Professor Tada Yipintsoi: beloved teacher, great researcher and practicing cardiologist (10 February 1934 - 9 January 2011)

Professor Tada Yipintsoi was born to a wealthy family in Thailand, the fourth of five children. Most of his early years were spent in education abroad. He received his undergraduate and medical degrees from the Welsh National School of Medicine at Cardiff and obtained his MRCP from the Royal College of Physicians of London. After spending two years at Royal Hammersmith and Brompton Hospitals at London as house officer in Cardiology, he returned for two years to work as a teaching cardiologist at Siriraj Hospital, Bangkok. He then moved to the Mayo Graduate School of Medicine at Rochester, Minnesota as fellow in Cardiology where he was awarded his PhD from the University of Minnesota. Subsequently, he was appointed a faculty member at the Montefiore Hospital in New York. He became Professor of Medicine and Physiology and Director of the Basic Cardiovascular Research Laboratory at the Medical Center and at Albert Einstein College of Medicine. He later became associated with Yeshiva University of New York, where he was also appointed as the Associate Director of the Cardiology Fellowship Training Program.

Predictive factors of systemic embolism in patients with mitral stenosis in sinus rhythm.

BACKGROUND: Systemic embolism is one of the major complications in patients with mitral stenosis (MS) who are in atrial fibrillation; however, this serious complication can also occur in patients with MS in sinus rhythm. OBJECTIVE: The purpose of the present study was to identify the predictive factors of systemic emboli in patients with MS in sinus rhythm. MATERIAL AND METHOD: Twenty patients with MS in sinus rhythm with recent cerebral embolism and 32 with MS in sinus rhythm without any history of systemic embolism were studied between January 2004 and May 2006. Clinical and echocardiographic data were assessed using stepwise logistic regression for prediction of systemic embolism. RESULTS: Age (odds ratio [OR], 1.14; 95% confidence interval [CI] 1.04-1.26) and left atrial spontaneous echo contrast (LASEC) grade 3+ and 4+ (OR, 46.42; 95% CI, 5.00-436.49) were associated with, and predictive of systemic emboli, whereas left atrial appendage contraction flow velocities, left atrial size and mitral valve area were not. CONCLUSION: The present study demonstrates that age and LASEC are the major predictive factors of systemic embolism in patients with MS in sinus rhythm. It would therefore be prudent to give anticoagulants to patients in atrial fibrillation as well as to those in sinus rhythm at risk of systemic embolism.

Predictors of in-hospital mortality in non-ST elevation acute coronary syndrome in Thai Acute Coronary Syndrome Registry (TACSR).

OBJECTIVE: To determine baseline prognostic factors of in-hospital mortality in Thai patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). MATERIAL AND METHOD: Among 5,537 NSTE-ACS patients enrolled in Thai Acute Coronary Syndrome Registry, a univariate analysis and multivariate analysis were used to estimate the relationship of baseline clinical variables and in-hospital mortality. Variables examined included demographics, history and presenting characteristics. RESULTS: The in-hospital mortality rate was 9.5%. The statistically significant, adjusted baseline prognostic factors of in-hospital death were older age > or =65 years) (odds ratio [OR] 2.2, 95% confidence interval [CI] = 1.54-3.09), shock at presentation (OR 4.6, 95%CI = 2.91-7.32), heart failure (OR 3.1, 95%CI = 2.15-4.38), positive cardiac marker (OR 1.7, 95%CI = 1.18-2.53), arrhythmia (OR 12.3, 95%CI = 8.71-17.35), major bleeding (OR 2.9, 95%CI = 1.84-4.51), and cerebrovascular accident (OR 4.9, 95% CI = 2.42-9.97). While dyslipidemia (OR 0.6, 95%CI = 0.45-0.87), having percutaneous coronary intervention (OR 0.6, 95% CI = 0.39-0.94), receiving aspirin (OR 0.6, 95%CI = 0.33-0.94), beta-blocker (OR 0.5, 95% CI = 0.40-0.73), angiotensin converting enzyme inhibitor (OR 0.6, 95% CI = 0.43-0.78) and nitrate (OR 0.5, 95%CI= 0.35-0.76) were associated with lower in-hospital mortality. CONCLUSION: The in-hospital mortality is higher in Thai NSTE-ACS patients compared to other populations. The present study supports and confirms the prognostics importance of several baseline characteristics reported in previous studies.

D-dimer and pulmonary arterial hypertension in systemic sclerosis.

BACKGROUND: Micro-vascular thrombus is a common pathological finding in pulmonary artery hypertension. The association between plasma D-dimer, a marker of thrombus formation, and pulmonary artery hypertension (PAH) in patients with systemic sclerosis is unknown. OBJECTIVE: To assess the correlation of the level of plasma D-dimer and pulmonary artery pressure in patients with systemic sclerosis. MATERIAL AND METHOD: One hundred and twenty nine patients with systemic sclerosis between 19 and 75 years of age (mean, 48 +/- 11.3) entered the study. Plasma D-dimer was determined using immunoturbidimetric assay (D-dimer plus, Dade Behring Inc., Newark, USA). Pulmonary artery pressure was estimated by Doppler echocardiography. PAH was considered present if the Doppler echocardiography-estimated right ventricular systolic pressure (RVSP) exceeded 36 mmHg. RESULTS: Forty-seven patients (36.4%) had PAH according to Doppler echocardiography including 32 (68.1 %) mild (RVSP, 36-45 mmHg), nine (19.1%) moderate (RVSP, 46-55 mmHg), and six (12.8%) severe PAH (RVSP > or = 56 mmHg). No significant correlation was found between plasma D-dimer and RVSP (r = 0. 02, p = 0. 82). CONCLUSION: The present study demonstrated that the D-dimmer level is not associated with the level of pulmonary artery pressure in patients with systemic sclerosis, indicating that microvascular thrombosis may not play a significant role in the pathogenesis of PAH in patients with systemic sclerosis.

Missed appointments at a tuberculosis clinic increased the risk of clinical treatment failure.

We investigated the charts of 381 new smear-positive tuberculosis patients at Khon Kaen Medical School during 1997-2001 using World Health Organization definitions to evaluate associations among treatment success or failure (defaulted, failed, died, or not evaluated) and tuberculosis clinic contact, demographics and clinical characteristics of the patients. Multinomial logistic regression was used for three-category outcome analysis: treatment success, transferred-out and clinical treatment failure. The treatment success and clinical treatment failure rates were 34.1% and 34.4%, respectively. About 46.5% and 85.8% of patients missed appointments at the tuberculosis clinic in the treatment success and treatment failure groups, respectively. The results show that patients who were absent from the tuberculosis clinic were 5.95 times more likely to have clinical treatment failure than treatment success, having adjusted for the effect of transfering-out and the effect of the treatment regimen and the sputum conversion status (adjusted odds ratio = 5.95; 95% CI: 2.99 to 11.84). The review showed that absence from the tuberculosis clinic was an independent risk factor for clinical treatment failure. We recommended that all new smear-positive tuberculosis patients should be followed closely at a tuberculosis clinic.