Estimation of blood loss in transurethral resection of prostate (TUR-P) by urine-strip.

OBJECTIVES: Blood loss in transurethral resection ofprostate (TUR-P) operation is estimated by the difference between pre- and post-operative hemoglobin (Hb) concentration. The authors introduced a novel practical method to estimate blood loss in the patients who were surgically managed with TUR-P operation. MATERIAL AND METHOD: Complete blood count was collected pre-operative, immediate post-operative, and 24-hour post-operative to determine red blood cells and Hb concentration. Hemoglobin of irrigating fluid was measured by standard spectrophotometry and blood loss was estimated by the authors' calculation. Irrigating fluid was frozen and thawed to completely hemolyse the red blood cells, then it was tested by urine-strips and calculated for red cells using estimating cell ranges given by the product's prescription. The correlation between these indicators was evaluated. RESULTS: Calculated blood loss detected by spectrophotometric method has no correlation with immediate post-operative or 24-hour post-operative Hb concentration. However, it had a significant positive correlation with calculated blood loss by urine-strip technique (r = 0.897, p = 0.01). CONCLUSION: Urine-strip method can be used to estimate total blood loss in irrigating fluid in patients with TUR-P operation. This is practical and useful in immediate post-operative evaluation of blood loss to consider the need of blood transfusion.

Crystalline composition and etiologic factors of kidney stone in Thailand : update 2007.

Objective: The etiology of kidney stone is multifactorial including environmental, behavioral and genetic. Insights about predisposing causes and mineral composition are mandatory for better management of kidney stone disease. The present hospital-based study aims to explore the mineral constituents and etiologic risks of kidney stones in Thai patients from the four geographic regions of the country. Method: Two hundred and fifty six kidney stone patients from four geographic regions of Thailand, including the northeastern (n=103), the northern (n=81), the central (n=47) and the southern (n=25) were recruited in this study. Of these, 144 patients completed the food frequency questionnaire to assess the kidney stone risk. Mineral composition of stones were analyzed by Fourier transformed infrared spectrometry. Results: Kidney stone frequently affected peoples aged 40-49 years. Only 31.9 % of patients had a positive family history of renal stone. Calcium oxalate (CaOx) stone was the most prevalent type (73.8 %). Uric acid (UA) stone was found in 16.0 % commonly affected peoples aged 60-70 years. Mixed stones, notably CaOx mixed with calcium phosphate (CaP), were more prevalent than pure stones. The food frequency questionnaire data showed that 59.7 % of stone patients consumed less than two liters of water per day. Low intakes of fruits and vegetables were notably present. In contrast, high consumption of rice was observed in over 65 % of stone patients. Conclusion: CaOx mixed with CaP was the most prevalent stone type. UA stone was more likely to occur in the elderly. Kidney stone patients were found to consume less-than-adequate amounts of water, food high in carbohydrates, along with low consumtion of fruits and vegetables. These dietary habits might be risk factors in stone development among the Thai population.

Environmental tobacco smoke exposure and respiratory syncytial virus infection in young children hospitalized with acute lower respiratory tract infection.

OBJECTIVE: The present study was performed to determine the relationship between environmental tobacco smoke (ETS) exposure and acute lower respiratory tract infection (LRI) caused by respiratory syncytial virus (RSV) in children. MATERIAL AND METHOD: The authors did the study in 71 children (median age 12 months; 60% male) who were admitted to King Chulalongkorn Memorial Hospital with acute LRI between June and September 2004. 27% had RSV infection. RESULTS: RSV-LRI required longer duration of oxygen therapy than non RSV-LRI (4.5 +/- 1.7 vs 2.8 +/- 1.3 days; p < 0.001). Desaturation in room air was more common in the former group compared to the latter group (37 vs 11%; p = 0.01). There was no difference in urinary cotinine level between the two groups (median 0.5 vs 0.6 mcg/mg Cr; ns). Among RSV-LRI, those with desaturation had higher urinary cotinine level than those without desaturation (median 0.8 vs 0.0 mcg/mg Cr; p = 0.04). CONCLUSION: ETS exposure was not associated with RSV-LRI but increased the risk of desaturation in these patients.

The benefits of vitamin C and vitamin E in children with beta-thalassemia with high oxidative stress.

The present study aimed to determine the benefits of vitamin C and vitamin E as antioxidant supplements in beta-Thalassemia children who are at risk of iron overload due to multiple blood transfusion and high oxidative stress. Antioxidant status, oxidative products, plasma free hemoglobin, total hemoglobin and bilirubin were discussed. Twenty children who had laboratory confirmation of major beta-Thalassemia at least 6 months with history of packed red cell transfusion without iron chelation were recruited. The informed consent for blood sample collection and antioxidant medication was performed. Most patients (85%) had hyperferritinemia and all of them had high oxidative stress. All of them had low vitamin C and vitamin E level at recruitment. Three months after vitamin C and vitamin E supplementation, plasma vitamin C, vitamin E and glutathione were significantly increased, while total bilirubin was slightly decreased without significance. Other parameters included total antioxidant status (TAS), plasma and erythrocyte malondialdehyde (MDA), hemoglobin and plasma free hemoglobin had no differences during the study period. CONCLUSION: B-Thalassemia major children who had multiple blood transfusion are at risk in iron overload and high oxidative stress. From the present study, no significant improvement in raising hemoglobin and concerning low dose vitamin C is not contraindication in beta-Thalassemia patients. Therefore, vitamin C plus vitamin E supplementation have benefits more than vitamin E alone in promoting antioxidant status and may enhance liver function as total bilirubin tends to decrease.

Changes in erythrocyte contents of potassium, sodium and magnesium and Na, K-pump activity after the administration of potassium and magnesium salts.

Low potassium and magnesium status and decreased Na, K-pump activity is an endemic condition among rural Northeast Thais. The authors examined the effect of supplementing potassium and magnesium on erythrocyte potassium, sodium and magnesium content and on Na, K-pump activity. Rural Northeast Thai renal stone patients (62) were recruited, divided into four groups and supplemented for one month with potassium chloride (Group1, n = 16), potassium-sodium citrate (Group2, n = 15), chelated magnesium (Group 3, n =16) and potassium-magnesium citrate (Group 4, n =15) in order to achieve 40 mmol potassium, 10 mmol magnesium and 60 mmol citrate daily. After supplementation with potassium (Groups 1, 2 and 4), plasma potassium and Na, K-pump activity rose significantly in Groups 1, 2 and 4, but erythrocyte potassium rose only in Groups 2 and 4. When supplementing elemental magnesium (Groups 3 and 4), the chelated magnesium caused a significant increase in plasma potassium, erythrocyte potassium, sodium and magnesium without a significant increase in Na, K-pump activity. By contrast, potassium-magnesium citrate caused a significant increase in erythrocyte potassium and magnesium and Na, K-pump activity, but depressed erythrocyte sodium. These results suggest the forms of potassium and /or magnesium salts being supplemented should be considered because they affect erythrocyte potassium, sodium and magnesium content and Na, K-pump activity differently.

The effects of potassium and magnesium supplementations on urinary risk factors of renal stone patients.

The effects of potassium and magnesium supplementation on urinary risk factors for renal stone disease were studied in 61 renal stone patients. The subjects were divided into four groups and supplemented for a period of one month with potassium chloride (KCl, Group 1), potassium sodium citrate (K Na citrate, Group 2), magnesium glycine (Mg glycine, Group 3) and potassium magnesium citrate (K Mg citrate, Group 4) with a daily dose of 42 mEq potassium, 21 mEq magnesium or sodium and 63 mEq citrate, accordingly. The results showed that serum potassium and magnesium of all four groups normalized after the supplementation. Though urinary potassium significantly increased in all three groups supplemented with elemental potassium containing solutions [i.e. KCl (p < 0.001), K Na citrate (p < 0.001) and K Mg citrate (p < 0.001)] only K Na citrate and K Mg citrate, caused a significant increase in urinary pH and citrate but decrease in calcium. Supplementation with Mg glycine in Group 3 although caused a significant increase in urinary magnesium, its effects on urinary pH, citrate and calcium, however, were similar to KCl, in that they caused a significant decrease in urinary pH without any change in urinary citrate or calcium. Supplementation with K Mg citrate in Group 4 seems to have given the best results, as far as lowering stone risk factors in that it caused an increase in urinary pH, potassium and citrate and decreased calcium excretions similar to K Na citrate in Group 2. In addition, K Mg citrate also caused the enrichment of urine with magnesium, another inhibitor of calcium-containing stones. Although the four supplements had no effect on urinary saturation of calcium oxalate salt, their effects on the saturations of brushite (CaHPO4 x 2H2O), octacalcium phosphate (Ca8H2 (PO4)6 x 5H2O) and uric acid were clearly associated with changes in urinary pH. Therefore, in Group 1 and 3, subjects having a decrease in urinary pH, also experienced a significant increase in uric acid saturation. Though the saturation of brushite and octacalcium phosphate in Group 2 and 4 and the sodium acid urate in Group 2 were significantly increased, these urinary risk factors could be overcome, however, by the concomitant increase in urinary citrate. The present results demonstrate that for those stone vulnerable subjects having a high risk of potassium and magnesium depletion, to obtain the best therapeutic results, they should be provided supplementations of both potassium and magnesium together and also in the forms that would result in the delivery of an alkali loading effect.

Magnesium and zinc status in survivors of sudden unexplained death syndrome in northeast Thailand.

Sudden Unexplained Death Syndrome (SUDS) is a major health problem in rural residents of Northeast Thailand. The cause of death in SUDS is suspected to be cardiovascular abnormalities. As magnesium (Mg) and zinc (Zn) deficiency contribute significantly to several cardiovascular diseases, we investigated the Mg- and Zn-status of patients with sudden respiratory distress and cardiac arrest who had survived resuscitation attempts or a near-SUDS episode (N-SUDS). The following subjects were enrolled: 12 N-SUDS inhabitants of rural Northeast Thailand (rural group 1, R1), 13 rural villagers with no past history of N-SUDS (rural group 2, R2), 15 urban Northeasterners (urban group 1, U1); 13 Bangkokians (urban group 2, U2). All subjects were free of structural heart disease. Magnesium and zinc were assessed by atomic absorption spectrophotometry of samples of plasma, red blood cells (RBC), white blood cells (WBC), and 24-hour urine. The mean levels of magnesium in the RBC, WBC, and 24-hour urine of N-SUDS patients (R1) were significantly lower than those of the urban groups (U1 and U2), while the plasma levels did not show any differences. When comparing the Zn-status of R1 with that of the urban groups (U1 and U2), the plasma, RBC, and WBC levels were found to be significantly lower in R1 (except for the RBC-Zn of the U1 group), while the 24-hour urine levels was higher. Although the magnesium and zinc parameters were not significantly different between the rural groups R1 and R2, the prevalence of hypomagnesuria (<2.2 mmol/day), hypozincemia (<9.7 micromol/l), and hyperzincuria (>10.7 micromol/day) was higher in the R1 group. These findings suggest that the homeostasis of both magnesium and zinc is altered in N-SUDS patients. Similar alterations, to a lesser degree, were observed in those people living in the same rural environment (R2).