Renal Protective Effects of Combination of Diltiazem and ACEI/ARB on the Progression of Diabetic Nephropathy: Randomized Controlled Trial.

Background: Strict control of blood sugar and maintenance of normal blood pressure levels are the standard treatments shown to delay the progression of diabetic nephropathy in type 2 diabetic patients. The recommended antihypertensive medications for diabetic nephropathy are angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Previous studies have shown that a non-dihydropyridine calcium channel blocker (diltiazem) could reduce urinary protein excretion in type 2 diabetic patients. Objective: To evaluate the effects of the combinations of diltiazem and ACEI/ARB treatment compared with ACEI/ARB alone in type 2 diabetic patients with diabetic nephropathy. Material and Method: A prospective, randomized, double-blind, placebo-controlled multicenter trial was conducted at the out-patient departments of Rajavithi Hospital (Bangkok) and Ban-phaeo Hospital (Samut Sakhon). A total of 106 type 2 diabetic patients with hypertension and urine protein/creatinine (UPCr) >0.3 gm/gm who had received ACE/ARB were randomized into two groups: a diltiazem group (ACEI/ARB + sustained-release diltiazem 120 mg daily) (50 cases) and a placebo group (ACEI/ARB + placebo) (56 cases). Intention-to-treat analysis was utilized with the data of patients who withdrew from the study before its completion date. Results: 39 cases in the diltiazem group (78.0%) and 38 in the placebo group (67.9%) completed the 1-year treatment. The diltiazem group achieved better preservation of glomerular filtration rate and had lower proteinuria than the placebo group (p<0.05), whereas blood pressure was similar in the two groups. Four patients in the diltiazem group and one patient in the placebo group developed severe pedal edema and discontinue treatment. Conclusion: A combination of diltiazem and ACE/ARB could reduce proteinuria and preserve kidney function in type 2 diabetic patients with diabetic nephropathy.

Sleep Quality among Residents and Fellows in Rajavithi Hospital.

Background: Sleep is one of the basic needs of human beings and is important to their health. Medicine is one of the most stressful fields of education because of its highly demanding professional and academic requirements, and psychological stress and poor sleep are highly prevalent in resident and fellowship training; however, they are not well documented and have not yet been taken seriously. Objective: This study aimed to determine the prevalence of poor sleep and associated factors in resident and fellowship training in Rajavithi Hospital, a tertiary referral hospital in Bangkok, Thailand. Material and Method: This cross-sectional study was conducted between June and August 2015. The two hundred and fourteen participants were all residents or fellows in the academic year 2015. The data were collected using: 1) Demographics; 2) Suanprung stress test-20 items (SPST-20) modified by the Department of Mental Health, Ministry of Public Health, Thailand; 3) Health behavior; and 4) a Thai version of the Pittsburgh Sleep Quality Index (T-PSQI) questionnaire (score >5 indicates poor sleep). Binary logistic regression was used to identify factors associated with poor sleep status. This study was reviewed and approved by the ethics committee, Rajavithi Hospital. Results: Most of the participants were female with mean age (±SD) of 28.87±2.55 years (range 25-41 years). Subjects studying in the 1st, 2nd and 3rd year accounted for 48.1%, 32.2% and 19.7% respectively, and 36.9% of participants were involved in shift work. The mean ± SD of SPST-20 scores was 15.57±8.27, and the prevalence of poor sleep quality was 54.7%. Factors associated with poor sleep were shifting work schedule (OR 2.10, 95% CI 1.07-4.12, p = 0.031) and raised stress score (OR 1.15, 95% CI 1.09-1.21, p<0.001). Those who had poor sleep quality stated that the activities they pursued to relieve this condition were social media (42.0%), followed by reading books (32.4%) and watching television (16.8%). Only a few poor sleepers used sleeping pills (6.4%). Conclusion: There was a high prevalence of poor sleep quality, and factors associated with this were shifting work schedule and higher stress scores. Proper interventions should be made in the form of recommendations of measures to help to relieve sleep problems.

Trends of Metabolic Syndrome Components in Personnel at the Rajavithi Hospital.

OBJECTIVE: Metabolic syndrome (MetS) is a combination of medical disorders which increases the risk of developing diabetes. Studies have shown variable prevalence of this syndrome, but being elderly has often been found to increase the likelihood of developing Mets. This study aims to determine trends in Mets components among Rajavithi Hospital personnel. MATERIAL AND METHOD: A cross-sectional study was carried out from 2009 to 2011. Participants were aged 35 years or more, and the numbers of participants were 504, 1,029 and 1,057 in 2009, 2010 and 2011, respectively. Using medical records after an annual check-up, MetS was defined in accordance with the updated National Cholesterol Educational Program Adult Treatment Panel III (NCEP-ATPIII) guideline. Binary logistic regression was used to assess the factors associated with Mets. RESULTS: Most participants were female, and the mean ages were 45.8 ± 7.6, 45.6 ± 7.9 and 46.1 ± 7.1 years in 2009, 2010 and 2011, respectively. In each of the three years, mean age, BMI, waist circumference, triglycerides, glucose and uric acid were all significantly higher in individuals who had Mets. The prevalence of Mets in 2009, 2010 and 2011 was 7.1%, 5.9% and 4.6%, respectively. Hypertension was the most common abnormal metabolic risk factor in both sexes. The most frequent cluster of MetS components was a combination of hypertension, hypertriglyceridemia and glucose in males, but hypertension, abdominal obesity, and high triglyceride levels in females. The prevalence of MetS was associated with advancing age, male gender and individuals who worked in administration. CONCLUSION: The prevalence of Mets was low and decreased slightly each year. Associated risk factors of Mets were increasing age, male gender and working in administration. Some components of MetS, especially waist circumference, blood pressure, triglyceride levels and glucose, are risk factors of metabolic syndrome and should be avoided in order to decrease its prevalence.