Use of Estimated Glomerular Filtration Rate and Urine Albumin-to-Creatinine Ratio Based on KDIGO 2012 Guideline in a Thai Community Hospital: Prevalence of Chronic Kidney Disease and its Risk Factors.

BACKGROUND Kidney disease is hard to detect at its early stage; therefore, the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guideline was developed for improving care and outcomes of patients with kidney disease. This study aimed to determine clinical outcomes from applying this guideline in a community hospital service. MATERIAL AND METHODS The patients' data were extracted from their medical records and analyzed for outcomes of using the estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) for detecting kidney disease. RESULTS The eGFR was utilized in 36 172 patients aged ≥18 years, and 76.86% of them had normal kidney function. The prevalence of chronic kidney disease (CKD) was 8.20%; most patients (68%) with CKD were in stages 3a and 3b. The most common causes of CKD were diabetes and hypertension. The UACR was mainly used in patients with diabetes. The percentage of patients with UACR ≥3 mg/mmol creatinine alone was significantly higher than that of patients with eGFR.

Prevalence of Hepatitis B and C Virus Infections: Influence of National Health Care Policies and Local Clinical Practices.

BACKGROUND Because reliable epidemiological data are necessary to eliminate hepatitis B and C virus (HBV and HCV) infections, factors influencing their prevalence should be determined. This study aimed to disclose practical issues that affect the prevalence of these viral infections. MATERIAL AND METHODS All medical records with laboratory findings during 2016 to 2018 were reviewed, and all relevant data were extracted. All HBV and HCV infections were followed within these 3 years and investigated in detail. RESULTS The total number of records was 103 197, with a male to female ratio of 1: 1.4. Hepatitis B surface antigen (HBsAg) was tested in 12 934 cases, with a male to female ratio of 1: 2.6. Anti-HCV antibody (anti-HCV Ab) testing was done in 475 cases (53% male). The seroprevalence of HBV and HCV was 5.2% and 4.4%, respectively. Chronic HBV and HCV infections and their life-threatening complication, liver cancer, were highly detected in men aged 41-60 years. CONCLUSIONS HBsAg was highly screened in women owing to the nationwide implementation of the universal HBsAg screening in pregnant women to prevent vertical transmission. Screening for anti-HCV Ab was neglected, probably due to lack of vaccine and high costs of anti-HCV drugs, which most people in low- to middle-income countries generally cannot afford. Local practices under national health care policies and limited budget and resources can cause underestimation of the prevalence of the HBV and HCV infections and persistent transmission of these viruses owing to unidentified cases.

Clinical Utilization of Blood and Urine Cultures and Incidences of Bacteremia and Bacteriuria in a Hospital in Thailand.

BACKGROUND To effectively treat sepsis and urinary tract infection (UTI), blood and urine cultures should be used appropriately and relative to incidences of bacteremia and bacteriuria. This study aimed to investigate the use of blood and urine cultures and incidences of bacteremia and bacteriuria in a hospital in Thailand. MATERIAL AND METHODS Medical records of patients admitted from 2016 to 2018 were randomly selected and data in the records were anonymously extracted for investigation. RESULTS From 12 000 records, data on blood and urine cultures were extracted from 9% and 4% of them, respectively. The negative rate of blood culture was 87.48%. Bacteremia was detected in 10.22%. The positive rate of urine culture was 27.38% and the contamination rate was 31.26%. Escherichia coli was the most common cause of community-onset bacteremia and bacteriuria. Methicillin-resistant coagulase-negative staphylococci and Acinetobacter baumannii were the most common cause of hospital-acquired bacteremia while yeasts were the most common cause of hospital-acquired UTI. CONCLUSIONS A high negative rate of blood culture may result not only from its low sensitivity but also from liberal test use to identify sepsis in some conditions. Improper urine collection is the main problem with use of urine culture.

Experiences of Screening for Human Immunodeficiency Virus, Viral Hepatitis B, and Viral Hepatitis C Infections at a Hospital in Thailand: Test Utilization and Outcomes.

BACKGROUND To prevent the transmission of HIV and hepatitis B and C viruses, early detection is necessary; however, in the early stage, most infected people are symptomless. Screening for these infections should be targeted to certain clinical settings to increase the early detection rate. MATERIAL AND METHODS This retrospective study was conducted by analyzing data from patients' medical records to determine how the screening tests for these viral infections were utilized and what the clinical outcomes from the test utilization were. RESULTS From 11 676 collected records, the screening tests for HIV, HBV, and HCV infections were utilized in 871, 556, and 236 cases, respectively. The tests for HIV and HCV were utilized the most in people with chronic non-infectious diseases, while the test for HBV infection was utilized the most in pregnant women. The positive results of these tests were highly found in the group of patients with acute non-infectious diseases. HIV infection was newly detected in 1.38% of patients, and HBV and HCV infections were newly detected in 5.58% and 2.12%, respectively. CONCLUSIONS Screening for HIV and HBV infections was performed according to the guidelines of the national HIV and HBV programs. The Outpatient Department (OPD) and medical ward may be the most appropriate clinical settings for HIV screening because most patients are there and blood tests are often ordered there, too. The national programs helped slow the rates of HIV and HBV infections in this community.

Appropriateness of Using Tests for Blood Glucose and Diabetic Complications in Clinical Practice: Experiences in a Hospital in Thailand.

BACKGROUND This study aimed to evaluate how the tests for blood glucose (BG) and diabetic complications have been utilized in a hospital in Thailand. MATERIAL AND METHODS Patient medical records having the results of BG, HbA1c, and/or urine microalbumin presented and the records of DM patients having the results of serum lipids, serum LDL-C, and/or serum creatinine presented were selected. The data of diagnosis, ordered tests, and testing results in these records were extracted for evaluation. RESULTS This study recruited 1066 patients diagnosed with DM and 3081 patients diagnosed with other diseases. Point-of-care testing (POCT) for BG was repeatedly used in 371 non-DM cases; most of its results were normal. The results of BG and HbA1c were often used together. There was a good relationship between them, and these test results indicated poor glycemic control in 58% of DM cases. In non-DM cases, the test results agreed, indicating normoglycemia in 17.32%, pre-diabetes in 20.47%, and diabetes in 21.78%. To prevent diabetic nephropathy, serum creatinine was frequently used, whereas urine microalbumin, the recommended test, was underutilized. The result of LDL-C from both direct measurement and calculation were used; however, based on the same guidelines, the results of measured LDL-C indicated risk of cardiovascular diseases in a higher percentage of DM cases than did the results of calculated LDL-C. CONCLUSIONS The use of POCT for BG in hospitalized patients may be inappropriate. The utilization of urine microalbumin should be promoted to effectively prevent diabetic nephropathy.

Factors Causing Disagreement between Measured and Calculated Low Density Lipoprotein-Cholesterol (LDL-C) in Clinical Laboratory Services.

BACKGROUND Since measured low density lipoprotein-cholesterol (LDL-C) has been available in clinical laboratories, there have been concern about the disagreement between measured and calculated LDL-C and the factors causing their disagreement. MATERIAL AND METHODS Serum lipid concentrations were collected from 1,339 medical records of patients admitted to hospital between 2013 and 2015. They were grouped by their total cholesterol (TC), triglycerides (TG), and high-density lipoprotein-cholesterol (HDL-C) concentrations and the agreement between measured and calculated LDL-C was statistically analyzed. RESULTS A strong relationship was found between measured and calculated LDL-C. Significantly disagreements between measured and calculated LDL-C were found in all groups in 2013 and 2014 when lipids were analyzed by Cobas C501. Disagreements found in groups of low TG and low HDL-C concentrations in 2015 were when lipids were analyzed by Abbott Architect ci8200. In groups of calculated LDL-C <1.81 mmol/L, around 80% had the measured LDL-C >1.81 mmol/L. Among various atherogenic indices, non-HDL-C showed the strongest relationship with LDL-C, while TC to HDL-C ratio showed the strongest agreement with the LDL-C. CONCLUSIONS The disagreement between measured and calculated LDL-C in a clinical laboratory seemed to depend on the analytical system used, and was probably associated with individual laboratory variations.

Quantitation of anticancer drugs - Cyclophosphamide and ifosfamide in urine and water sewage samples by gas chromatography-mass spectrometry.

OBJECTIVES: Cyclophosphamide (CP) and ifosfamide (IF) are effective anti-cancer drugs but their genotoxicity can harm everyone contacting them occupationally or environmentally. Therefore, a sensitive method for monitoring their amounts in biological and environmental samples is needed. This has aimed to develop a method for analyzing these drugs in urine and water sewage samples. MATERIAL AND METHODS: The drug spiked samples were extracted, derivatized, and analyzed by gas chromatography-mass spectrometry and the analytical parameters were validated. RESULTS: The method gave linear calibration curves at the concentrations of 0-190 nmol/l. It had the quantitation limit of 3.8 nmol/l and showed acceptable specificity, accuracy, recovery and precision. CONCLUSIONS: The developed method can be used reliably for monitoring CP and IF concentrations in urine and water sewage. The method will be applied for preventing health risk from occupational and environmental exposures to these drugs. Int J Occup Med Environ Health 2016;29(5):815-822.

Blood alcohol concentrations after "one standard drink" in Thai healthy volunteers.

OBJECTIVE: The present study aimed to investigate if drinking one standard drink per hour could keep blood alcohol concentration below the legal limit of 0.05% in Thai men and women. MATERIAL AND METHOD: After overnight fast, 15 healthy Thai men and 15 healthy Thai women received 12 g of ethanol by drinking beer, rum, or carbonate mixed rum and their blood alcohol concentrations were monitored every 15 min for 1 hours. RESULTS: With one standard drink or 12 g of ethanol per hour both Thai men and women had blood alcohol concentrations below 0.05%. At 45 min after drinking, women had significantly higher blood alcohol concentrations than men (p < 0.05). There was an inverse correlation between blood alcohol concentrations and the person's body weight. Blood alcohol concentrations were very low when alcoholic beverage was taken immediately after a meal. However, drinking alcohol along with a snack had no effect on blood alcohol concentrations. Drinking carbonate mixed rum led to the highest blood alcohol levels, followed by beer either rapidly drinking or sipping and pure rum, respectively. CONCLUSION: For Thai people, one standard drink per hour should be considered in the definition of safe level of drinking for men and women driving motor vehicles. It will be safer if drinking immediately after a big meal. Due to rapid absorption of alcohol in the bloodstream, drinking a beverage with low alcohol content could inebriate more rapidly.