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Zeitschriftendaten
Format
Zeitschrift
eISSN
1875-855X
Erstveröffentlichung
01 Jun 2007
Erscheinungsweise
6 Hefte pro Jahr
Sprachen
Englisch

Suche

Volumen 10 (2016): Heft 2 (April 2016)

Zeitschriftendaten
Format
Zeitschrift
eISSN
1875-855X
Erstveröffentlichung
01 Jun 2007
Erscheinungsweise
6 Hefte pro Jahr
Sprachen
Englisch

Suche

12 Artikel

Editorial

Uneingeschränkter Zugang

Predicting mortality from upper gastrointestinal bleeding

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 113 - 113

Zusammenfassung

Original article

Uneingeschränkter Zugang

Factors predicting mortality of elderly patients with acute upper gastrointestinal bleeding

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 115 - 122

Zusammenfassung

Abstract

Acute upper gastrointestinal bleeding (UGIB) is a common gastrointestinal disease emergency and a cause of morbidity and mortality.

To assess the clinical outcomes and explore predictive factors for mortality of elderly patients with acute UGIB.

During the study period from January 2010 to September 2011, we prospectively enrolled 981 patients presenting with UGIB from 11 hospitals (mean age ± standard deviation (SD), 59.4 ± 14.9 years; range, 17–94 years; including 661 men). Of these 981 patients, 499 (50.9%) were elderly. Basic demographic data and clinical findings, and Rockall scores were collected and calculated.

We studied 499 elderly patients. Their mean age ± SD was 71.63 ± 7.65 years. The 30-day mortality rate was 9% and rebleeding was just 1%. Regression analysis showed a pulse rate >100 beats per min at first visit, red blood in a nasogastric aspiration, comorbidity with coronary artery disease, and creatinine >1.5 mg/dL were independent predictive factors of 30-day mortality.

Peptic ulcer bleeding is a major cause of acute UGBI in the elderly. We recommend patients with predictive factors of mortality, pulse rate >100 beats per min at first visit, red blood in nasogastric aspiration, comorbidity with coronary artery disease, and creatinine >1.5 mg/dL be closely monitored and treated promptly. Reducing mortality from peptic ulcer bleeding should focus on preventing peptic ulcer occurrence as a result of ulcerogenic medications.

Schlüsselwörter

  • Elderly patients
  • mortality
  • predictive factors
  • upper gastrointestinal bleeding

Brief communication (Original)

Uneingeschränkter Zugang

A secondary analysis of atypical presentations of older patients with infection in the emergency department of a tertiary care hospital in Thailand

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 181 - 187

Zusammenfassung

Abstract

Classic symptoms of illness are often absent in older adults, delaying diagnosis and management, and resulting in unfavorable outcomes.

To determine the prevalence of atypical presentations by older Thai adults with infections in the emergency department (ED) of a tertiary care hospital, and to identify factors associated with atypical presentations in such patients.

We performed a secondary analysis of a retrospective cohort observational study of atypical presentations of patients aged ≥65 years in the ED using a subset of data first reported in the Archives of Gerontology and Geriatrics in 2015; 62:97-102.

The prevalence of atypical presentations was 35% of those with infectious diseases (64 of 183 cases). Pneumonia was the most common (30%). We identified 4 associated risk factors: complicated urinary tract infection (UTI) (odds ratio (OR) 4.54; 95% confidence interval (CI) 1.75,11. 78; P = 0.002), cancer (OR 2.64; 95% CI 1.07, 6.53; P = 0.04), dementia (OR 6.66; 95% CI 1.47, 30.11; P = 0.01), and pulse rate >90 beats/min (OR 2.06; 95% CI 1.01, 4.22; P = 0.04). Infective diarrhea was protective (OR 0.27; 95% CI 0.09, 0.8; P = 0.02).

Atypical presentations of infectious diseases by older Thai patients in the ED accounted for about one third of those with infectious disease. Associated risk factors were complicated UTI, cancer, dementia, and increased pulse rate. Older patients with these factors who have uncertain diagnoses should be considered for hospitalization because the absence of classic symptoms does not exclude life-threatening infections.

Schlüsselwörter

  • Geriatrics
  • geriatric syndrome
  • infection presentation
Uneingeschränkter Zugang

Evaluation of the utility of cardiac ultrasonography of patients in a surgical intensive care unit

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 173 - 179

Zusammenfassung

Abstract

Ultrasonography is being more commonly used by intensivists to assess the hemodynamic status of patients in intensive care units (ICUs) and for other purposes.

To review the indications for and evaluate the impact of cardiac ultrasonography (CUS) on the management of patients in a surgical ICU (SICU).

We conducted a retrospective observational cohort study of patients in the SICU who underwent CUS performed by intensivists at King Chulalongkorn Memorial Hospital from January 2011 to March 2013. CUS was used to determine (1) preload (using inferior vena cava (IVC) diameter and collapsibility index), (2) cardiac contractility (using subjective assessment and fractional shortening), and (3) other miscellaneous findings.

We included data from 157 patients (96 male and 61 female) whose age ranged from 15 to 99 years (mean 63.5 years) in the study. CUS was performed 190 times in these 157 patients. The most common indication for CUS was hemodynamic status assessment (78), followed by shock (69), oliguria (35), and other (8). CUS results led to 71 changes in management (37% of cases) ; namely, fluid challenge (38), inotropic drug management (7), drainage of pleural/abdominal fluid (12), and other changes (14). A weakly-positive correlation between the IVC diameter and CVP (Pearson’s r = 0.45) was demonstrated. The overall mortality rate was 14.6%.

CUS performed by intensivists can be used to assess the hemodynamic status of patients in the SICU, especially those with shock or oliguria, and lead to changes in the management of these patients.

Schlüsselwörter

  • Cardiac ultrasonography
  • surgical ICU
Uneingeschränkter Zugang

Serum microRNA-34a is potential biomarker for inflammation in nonalcoholic fatty liver disease

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 163 - 171

Zusammenfassung

Abstract

MicroRNA-34a (miR-34a) contributes to liver injury through an apoptosis pathway.

To determine the correlation between serum miR-34a and liver inflammation as assessed by nonalcoholic fatty liver disease (NAFLD) activity score (NAS).

We included a cross-selectional study of 50 patients with NAFLD in this observational study and confirmed diagnosis by liver biopsy, with NAS grading. A control group comprised 23 healthy individuals without chronic liver disease. Serum miR-34a was assayed using a real-time quantitative PCR (Applied Biosystems).

The mean age of NAFLD patients was 46.0 ± 13.7 years, and 52% were female. Metabolic syndrome was found in 76%. Liver histopathology showed that 54% of patients had NAS ≥4 and significant fibrosis (≥2) was found in 22%. Serum levels of miR-34a were significantly correlated with NAS (r = 0.39, P = 0.005), and the degree of steatosis (r = 0.28, P = 0.049), ballooning (r = 0.30, P = 0.034), and fibrosis (r = 0.39, P = 0.005). Serum miR-34a in patients with NAS ≥4 was significantly higher than in those with NAS <4 (P = 0.011) and controls (P < 0.001). There was no significant correlation between serum miR-34a and other variables. The area under receiver operating characteristic curve for serum miR-34a comparing patients with NAS ≥4 and with NAS <4 was 0.67 (95% CI 0.52, 0.82).

Serum level of miR-34a has a significant fair to good correlation with NAS and may serve as a biomarker of liver inflammation and fibrosis in patients with NAFLD.

Schlüsselwörter

  • Biomarker
  • microRNA-34a
  • non-alcoholic fatty liver disease
Uneingeschränkter Zugang

Emergency severity index compared with 4-level triage at the emergency department of Ramathibodi University Hospital

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 155 - 161

Zusammenfassung

Abstract

Emergency department (ED) triage is important for categorizing and prioritizing patients. Effective triage may assist in crowd reduction in the ED and appropriate patient management. There are several systems, including the 5-level Emergency Severity Index (ESI) and the 4-level Ramathibodi-nurse triage. Currently, there are limited data by which to compare the 5- versus 4-level triage; particularly on health outcomes, such as length of stay in the ED, mortality, and resource needs.

To compare the accuracy of 5- and 4-level triage in an ED.

This observational study was conducted on a cross-section of patients in the ED at Ramathibodi Hospital of Mahidol University, Bangkok, Thailand. Eligible patients were those who visited the ED and were evaluated by ESI and nurse triage. Each evaluation was blinded to the results of the other. Discrimination performance between the 5- and 4-level triage was compared by using the area under a receiver operating characteristic (ROC) curve and concordance statistic for prediction of life saving intervention. Net reclassification improvement (NRI) of the 5-level ESI over the 4-level triage was performed.

Study criteria were met by 520 patients. The areas under the ROC curves of the ESI and nurse triage on life-saving intervention were 92.2% (95% confidence intervals were 87.3%, 96.9%) and 81.3% (95% CI 75.2%, 87.3%), respectively. Areas under the ROC curve differed significantly (P < 0.001). The overall reclassification improvement was 42.4%.

The 5-level emergency severity index was more accurate than the 4-level triage in terms of lifesaving intervention.

Schlüsselwörter

  • Emergency room
  • ROC
  • triage
Uneingeschränkter Zugang

Association of cytochrome P450 2A6 polymorphism, anxiety, and environmental factors with cigarette smoking by Thai adults

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 147 - 154

Zusammenfassung

Abstract

The effects and associations of genetic variation, psychological, and environment factors associated with cigarette smoking and nicotine dependence remain largely unknown.

To determine the influence and association of functional genetic polymorphisms of cytochrome P450 2A6 (CYP2A6), anxiety, and environmental factors on cigarette smoking and nicotine dependence.

A cross-sectional study was conducted at King Chulalongkorn Memorial Hospital, Thailand between October 2014 and June 2015. We recruited 127 Thai adult smokers when they visited for an annual physical check-up. Participants completed questionnaires regarding demographic characteristics, The Fagerstrom Test for Nicotine Dependence, and The Thai Hospital Anxiety and Depression Scale. Blood was collected for CYP2A6 genotyping to determine the enzyme metabolism level/group.

Factors associated with significantly greater cigarette consumption were age and being ultrarapid/ extensive metabolizers (UM/EM). Anxiety and smoking by household family members were significantly associated with the degree of nicotine dependence. We observed associations between severe nicotine dependence and genotype (UM/EM) and age (b = 0.037; P = 0.005), intermediate metabolizers (IM) and age (b = 0.031; P = 0.43), UM/EM and anxiety (b = 0.258; P < 0.001), IM and anxiety (b = 0.285; P < 0.001), UM/EM and household smoking in the family members (b = 1.427; P = 0.003), and IM and smoking by household family members (b = 1.293; P = 0.024).

Information regarding the association between the gene encoding enzyme metabolism, anxiety, and their interactions may be beneficial for selecting treatment choices for smoking cessation for individual genotypic metabolizers.

Schlüsselwörter

  • Anxiety
  • cigarette smoking
  • cytochrome P450 2A6 polymorphism
Uneingeschränkter Zugang

Subclinical atherosclerosis in young Thai adults with juvenile-onset systemic lupus erythematosus

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 139 - 146

Zusammenfassung

Abstract

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in adult patients with systemic lupus erythematosus (SLE). Increased risk of CVD and atherosclerosis has been demonstrated in children with SLE. However, evidence of atherosclerosis in adults with juvenile-onset SLE is limited and their additional CVD risk factors unclear.

To investigate the presence of subclinical atherosclerosis in young Thai adults with juvenile-onset SLE, and evaluate atherosclerotic risk factors.

We recruited a cohort of patients aged 18-40 years who had been diagnosed SLE before the age of 18 years for this observational study. Patients with chronic kidney disease stage IV or V, alcoholism, chronic liver disease, or life threatening illness were excluded. Common carotid intima-media thickness (CCIMT) was measured. Clinical and laboratory parameters, treatment, and SLE-related factors, which could be risk factors for atherosclerosis and classic risk factors were obtained.

We enrolled 29 patients (24 female). Their mean age was 25.1 years and mean disease duration 11.3 years. The age of participants, persistent proteinuria and use of cyclosporin correlated with increased CCIMT by multivariable analysis (P = 0.02, 0.02, and 0.03, respectively). These patients had significantly abnormal CCIMT when compared with a healthy population (mean 690 (SD 150) μm versus mean 447 (SD 76) μm, respectively; P < 0.001).

Subclinical atherosclerosis, identified by abnormal CCIMT, appears in young adults with juvenile-onset SLE. The CCIMT abnormality progresses with increasing age, and persistent proteinuria and use of cyclosporin appears to increase the risk for atherosclerosis.

Schlüsselwörter

  • Atherosclerosis
  • carotid intima-media thickness
  • juvenile-onset systemic lupus erythematosus
  • subclinical atherosclerosis
  • systemic lupus erythematosus
Uneingeschränkter Zugang

Prevalence of dry eye disease in autoimmune thyroid disease and the association of dry eye with clinical signs of thyroid associated ophthalmopathy: observational, noncomparative, cross-sectional study

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 133 - 138

Zusammenfassung

Abstract

Autoimmune thyroid disease (AITD) is a risk factor for dry eye disease. The prevalence of dry eye in AITD is not definitely known.

To determine the prevalence of dry eye in AITD and its association with clinical signs of thyroid associated ophthalmopathy (TAO).

We enrolled a cross-section of 92 patients with AITD between May 1 and August 31, 2013. All were examined to establish thyroid eye signs, and severity was classified as none, mild, and moderate-severe according to the European Group on Graves’ orbitopathy. Dry eye disease was verified using an Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), Schirmer test, and ocular surface fluorescein staining. Features of meibomian glands were inspected. This observational study was registered at www.clinicaltrials.in.th, No. TCTR20130713001.

The prevalence of dry eye in AITD was 27% by OSDI questionnaire (95% confidence interval (CI), 16%-34%); 96% (95% CI, 93%-99%) by TBUT; 69% (95% CI, 62%-75%) by ocular surface staining; and 18% (95% CI, 12%-23%) using a Schirmer test, which associated dry eye and proptosis with an odds ratio (OR) of 9.3 (95% CI, 1.2-70.6, P = 0.031), and lagophthalmos by ocular surface staining with an OR of 5.8 (95% CI, 1.2-27.7, P = 0.026). Dry eye in patients with or without clinical signs of TAO was not significantly different.

The prevalence of dry eye varied by criteria, but was not different in AITD patients with or without TAO. Proptosis and lagophthalmos were associated more strongly with dry eye disease in AITD with TAO, than without.

Schlüsselwörter

  • AITD
  • autoimmune thyroid disease
  • dry eye
  • TAO
  • thyroid associated ophthalmopathy
Uneingeschränkter Zugang

Clinical factors associated with death from acute pulmonary embolism in Thailand

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 129 - 132

Zusammenfassung

Abstract

Acute pulmonary embolism (APE) is under diagnosed and may be fatal. Computed tomographic pulmonary angiography (CTPA) showing right ventricular failure is associated with mortality in APE. In resource-limited facilities, clinical factors are crucial.

We studied clinical factors that were associated with death from APE.

We enrolled patients with APE proven by CTPA between January 1, 2007 and July 31, 2011 at Khon Kaen University. Clinical factors associated with death from APE were studied by multiple logistic regression analysis. An online tool to assess risk of death from APE was also used.

There were 81 eligible patients in the study. Of those, 20 patients (25%) died within 3 months. Clinical factors significantly associated with death were low systolic blood pressure (SBP), high pulse rate, and low oxygen saturation at presentation.

Initial systolic blood pressure, pulse rate, and oxygen saturation are associated with mortality from APE.

Schlüsselwörter

  • Clinical factors
  • mortality
  • online tool
  • predictors
  • pulmonary embolism
Uneingeschränkter Zugang

Seroprevalence of foot-and-mouth disease in large ruminants in periurban dairy farms near Islamabad, Pakistan

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 123 - 127

Zusammenfassung

Abstract

Foot-and-mouth disease (FMD) is an enzootic viral disease affecting livestock in Pakistan.

To determine the seroprevalence of FMD in large ruminants in periurban dairy farms near Islamabad.

Serum samples were collected from 636 large ruminants during 2011 to 2012; 584 (92%) were buffaloes (Bos bubalis bubalis) and 52 (18%) were cattle (Bos taurus indicus). The population sampled was mainly adult (n = 514) and female (n = 596). Sera were assayed for antibodies against a nonstructural protein of the FMD virus using a Chekit FMD-3ABC bo-ov enzyme immunoassay Kit (Idexx Laboratories). Data were analyzed using a χ2 test and multiple logistic regression.

The seroprevalence of FMD in the ruminants was 46% (n = 293, 95% confidence interval (CI); 42.18- 49.95) and was significantly higher in buffaloes (285, 97%; χ2 = 21.46; P < 0.001) than in cattle (8, 3%). The risk of seropositivity increased significantly with age (χ2 = 72.71; P < 0.001); adult animals were 7.05 times more likely (odds ratio (OR) 7.05, 95% CI 3.60-13.79; P < 0.001) to be seropositive after adjusting for the effect of species. Buffaloes were more likely to be seropositive (OR 3.99, 95% CI 1.78-8.92, P = 0.001). Sex was not significantly associated with FMD seropositivity (OR 0.58, 95% CI 0.17-1.95, P = 0.38).

Large ruminants in periurban dairy farms near Islamabad have a high FMD virus seroprevalence and play a potential role in the persistence and transmission of FMD in Pakistan.

Schlüsselwörter

  • FMD
  • seroprevalence
  • buffaloes
  • cattle
  • large ruminants
  • periurban
  • Pakistan

Clinical report

Uneingeschränkter Zugang

Hematuria, an unusual systemic toxicity, in formic acid ingestion: a case report

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 189 - 190

Zusammenfassung

Abstract

Acid ingestion can cause severe injuries of the upper gastrointestinal tract and the respiratory tract. Besides hydrofluoric acid and selenious acid, systemic toxicities of acid ingestion can occasionally occur. However, hematuria is a rare systemic toxicity reported in caustic poisoning.

To describe a case of a one-year-old girl who accidentally ingested liquid formic acid.

This patient had severe local corrosive effects including a compromised upper respiratory tract and developed gross hematuria during the hospital admission.

Hematuria could be a consequence of acid ingestion.

Significant hematuria can be a systemic effect of acid ingestion, but in this case was self-limiting

Schlüsselwörter

  • Caustic poisoning
  • formic acid
  • hematuria
  • systemic toxicity
  • unusual
12 Artikel

Editorial

Uneingeschränkter Zugang

Predicting mortality from upper gastrointestinal bleeding

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 113 - 113

Zusammenfassung

Original article

Uneingeschränkter Zugang

Factors predicting mortality of elderly patients with acute upper gastrointestinal bleeding

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 115 - 122

Zusammenfassung

Abstract

Acute upper gastrointestinal bleeding (UGIB) is a common gastrointestinal disease emergency and a cause of morbidity and mortality.

To assess the clinical outcomes and explore predictive factors for mortality of elderly patients with acute UGIB.

During the study period from January 2010 to September 2011, we prospectively enrolled 981 patients presenting with UGIB from 11 hospitals (mean age ± standard deviation (SD), 59.4 ± 14.9 years; range, 17–94 years; including 661 men). Of these 981 patients, 499 (50.9%) were elderly. Basic demographic data and clinical findings, and Rockall scores were collected and calculated.

We studied 499 elderly patients. Their mean age ± SD was 71.63 ± 7.65 years. The 30-day mortality rate was 9% and rebleeding was just 1%. Regression analysis showed a pulse rate >100 beats per min at first visit, red blood in a nasogastric aspiration, comorbidity with coronary artery disease, and creatinine >1.5 mg/dL were independent predictive factors of 30-day mortality.

Peptic ulcer bleeding is a major cause of acute UGBI in the elderly. We recommend patients with predictive factors of mortality, pulse rate >100 beats per min at first visit, red blood in nasogastric aspiration, comorbidity with coronary artery disease, and creatinine >1.5 mg/dL be closely monitored and treated promptly. Reducing mortality from peptic ulcer bleeding should focus on preventing peptic ulcer occurrence as a result of ulcerogenic medications.

Schlüsselwörter

  • Elderly patients
  • mortality
  • predictive factors
  • upper gastrointestinal bleeding

Brief communication (Original)

Uneingeschränkter Zugang

A secondary analysis of atypical presentations of older patients with infection in the emergency department of a tertiary care hospital in Thailand

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 181 - 187

Zusammenfassung

Abstract

Classic symptoms of illness are often absent in older adults, delaying diagnosis and management, and resulting in unfavorable outcomes.

To determine the prevalence of atypical presentations by older Thai adults with infections in the emergency department (ED) of a tertiary care hospital, and to identify factors associated with atypical presentations in such patients.

We performed a secondary analysis of a retrospective cohort observational study of atypical presentations of patients aged ≥65 years in the ED using a subset of data first reported in the Archives of Gerontology and Geriatrics in 2015; 62:97-102.

The prevalence of atypical presentations was 35% of those with infectious diseases (64 of 183 cases). Pneumonia was the most common (30%). We identified 4 associated risk factors: complicated urinary tract infection (UTI) (odds ratio (OR) 4.54; 95% confidence interval (CI) 1.75,11. 78; P = 0.002), cancer (OR 2.64; 95% CI 1.07, 6.53; P = 0.04), dementia (OR 6.66; 95% CI 1.47, 30.11; P = 0.01), and pulse rate >90 beats/min (OR 2.06; 95% CI 1.01, 4.22; P = 0.04). Infective diarrhea was protective (OR 0.27; 95% CI 0.09, 0.8; P = 0.02).

Atypical presentations of infectious diseases by older Thai patients in the ED accounted for about one third of those with infectious disease. Associated risk factors were complicated UTI, cancer, dementia, and increased pulse rate. Older patients with these factors who have uncertain diagnoses should be considered for hospitalization because the absence of classic symptoms does not exclude life-threatening infections.

Schlüsselwörter

  • Geriatrics
  • geriatric syndrome
  • infection presentation
Uneingeschränkter Zugang

Evaluation of the utility of cardiac ultrasonography of patients in a surgical intensive care unit

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 173 - 179

Zusammenfassung

Abstract

Ultrasonography is being more commonly used by intensivists to assess the hemodynamic status of patients in intensive care units (ICUs) and for other purposes.

To review the indications for and evaluate the impact of cardiac ultrasonography (CUS) on the management of patients in a surgical ICU (SICU).

We conducted a retrospective observational cohort study of patients in the SICU who underwent CUS performed by intensivists at King Chulalongkorn Memorial Hospital from January 2011 to March 2013. CUS was used to determine (1) preload (using inferior vena cava (IVC) diameter and collapsibility index), (2) cardiac contractility (using subjective assessment and fractional shortening), and (3) other miscellaneous findings.

We included data from 157 patients (96 male and 61 female) whose age ranged from 15 to 99 years (mean 63.5 years) in the study. CUS was performed 190 times in these 157 patients. The most common indication for CUS was hemodynamic status assessment (78), followed by shock (69), oliguria (35), and other (8). CUS results led to 71 changes in management (37% of cases) ; namely, fluid challenge (38), inotropic drug management (7), drainage of pleural/abdominal fluid (12), and other changes (14). A weakly-positive correlation between the IVC diameter and CVP (Pearson’s r = 0.45) was demonstrated. The overall mortality rate was 14.6%.

CUS performed by intensivists can be used to assess the hemodynamic status of patients in the SICU, especially those with shock or oliguria, and lead to changes in the management of these patients.

Schlüsselwörter

  • Cardiac ultrasonography
  • surgical ICU
Uneingeschränkter Zugang

Serum microRNA-34a is potential biomarker for inflammation in nonalcoholic fatty liver disease

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 163 - 171

Zusammenfassung

Abstract

MicroRNA-34a (miR-34a) contributes to liver injury through an apoptosis pathway.

To determine the correlation between serum miR-34a and liver inflammation as assessed by nonalcoholic fatty liver disease (NAFLD) activity score (NAS).

We included a cross-selectional study of 50 patients with NAFLD in this observational study and confirmed diagnosis by liver biopsy, with NAS grading. A control group comprised 23 healthy individuals without chronic liver disease. Serum miR-34a was assayed using a real-time quantitative PCR (Applied Biosystems).

The mean age of NAFLD patients was 46.0 ± 13.7 years, and 52% were female. Metabolic syndrome was found in 76%. Liver histopathology showed that 54% of patients had NAS ≥4 and significant fibrosis (≥2) was found in 22%. Serum levels of miR-34a were significantly correlated with NAS (r = 0.39, P = 0.005), and the degree of steatosis (r = 0.28, P = 0.049), ballooning (r = 0.30, P = 0.034), and fibrosis (r = 0.39, P = 0.005). Serum miR-34a in patients with NAS ≥4 was significantly higher than in those with NAS <4 (P = 0.011) and controls (P < 0.001). There was no significant correlation between serum miR-34a and other variables. The area under receiver operating characteristic curve for serum miR-34a comparing patients with NAS ≥4 and with NAS <4 was 0.67 (95% CI 0.52, 0.82).

Serum level of miR-34a has a significant fair to good correlation with NAS and may serve as a biomarker of liver inflammation and fibrosis in patients with NAFLD.

Schlüsselwörter

  • Biomarker
  • microRNA-34a
  • non-alcoholic fatty liver disease
Uneingeschränkter Zugang

Emergency severity index compared with 4-level triage at the emergency department of Ramathibodi University Hospital

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 155 - 161

Zusammenfassung

Abstract

Emergency department (ED) triage is important for categorizing and prioritizing patients. Effective triage may assist in crowd reduction in the ED and appropriate patient management. There are several systems, including the 5-level Emergency Severity Index (ESI) and the 4-level Ramathibodi-nurse triage. Currently, there are limited data by which to compare the 5- versus 4-level triage; particularly on health outcomes, such as length of stay in the ED, mortality, and resource needs.

To compare the accuracy of 5- and 4-level triage in an ED.

This observational study was conducted on a cross-section of patients in the ED at Ramathibodi Hospital of Mahidol University, Bangkok, Thailand. Eligible patients were those who visited the ED and were evaluated by ESI and nurse triage. Each evaluation was blinded to the results of the other. Discrimination performance between the 5- and 4-level triage was compared by using the area under a receiver operating characteristic (ROC) curve and concordance statistic for prediction of life saving intervention. Net reclassification improvement (NRI) of the 5-level ESI over the 4-level triage was performed.

Study criteria were met by 520 patients. The areas under the ROC curves of the ESI and nurse triage on life-saving intervention were 92.2% (95% confidence intervals were 87.3%, 96.9%) and 81.3% (95% CI 75.2%, 87.3%), respectively. Areas under the ROC curve differed significantly (P < 0.001). The overall reclassification improvement was 42.4%.

The 5-level emergency severity index was more accurate than the 4-level triage in terms of lifesaving intervention.

Schlüsselwörter

  • Emergency room
  • ROC
  • triage
Uneingeschränkter Zugang

Association of cytochrome P450 2A6 polymorphism, anxiety, and environmental factors with cigarette smoking by Thai adults

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 147 - 154

Zusammenfassung

Abstract

The effects and associations of genetic variation, psychological, and environment factors associated with cigarette smoking and nicotine dependence remain largely unknown.

To determine the influence and association of functional genetic polymorphisms of cytochrome P450 2A6 (CYP2A6), anxiety, and environmental factors on cigarette smoking and nicotine dependence.

A cross-sectional study was conducted at King Chulalongkorn Memorial Hospital, Thailand between October 2014 and June 2015. We recruited 127 Thai adult smokers when they visited for an annual physical check-up. Participants completed questionnaires regarding demographic characteristics, The Fagerstrom Test for Nicotine Dependence, and The Thai Hospital Anxiety and Depression Scale. Blood was collected for CYP2A6 genotyping to determine the enzyme metabolism level/group.

Factors associated with significantly greater cigarette consumption were age and being ultrarapid/ extensive metabolizers (UM/EM). Anxiety and smoking by household family members were significantly associated with the degree of nicotine dependence. We observed associations between severe nicotine dependence and genotype (UM/EM) and age (b = 0.037; P = 0.005), intermediate metabolizers (IM) and age (b = 0.031; P = 0.43), UM/EM and anxiety (b = 0.258; P < 0.001), IM and anxiety (b = 0.285; P < 0.001), UM/EM and household smoking in the family members (b = 1.427; P = 0.003), and IM and smoking by household family members (b = 1.293; P = 0.024).

Information regarding the association between the gene encoding enzyme metabolism, anxiety, and their interactions may be beneficial for selecting treatment choices for smoking cessation for individual genotypic metabolizers.

Schlüsselwörter

  • Anxiety
  • cigarette smoking
  • cytochrome P450 2A6 polymorphism
Uneingeschränkter Zugang

Subclinical atherosclerosis in young Thai adults with juvenile-onset systemic lupus erythematosus

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 139 - 146

Zusammenfassung

Abstract

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in adult patients with systemic lupus erythematosus (SLE). Increased risk of CVD and atherosclerosis has been demonstrated in children with SLE. However, evidence of atherosclerosis in adults with juvenile-onset SLE is limited and their additional CVD risk factors unclear.

To investigate the presence of subclinical atherosclerosis in young Thai adults with juvenile-onset SLE, and evaluate atherosclerotic risk factors.

We recruited a cohort of patients aged 18-40 years who had been diagnosed SLE before the age of 18 years for this observational study. Patients with chronic kidney disease stage IV or V, alcoholism, chronic liver disease, or life threatening illness were excluded. Common carotid intima-media thickness (CCIMT) was measured. Clinical and laboratory parameters, treatment, and SLE-related factors, which could be risk factors for atherosclerosis and classic risk factors were obtained.

We enrolled 29 patients (24 female). Their mean age was 25.1 years and mean disease duration 11.3 years. The age of participants, persistent proteinuria and use of cyclosporin correlated with increased CCIMT by multivariable analysis (P = 0.02, 0.02, and 0.03, respectively). These patients had significantly abnormal CCIMT when compared with a healthy population (mean 690 (SD 150) μm versus mean 447 (SD 76) μm, respectively; P < 0.001).

Subclinical atherosclerosis, identified by abnormal CCIMT, appears in young adults with juvenile-onset SLE. The CCIMT abnormality progresses with increasing age, and persistent proteinuria and use of cyclosporin appears to increase the risk for atherosclerosis.

Schlüsselwörter

  • Atherosclerosis
  • carotid intima-media thickness
  • juvenile-onset systemic lupus erythematosus
  • subclinical atherosclerosis
  • systemic lupus erythematosus
Uneingeschränkter Zugang

Prevalence of dry eye disease in autoimmune thyroid disease and the association of dry eye with clinical signs of thyroid associated ophthalmopathy: observational, noncomparative, cross-sectional study

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 133 - 138

Zusammenfassung

Abstract

Autoimmune thyroid disease (AITD) is a risk factor for dry eye disease. The prevalence of dry eye in AITD is not definitely known.

To determine the prevalence of dry eye in AITD and its association with clinical signs of thyroid associated ophthalmopathy (TAO).

We enrolled a cross-section of 92 patients with AITD between May 1 and August 31, 2013. All were examined to establish thyroid eye signs, and severity was classified as none, mild, and moderate-severe according to the European Group on Graves’ orbitopathy. Dry eye disease was verified using an Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), Schirmer test, and ocular surface fluorescein staining. Features of meibomian glands were inspected. This observational study was registered at www.clinicaltrials.in.th, No. TCTR20130713001.

The prevalence of dry eye in AITD was 27% by OSDI questionnaire (95% confidence interval (CI), 16%-34%); 96% (95% CI, 93%-99%) by TBUT; 69% (95% CI, 62%-75%) by ocular surface staining; and 18% (95% CI, 12%-23%) using a Schirmer test, which associated dry eye and proptosis with an odds ratio (OR) of 9.3 (95% CI, 1.2-70.6, P = 0.031), and lagophthalmos by ocular surface staining with an OR of 5.8 (95% CI, 1.2-27.7, P = 0.026). Dry eye in patients with or without clinical signs of TAO was not significantly different.

The prevalence of dry eye varied by criteria, but was not different in AITD patients with or without TAO. Proptosis and lagophthalmos were associated more strongly with dry eye disease in AITD with TAO, than without.

Schlüsselwörter

  • AITD
  • autoimmune thyroid disease
  • dry eye
  • TAO
  • thyroid associated ophthalmopathy
Uneingeschränkter Zugang

Clinical factors associated with death from acute pulmonary embolism in Thailand

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 129 - 132

Zusammenfassung

Abstract

Acute pulmonary embolism (APE) is under diagnosed and may be fatal. Computed tomographic pulmonary angiography (CTPA) showing right ventricular failure is associated with mortality in APE. In resource-limited facilities, clinical factors are crucial.

We studied clinical factors that were associated with death from APE.

We enrolled patients with APE proven by CTPA between January 1, 2007 and July 31, 2011 at Khon Kaen University. Clinical factors associated with death from APE were studied by multiple logistic regression analysis. An online tool to assess risk of death from APE was also used.

There were 81 eligible patients in the study. Of those, 20 patients (25%) died within 3 months. Clinical factors significantly associated with death were low systolic blood pressure (SBP), high pulse rate, and low oxygen saturation at presentation.

Initial systolic blood pressure, pulse rate, and oxygen saturation are associated with mortality from APE.

Schlüsselwörter

  • Clinical factors
  • mortality
  • online tool
  • predictors
  • pulmonary embolism
Uneingeschränkter Zugang

Seroprevalence of foot-and-mouth disease in large ruminants in periurban dairy farms near Islamabad, Pakistan

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 123 - 127

Zusammenfassung

Abstract

Foot-and-mouth disease (FMD) is an enzootic viral disease affecting livestock in Pakistan.

To determine the seroprevalence of FMD in large ruminants in periurban dairy farms near Islamabad.

Serum samples were collected from 636 large ruminants during 2011 to 2012; 584 (92%) were buffaloes (Bos bubalis bubalis) and 52 (18%) were cattle (Bos taurus indicus). The population sampled was mainly adult (n = 514) and female (n = 596). Sera were assayed for antibodies against a nonstructural protein of the FMD virus using a Chekit FMD-3ABC bo-ov enzyme immunoassay Kit (Idexx Laboratories). Data were analyzed using a χ2 test and multiple logistic regression.

The seroprevalence of FMD in the ruminants was 46% (n = 293, 95% confidence interval (CI); 42.18- 49.95) and was significantly higher in buffaloes (285, 97%; χ2 = 21.46; P < 0.001) than in cattle (8, 3%). The risk of seropositivity increased significantly with age (χ2 = 72.71; P < 0.001); adult animals were 7.05 times more likely (odds ratio (OR) 7.05, 95% CI 3.60-13.79; P < 0.001) to be seropositive after adjusting for the effect of species. Buffaloes were more likely to be seropositive (OR 3.99, 95% CI 1.78-8.92, P = 0.001). Sex was not significantly associated with FMD seropositivity (OR 0.58, 95% CI 0.17-1.95, P = 0.38).

Large ruminants in periurban dairy farms near Islamabad have a high FMD virus seroprevalence and play a potential role in the persistence and transmission of FMD in Pakistan.

Schlüsselwörter

  • FMD
  • seroprevalence
  • buffaloes
  • cattle
  • large ruminants
  • periurban
  • Pakistan

Clinical report

Uneingeschränkter Zugang

Hematuria, an unusual systemic toxicity, in formic acid ingestion: a case report

Online veröffentlicht: 31 Jan 2017
Seitenbereich: 189 - 190

Zusammenfassung

Abstract

Acid ingestion can cause severe injuries of the upper gastrointestinal tract and the respiratory tract. Besides hydrofluoric acid and selenious acid, systemic toxicities of acid ingestion can occasionally occur. However, hematuria is a rare systemic toxicity reported in caustic poisoning.

To describe a case of a one-year-old girl who accidentally ingested liquid formic acid.

This patient had severe local corrosive effects including a compromised upper respiratory tract and developed gross hematuria during the hospital admission.

Hematuria could be a consequence of acid ingestion.

Significant hematuria can be a systemic effect of acid ingestion, but in this case was self-limiting

Schlüsselwörter

  • Caustic poisoning
  • formic acid
  • hematuria
  • systemic toxicity
  • unusual

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