphamide, vincristine and prednisolone every month for two years. Every patient were followed up about 55 months (average). Main outcome measures: Median survival time and crude mortality rate. Results: Median survival time of CHOP group is 28 months whereas 44 months in COP group but there was no statistically significant difference (p = 0.19). The crude mortality rate in CHOP group was higher than in COP patients 1.901 time, but there was no statistically significant difference (p = 0.35). When they were adjust Kaplan-Miere curve of survival by age group and staging there was statistically significant difference, by grading there was no statistically significant difference. Conclusion: Median survival time and crude mortality rate in this study showed no difference in efficacy of CHOP and COP treatment. When they were adjust Kaplan-Miere curve of survival by age group and staging there was statistically significant difference, by grading there was no statistically significant difference. Key words: non-Hodgkin's lymphoma, chemotherapy Vajira Med J 2001 ; 45 : 13 - 20
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Abstract Penicillin Resistant Streptococcus pneumonia Warangkana Munsakul MD Petch Rawdaree MD,MSc Epidemiology, DLSHTM Department of Medicine, BMA Medical College and Vajira Hospital Objective : To determine the prevalence of penicillin - resistant Streptococcus pneumonia (PRSP) and to compare clinical difference of infection by penicillin - resistant Streptococcus pneumonia and penicillin - sensitive Streptococcus pneumoniae (PSSP). Study design : Cross - sectional descriptive study. Subjects : Sixty three Streptococcus pneumonia infected patients were studied from January 1996 to December 2000 in BMA Medical College and Vajira Hospital. Methods : Age, sex, symptoms, signs, prior antibiotic use, underlying diseases, smoking, length of hospital stay, culture, sensitivity and outcome of treatment were recorded from medical records. The data were analyzed to determine prevalence of PRSP and clinical difference between PRSP and PSSP infection. Main outcome measures : Prevalence of PRSP, clinical difference between PRSP and PSSP infection. Results : The prevalence of PRSP since 1996-2000 were 14.3%, 0%, 29.6%, 20.0% and 27.3% respectively. The clinical data of PRSP and PSSP (mean age, underlying diseases, smoking, duration of fever prior to admission, white blood count, length of hospital stay, bacteremia, mortality rate) were no statistically significant difference. The sensitivity to chloramphenical, erythromycin, co-trimoxazole and tetracycline of Streptococcus pneumoniae were 73.3%, 60.7%, 47.5% and 45,9% respectively, but the results of PRSP were 50.0%, 21.4%, 21.4% and 18.2% respectively. The sensitivity to cefotaxime and vancomycin if PRSP were both 100%. Drug - resistant Streptococcus pneumonia (DRSP) was 86.7% of PRSP. Conclusion : The prevalence of PRSP sine 1996-2000 were 14.3%, 0%, 29.6%, 20.0% and 27.3% respectively. There was no statistically significant difference between the clinical data of the PRSP and PSSP groups Most of PRSP were DRSP. Key words : penicillin-resistant Streptococcus pneumoniae (PRSP), drug-resistant Streptococcus pneumonia (DRSP), prevalenceVajira Med J 2002 ; 46 : 19 - 26
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Abstract Effectiveness and Side Effects of Therapy Using a 3-drug Antiretroviral Tablet: Nevirapine/Stavudine/Lamivudine (GPOvir) in HIV-infected Patients Warangkana Munsakul MD Petch Rawdaree MD, MSc Epidermiology, DLSHTM Natee Munsakuo MD *Department of Medicine, BMA Medical College and Vajira Hospital Objective: To determine the effectiveness and side effects of the 3 drug antiretroviral tablet: nevirapine/stavudine/lamivudine (GPOvir) in treatment of HIV- infected patients. Study design: Analytic longitudinal study Subjects: Eighty-seven HIV -infected patients who were treated with GPOvir from April 2002 to November 2002 in Infectious Diseases Clinic, Department of Medicine, BMA Medical College and Vajira Hospital. Methods: Sex, body weight, history of taking antiretroviral agent and CD4+cell count were recorded when starting GPOvir. After following up for 3 months, body weight and CD4+cell count were recorded again. Side effects were also recorded. The data were analyzed to determine the outcomes and influence variables. Main outcome measures: Body weight, CD4+cell count and side effects. Results: Severe side effects were occurred in 13 cases (14.94%). The most common side effect was rash (13.79%), severe form of rash were found 10.34% and one case developed Stevens-Johnson syndrome, The 74 of 87 patients were completely received 3 months of therapy. Mean CD4+cell countless increased 99.250 cell/mm3 mean body weight increased 2.892 kg. The patients who had CD4+cell count less than or equal 100 cell/ mm3 had better response than the others, but no statistically significant difference. Male patients had better response than female patients, but no statistically significant difference. High body weight patients (greater than or equal 50 kg) had better response statistically significant than the others. Naïve patients had better response than antiretroviral-experienced patients with statistically significant difference. Conclusion: This study demonstrated that GPOvir was effective in the treatment of HIV-infected patients. The significant factors associated with good outcomes were body weight and history of antiretroviral treatment. The most common side effect was rash. Severe side effects were 14.94% Key word: nevirapine, stavudine, lamivudine, effectiveness, side effect.Vajira Med J 2003 ; 47 : 29 - 36
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Abstract Factors Associaed with Diabetic Retinopathy in Type 2 Diabetes Supatra Chaikaew BNS, MSc (Public Health)* Natchaporn Pichainarong DrPH (Epidemiology)** Wisit Chaveepojnkamjorn DVM, MPH** Piangchan Rojanavipart MHS (Biostatistics)*** Petch Rawdaree MD,MSc (Epidemiology)**** * Amnatchareon Hospital ** Department of Epidemiology, Faculty of Public Health, Mahidol University *** Department of Biostatistic, Biostatic, Faculty of Public Health, Mahidol University **** Department of Medicine, BMA Medical college and Vajira HospItal Objective: To determine factors associated with diabetic retinopathy in type 2 diabetes. Study design: Hospital based case-control study. Setting: Diabetes Clinic, BMA Medical college and Vajira Hospital from May 2003 to September 2003. Subjects: Two hundred and sixty type 2 diabetes mellitus. One hundred and thirty patients with diabetic retinopathy were case and 130 patients without diabetic retinopathy were control. Methods: Data were collected from medical record and interview questionnaire. It is divided into 3 sections: Information from interview; part 1 general information including demography and socio-economy, part 2 illness factors, part 3 laboratory data which was obtained from medical record. The obtained data were analyzed by statistical program. Main outcome measures: Odds ratio and 95% CI of odds ratio of hyperglycemia, hypertension, type of therapy, smoking, (Body mass index : BMI), age at onset, alcohol consumption, dyslipidemia and duration of diabetes. Results: There were only five variable that were significantly associated with diabetic retinopathy. After adjusting the effect of each variables, the magnitude of association between each variables and diabetic retinopathy were fasting plasma glucose (FPG) between 161-180 mg/dl and \>180 mg/dl (OR=3.82, 95% CI 1.02-14.24 and OR=5.98, 95% CI 1.66-21.56), HbA1c \>9%(OR=4.09, 95% CI 1.69-9.92), hypertension (OR=5.00, 95% CI 2.64-9.46), systolic blood pressure between 140-159 mmHg and 160 mmHg (OR=3.22, 95% CI 1.50-6.88 and OR=9.98, 95% CI 1.38-58.41) and BMI between 23-24.9, 25-29 and 30 kg/m (OR=0.20, 95% CI 0.08-0.49, OR=0.36, 95% CI 0.16-0.83 and OR=0.10, 95% CI 0.03-0.32) respectively. Other variables consisted of diastolic blood pressure, cholesterol, triglyceride, type of therapy, age at onset duration of diabetes, smoking and alcohol consumption did not show significant association with diabetic retinopathy. Conclusion: The factors found to be significantly associated with diabetic retinopathy were FPG, HbA1c, BMI, hypertension and systolic blood pressure. Key words: Type 2 diabetes, diabetic retinopathy, risk factors Vajira Med J 2004 ; 48 : 97 - 106
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Abstract Effectiveness of Surveillance System in Prevention of Hospital Hypoglycemia. Swangjit Sura-amornkul MD, FRCP(T), MSc Petcharaphan Tiyamani BSc Petch Rawdaree MD, FRCP(T), MSc Endocrinology unit, department of medicine, Bangkok Metropolitan Administration Medical College and Vajira Hospital. Objective: To reduce incidence and clinical impact of hospital hypoglycemia in diabetic patients at medicine ward. Study design: A prospective interventional study. Setting: Department of Medicine, Bangkok Metropolitan Administration Medical College and Vajira Hospital. Subjects: 1,233 diabetic patients admitted in department of medicine from January to December 2004. Intervention: The surveillance of hospital hypoglycemia had been implemented from January to December 2004 by multidisciplinary team. Main outcome measures: Comparison the incidence of hospital hypoglycemia before and after surveillance indicated by 1. rate of hospital hypoglycemia per all diabetic patients 2. rate of hospital hypoglycemia per high risk diabetic patients 3. level of clinical impacts of hospital hypoglycemia. Results: Incidence of hospital hypoglycemia per all diabetic patients reduced after the surveillance of hospital hypoglycemia by multidisciplinary team from 5.01% to 4.28%. As well as incidence of hospital hypoglycemia per high risk diabetic patients decreased from 19.08% to 11.74% with relative risk reduction 38.5% after the surveillance. Less severity of clinical impacts of hospital hypoglycemia also demonstrated. Conclusion: This study is a part of hospital accreditation process, clinical risk management. Hospital hypoglycemia in diabetic patients is the priority watch list of incident reports. The surveillance of hospital hypoglycemia by multidisciplinary team decreased rate of hospital hypoglycemia and severity of clinical impact. Key words: hospital hypoglycemia, diabetes, root cause analysis, clinical risk, surveillance, multidisciplinary Vajira Med J 2005 ; 49 : 59 - 67
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Abstract Comparison between Single-field Nonmydriatic Digital Fundus Image and Gold Standard for Diabetic Retinopathy Screening Apichat Suansilpong MD* Petch Rawdaree MD** * Department of Ophthalmology, BMA Medical College and Vajira Hospital ** Department of Medicine, BMA Medical College and Vajira Hospital Objective: To determine the accuracy, sensitivity and specificity of single-field nonmydriatic digital fundus image interpreted by ophthalmologist for diabetic retinopathy screening. Study design: Diagnostic test. Subjects: Two hundred and forty-eight diabetic patients who attended the Diabetic Center, BMA Medical College and Vajira Hospital during May 2007 and March 2008 were enrolled. Methods: The fundi of all patients were captured using nonmydriatic digital fundus camera, the single-field fundus image included optic nerve and macular area. Fundus images were interpreted by ophthalmologist. After digital retinal image capture, patients were examined for detecting diabetic retinopathy by ophthalmologist as a gold standard. All data were recorded for statistical analysis. Main outcome measures: Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. Results: The prevalence of eyes with diabetic retinopathy was 22.8%. The prevalence of patients with diabetic retinopathy was 24.2%. Of the 60 patients, who had diabetic retinopathy, there were 7 patients whom diabetic retinopathy was detected in one eye. In 40 eyes of 248 diabetic patients, the images were of low quality, which could not be used for the interpretation. The accuracy for screening diabetic retinopathy was 89.3% (95% CI 86.0-91.9) the sensitivity and the specificity for screening diabetic retinopathy were 72.6% (95% CI 68.6-76.7) and 94.3% (95% CI 92.1-96.4) respectively. Positive predictive value and negative predictive value were 79.4% (95% CI 75.7-83.1) and 91.9% (95% CI 89.4-94.4) respectively. Conclusion: Single-field nonmydriatic digital fundus image can be used for screening of diabetic retinopathy but can not replace standard eye examination. Vajira Med J 2008 ; 52 : 83 - 91
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Abstract Prevalence and Association between Androgen Deficiency and Metabolic Syndrome in Aging Thai Male with Type 2 Diabetes Mellitus Swangjit Sura-amornkul MD, FRCP (T),MSc (Chinical Investigation) Thantip Jongboonyanupap MD, FRCP (T) Petch Rawdaree MD, FRCP (T),MSc Endocrinology unit, Department of Medicine, BMA Medical College and Vajira Hospital. Objective: To determine the prevalence and association between androgen deficiency (AD) and metabolic syndrome in aging Thai male with type 2 diabetes mellitus. Study design: Cross-sectional study. Subjects: 246 males aged ≥ 55 years old with type 2 diabetes who attended Diabetic Clinic, Department of Medicine, BMA Medical College and Vajira Hospital from June 2007 to October 2008. Methods: Waist circumference and blood pressure were measured. Blood was drawn for fasting plasma glucose, glycated hemoglobin (),lipid and total testosterone levels in all participants. Main outcome measures: total testosterone level, metabolic syndrome according to American Heart Association (AHA) criteria. Results: Prevalence of androgen deficiency (AD) in aging Thai male with type 2 diabetes was 35.8%. The total testosterone level of type 2 diabetes aging male with and without AD was 2.55 ± 0.74 and 4.95 ± 1.44 ng/ml respectively. Body weight, body mass index (BMI) and waist circumference were significantly negatively correlated with total testosterone levels. Prevalence of metabolic syndrome in type 2 diabetes aging male with and without AD was not significantly different (87.5% vs 83.5%). Conclusion: AD was frequently found in aging Thai male with type 2 diabetes. However, there was no association between AD and metabolic syndrome in this group. Vajira Med J 2009 ; 53 : 33 - 39