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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 "Diabesity": The 21st Century Epidemic Swangjit Sura-amornkul MD, FRCP(T), MSc (clinical investigation) Endocrinology unit, Department of Medicine, BMA Medical College and Vajira Hospital. Diabetes and obesity are twin interrelated epidemics which threaten to engulf the world's healthcare systems over the next two decades. The prevalences of both are increasing at an alarming rate with up to 400 million people likely to develop diabetes, largely type 2, in the next 15 to 20 years unless action is taken. Indeed, much of this increase in diabetes prevalence is directly attributable to the epidemic of obesity. Both diabetes and obesity are associated with significant mortality and morbidity from macrovascular disease such as heart attack, stroke and peripheral vascular disease. In addition, diabetes carries the extra burden from the specific microvascular complications of retinopathy, nephropathy and neuropathy. The costs of these conditions, both personal and economic, are enormous. Vajira Med J 2008 ; 52 : 77 - 82
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Abstract Prevalence of Thyroid Antibodies in Hyperthyroid patients treated at BMA Medical College and Vajira Hospital Suvimol Rimdusid MT* Swangjit Sura-amornkul MD, MSc** Prapun Rimdusid MD*** * Radioimmunoassay (RIA) laboratory, Division of Nuclear Medicine, Department of Radiology, BMA Medical College and Vajira Hospital ** Department of Medicine, BMA Medical College and Vajira Hospital ** Medical Department, Trang-ruampat Hospital Objectives: To study the prevalence of abnormally high thyroid peroxidase (TPO) antibody and thyroglobulin antibody in hyperthyroid patients and to evaluate the association of these antibodies with other clinical characteristics of hyperthyroid patients. Study design: Descriptive study. Subjects: 133 hyperthyroid patients with high T3 , total T4 , free T4 and low thyroid stimulating hormone (TSH), who underwent laboratory investigations at RIA laboratory, Division of Nuclear Medicine, Department of Radiology, BMA Medical College and Vajira Hospital during September 2004 and February 2005 were enrolled. Methods: Demographic data, thyroid hormone level and thyroid antibodies level of the patients were collected from hospital and laboratory records. Main outcome measures: TPO antibody level and thyroglobulin antibody level. Results: Mean age of the patients was 39.0 ± 13.8 years old. Female to male ratio was 3.4:1. The etiologies of hyperthyroidism were: Graves' disease (101 cases), toxic multinodular goiter (21 cases), and others (11 cases). Median value of free T4 was high at 4.2 (0.8-6.0) ng/dL while median TSH level was low at 0.012 (0-6.9) IU/mL. Abnormally high level of TPO and thyroglobulin antibody were detected in 80.5% and 67.7% of hyperthyroid patients, respectively. In patients with Graves' disease, high TPO antibody level was found in 85.1%. There was statistically significant association between Graves' disease and TPO antibody, but not with thyroglobulin antibody. No association between thyroid antibodies and age, gender were observed. Conclusion: The prevalence of abnormally high TPO antibody and thyroglobulin antibody in hyperthyroid patients, especially in Graves' disease, were high. There was statistically significant association between Graves' disease and TPO antibody. Vajira Med J 2008 ; 52 : 159 - 165
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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