Doxycycline treatment of otosyphilis with hearing loss.

OBJECTIVES: The recommended treatment of otosyphilis is intravenous penicillin therapy. The response rate varied between 23% and 31%. This treatment needs hospitalisation and is costly, inconvenient and time consuming. Oral doxycycline was tested for its efficacy in otosyphilis. METHOD: The authors reviewed 19 patients diagnosed as having otosyphilis with hearing loss at the outpatient unit between 2004 and 2008 by oral doxycycline 400 mg/day for 21 days. RESULTS: Of those enrolled patients, 12 patients were male and the mean age is 69.4 years. The hearing was improved in nine patients (47.3%) and the audiogram of seven patients (36.8%) showed improvement. There was no serious side effect of doxycycline. CONCLUSION: The data suggest that doxycycline may be an effective alternate regimen for otosyphilis.

The best criteria to diagnose metabolic syndrome in hypertensive Thai patients.

The metabolic syndrome (MS) is commonly found in clinical practice. There are many criteria to diagnose MS. The authors did a cross-sectional study to study the difference among the WHO criteria, the National Cholesterol Educational Program (NCEP) Adult Treatment Panel (ATP III), and the International Diabetes Foundation (IDF) in hypertensive patients. Between July and September 2005, 100 patients (62 women) treated at the hypertension clinic, Srinagarind Hospital were included. The WHO, NCEP A TP III and IDF criteria gave the diagnosis of MS in 37, 33, 60 cases, respectively. The IDF criteria had the significantly highest yield among those three criteria (p < 0.0001). Body mass index (BMI) was the only significant correlated with the diagnosis of MS by the IDF criteria (p-value = 0.04). It also had moderately positive correlated with waist circumference, WC (p < 0.0001, Pearson Correlation 0.58). At the cut point of BMI 23 kg/m2, we suggested the appropriate WC cut-point for Thai hypertensive men and women was 82.5 cm (32.5") and 79.5 cm (31.3"), respectively.

Superior divisional oculomotor nerve palsy caused by midbrain neurocysticercosis.

Superior divisional oculomotor nerve palsy caused by intrinsic brainstem disease occurs rarely. We herein report, to our knowledge, the first case of midbrain neurocysticercosis presenting as isolated superior divisional paresis of the oculomotor nerve. A 25-year-old woman presented with acute onset of headache and ptosis-upgaze palsy of the right eye. Results of the CT scan and MRI of the brain were compatible with neurocysticercosis at the left midbrain. She was dramatically responded to albendazole treatment. The diagnosis was confirmed by positive enzyme-linked immunosorbent assay (ELISA) test for cysticercus in her serum.

Bone mineral density in rural Thai adults living in Khon Kaen province.

OBJECTIVES: To define the bone status and pattern of bone loss in a normal adult population living in a rural area of Khon Kaen province. STUDY DESIGN: A descriptive study. SETTINGS: Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand. Subjects 436 subjects (181 men and 255 women), aged 20-80 years. MAIN OUTCOME MEASURES: Bone parameter including total bone mineral density (BMD), the bone mineral density at different sites such as forearm, lumbar spine and hip, bone mineral content (BMC) were measured by dual energy X-ray absorptiometry (DEXA). RESULTS: The result revealed that women had lower bone mass at various bone sites than men. The peak bone mass in women was observed between 30-39 years of age except at the distal radius which occurred between 20-29 years of age while the peak bone mass in men was observed between 20-29 years of age. It was also shown that bone loss occurred in both men and women with advancing age. The rate of decline at all sites in women was greater than men especially when they were over 60 years old. When comparisons were made between pre and post-menopausal women, the mean of bone mineral density in pre-menopausal women was 1.18 +/- 0.08, 0.69 +/- 0.06, 0.69 +/- 0.06, 1.0 +/- 0.13, 1.15 +/- 0.13 g/cm2 at total body, mid-shaft radius, ultra distal radius, femoral neck and lumbar spine, respectively while the mean of bone mineral density in post-menopausal women was 1.02 +/- 0.12, 0.54 +/- 0.11, 0.54 +/- 0.11, 0.75 +/- 0.16, 0.88 +/- 0.2 g/cm2 at total body, mid-shaft radius, ultra distal radius, femoral neck and lumbar spine, respectively which were lower than BMD in pre-menopausal women (p<0.05). The mean bone mineral content (BMC) in pre-menopausal women was 2401+318.3 g while in post-menopausal women it was 1915.4+421.7 g (p<0.05). The rate of bone loss correlated with the duration after menopause. In this study, using World Health Organization criteria for diagnosis of osteopenia and osteoporosis and a reference value obtained from Khon Kaen young adults, the prevalence of osteopenia in Khon Kaen women subjects was 37.4 per cent at femoral neck, 30.2 per cent at lumbar spine, 44.5 per cent at ultra distal radius, 31.5 per cent at mid-shaft radius and the prevalence of was osteoporosis 19.3 per cent at femoral neck, 24.7 per cent at lumbar spine, 18.5 per cent at ultra distal radius and 26.4 per cent at mid-shaft radius. CONCLUSION: The result of this study demonstrated the bone parameters in rural Thai adults living in Khon Kaen province, the pattern of bone loss, the difference between men and women and finally the prevalence of osteopenia and osteoporosis.