Random capillary plasma glucose measurement in the screening of diabetes mellitus in high-risk subjects in Thailand.

To assess the usefulness of random capillary plasma glucose (RCPG) measurement in screening for diabetes mellitus in high-risk subjects, a RCPG measurement and a 75-g oral glucose tolerance test (OGTT) were performed in 684 women and 164 men, aged 16-76 years (mean+/-SD: 41.9+/-11.3 years). Risk factors included family history of diabetes in first degree relatives (53.8%), obesity (BMI > or =27 kg/m(2)) in 37.9%, dyslipidemia (78.4%), hypertension, i.e. BP > or =140/90 mmHg (28.5%), and history of gestational diabetes mellitus (16.6%). According to the 1997 ADA/1998 WHO Consultation criteria for a full OGTT, 118 cases (13.9%) were found to have diabetes. Each of 19 cases with RCPG > or =13.3 mmol/l had diabetes according to OGTT, 4.7% of 427 cases with RCPG<6.1 mmol/l had diabetes. Among 402 subjects with RCPG between 6.1 and <13.3 mmol/l, 19.7% were found to have diabetes. Thus, 446 (52.6%) of 848 subjects would have been saved from OGTT if RCPG was used as a screening test, in comparison to 33.1% if the cutpoints for RCPG (12.2 and 5.5 mmol/l) recommended by WHO Study Group (1985)/WHO Consultation (1998) were applied. Therefore, RCPG measurement is a useful screening test for the screening of diabetes mellitus in high-risk subjects.

The efficacy and safety of gliquidone in Thai diabetics.

This study was aimed to evaluate the efficacy and safety of gliquidone, the latest available sulphonylurea, as a monotherapy for patients with non-insulin dependent diabetes millitus (NIDDM). Ninety patients attending diabetic clinics of Siriraj, Rajavithi and Pramongkutklao Army Hospitals were recruited in study. They were 21 males and 69 females, 27-82 years old (mean +/- SD = 52.3 +/- 11.2 years). The diabetic duration varied from newly diagnosed to 18 years (mean +/- SD = 1.5 +/- 2.8 years). Four weeks washout period was applied to 40 patients who had been treated with oral hypoglycemic agents. Before initiation of therapy, fasting venous blood samples were obtained for determination of fasting plasma glucose (FPG), Hemoglobin A1 (HbA1), lipid profile, chemistry profile and complete blood count (CBC). The starting dose of gliquidone was 15-60 mg by mouth once or twice daily. The dosage was adjusted every 4 weeks. FPG, HbA1 and lipid profile were assessed every 4 weeks. Blood chemistry profile and CBC were monitored at 4 weeks after treatment and at the end. After 12 weeks of therapy, FPG and HbA1 significantly declined from 220.8 +/- 55.5 mg/dl and 11.3 +/- 2.6 per cent to 159.1 +/- 38.6 mg/dl and 9.2 +/- 1.4 per cent, respectively (p < 0.001). A small but statistically significant decrease in serum total cholesterol from 229.3 +/- 46.9 to 219.8 +/- 40.7 mg/dl (p < 0.01) as well as serum low density lipoprotein cholesterol from 150.2 +/- 43.7 to 142.2 +/- 42.1 mg/dl (p < 0.05) were observed. Serum triglyceride and high density lipoprotein cholesterol did not significantly alter. Clinical follow-up, blood chemistry profile and CBC did not indicate any adverse reactions from gliquidone therapy. We concluded that gliquidone is an effective oral hypoglycemic agent for treating patients with NIDDM. Adverse effects were not experienced by this group of patients.

Pemphigus vulgaris in siblings: HLA-DR4 and HLA-DQw3 and susceptibility to pemphigus.

BACKGROUND: The association of pemphigus vulgaris with the HLA serotypes, DR4 and DRw6, and with the DQ-beta chain alleles, DQw1 and DQw3, suggests that there is a genetic predisposition to this disease. However, familial cases of pemphigus vulgaris are exceedingly rare. OBJECTIVE: We studied two siblings with pemphigus vulgaris and three unaffected family members to determine whether an HLA allele was associated with the development of pemphigus vulgaris in this family. METHODS: We utilized restriction fragment length polymorphism methods using the HLA-DR beta 1, HLA-DQ alpha, and HLA-DW beta 1 genes as cDNA probes. RESULTS: We found that the affected siblings share the haplotype HLA-DR4 and the DQw.3.2 allele. CONCLUSION: Our findings of gene sharing among siblings with pemphigus vulgaris lend support to previous studies of unrelated Caucasian patients, which implicated DQw3 allele polymorphisms in conferring susceptibility to pemphigus.

Disseminated strongyloidiasis: report of seven cases.

Disseminated strongyloidiasis with associated infection from various organisms in 7 cases on corticosteroid therapy are reported. Either respiratory or abdominal symptoms or both without other obvious etiological factors are its usual clinical manifestations. The highly motile filariform larvae of Strongyloides stercoralis were demonstrated in sputum, gastric content, peritoneal fluid as well as in stool. Associated infection from various organisms were found in 6 cases and it is believed that these contributed to immediate cause of death since disseminated strongyloidiasis had been eradicated before death. Only one case survived. Thiabendazole therapy in conventional dosage is adequate in eradicating disseminated strongyloidiasis.