Prevalence of gestational diabetes mellitus (GDM) in pregnant women aged 30 to 34 years old at Phramongkutklao Hospital.

OBJECTIVE: To assess the prevalence of GDM in pregnant women aged 30 to 34 years old who were screened by glucose challenge test (GCT) at Phramongkutklao Hospital. MATERIAL AND METHOD: The cross-sectional data were collected from 1332 pregnant women aged between 30-34 years who attended the antenatal care clinic and delivered at Phramongkutklao Hospital from March, 2003 to January, 2005. The 564 pregnant women aged between 30-34 years old who joined the project were tested by GCT at the gestational age of 24-28 weeks. If the level of blood sugar was the abnormal results, 100-g, 3-hour oral glucose tolerance test (OGTT) would be conducted. All relevant data including demographic information, risks factor for GDM, GCT and OGTT results and pregnancy outcomes were collected for further statistical analysis. RESULTS: There were 1332 pregnancies enrolled into the study. The 564 pregnant women were eligible for GCT with 228 positive results. Thirty-two cases of GDM were detected with the prevalence of 5.7%. In the GDM group, percentage of the common risk factors were family DM (28.1%) glucosuria (12.5%). Furthermore, only one case of premature rupture of membrane and one case of pregnancy-induced hypertension were found. Preterm labor, LGA, SGA, birth asphyxia, fetal anomalies and cesarean section were observe in 3.1%, 9.4%, 0%, 0%, 0%, and 40.6% respectively CONCLUSION: The prevalence rate of GDM in pregnant women aged 30-34 years old screened by GCT at Phramongkutklao Hospital is 5.7%. The GDM class A1 were 23 cases (4.1%) and GDM class A2 were nine cases (1.6%). Their impact on obstetric complication and pregnancy outcome was inconclusive due to the small number of cases.

Anemia and survival in Thai hemodialysis patients: evidence from national registry data.

BACKGROUND: Anemia is a major contributor to morbidity and mortality in chronic dialysis patients. The K/DOQI guideline recommends the target hemoglobin of 11-12 g/dl (hematocrit of 33-36%). However the appropriate hematocrit level for Thai hemodialysis patients has been controversial. OBJECTIVE: To investigate the influence of anemia on mortality in Thai chronic hemodialysis patients who initiated their dialysis from 1999 through 2003. MATERIAL AND METHOD: The data from the Thailand Renal Replacement Therapy Registry who has conducted an annual report of chronic dialysis patients throughout Thailand since 1997 was used. Data of twice- and thrice-weekly hemodialysis patients who had recorded hematocrit from 1999 through 2003 were processed and confirmed before final analysis. Records of 3,211 hemodialysis patients from 301 centers were included. RESULT: The original kidney diseases were diabetes mellitus (31.5%) and hypertension (20.9%). Most patients received twice-weekly hemodialysis (86.3%). The mean hematocrit was 29.3 +/- 5.5%. Most patients (72.8%) had hematocrits of less than 33%. Kaplan-Meier analysis showed patients with hematocrit of ?33% or more had better survival than patients with hematocrits of less than 33% (p <0.01). Patients with hematocrits of less than 27, 27-29.9, 30-32.9 and 36% or more had mortality risks of 1.90 (95% CI: 1.31-2.76, p <0.01), 2.10 (95% CI: 1.42-3.09, p <0.01), 1.74 (95% CI: 1.18-2.56, p <0.01) and 1.174 (95% CI: 0.73-1.90, p = 0.51) respectively, compared to those with hematocrit of 33-35.9%. CONCLUSION: The best survival can be achieved in Thai patients with hematocrits of at least 33%.

Significance of antiphospholipid antibodies in lupus nephritis.

BACKGROUND: Some autoantibodies have been associated with lupus nephritis but the role of antiphospholipid antibodies (APA) is controversial. OBJECTIVE: The present study was to explore the role of APA by comparing demographic profiles and the presence of anticardiolipin antibody (aCL) and lupus anticoagulant (LA) in systemiclupus erythematosus 1 (SLE) patients with and without nephritis. MATERIAL AND METHOD: The cross-sectional study in a tertiary center was conducted in 77 SLE patients. All patients attended our renal or rheumatology clinics between June 2002 and December 2003. RESULTS: Sixty-three (82%) of the 77 SLE patients had nephritis. The prevalence of antiphospholipid syndrome (APS) was 10% (8 patients), positive aCL (IgG) was 26% (20 patients) and positive LA was 26% (20 patients). The receiver operating characteristic (ROC) method was applied to assess the significance of aCL in both nephritis and non-nephritis groups. Area under the ROC curve was 0.538 (95%CI 0.312-0.765), a cutoff value of 20.5 GPL had a sensitivity of 75% and a specificity of 53%. In univariate analysis, neither positivity for anticardiolipin antibody nor lupus anticoagulant was associated with lupus nephritis. Analyzed in only the lupus nephritis group, LA-positive lupus nephritis patients had higher systolic blood pressure (SBP) (133.7 vs 121.9 mmHg, p = 0.005), lower platelet count (209.8 vs 264.4 x 10(3)/microL, p = 0.02) and higher 24-hr urine protein excretion (2.6 vs 1.4 g, p = 0.02) than LA-negative lupus nephritis patients. Serum creatinine was higher in LA-positive lupus nephritis than LA-negative (233.0 vs 94.9 micromol/L), but did not reach statistical significance. CONCLUSION: APA are frequently seen in SLE patients, but not associated with lupus nephritis. However lupus anticoagulant tends to associate with lupus nephritis. Detection of LA in lupus nephritis patients could identify patients who had increased risk to develop bad renal outcomes (elevated SBP and 24-hr urine protein excretion).

Gemcitabine and radiotherapy in the treatment of uterine cervical cancer patients at Phramongkutklao Hospital.

OBJECTIVES: To determine response, complication and survival of uterine cervical cancer patients treated with concurrent gemcitabine radiotherapy. MATERIAL AND METHOD: A retrospective review of medical records of 41 patients with uterine cervical cancer patients, stage IIB and above treated with concurrent gemcitabine radiotherapy from August 2000 to August 2003. RESULTS: At 6 and 12 months of follow up, the complete response rate was 75.6% and 65.9%. The cumulative probability of survival at 6 and 12 months after treatment was 0.93 and 0.85. The main complications were mild hematologic and nonhematologic toxicities. CONCLUSION: Concurrent gemcitabine radiotherapy provided a satisfactory response in patients with uterine cervical cancer with mild toxicity. Long term follow up data is necessary to determine the recurrent rate of this regimen.

Dietary behaviors and nutritional status of adolescents in a remote rural area of Thailand.

INTRODUCTION: Nutritional status among adolescents is an important health indicator. The up-to-date information about nutritional status and food consumption pattern in the remote rural area is required for the effective public health intervention in the rural area of the country. The present study aimed to demonstrate the prevalence of malnutrition, eating behavior and nutritional knowledge among secondary school students in a remote rural area in Thailand. MATERIAL AND METHOD: Body weight and height data were collected from 298 secondary school students for nutritional status calculation using the Institute of Nutrition Research, Mahidol University, INMU-Thaigrowth program. Eating behavior and nutritional knowledge were observed by self-administrated questionnaires. RESULTS: The prevalence low height-for-age (<-2SD) 6.1% and it was 0.7% for low weight-for-height (<-2SD). Fruits (69%) and vegetables (79.4%) consumptions were in the high level. The authors found that the students always consumed commercial snacks especially salted chips more often than regular Thai dessert (74.0% VS 52.3%). The inappropriate behavior found in the present study included always drinking caffeine beverage (43.5%), always drinking alcoholic beverage (6.5%) and always consuming instant noodles (64.4%). CONCLUSION: The prevalence of malnutrition was low among this population. The studied population had a fair knowledge about nutrition. The authoes found that regular consumption of highly commercialized snack products especially salted chips and instant noodles were at a high level in this remote rural area of Thailand. The pattern of nutritional problems in Thailand may have changed in which a public health program for children in rural areas of the country should recognize this transition.

Teaching medical ethics: Phramongkutklao College of Medicine's model.

BACKGROUND: Third-year (first preclinical year) Royal Thai Army (RTA) medical cadets were exposed to a rural community in a community medicine field activity. The poor, kind rural people gave good conditions for student's professional development and empathy. OBJECTIVES: To report a community medicine field work activity for professional development of the RTA medical school. MATERIAL AND METHOD: Descriptive analysis on two occasions to evaluate the third-year RTA medical cadets' impressions immediately after the community medicine field activity in a rural area in central Thailand and one year later using baseline scores of cadets' impressions against our institute's objectives. RESULTS: At the end of the field work, 90.9% of the cadets reported they achieved several institute objectives. The four most frequent mentioned were ethical development (70.6%), professionalism (84.3%), human relationship & communication skills (92.2%), and capability to work in the cmmunity (64.7%). Furthermore, RTA medical cadets rated the staff as good role models (51%). CONCLUSION: The community field work course provided a good environment for the third year medical cadets in building morality and professional development to be good doctors.

The correlations between Central Corneal Thickness and age, gender, intraocular pressure and refractive error of aged 12-60 years old in rural Thai community.

OBJECTIVES: To study the normal Central Corneal Thickness (CCT) and investigate the correlation between CCT and age, gender intraocular pressure and refractive error MATERIAL AND METHOD: Population of age 12-60 years old were interviewed with standard questionnaire. Refractive error was measured and graded according to spherical equivalent power. Then intraocular pressure and central cornea thickness were measured by applanation tonometer and ultrasonic pachymeter, respectively. The data were analyzed using T-test, correlation and multivariate linear regression to identify mean CCT and correlation between age, gender, intraocular pressure, and refractive error. RESULTS: A total of 467 participants were enrolled into the study. One hundred and eighty-six (39.8%) were males and 281 (60.2%) were females. The average CCT was 535.2 +/- 29.9 microm. The mean CCT of right and left eyes were 535.3 +/- 30.4 microm, and 535.1 +/- 29.5 microm, respectively. The multivariate linear regression indicated that increasing in age would decrease the CCT 0.28 microm and an increasing of intraocular pressure would increase the CCT 1.4 microm statistically significance. CONCLUSION: The CCT was independently related to the refractive error and gender Greater CCT was associated with higher intraocular pressure. Conversely, thinner cornea was correlated with older age group.

Dyslipidemia in Thai rural adults.

The present study aimed to determine the prevalence of dyslipidemia in adults in a rural area of Thailand. Random sampling was conducted in 443 volunteers, 187 males and 256 females, aged > or = 35 years in Chachoengsao Province. After a 12-hour fast, the blood was drawn for the analysis of total cholesterol, triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol. Mean serum lipids of cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were 207.79 +/- 46.98, 117.26 +/- 36.59, 50.53 +/- 2.14 and 201.21 +/- 131.07 mg/dL, respectively. Nineteen percent of them had cholesterol > or = 240 mg/dL and 10% had LDL cholesterol > or = 160 mg/dL. Seven percent had HDL cholesterol < or = 35 mg/dL. However, LDL/HDL cholesterol ratios > 5, were found in only 0.9%. In conclusion, the prevalence of dyslipidemia was high in rural Thai adults. Further surveillance in this population is essential in verifying the impact of dyslipidemia as a risk of cardiovascular disease in rural Thai adults.

Survey for intestinal parasites in Belize, Central America.

A stool survey was carried out in 5 villages in the Toledo district of the Central American country of Belize. Eighty-two percent of a total population of 672 participated. The stools were examined by the formalin-ethyl-acetate concentration technique. Sixty-six percent of the population was found to have one or more intestinal parasites. The most common infection was hookworm (55%) followed by Ascaris lumbricoides (30%), Entamoeba coli (21%), Trichuris trichiura (19%), Giardia lamblia (12%), Iodamoeba beutschlii (9%), and Entamoeba histolytica/dispar (6%). Other parasites found were Entamoeba hartmani, Strongyloides stercoralis, Endolimax nana, Isospora belli, and Chilomastix mesnili. Children were more often infected than adults and more females had hookworm infections. Sixty percent of 111 households surveyed had dirt floors, 43% were without toilets, 35% of the houses were overcrowded, and 10% obtained drinking water from streams. Cross-tabulation and logistic regression analyses were used to identify risk and protective factors associated with parasitoses. The risk factors were: being in the Mayan Ketchi population group, and abtaining housework and drinking water from streams. Protective factors were: drinking treated water and the wearing of shoes.