Rural-urban difference in lipid levels and prevalence of dyslipidemia: a population-based study in Khon Kaen province, Thailand.

OBJECTIVES: To determine the lipid levels and examine the effect of an urban lifestyle on dyslipidemia, by comparing the lipid levels and the prevalence of dyslipidemia of rural vs. urban dwellers in Thailand MATERIAL AND METHOD: A cross-sectional study was conducted in both rural and urban areas of Khon Kaen province. After a 12-hour fast, blood was drawn for assessment of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol. The classification of dyslipidemia was based on the NCEP A TP III guidelines. RESULTS: The authors recruited 916 subjects (595 urban; 321 rural), ranging between 20 and 88 years of age. In both the men and women, the mean TC and LDL-C were significantly higher in urban vs. rural subjects (TC; 207 vs. 169 for men and 204 vs. 192 mg/dl for women and LDL-C; 120 vs. 87 for men and 122 vs. 110 mg/dl for women, p < 0.001). The rural women had a significantly higher mean TG (159 vs. 111 mg/dl, p < 0.001) but lower HDL-C (51 vs. 59, mg/dl, p < 0.001) than urban women. The TG and HDL-C between urban and rural men was not significantly different. Urban men had a significantly higher prevalence of dyslipidemia (TC > or =240 and LDL-C > or = 60 mg/dl) than rural men (25.9 vs. .3.7 per cent for TC and 16.7 vs. 3.7 percent for LDL-C, p < 0.001) while the prevalence of hypertriglyceridemia (> or =200 mg/dl) and low HDL-C (< 40 mg/dl) was significantly higher in rural women (18.2 vs. 7.9 percent for TG and 15.0 vs. 3.8 per cent of HDL-C, p < 0.001). The results were unchanged after matching for age and sex between the urban and rural populations. CONCLUSION: This present study demonstrated a significant difference in urban vs. rural lipid levels and the prevalence of dyslipidemia. Migration to urban centers and adopting an urban lifestyle is likely related to the rising lipid level and prevalence of dyslipidemia.

Etiologies and treatment outcomes in patients hospitalized with community-acquired pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand.

Local epidemiological data on the etiologies of in-patients who are hospitalized with CAP is needed to develop guidelines for clinical practice. This study was conducted to determine the pattern of microorganisms causing community-acquired pneumonia (CAP) in adult patients admitted to Srinagarind Hospital, Khon Kaen, Thailand, between January 2001 and December 2002. Altogether, 254 patients (124 males, 130 females) averaging 56.4 (SD 19.8) years were included. Eighty-six of them (33.8%) presented with severe CAP on initial clinical presentation. The etiologies for the CAP cases were discovered by isolating the organisms from the blood, sputum, pleural fluid, and other sterile sites. Serology for Chlamydia pneunmoniae and Mycoplasma pneumoniae were performed to diagnose current infection. The causative organisms were identified in 145 patients (57.1%). Streptococcus pneumoniae was the commonest pathogen, identified in 11.4% of the cases, followed by Burkholderia pseudomallei (11.0%) and Klebsiella pneumoniae (10.2%). The atypical pathogens, C. pneumoniae and M. pneumoniae, accounted for 8.7% and 3.9% of the isolates, respectively. Sixteen patients (6.3%) had dual infections; C. pneumoniae was the most frequent coinfecting pathogen. The average length of hospital stay was 12.9 (SD 14.0) days, with 27.9% staying more than 2 weeks. Overall, 83.9% of the patients improved with treatment, 10.2% did not improve and 5.9% died. The most common complications were acute respiratory failure (31.1%) and septic shock (20.9%). We conclude that initial antibiotic use should cover the atypical pathogens, C. pneumoniae and M. pneumoniae, in hospitalized CAP patients. B. pseudomallei is an endemic pathogen in Northeast Thailand, and should be considered in cases of severe CAP.

Severe community-acquired pneumonia (CAP) treated at Srinagarind Hospital, Khon Kaen, Thailand.

In Thailand, the death rate from community-acquired pneumonia (CAP), especially severe CAP, has increased steadily over the past decade. To optimize the outcome, rapid start of appropriate antibiotics and supportive care are the mainstay of management. We therefore assessed the local etiology and outcome of adult patients with severe CAP admitted between January 1, 1999 and December 31, 2001. One hundred and five of 383 patients (27.4%) met the ATS criteria for severe CAP. The mean age was 56.9 (SD 18.2) years. The male to female ratio was 60:45. Duration of symptoms before admission was 5.3 (SD 4.0) days. Most of them (91.4%) had co-morbidity, diabetes mellitus being most common. A microbiological pathogen was isolated in 62 patients (59%). The pathogens most commonly isolated were B. pseudomallei (29.4%), S. pneumoniae (20.6%), K. pneumoniae (19.1%), and H. influenzae (11.8%). Other less common pathogens were E. coli (5.9%), S. aureus (5.9%), M. pneumoniae (1.5%), M. catarrhalis (1.5%), P. aeruginosa (1.5%), P. fluorescens (1.5%), and S. stercoralis (1.5%). Hospitalization averaged 14.7 (SD 14.3) days and mortality was 21%. Clinicals in 17.1 % of patients did not improve and they transferred home. Most (81.9%) patients required mechanical ventilation, while 60 (57.1%) developed septic shock, and 13 (12.3%) acute renal failure. Severe CAP carried high mortality, despite intensive care. Empirical therapy for B. pseudomallei should be considered, where endemic, and for patients with diabetes mellitus or chronic renal failure.