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

Suche

Volumen 8 (2014): Heft 2 (April 2014)

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

Suche

20 Artikel

Editorial

Uneingeschränkter Zugang

Bioequivalence studies of reformulated pharmaceuticals newly off patent

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 137 - 138

Zusammenfassung

Review article

Uneingeschränkter Zugang

Behcet’s disease: from heat shock proteins to infections

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 139 - 155

Zusammenfassung

Abstract

Background: Behcet’s disease (BD) is a chronic, inflammatory multisystemic condition of unknown etiology. Although the cause of BD is not clear, it is believed to be the result of an autoimmune process triggered by an infectious or environmental agent (possibly local to a geographic region) in a genetically predisposed individual.

Objective: To detail current knowledge of the role of microorganisms in the pathogenesis of BD and review the infectious etiology of this disease.

Methods: The review based on publication in SCOPUS, Science direct, and PubMed.

Results: A microbial infection has been implicated in the development of the disease to explain the strong inflammatory reactions observed, the activation of monocytes and macrophages, and the induction of proinflammatory cytokines and chemokines detected. Common factors linking some of the possible pathogenetic agents are extrinsically induced tissue stress or heat shock proteins, which react with host tissues and elicit significant T-helper type 1 cell responses.

Conclusion: Based on collected data, we conclude that the microorganisms discussed seem to participate and, at least in part, act as triggers during the course of BD. By clarifying the microbial associations of BD and finding its etiology, particularly the causative antigens leading to BD, it would be easier to suggest more effective treatment and preventive strategies for this disease.

Schlüsselwörter

  • Bacterial infections
  • Behcet’s disease
  • fungal infections
  • heat shock proteins
  • infectious etiology
  • microorganisms
  • viral infections
Uneingeschränkter Zugang

Risk factors of delirium in elderly patients with hip fracture

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 157 - 165

Zusammenfassung

Abstract

Background: Delirium is a leading cause of death and disability in the elderly with hip fracture. Identifying reliable risk factors for delirium is critical to support optimal outcomes for prevention and reducing delirium.

Objective: To quantify the reported factors associated to delirium for patients with hip fracture.

Methods: Electronic databases were searched (including Medline, Pub Med, CINAHL, EMBASE, Evidence Based Medicine Reviews, Cochrane Review, Web of Science, and PsycINFO) to identify all studies, published in English language that evaluated the risk factors of delirium hospitalized people with hip fracture. Two reviewers independently assessed methodology quality and extracted relevant data. The data from the included studies were summarized, and pooled estimates were calculated for 12 risk factors.

Results: Thirty-seven studies were included in the review and 25 in the meta-analysis. The incidence of delirium was 32.4% (95% confidence interval [CI] = 25.9%-39.5%). Six predisposing and four precipitating factors predicted delirium among older patients with hip fracture confirmed. The predisposing factors included advanced age (ES = 1.06, 95% CI = 1.03-1.09), male sex (ES = 1.34, 95% CI = 1.08-1.68), impairment of cognition (ES = 2.91, 95% CI = 1.91-4.42), and function (ES = 1.75, 95% CI = 1.39-2.2), comorbidity (ES = 1.59, 95% CI = 1.30-1.96), and health problems (ES = 2.64, 95% CI = 2.04-3.42). Precipitating factors were hypo- or hypernatremia (ES = 1.73, 95% CI = 1.14-2.64), depression (ES = 4.07, 95% CI = 1.95-8.49), more than three prescribed drugs (ES = 1.28, 95% CI = 1.10-1.49), and drugs including opioids (ES = 2.13, 95% CI = 1.42-3.18) and anticholinergic agents (ES = 2.10, 95% CI = 1.60-2.75).

Conclusion: This meta-analysis result provides evidence that these risk factors have a significant impact on delirium in elders with hip fracture during hospitalization. Developing formal screening, and effective preventive and management strategies for delirium is important.

Schlüsselwörter

  • Delirium
  • elderly
  • hip fracture
  • risk factors
  • systematic review
Uneingeschränkter Zugang

Antimicrobial agents and Burkholderia pseudomallei: perspectives from Thailand

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 167 - 172

Zusammenfassung

Abstract

Background: Burkholderia pseudomallei are the causative agent of melioidosis, a potentially life-threatening disease in humans and animals. It is a common public health threat in parts of Thailand.

Objective: To summarizes the current knowledge regarding antimicrobial agents and B. pseudomallei.

Methods: A literature search using MEDLINE (PubMed), SCOPUS, and OVID/LWWW databases.

Results: B. pseudomallei are intrinsically resistant to a wide range of antimicrobial agents including β-lactam antibiotics, aminoglycosides, and macrolides. Antimicrobial therapy for melioidosis is divided into an acute phase and an eradication phase. The current recommendations for the acute phase are parenteral antimicrobial agents for ≥10 days using ceftazidime or a carbapenem. The eradication phase involves oral antimicrobial agents for ≥180 days using trimethoprim-sulfamethoxazole. Amoxicillin-clavulanic acid may be used as an alternative. Ceftazidime revealed rare primary resistance and a high relapse rate.

Conclusion: Patients with acute melioidosis usually need intensive care and appropriate antibiotics for the acute and eradication phases. Ceftazidime is remains an effective agent in Thailand. A trend for decreasing susceptibility to antibiotics requires monitoring.

Schlüsselwörter

  • Antibiotic resistance
  • Burkholderia pseudomallei
  • mechanisms of resistance
  • melioidosis

Original article

Uneingeschränkter Zugang

Molecular mechanisms for NG-nitro-L-arginine methyl ester action against cerebral ischemia–reperfusion injury-induced blood–brain barrier dysfunction

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 173 - 184

Zusammenfassung

Abstract

Background: Ischemic stroke, an acute neurological injury lacking an effective therapy, is a leading cause of death worldwide. The unmet need in stroke research is to identify viable therapeutic targets and to understand their interplay during cerebral ischemia-reperfusion (I/R) injury.

Objective: To explore the protective effects and molecular mechanism of NG-nitro-L-arginine methyl ester (L-NAME) in cerebral ischemia-reperfusion injury-induced blood-brain barrier (BBB) dysfunction.

Methods: Two hundred fifty-six rats were randomly assigned to a sham operation group, I/R group, and I/R with L-NAME treatment group. Brain water content was determined by calculating dry/wet weight. The permeability of the BBB was observed using an electron microscope and by determining the Evans Blue leakage from brain tissue on the ischemic side. The expression of brain MMP-9 and GFAP was determined using an immunohistochemical method. The expression of ZO-1 protein was determined by western blotting.

Results: We found that L-NAME remarkably attenuated the permeability of the BBB after I/R as assessed by Evans Blue leakage and brain water content (p < 0.05). This was further confirmed by examination of the ultrastructural morphology of the BBB using a transmission electron microscope. Furthermore, we found that expression of the zonae occludens-1 (ZO-1) was decreased in endothelial cells, and expression of MMP-9 and GFAP was increased in the basement membrane and astrocyte end-feet in vehicle control groups, respectively, but these changes could be prevented by L-NAME pretreatment.

Conclusion: These results suggested that the neuroprotective effects of L-NAME against BBB damage induced by I/R might be related to the upregulation of tight junction proteins and inhibition of MMP-9 and GFAP expression. L-NAME can be used as a potential MMP-9-based multiple targeting therapeutic strategy in cerebral I/R injury.

Schlüsselwörter

  • blood-brain barrier
  • cerebral ischemia-reperfusion injury
  • glial fibrillary acidic protein
  • matrix metalloproteinase
  • NG-nitro-L-arginine methyl ester
  • zonae occludens-1
Uneingeschränkter Zugang

Improved insulin sensitivity, central systolic pressure and inflammatory indicators achieved with minor weight reduction in overweight and obese subjects given education on lifestyle modification

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 185 - 194

Zusammenfassung

Abstract

Background: Obesity is a global epidemic disease; lifestyle modification is an approach in the prevention and management of obesity.

Objective: We determined the effects of education on modified lifestyle intervention on arterial stiffness, metabolic and inflammatory markers.

Methods: Twenty-five generally healthy overweight and obese subjects completed nine months education on modified lifestyle intervention at Hospital Universiti Sains Malaysia, Kota Bharu. Subjects were regularly counselled to increase physical activity and modify their diet during intervention. Arterial stiffness was measured noninvasively using carotid femoral pulse wave velocity (PWV) and pulse wave analysis (PWA). Anthropometric measurements, body fat percentage and visceral fat, central and brachial blood pressures, lipid profile, the inflammatory marker high sensitivity C-reactive protein (hsCRP) and insulin sensitivity were also recorded.

Results: After nine months, a significant weight loss of 2.2 kg was observed associated with significant reductions in waist and hip circumference, aortic systolic blood pressure, serum fasting insulin, insulin resistance, and hsCRP levels. Insulin sensitivity was increased, while body fat and visceral fat percentages were marginally reduced (p = 0.058 and p = 0.059). No significant differences were seen in arterial stiffness, fasting plasma glucose and lipid profile.

Conclusion: Education on modified lifestyle intervention improved insulin sensitivity and resistance, reduced hsCRP and aortic systolic blood pressure despite the small weight reduction achieved.

Schlüsselwörter

  • Arterial stiffness
  • education on lifestyle modification
  • hsCRP
  • insulin sensitivity and resistance
  • obesity
Uneingeschränkter Zugang

Acute effect of Russell’s viper (Daboia siamensis) venom on renal tubular handling of sodium in isolated rabbit kidney

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 195 - 202

Zusammenfassung

Abstract

Background: The common complication in cases of poisoning by Russell’s viper (Daboia siamensis) venom (RVV) is acute renal failure, but the pathogenesis involved in the alteration of kidney function is still not well understood.

Objective: To clarify the role of RVV in the pathogenesis of renal damage, the present study examines the functional short-term alterations acutely induced by RVV in isolated perfused rabbit kidney.

Methods: Effects of RVV on renal tubular handling of sodium including mean perfusion pressure (PP), the renalvascular resistance (RVR), the glomerular filtration rate (GFR), the urinary flow (V) and osmolar clearance (Cosm) were studied in two groups of isolated perfused rabbit kidneys; each group had four isolated rabbit kidneys. RVV was added to the perfusion system to obtain the final concentration of 10 ⃞g/ml.

Results: Immediate decreases in PP and RVR caused by the venom were significantly apparent (p < 0.05) in the first 15 min after RVV administration. A gradual rise in both PP and RVR occurred 15 min after the initial reduction of the first phase, but its remained below pretreatment values. The GFR, V, and Cosm decreased significantly throughout experiments after venom perfusion (p < 0.05). The total fractional sodium excretion increased significantly after venom perfusion throughout experiments, while significant reductions (p < 0.05) of renal tubular handling of sodium were apparent for proximal absolute reabsorption of sodium and proximal fractional reabsorption of sodium including marked reductions of distal absolute reabsorption of sodium and distal fractional reabsorption of sodium of the venom treated kidney. Optical microscopy of treated kidney tissue showed acute tubular necrosis at the end of experiment.

Conclusion: The present study suggests that an administration of RVV in the isolated rabbit kidney causes direct acute nephrotoxicity and acute alterations of main functional parameters that are probably mediated by either the direct action of venom components or an indirect effect from vasoactive mediators released from renal cells of the RVV-treated kidney.

Schlüsselwörter

  • Daboia siamensis
  • isolated rabbit kidney
  • renal tubular handling of sodium
  • Russell’s viper venom
Uneingeschränkter Zugang

A novel approach to ultrasound-guided percutaneous native renal biopsy: a better tissue sampling technique

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 203 - 210

Zusammenfassung

Abstract

Background: Percutaneous renal biopsy (PRB) is an essential tool in diagnosis and management of various renal diseases. Conventional ultrasound-guided free-hand approaches to the lower pole of the kidney for PRB yield marginal tissue adequacy and causes a certain incidence of bleeding complications.

Objective: To describe a novel ultrasound-guided approach to the middle part of the kidney for PRB to obtain better tissue sampling.

Patients and methods: The plane angle between the renal biopsy needle and the skin was set at 30° for patients in the novel middle part approach group (n = 15) and 45° for patients in the conventional lower pole approach group (n = 15).

Results: The perpendicular distance between the needle tip and renal capsule in the middle part approach was significantly shorter than the lower pole approach group (0.92 ± 0.6 vs. 1.49 ± 0.4 cm, p = 0.005). The middle part approach to PRB yielded a significantly higher number of glomeruli (22.8 ± 7.2 vs. 15.3 ± 4.1, p = 0.002) and arcuate arteries (0.9 ± 0.6 vs. 0.5 ± 0.1, p = 0.02). The bleeding complications in the middle part approach seemed to be less than in the lower pole approach technique. Pain scores between the two methods as assessed using a visual analog scale were not different.

Conclusion: This novel approach to the middle part of the kidney for PRB provides comparable patient satisfaction and a superior adequacy of renal tissue when compared with the conventional lower pole approach with its consequent lower post biopsy bleeding complications. Larger studies to confirm this finding are warranted.

Schlüsselwörter

  • Middle part approach
  • percutaneous native renal biopsy
Uneingeschränkter Zugang

Understanding the pain status of the patient: a survey of pain status and pain treatment in an orthopedic outpatient department

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 211 - 219

Zusammenfassung

Abstract

Background: Pain assessments help clinicians to evaluate their patients’ symptoms. However, patients’ satisfaction with pain management is difficult to interpret and may mislead the clinician into being satisfied with inadequate pain management.

Objective: We described and explored patients’ pain status, patients’ satisfaction with their pain management, the impact of pain on sleep habit and routine activities of daily living (ADLs), and the proportion of patients who had undertreatment of pain in the Orthopaedic Outpatient Department, Ramathibodi Hospital.

Methods: A prospective, cross-sectional survey study of pain characteristics and pain management of Orthopaedic outpatients aged over 18 years in the Orthopaedics Department, Ramathibodi Hospital using two parts of a verified questionnaire.

Results: In all, 863 patients were studied. Numbers of patients with acute or chronic pain were in similar proportions and mainly diagnosed as nociceptive pain (83.7%). Most of them suffered from moderate or severe pain (42.6% vs. 39.1%). Severity of symptoms was correlated with sleep disturbance and disturbance in ADLs. However, no correlation was revealed between satisfaction with pain management and the intensity of pain and there was also no correlation between satisfaction with pain management and sleep disturbance or disturbance in ADLs. Most commonly prescribed medications were nonsteroidal antiinflammatory drugs (NSAIDs) (58.8%). However, 93.4% of returning patients who suffered from severe pain were still treated with nonopioid analgesics.

Conclusion: Patients suffered from moderate to severe pain and had disturbances in their sleep habit and ADLs. Most of them were satisfied with previous pain management, which was usually with nonopioid analgesics including NSAIDs and muscle relaxants. This group included some patients who experienced a high intensity of pain. We recommend clinicians pay more attention to the pain intensity of individual patients and justify appropriate medication by using a step-up approach and multimodal analgesics

Schlüsselwörter

  • Activities of daily living disturbance
  • pain intensity
  • satisfaction with pain management
  • sleep disturbance
  • undertreatment
Uneingeschränkter Zugang

The effect of the Thai “Eye Drop Guide” on success rate of eye drop self-instillation by glaucoma patients

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 221 - 227

Zusammenfassung

Abstract

Background: Noncompliance can mislead clinicians regarding the efficacy of therapy and result in more aggressive, but inappropriate treatment. Improper techniques used for eye drop instillation frequently occurs in chronic glaucoma patients. The Thai Eye Drop Guide (EDG) device has been developed to ensure precise instillation. However, whether the EDG is more effective than the traditional technique when careful instructions for both techniques are given is still unknown.

Objective: To compare success rates of eye drop self-instillation by chronic glaucoma patients using a traditional technique and the EDG when careful instructions for both are given.

Methods: Fifty-nine chronic glaucoma patients were instructed to instill eye drops using the EDG or a traditional technique in a randomized sequence. A two week practice period was assigned before groups were crossed-over. The instillation performance was VDO recorded after each practice period. Three criteria of success: time taken to instill an eye drop into the eye; instillation of only one drop; and without the bottle tip touching lids, lashes, periocular tissues, or the other hand, were scored by three independent readers from video-records. The readers were blinded to the sequence to which the patients were randomized.

Results: There were no significant differences in success rates between the EDG and traditional technique (61.0% and 66.1% respectively, p = 0.607) and the number of drops dispensed per application (median of 1 drop in both groups, p = 0.89). The time taken to instill eye drops with the EDG was significantly longer than using the traditional technique (median of 19 and 9 s respectively, p < 0.001). Older age (p = 0.049, OR 4.23) and more education (p = 0.025, OR 0.19) were found to be significantly associated with failure of the EDG.

Conclusion: EDG is not more effective than a traditional technique in terms of improving dispensing accuracy and decreasing the drops dispensed per application even when careful instructions are given. The results suggest that, if good instructions are provided, experienced glaucoma patients can improve their eye drop instillation performance.

Schlüsselwörter

  • Compliance
  • drop administration
  • eye drop guide
  • glaucoma
  • self-instillation
Uneingeschränkter Zugang

Precipitating causes and outcomes of chronic obstructive pulmonary disease exacerbation at a tertiary care center in northeast Thailand

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 229 - 236

Zusammenfassung

Abstract

Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalization and economic burden. Frequent exacerbations impair quality of life and effect decline of lung function.

Objective: We evaluated characteristics of COPD patients with frequent exacerbations. The precipitating causes, outcomes, hospital stay, and cost of admission were also determined.

Methods: The study population included COPD patients admitted because of acute COPD exacerbation at Srinagarind Hospital between 1 January 2006 and 31 December 2010.

Results: Over the 5-year period, 183 patients were admitted. Their mean age was 74.9 (SD 9.28) years and the male to female ratio was 170:13. Most patients (144; 79%) had one exacerbation per year and 39 (21%) had more than one per year. The group with more exacerbations, had a higher stage of the disease than those with only one exacerbation (p = 0.023), but there was no significant difference in the mortality rate (18% vs 14%, p = 0.53). A total of 245 episodes of acute exacerbation of COPD occurred in 183 patients. The mean duration of symptoms was 4.1 (SD 3.46) days. Forty-seven percent presented with Anthonisen type III, 42.4% with Anthonisen type II, and 10.6% with Anthonisen type I exacerbations. For 44 exacerbations (18%), the precipitating causes were not determined. The most common precipitating cause was pneumonia, which occurred in 90 episodes (36.7%). The second common was bronchitis (27.8%); followed by heart failure (8.2%), infected bronchiectasis (5.3%), diarrhea (1.2%), acute urinary retention (0.8%), unstable angina (0.4%), pneumothorax (0.4%), urinary tract infection (0.4%), atrial fibrillation (0.4%) and drug induced cough (0.4%). The organisms responsible for respiratory tract infection were identified in 31% cases of pneumonia and 18% of bronchitis cases. The top three common pathogens for pneumonia were Pseudomonas aeruginosa (9%), Acinetobacter baumannii (8%), and Klebsiella pneumoniae (8%). The top three common pathogens for bronchitis were P aeruginosa (7%), Haemophilus influenza (6%), and K pneumoniae (4%). About one quarter (25.3%) of acute exacerbations were complicated by respiratory failure. The mean duration of admission was 17.3 days (range 1-682 days). The mean cost of admission per exacerbation was 80,010 Thai baht (US $2,666) (range, 2,779-3,433,108 baht). The total cost for 245 exacerbations was 19.6 million baht ($653,000).

Conclusion: Respiratory tract infections were common causes of COPD exacerbation and one quarter of which developed respiratory failure. Preventive measures such as vaccination, smoking cessation, lung rehabilitation, and appropriate drug use are helpful.

Schlüsselwörter

  • COPD exacerbation
  • precipitating causes
  • outcomes

Brief communication (Original)

Uneingeschränkter Zugang

Bioequivalence study of cefepime intramuscular injection

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 237 - 240

Zusammenfassung

Abstract

Background: Cefepime, a fourth generation cephalosporin, is a broad spectrum antibiotic effective against both Gram positive and Gram negative bacteria. It is available from several pharmaceutical firms in southeast Asia. We studied bioequivalence of two products.

Objective: To assess the bioequivalence of two cefepime formulations: Cefamax 1 g intramuscular (Siam Pharmaceutical, Bangkok, Thailand) as the test formulation and Maxipime 1 g (Bristol-Myers Squibb, Bangkok, Thailand) as the reference formulation.

Methods: The study was conducted as an open, randomized, two-period crossover trial with a 1 week washout period in 18 healthy volunteers. Each subject received a single dose of 1 g intramuscular injection of the test or reference formulation. Blood samples were collected via an intravascular catheter at several time points over a 12 h period. Plasma cefepime concentrations were quantified by HPLC with photodiode array detection at 280 nm. The statistical comparisons for pharmacokinetic parameters were made using a paired t test.

Results: There was no significant difference in the logarithmically transformed values of Cmax, AUC0-12, and AUC0-∞ between Cefamax and Maxipime using an analysis of variance (ANOVA). The 90% confidence intervals (CIs) of Cmax, AUC0-12, and AUC0-∞ between the two formulations were 91.17-105.78, 90.29-97.63, and 88.89-96.57, respectively. All subjects had good tolerance and no serious adverse events were observed.

Conclusion: Cefamax 1 g intramuscular formulation is bioequivalent to Maxipime 1 g intramuscular formulation based on 90% CIs for Cmax, AUC0-12, and AUC0-∞ within 80%-125%.

Schlüsselwörter

  • Bioequivalence study
  • Cefamax
  • cefepime
  • fourth generation cephalosporin
  • pharmacokinetics
Uneingeschränkter Zugang

Burns in Tehran: demographic, etiological, and clinical trends

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 241 - 245

Zusammenfassung

Abstract

Background: Burns are a major public health problem. They often require intensive care and long periods of hospitalization. In Tehran, about 5% of all hospitalized injuries are burns. There are no published long-term epidemiological studies regarding burn injuries of adults in Iran.

Objective: To identify risk factors for burn injuries and provide a starting point for the establishment of an effective prevention plan.

Methods: We analyzed the demographic, etiological, and clinical data of 1860 burn patients admitted to a major acute care hospital in Tehran between March 2010 and April 2011. Data were obtained from the registry recorded in Shahid Motahari Trauma Hospital and evaluated using a chi-square test.

Results: Males were more than twice as likely to be burn patients than females (72.0% vs. 28.0%). Second and third-degree burns with a body surface area of 21%-30% constituted the highest injury reported (75.3%). The most common causes of the recorded burns were natural gas, gasoline (42%) and open fire (10.2%). Unintentional burns were reported in 85% of the cases, and 15% of the burn victims were suicide-related incidents; mainly among women. In 75% of suicide attempts, women set themselves on fire to commit suicide. The mean duration of hospitalization was 25 days and the mortality rate was 10.7%. Mean age of reported deaths was 38.6 years; with a mean of 30 years among women and 51.5 years among men.

Conclusion: The group at highest risk was young men 21-30 years old. However, an astonishing finding was that 75% of suicidal-related incidents involved women setting themselves on fire. Those with the highest mortality rate were victims of burns with gas, gasoline, and kerosene; with a mean age of 30 years of death among women.

Schlüsselwörter

  • Burns
  • demographic data
  • etiology
  • hospitalization
  • Iran
  • morbidity
  • mortality
  • Tehran
Uneingeschränkter Zugang

Effects of daidzein on testosterone secretion in cultured immature mouse testis

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 247 - 253

Zusammenfassung

Abstract

Background: Daidzein is a major isoflavone in soybeans. Several in vivo studies have showed that daidzein can affect immature male testosterone production. However, whether daidzein has direct action on immature male testis is unknown.

Objective: We investigated the effects of daidzein on testosterone secretion in 3-day-old and 21-day-old mouse Leydig cells with organotypic culture model.

Materials and Methods: The testes were exposed to different concentrations (10-7 to 10-4 M) of daidzein for 72 h with medium changed every 24 h. From 72 to 75 h of culture, 100 ng/ml human chorionic gonadotropin (hCG) was added. The testosterone production was determined, and the related mechanisms of daidzein action were also evaluated by measuring the mRNA levels of steroidogenic acute regulatory protein (StAR), cholesterol side-chain cleavage enzyme (P450scc), and 3β-hydroxysteroid dehydrogenase (3β-HSD-1) involved in testosterone biosynthesis.

Results: The results revealed that in the presence of 100 ng/ml hCG, 10-7 to 10-5 M daidzein had no significant effect on testosterone secretion in cultured 3-day-old mouse testis. But 10-4 M daidzein significantly increased testosterone concentration (p < 0.05). Daidzein in range of studied doses had no obvious influence on testosterone production in cultured 21-day-old mouse testis. RT-PCR results showed that 10-4 M daidzein had obvious influence on the mRNA levels of StAR, P450scc and 3β-HSD-1 in cultured 3-day-old mouse testis (p < 0.05).

Conclusion: These results suggest that daidzein mainly influences neonatal mouse testis function, and the influence is partially related to the upregulation of StAR, P450scc, and 3β-HSD-1 mRNA levels.

Schlüsselwörter

  • Daidzein
  • immature mouse Leydig cells
  • P450scc
  • testosterone
  • StAR
  • 3β-HSD-1
Uneingeschränkter Zugang

Prognostic significance of p16, p53, Bcl-2, and Bax in oral and oropharyngeal squamous cell carcinoma

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 255 - 261

Zusammenfassung

Abstract

Background: The proteins p16, p53, Bcl-2, and Bax are important cell cycle and apoptotic regulators involved in carcinogenesis and found to have prognostic significance in various cancers. However, the data for squamous cell carcinoma of oral cavity (OSCC) and of oropharynx (OPSCC) are conflicting.

Objective: We sought to determine if expression of p16, p53, Bcl-2, and Bax expression are associated with 5-year overall survival (OS) of patients with OSCC and OPSCC.

Methods: One-hundred thirty-seven cases of OSCC and 140 cases of OPSCC diagnosed from January 2002 to December 2004 at Songklanagrind Hospital, Songkhla, Thailand, were analyzed using a Cox proportional hazards model for 5-year OS in relation to immunohistochemical detection of Bcl-2, Bax, p53, and p16 proteins.

Results: The frequencies of p16, p53, Bcl-2, and Bax expression in OSCC were 13%, 45%, 4%, and 66%, and in OPSCC were 18%, 53%, 22%, and 75%, respectively. In univariate analysis, clinical variables including T stage, N stage and treatment were significantly associated with survival. In multivariate Cox regression, Bax overexpression was significantly associated with poor survival both in OSCC (HR 1.77, 95% CI 1.04-3.01) and in OPSCC (HR 2.21, 95% CI 1.00-4.85). We found no significant association of p16, Bcl-2, and p53 expression with survival.

Conclusion: The expression pattern of p16, p53, Bcl-2, and Bax are similar in OSCC and OPSCC. Only Bax expression has prognostic significance for both tumor sites.

Schlüsselwörter

  • Bcl-2
  • Bax
  • immunohistochemistry
  • oral cancer
  • oropharynx
  • p53
  • p16
  • prognostic marker
  • squamous cell carcinoma
Uneingeschränkter Zugang

Surveillance of marine fish for ciguatera toxin at fish markets in Bangkok, Thailand

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 263 - 268

Zusammenfassung

Abstract

Background: Ciguatera intoxication is a form of food poisoning. It is caused by the consumption of certain warm-water fish that have accumulated ciguatera toxin (CTX) through the marine food chain. Ciguatera fish poisoning (CFP) is a global disease, which although common, has been largely ignored in Thailand. This may be attributed to lack of confirmatory tests and seemingly nonspecific clinical presentations.

Objective: We studied CTX contamination in marine fish sold at Bangkok markets.

Methods: A surveillance of CTX in fish using the Cigua-Check assay has been conducted in Bangkok, the center of seafood marketing in Thailand. Here, there are several types of fish. Some come from domestic fishing and others are imported from Indonesia, Myanmar, or India.

Results: A random survey at three fish markets in Bangkok revealed two samples possibly contaminated with ciguatera toxin from a total 227 fish samples (of 21 fish species). This is the first report of finding CTX contamination in fish meat sold in Bangkok.

Conclusion: It is possible that these CTX-positive fish were caught from other countries. Even though the positivity (0.88%) is lower when compared with studies of other endemic areas (5.0% in Hawaii and Pacific Islands), this finding should raise awareness of the possibility of facing rare CFP intoxication from fish obtained at local Thai markets.

Schlüsselwörter

  • Bangkok
  • ciguatera toxin
  • marine fish
Uneingeschränkter Zugang

Phylogenetic analysis of the king cobra, Ophiophagus hannah in Thailand based on mitochondrial DNA sequences

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 269 - 274

Zusammenfassung

Abstract

Background: Snakes possess adaptive characteristics of morphology that may result in incorrect reconstruction of phylogeny. Molecular approaches have become the major source of new information for advancing our understanding of evolutionary, genetic relationships, and species identification.

Objective: We studied DNA sequences of Ophiophagus hannah in different parts of Thailand and compared them with those of O. hannah from other countries.

Materials and Methods: We studied the mitochondrial NADH dehydrogenase subunit 2 (ND2) and control region (CR) sequences of 12 individuals O. hannah from different localities across Thailand. Phylogenetic analysis of DNA sequences were compared to the published sequences of O. hannah deposited in NCBI GenBank database from other countries.

Results: O. hannah could be categorized into 2 Clades, 5 haplotypes, and 4 localities based on 43 different nucleotide positions from the 736 bp of ND2 and 673 bp of CR. Clade A was haplotype A from southern Thailand. Clade B consisted of haplotypes B, C, D, and E. Haplotype B and C came from northern Thailand. Haplotype D came from western Thailand, while haplotype E was O. hannah from central Thailand. The DNA sequences of Clade B were similar to the sequences of O. hannah in Myanmar and southern China that are already deposited in NCBI GenBank database.

Conclusion: We found a different genotype of O. hannah from southern Thailand and suggest that this may be a new species of O. hannah.

Schlüsselwörter

  • CR
  • ND2
  • Ophiophagus hannah
  • phylogenetic
Uneingeschränkter Zugang

Clinical and microbiological characteristics of corneal ulcers in a Thai referral center

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 275 - 282

Zusammenfassung

Abstract

Background: There are regional variations in causative organisms and epidemiologic patterns of corneal ulcers. It is essential to review periodically in terms of epidemiology and the microbial keratitis profiles that occur in a specific region in order to develop a comprehensive strategy for diagnosis and management of corneal ulcers.

Objective: To review the epidemiology, predisposing factors, microbiological characteristics and visual outcomes in corneal ulcers at a referral center in Thailand.

Methods: A retrospective review of patients with clinically diagnosed corneal ulcers presenting between January 2006 and December 2010 was performed.

Results: A total of 159 patients (159 eyes) were analyzed. Ninety-one cases (57.2%) were in men. The mean age of the patients was 43.0 ± 20.0 years. The most common predisposing factor was ocular trauma found in 72 eyes (45%). Culture was grown from 123 eyes and results were positive in 52%. The most frequent causative organisms were bacteria (72%), followed by fungus (28%). The most common bacteria was Pseudomonas aeruginosa (55%) and most common fungus was Fusarium species (33%). In a comparison between fungal and bacterial groups, the latter was more likely to be associated with contact lens wear (p = 0.05). The hospitalization time for the fungal group was significantly longer than for the bacterial group (p = 0.001). The posttreatment corrected visual acuity equal to or better than 20/200 was found significantly more commonly in the bacterial group than in the fungal group (p = 0.031). While therapeutic keratoplasty was significantly higher in the fungal group than in the bacterial group (p = 0.048).

Conclusion: Fungal keratitis was more severe than bacterial keratitis resulting in longer hospitalization time, poorer visual acuity, and with more chance to have therapeutic keratoplasty.

Schlüsselwörter

  • Corneal ulcers
  • epidemiology
  • organisms
  • predisposing factors
  • visual outcomes
Uneingeschränkter Zugang

High glucose enhances CD39 expression in vascular endothelial cells

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 283 - 287

Zusammenfassung

Abstract

Background: Diabetes mellitus (DM) patients lose their ability to control normal blood glucose levels, resulting in high blood glucose levels (hyperglycemia). Hyperglycemia causes DM complications. This involves responses of vascular endothelial cells (VECs) to hyperglycemia, affecting inflammatory process and platelet activity. Ecto-enzyme CD39 is expressed on VECs, catalyzing the hydrolysis of ATP and ADP to AMP and, consequently, regulating inflammatory process and platelet activation.

Objective: We studied whether high glucose concentration has an effect on CD39 expression on VECs.

Methods: Cultured human umbilical vein endothelial cells (HUVEC) were used as a model of study. HUVEC were cultured in different glucose conditions (4, 9, 24, and 34 mM) for 24 hours. Cell viability was assessed using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)-based assay and expression of CD39 was examined by using SDS-PAGE and western blot techniques.

Results: HUVEC were cultured in normal (4 and 9 mM) or high (24 and 34 mM) glucose concentrations for short term (24 hours). The results showed that high glucose (24 and 34 mM) reduced cell viability to 89.5 ± 11.3 and 86.3 ± 13.5 (mean ± SD), compared with control (4 mM), respectively. High glucose also induced increases in CD39 expression in HUVEC.

Conclusion: High glucose decreases cell viability and increases CD39 expression in HUVEC, suggesting involvement of CD39 in cell responses to high glucose.

Schlüsselwörter

  • CD39
  • cell viability
  • diabetes mellitus
  • HUVEC
  • hyperglycemia
  • short term
  • vascular endothelial cell

Clinical report

Uneingeschränkter Zugang

Damage control surgery in blunt cardiac injury

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 289 - 293

Zusammenfassung

Abstract

Background: Blunt cardiac injury (BCI) is a rare, but life threatening injury. The treatment of BCI is surgical repair. However, in a BCI patient with hypothermia, acidosis, and coagulopathy, an attempt to control the bleeding completely by surgery alone may not be successful. Damage control principles should be used in this situation.

Objective: To study a BCI patient who underwent a successful operation using damage control principles.

Methods: We reviewed and analyzed the patient’s chart, operative notes and follow up visit records. Review of the literature regarding the issue was also conducted.

Results: We report the case of a patient with BCI who developed hypothermia and coagulopathy during surgery. Abbreviated surgical repair was performed with a right pleuropericardial window created to avoid blood accumulation in the pericardial sac. Subsequent aggressive resuscitation was performed in the intensive care unit. We accepted ongoing bleeding through the right chest tubes while correction of hypothermia and coagulopathy was undertaken. The bleeding was gradually stopped once the patient’s physiology was restored. Although the patient developed a retained right hemothorax requiring subsequent video-assisted thoracoscopic surgery on the third postoperative week, he recovered uneventfully and was discharged on postoperative day 36.

Conclusion: In patients with BCI who develop coagulopathy during surgery, terminating the operation quickly and creating a pleuropericardial window is a possible bailout solution because this can prevent postoperative cardiac tamponade without leaving the chest open. Continue bleeding from the chest tubes is acceptable provided that adequate resuscitation to correct coagulopathy is underway.

Schlüsselwörter

  • Blunt cardiac injury
  • damage control
  • pleuropericardial window
20 Artikel

Editorial

Uneingeschränkter Zugang

Bioequivalence studies of reformulated pharmaceuticals newly off patent

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 137 - 138

Zusammenfassung

Review article

Uneingeschränkter Zugang

Behcet’s disease: from heat shock proteins to infections

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 139 - 155

Zusammenfassung

Abstract

Background: Behcet’s disease (BD) is a chronic, inflammatory multisystemic condition of unknown etiology. Although the cause of BD is not clear, it is believed to be the result of an autoimmune process triggered by an infectious or environmental agent (possibly local to a geographic region) in a genetically predisposed individual.

Objective: To detail current knowledge of the role of microorganisms in the pathogenesis of BD and review the infectious etiology of this disease.

Methods: The review based on publication in SCOPUS, Science direct, and PubMed.

Results: A microbial infection has been implicated in the development of the disease to explain the strong inflammatory reactions observed, the activation of monocytes and macrophages, and the induction of proinflammatory cytokines and chemokines detected. Common factors linking some of the possible pathogenetic agents are extrinsically induced tissue stress or heat shock proteins, which react with host tissues and elicit significant T-helper type 1 cell responses.

Conclusion: Based on collected data, we conclude that the microorganisms discussed seem to participate and, at least in part, act as triggers during the course of BD. By clarifying the microbial associations of BD and finding its etiology, particularly the causative antigens leading to BD, it would be easier to suggest more effective treatment and preventive strategies for this disease.

Schlüsselwörter

  • Bacterial infections
  • Behcet’s disease
  • fungal infections
  • heat shock proteins
  • infectious etiology
  • microorganisms
  • viral infections
Uneingeschränkter Zugang

Risk factors of delirium in elderly patients with hip fracture

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 157 - 165

Zusammenfassung

Abstract

Background: Delirium is a leading cause of death and disability in the elderly with hip fracture. Identifying reliable risk factors for delirium is critical to support optimal outcomes for prevention and reducing delirium.

Objective: To quantify the reported factors associated to delirium for patients with hip fracture.

Methods: Electronic databases were searched (including Medline, Pub Med, CINAHL, EMBASE, Evidence Based Medicine Reviews, Cochrane Review, Web of Science, and PsycINFO) to identify all studies, published in English language that evaluated the risk factors of delirium hospitalized people with hip fracture. Two reviewers independently assessed methodology quality and extracted relevant data. The data from the included studies were summarized, and pooled estimates were calculated for 12 risk factors.

Results: Thirty-seven studies were included in the review and 25 in the meta-analysis. The incidence of delirium was 32.4% (95% confidence interval [CI] = 25.9%-39.5%). Six predisposing and four precipitating factors predicted delirium among older patients with hip fracture confirmed. The predisposing factors included advanced age (ES = 1.06, 95% CI = 1.03-1.09), male sex (ES = 1.34, 95% CI = 1.08-1.68), impairment of cognition (ES = 2.91, 95% CI = 1.91-4.42), and function (ES = 1.75, 95% CI = 1.39-2.2), comorbidity (ES = 1.59, 95% CI = 1.30-1.96), and health problems (ES = 2.64, 95% CI = 2.04-3.42). Precipitating factors were hypo- or hypernatremia (ES = 1.73, 95% CI = 1.14-2.64), depression (ES = 4.07, 95% CI = 1.95-8.49), more than three prescribed drugs (ES = 1.28, 95% CI = 1.10-1.49), and drugs including opioids (ES = 2.13, 95% CI = 1.42-3.18) and anticholinergic agents (ES = 2.10, 95% CI = 1.60-2.75).

Conclusion: This meta-analysis result provides evidence that these risk factors have a significant impact on delirium in elders with hip fracture during hospitalization. Developing formal screening, and effective preventive and management strategies for delirium is important.

Schlüsselwörter

  • Delirium
  • elderly
  • hip fracture
  • risk factors
  • systematic review
Uneingeschränkter Zugang

Antimicrobial agents and Burkholderia pseudomallei: perspectives from Thailand

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 167 - 172

Zusammenfassung

Abstract

Background: Burkholderia pseudomallei are the causative agent of melioidosis, a potentially life-threatening disease in humans and animals. It is a common public health threat in parts of Thailand.

Objective: To summarizes the current knowledge regarding antimicrobial agents and B. pseudomallei.

Methods: A literature search using MEDLINE (PubMed), SCOPUS, and OVID/LWWW databases.

Results: B. pseudomallei are intrinsically resistant to a wide range of antimicrobial agents including β-lactam antibiotics, aminoglycosides, and macrolides. Antimicrobial therapy for melioidosis is divided into an acute phase and an eradication phase. The current recommendations for the acute phase are parenteral antimicrobial agents for ≥10 days using ceftazidime or a carbapenem. The eradication phase involves oral antimicrobial agents for ≥180 days using trimethoprim-sulfamethoxazole. Amoxicillin-clavulanic acid may be used as an alternative. Ceftazidime revealed rare primary resistance and a high relapse rate.

Conclusion: Patients with acute melioidosis usually need intensive care and appropriate antibiotics for the acute and eradication phases. Ceftazidime is remains an effective agent in Thailand. A trend for decreasing susceptibility to antibiotics requires monitoring.

Schlüsselwörter

  • Antibiotic resistance
  • Burkholderia pseudomallei
  • mechanisms of resistance
  • melioidosis

Original article

Uneingeschränkter Zugang

Molecular mechanisms for NG-nitro-L-arginine methyl ester action against cerebral ischemia–reperfusion injury-induced blood–brain barrier dysfunction

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 173 - 184

Zusammenfassung

Abstract

Background: Ischemic stroke, an acute neurological injury lacking an effective therapy, is a leading cause of death worldwide. The unmet need in stroke research is to identify viable therapeutic targets and to understand their interplay during cerebral ischemia-reperfusion (I/R) injury.

Objective: To explore the protective effects and molecular mechanism of NG-nitro-L-arginine methyl ester (L-NAME) in cerebral ischemia-reperfusion injury-induced blood-brain barrier (BBB) dysfunction.

Methods: Two hundred fifty-six rats were randomly assigned to a sham operation group, I/R group, and I/R with L-NAME treatment group. Brain water content was determined by calculating dry/wet weight. The permeability of the BBB was observed using an electron microscope and by determining the Evans Blue leakage from brain tissue on the ischemic side. The expression of brain MMP-9 and GFAP was determined using an immunohistochemical method. The expression of ZO-1 protein was determined by western blotting.

Results: We found that L-NAME remarkably attenuated the permeability of the BBB after I/R as assessed by Evans Blue leakage and brain water content (p < 0.05). This was further confirmed by examination of the ultrastructural morphology of the BBB using a transmission electron microscope. Furthermore, we found that expression of the zonae occludens-1 (ZO-1) was decreased in endothelial cells, and expression of MMP-9 and GFAP was increased in the basement membrane and astrocyte end-feet in vehicle control groups, respectively, but these changes could be prevented by L-NAME pretreatment.

Conclusion: These results suggested that the neuroprotective effects of L-NAME against BBB damage induced by I/R might be related to the upregulation of tight junction proteins and inhibition of MMP-9 and GFAP expression. L-NAME can be used as a potential MMP-9-based multiple targeting therapeutic strategy in cerebral I/R injury.

Schlüsselwörter

  • blood-brain barrier
  • cerebral ischemia-reperfusion injury
  • glial fibrillary acidic protein
  • matrix metalloproteinase
  • NG-nitro-L-arginine methyl ester
  • zonae occludens-1
Uneingeschränkter Zugang

Improved insulin sensitivity, central systolic pressure and inflammatory indicators achieved with minor weight reduction in overweight and obese subjects given education on lifestyle modification

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 185 - 194

Zusammenfassung

Abstract

Background: Obesity is a global epidemic disease; lifestyle modification is an approach in the prevention and management of obesity.

Objective: We determined the effects of education on modified lifestyle intervention on arterial stiffness, metabolic and inflammatory markers.

Methods: Twenty-five generally healthy overweight and obese subjects completed nine months education on modified lifestyle intervention at Hospital Universiti Sains Malaysia, Kota Bharu. Subjects were regularly counselled to increase physical activity and modify their diet during intervention. Arterial stiffness was measured noninvasively using carotid femoral pulse wave velocity (PWV) and pulse wave analysis (PWA). Anthropometric measurements, body fat percentage and visceral fat, central and brachial blood pressures, lipid profile, the inflammatory marker high sensitivity C-reactive protein (hsCRP) and insulin sensitivity were also recorded.

Results: After nine months, a significant weight loss of 2.2 kg was observed associated with significant reductions in waist and hip circumference, aortic systolic blood pressure, serum fasting insulin, insulin resistance, and hsCRP levels. Insulin sensitivity was increased, while body fat and visceral fat percentages were marginally reduced (p = 0.058 and p = 0.059). No significant differences were seen in arterial stiffness, fasting plasma glucose and lipid profile.

Conclusion: Education on modified lifestyle intervention improved insulin sensitivity and resistance, reduced hsCRP and aortic systolic blood pressure despite the small weight reduction achieved.

Schlüsselwörter

  • Arterial stiffness
  • education on lifestyle modification
  • hsCRP
  • insulin sensitivity and resistance
  • obesity
Uneingeschränkter Zugang

Acute effect of Russell’s viper (Daboia siamensis) venom on renal tubular handling of sodium in isolated rabbit kidney

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 195 - 202

Zusammenfassung

Abstract

Background: The common complication in cases of poisoning by Russell’s viper (Daboia siamensis) venom (RVV) is acute renal failure, but the pathogenesis involved in the alteration of kidney function is still not well understood.

Objective: To clarify the role of RVV in the pathogenesis of renal damage, the present study examines the functional short-term alterations acutely induced by RVV in isolated perfused rabbit kidney.

Methods: Effects of RVV on renal tubular handling of sodium including mean perfusion pressure (PP), the renalvascular resistance (RVR), the glomerular filtration rate (GFR), the urinary flow (V) and osmolar clearance (Cosm) were studied in two groups of isolated perfused rabbit kidneys; each group had four isolated rabbit kidneys. RVV was added to the perfusion system to obtain the final concentration of 10 ⃞g/ml.

Results: Immediate decreases in PP and RVR caused by the venom were significantly apparent (p < 0.05) in the first 15 min after RVV administration. A gradual rise in both PP and RVR occurred 15 min after the initial reduction of the first phase, but its remained below pretreatment values. The GFR, V, and Cosm decreased significantly throughout experiments after venom perfusion (p < 0.05). The total fractional sodium excretion increased significantly after venom perfusion throughout experiments, while significant reductions (p < 0.05) of renal tubular handling of sodium were apparent for proximal absolute reabsorption of sodium and proximal fractional reabsorption of sodium including marked reductions of distal absolute reabsorption of sodium and distal fractional reabsorption of sodium of the venom treated kidney. Optical microscopy of treated kidney tissue showed acute tubular necrosis at the end of experiment.

Conclusion: The present study suggests that an administration of RVV in the isolated rabbit kidney causes direct acute nephrotoxicity and acute alterations of main functional parameters that are probably mediated by either the direct action of venom components or an indirect effect from vasoactive mediators released from renal cells of the RVV-treated kidney.

Schlüsselwörter

  • Daboia siamensis
  • isolated rabbit kidney
  • renal tubular handling of sodium
  • Russell’s viper venom
Uneingeschränkter Zugang

A novel approach to ultrasound-guided percutaneous native renal biopsy: a better tissue sampling technique

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 203 - 210

Zusammenfassung

Abstract

Background: Percutaneous renal biopsy (PRB) is an essential tool in diagnosis and management of various renal diseases. Conventional ultrasound-guided free-hand approaches to the lower pole of the kidney for PRB yield marginal tissue adequacy and causes a certain incidence of bleeding complications.

Objective: To describe a novel ultrasound-guided approach to the middle part of the kidney for PRB to obtain better tissue sampling.

Patients and methods: The plane angle between the renal biopsy needle and the skin was set at 30° for patients in the novel middle part approach group (n = 15) and 45° for patients in the conventional lower pole approach group (n = 15).

Results: The perpendicular distance between the needle tip and renal capsule in the middle part approach was significantly shorter than the lower pole approach group (0.92 ± 0.6 vs. 1.49 ± 0.4 cm, p = 0.005). The middle part approach to PRB yielded a significantly higher number of glomeruli (22.8 ± 7.2 vs. 15.3 ± 4.1, p = 0.002) and arcuate arteries (0.9 ± 0.6 vs. 0.5 ± 0.1, p = 0.02). The bleeding complications in the middle part approach seemed to be less than in the lower pole approach technique. Pain scores between the two methods as assessed using a visual analog scale were not different.

Conclusion: This novel approach to the middle part of the kidney for PRB provides comparable patient satisfaction and a superior adequacy of renal tissue when compared with the conventional lower pole approach with its consequent lower post biopsy bleeding complications. Larger studies to confirm this finding are warranted.

Schlüsselwörter

  • Middle part approach
  • percutaneous native renal biopsy
Uneingeschränkter Zugang

Understanding the pain status of the patient: a survey of pain status and pain treatment in an orthopedic outpatient department

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 211 - 219

Zusammenfassung

Abstract

Background: Pain assessments help clinicians to evaluate their patients’ symptoms. However, patients’ satisfaction with pain management is difficult to interpret and may mislead the clinician into being satisfied with inadequate pain management.

Objective: We described and explored patients’ pain status, patients’ satisfaction with their pain management, the impact of pain on sleep habit and routine activities of daily living (ADLs), and the proportion of patients who had undertreatment of pain in the Orthopaedic Outpatient Department, Ramathibodi Hospital.

Methods: A prospective, cross-sectional survey study of pain characteristics and pain management of Orthopaedic outpatients aged over 18 years in the Orthopaedics Department, Ramathibodi Hospital using two parts of a verified questionnaire.

Results: In all, 863 patients were studied. Numbers of patients with acute or chronic pain were in similar proportions and mainly diagnosed as nociceptive pain (83.7%). Most of them suffered from moderate or severe pain (42.6% vs. 39.1%). Severity of symptoms was correlated with sleep disturbance and disturbance in ADLs. However, no correlation was revealed between satisfaction with pain management and the intensity of pain and there was also no correlation between satisfaction with pain management and sleep disturbance or disturbance in ADLs. Most commonly prescribed medications were nonsteroidal antiinflammatory drugs (NSAIDs) (58.8%). However, 93.4% of returning patients who suffered from severe pain were still treated with nonopioid analgesics.

Conclusion: Patients suffered from moderate to severe pain and had disturbances in their sleep habit and ADLs. Most of them were satisfied with previous pain management, which was usually with nonopioid analgesics including NSAIDs and muscle relaxants. This group included some patients who experienced a high intensity of pain. We recommend clinicians pay more attention to the pain intensity of individual patients and justify appropriate medication by using a step-up approach and multimodal analgesics

Schlüsselwörter

  • Activities of daily living disturbance
  • pain intensity
  • satisfaction with pain management
  • sleep disturbance
  • undertreatment
Uneingeschränkter Zugang

The effect of the Thai “Eye Drop Guide” on success rate of eye drop self-instillation by glaucoma patients

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 221 - 227

Zusammenfassung

Abstract

Background: Noncompliance can mislead clinicians regarding the efficacy of therapy and result in more aggressive, but inappropriate treatment. Improper techniques used for eye drop instillation frequently occurs in chronic glaucoma patients. The Thai Eye Drop Guide (EDG) device has been developed to ensure precise instillation. However, whether the EDG is more effective than the traditional technique when careful instructions for both techniques are given is still unknown.

Objective: To compare success rates of eye drop self-instillation by chronic glaucoma patients using a traditional technique and the EDG when careful instructions for both are given.

Methods: Fifty-nine chronic glaucoma patients were instructed to instill eye drops using the EDG or a traditional technique in a randomized sequence. A two week practice period was assigned before groups were crossed-over. The instillation performance was VDO recorded after each practice period. Three criteria of success: time taken to instill an eye drop into the eye; instillation of only one drop; and without the bottle tip touching lids, lashes, periocular tissues, or the other hand, were scored by three independent readers from video-records. The readers were blinded to the sequence to which the patients were randomized.

Results: There were no significant differences in success rates between the EDG and traditional technique (61.0% and 66.1% respectively, p = 0.607) and the number of drops dispensed per application (median of 1 drop in both groups, p = 0.89). The time taken to instill eye drops with the EDG was significantly longer than using the traditional technique (median of 19 and 9 s respectively, p < 0.001). Older age (p = 0.049, OR 4.23) and more education (p = 0.025, OR 0.19) were found to be significantly associated with failure of the EDG.

Conclusion: EDG is not more effective than a traditional technique in terms of improving dispensing accuracy and decreasing the drops dispensed per application even when careful instructions are given. The results suggest that, if good instructions are provided, experienced glaucoma patients can improve their eye drop instillation performance.

Schlüsselwörter

  • Compliance
  • drop administration
  • eye drop guide
  • glaucoma
  • self-instillation
Uneingeschränkter Zugang

Precipitating causes and outcomes of chronic obstructive pulmonary disease exacerbation at a tertiary care center in northeast Thailand

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 229 - 236

Zusammenfassung

Abstract

Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalization and economic burden. Frequent exacerbations impair quality of life and effect decline of lung function.

Objective: We evaluated characteristics of COPD patients with frequent exacerbations. The precipitating causes, outcomes, hospital stay, and cost of admission were also determined.

Methods: The study population included COPD patients admitted because of acute COPD exacerbation at Srinagarind Hospital between 1 January 2006 and 31 December 2010.

Results: Over the 5-year period, 183 patients were admitted. Their mean age was 74.9 (SD 9.28) years and the male to female ratio was 170:13. Most patients (144; 79%) had one exacerbation per year and 39 (21%) had more than one per year. The group with more exacerbations, had a higher stage of the disease than those with only one exacerbation (p = 0.023), but there was no significant difference in the mortality rate (18% vs 14%, p = 0.53). A total of 245 episodes of acute exacerbation of COPD occurred in 183 patients. The mean duration of symptoms was 4.1 (SD 3.46) days. Forty-seven percent presented with Anthonisen type III, 42.4% with Anthonisen type II, and 10.6% with Anthonisen type I exacerbations. For 44 exacerbations (18%), the precipitating causes were not determined. The most common precipitating cause was pneumonia, which occurred in 90 episodes (36.7%). The second common was bronchitis (27.8%); followed by heart failure (8.2%), infected bronchiectasis (5.3%), diarrhea (1.2%), acute urinary retention (0.8%), unstable angina (0.4%), pneumothorax (0.4%), urinary tract infection (0.4%), atrial fibrillation (0.4%) and drug induced cough (0.4%). The organisms responsible for respiratory tract infection were identified in 31% cases of pneumonia and 18% of bronchitis cases. The top three common pathogens for pneumonia were Pseudomonas aeruginosa (9%), Acinetobacter baumannii (8%), and Klebsiella pneumoniae (8%). The top three common pathogens for bronchitis were P aeruginosa (7%), Haemophilus influenza (6%), and K pneumoniae (4%). About one quarter (25.3%) of acute exacerbations were complicated by respiratory failure. The mean duration of admission was 17.3 days (range 1-682 days). The mean cost of admission per exacerbation was 80,010 Thai baht (US $2,666) (range, 2,779-3,433,108 baht). The total cost for 245 exacerbations was 19.6 million baht ($653,000).

Conclusion: Respiratory tract infections were common causes of COPD exacerbation and one quarter of which developed respiratory failure. Preventive measures such as vaccination, smoking cessation, lung rehabilitation, and appropriate drug use are helpful.

Schlüsselwörter

  • COPD exacerbation
  • precipitating causes
  • outcomes

Brief communication (Original)

Uneingeschränkter Zugang

Bioequivalence study of cefepime intramuscular injection

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 237 - 240

Zusammenfassung

Abstract

Background: Cefepime, a fourth generation cephalosporin, is a broad spectrum antibiotic effective against both Gram positive and Gram negative bacteria. It is available from several pharmaceutical firms in southeast Asia. We studied bioequivalence of two products.

Objective: To assess the bioequivalence of two cefepime formulations: Cefamax 1 g intramuscular (Siam Pharmaceutical, Bangkok, Thailand) as the test formulation and Maxipime 1 g (Bristol-Myers Squibb, Bangkok, Thailand) as the reference formulation.

Methods: The study was conducted as an open, randomized, two-period crossover trial with a 1 week washout period in 18 healthy volunteers. Each subject received a single dose of 1 g intramuscular injection of the test or reference formulation. Blood samples were collected via an intravascular catheter at several time points over a 12 h period. Plasma cefepime concentrations were quantified by HPLC with photodiode array detection at 280 nm. The statistical comparisons for pharmacokinetic parameters were made using a paired t test.

Results: There was no significant difference in the logarithmically transformed values of Cmax, AUC0-12, and AUC0-∞ between Cefamax and Maxipime using an analysis of variance (ANOVA). The 90% confidence intervals (CIs) of Cmax, AUC0-12, and AUC0-∞ between the two formulations were 91.17-105.78, 90.29-97.63, and 88.89-96.57, respectively. All subjects had good tolerance and no serious adverse events were observed.

Conclusion: Cefamax 1 g intramuscular formulation is bioequivalent to Maxipime 1 g intramuscular formulation based on 90% CIs for Cmax, AUC0-12, and AUC0-∞ within 80%-125%.

Schlüsselwörter

  • Bioequivalence study
  • Cefamax
  • cefepime
  • fourth generation cephalosporin
  • pharmacokinetics
Uneingeschränkter Zugang

Burns in Tehran: demographic, etiological, and clinical trends

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 241 - 245

Zusammenfassung

Abstract

Background: Burns are a major public health problem. They often require intensive care and long periods of hospitalization. In Tehran, about 5% of all hospitalized injuries are burns. There are no published long-term epidemiological studies regarding burn injuries of adults in Iran.

Objective: To identify risk factors for burn injuries and provide a starting point for the establishment of an effective prevention plan.

Methods: We analyzed the demographic, etiological, and clinical data of 1860 burn patients admitted to a major acute care hospital in Tehran between March 2010 and April 2011. Data were obtained from the registry recorded in Shahid Motahari Trauma Hospital and evaluated using a chi-square test.

Results: Males were more than twice as likely to be burn patients than females (72.0% vs. 28.0%). Second and third-degree burns with a body surface area of 21%-30% constituted the highest injury reported (75.3%). The most common causes of the recorded burns were natural gas, gasoline (42%) and open fire (10.2%). Unintentional burns were reported in 85% of the cases, and 15% of the burn victims were suicide-related incidents; mainly among women. In 75% of suicide attempts, women set themselves on fire to commit suicide. The mean duration of hospitalization was 25 days and the mortality rate was 10.7%. Mean age of reported deaths was 38.6 years; with a mean of 30 years among women and 51.5 years among men.

Conclusion: The group at highest risk was young men 21-30 years old. However, an astonishing finding was that 75% of suicidal-related incidents involved women setting themselves on fire. Those with the highest mortality rate were victims of burns with gas, gasoline, and kerosene; with a mean age of 30 years of death among women.

Schlüsselwörter

  • Burns
  • demographic data
  • etiology
  • hospitalization
  • Iran
  • morbidity
  • mortality
  • Tehran
Uneingeschränkter Zugang

Effects of daidzein on testosterone secretion in cultured immature mouse testis

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 247 - 253

Zusammenfassung

Abstract

Background: Daidzein is a major isoflavone in soybeans. Several in vivo studies have showed that daidzein can affect immature male testosterone production. However, whether daidzein has direct action on immature male testis is unknown.

Objective: We investigated the effects of daidzein on testosterone secretion in 3-day-old and 21-day-old mouse Leydig cells with organotypic culture model.

Materials and Methods: The testes were exposed to different concentrations (10-7 to 10-4 M) of daidzein for 72 h with medium changed every 24 h. From 72 to 75 h of culture, 100 ng/ml human chorionic gonadotropin (hCG) was added. The testosterone production was determined, and the related mechanisms of daidzein action were also evaluated by measuring the mRNA levels of steroidogenic acute regulatory protein (StAR), cholesterol side-chain cleavage enzyme (P450scc), and 3β-hydroxysteroid dehydrogenase (3β-HSD-1) involved in testosterone biosynthesis.

Results: The results revealed that in the presence of 100 ng/ml hCG, 10-7 to 10-5 M daidzein had no significant effect on testosterone secretion in cultured 3-day-old mouse testis. But 10-4 M daidzein significantly increased testosterone concentration (p < 0.05). Daidzein in range of studied doses had no obvious influence on testosterone production in cultured 21-day-old mouse testis. RT-PCR results showed that 10-4 M daidzein had obvious influence on the mRNA levels of StAR, P450scc and 3β-HSD-1 in cultured 3-day-old mouse testis (p < 0.05).

Conclusion: These results suggest that daidzein mainly influences neonatal mouse testis function, and the influence is partially related to the upregulation of StAR, P450scc, and 3β-HSD-1 mRNA levels.

Schlüsselwörter

  • Daidzein
  • immature mouse Leydig cells
  • P450scc
  • testosterone
  • StAR
  • 3β-HSD-1
Uneingeschränkter Zugang

Prognostic significance of p16, p53, Bcl-2, and Bax in oral and oropharyngeal squamous cell carcinoma

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 255 - 261

Zusammenfassung

Abstract

Background: The proteins p16, p53, Bcl-2, and Bax are important cell cycle and apoptotic regulators involved in carcinogenesis and found to have prognostic significance in various cancers. However, the data for squamous cell carcinoma of oral cavity (OSCC) and of oropharynx (OPSCC) are conflicting.

Objective: We sought to determine if expression of p16, p53, Bcl-2, and Bax expression are associated with 5-year overall survival (OS) of patients with OSCC and OPSCC.

Methods: One-hundred thirty-seven cases of OSCC and 140 cases of OPSCC diagnosed from January 2002 to December 2004 at Songklanagrind Hospital, Songkhla, Thailand, were analyzed using a Cox proportional hazards model for 5-year OS in relation to immunohistochemical detection of Bcl-2, Bax, p53, and p16 proteins.

Results: The frequencies of p16, p53, Bcl-2, and Bax expression in OSCC were 13%, 45%, 4%, and 66%, and in OPSCC were 18%, 53%, 22%, and 75%, respectively. In univariate analysis, clinical variables including T stage, N stage and treatment were significantly associated with survival. In multivariate Cox regression, Bax overexpression was significantly associated with poor survival both in OSCC (HR 1.77, 95% CI 1.04-3.01) and in OPSCC (HR 2.21, 95% CI 1.00-4.85). We found no significant association of p16, Bcl-2, and p53 expression with survival.

Conclusion: The expression pattern of p16, p53, Bcl-2, and Bax are similar in OSCC and OPSCC. Only Bax expression has prognostic significance for both tumor sites.

Schlüsselwörter

  • Bcl-2
  • Bax
  • immunohistochemistry
  • oral cancer
  • oropharynx
  • p53
  • p16
  • prognostic marker
  • squamous cell carcinoma
Uneingeschränkter Zugang

Surveillance of marine fish for ciguatera toxin at fish markets in Bangkok, Thailand

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 263 - 268

Zusammenfassung

Abstract

Background: Ciguatera intoxication is a form of food poisoning. It is caused by the consumption of certain warm-water fish that have accumulated ciguatera toxin (CTX) through the marine food chain. Ciguatera fish poisoning (CFP) is a global disease, which although common, has been largely ignored in Thailand. This may be attributed to lack of confirmatory tests and seemingly nonspecific clinical presentations.

Objective: We studied CTX contamination in marine fish sold at Bangkok markets.

Methods: A surveillance of CTX in fish using the Cigua-Check assay has been conducted in Bangkok, the center of seafood marketing in Thailand. Here, there are several types of fish. Some come from domestic fishing and others are imported from Indonesia, Myanmar, or India.

Results: A random survey at three fish markets in Bangkok revealed two samples possibly contaminated with ciguatera toxin from a total 227 fish samples (of 21 fish species). This is the first report of finding CTX contamination in fish meat sold in Bangkok.

Conclusion: It is possible that these CTX-positive fish were caught from other countries. Even though the positivity (0.88%) is lower when compared with studies of other endemic areas (5.0% in Hawaii and Pacific Islands), this finding should raise awareness of the possibility of facing rare CFP intoxication from fish obtained at local Thai markets.

Schlüsselwörter

  • Bangkok
  • ciguatera toxin
  • marine fish
Uneingeschränkter Zugang

Phylogenetic analysis of the king cobra, Ophiophagus hannah in Thailand based on mitochondrial DNA sequences

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 269 - 274

Zusammenfassung

Abstract

Background: Snakes possess adaptive characteristics of morphology that may result in incorrect reconstruction of phylogeny. Molecular approaches have become the major source of new information for advancing our understanding of evolutionary, genetic relationships, and species identification.

Objective: We studied DNA sequences of Ophiophagus hannah in different parts of Thailand and compared them with those of O. hannah from other countries.

Materials and Methods: We studied the mitochondrial NADH dehydrogenase subunit 2 (ND2) and control region (CR) sequences of 12 individuals O. hannah from different localities across Thailand. Phylogenetic analysis of DNA sequences were compared to the published sequences of O. hannah deposited in NCBI GenBank database from other countries.

Results: O. hannah could be categorized into 2 Clades, 5 haplotypes, and 4 localities based on 43 different nucleotide positions from the 736 bp of ND2 and 673 bp of CR. Clade A was haplotype A from southern Thailand. Clade B consisted of haplotypes B, C, D, and E. Haplotype B and C came from northern Thailand. Haplotype D came from western Thailand, while haplotype E was O. hannah from central Thailand. The DNA sequences of Clade B were similar to the sequences of O. hannah in Myanmar and southern China that are already deposited in NCBI GenBank database.

Conclusion: We found a different genotype of O. hannah from southern Thailand and suggest that this may be a new species of O. hannah.

Schlüsselwörter

  • CR
  • ND2
  • Ophiophagus hannah
  • phylogenetic
Uneingeschränkter Zugang

Clinical and microbiological characteristics of corneal ulcers in a Thai referral center

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 275 - 282

Zusammenfassung

Abstract

Background: There are regional variations in causative organisms and epidemiologic patterns of corneal ulcers. It is essential to review periodically in terms of epidemiology and the microbial keratitis profiles that occur in a specific region in order to develop a comprehensive strategy for diagnosis and management of corneal ulcers.

Objective: To review the epidemiology, predisposing factors, microbiological characteristics and visual outcomes in corneal ulcers at a referral center in Thailand.

Methods: A retrospective review of patients with clinically diagnosed corneal ulcers presenting between January 2006 and December 2010 was performed.

Results: A total of 159 patients (159 eyes) were analyzed. Ninety-one cases (57.2%) were in men. The mean age of the patients was 43.0 ± 20.0 years. The most common predisposing factor was ocular trauma found in 72 eyes (45%). Culture was grown from 123 eyes and results were positive in 52%. The most frequent causative organisms were bacteria (72%), followed by fungus (28%). The most common bacteria was Pseudomonas aeruginosa (55%) and most common fungus was Fusarium species (33%). In a comparison between fungal and bacterial groups, the latter was more likely to be associated with contact lens wear (p = 0.05). The hospitalization time for the fungal group was significantly longer than for the bacterial group (p = 0.001). The posttreatment corrected visual acuity equal to or better than 20/200 was found significantly more commonly in the bacterial group than in the fungal group (p = 0.031). While therapeutic keratoplasty was significantly higher in the fungal group than in the bacterial group (p = 0.048).

Conclusion: Fungal keratitis was more severe than bacterial keratitis resulting in longer hospitalization time, poorer visual acuity, and with more chance to have therapeutic keratoplasty.

Schlüsselwörter

  • Corneal ulcers
  • epidemiology
  • organisms
  • predisposing factors
  • visual outcomes
Uneingeschränkter Zugang

High glucose enhances CD39 expression in vascular endothelial cells

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 283 - 287

Zusammenfassung

Abstract

Background: Diabetes mellitus (DM) patients lose their ability to control normal blood glucose levels, resulting in high blood glucose levels (hyperglycemia). Hyperglycemia causes DM complications. This involves responses of vascular endothelial cells (VECs) to hyperglycemia, affecting inflammatory process and platelet activity. Ecto-enzyme CD39 is expressed on VECs, catalyzing the hydrolysis of ATP and ADP to AMP and, consequently, regulating inflammatory process and platelet activation.

Objective: We studied whether high glucose concentration has an effect on CD39 expression on VECs.

Methods: Cultured human umbilical vein endothelial cells (HUVEC) were used as a model of study. HUVEC were cultured in different glucose conditions (4, 9, 24, and 34 mM) for 24 hours. Cell viability was assessed using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)-based assay and expression of CD39 was examined by using SDS-PAGE and western blot techniques.

Results: HUVEC were cultured in normal (4 and 9 mM) or high (24 and 34 mM) glucose concentrations for short term (24 hours). The results showed that high glucose (24 and 34 mM) reduced cell viability to 89.5 ± 11.3 and 86.3 ± 13.5 (mean ± SD), compared with control (4 mM), respectively. High glucose also induced increases in CD39 expression in HUVEC.

Conclusion: High glucose decreases cell viability and increases CD39 expression in HUVEC, suggesting involvement of CD39 in cell responses to high glucose.

Schlüsselwörter

  • CD39
  • cell viability
  • diabetes mellitus
  • HUVEC
  • hyperglycemia
  • short term
  • vascular endothelial cell

Clinical report

Uneingeschränkter Zugang

Damage control surgery in blunt cardiac injury

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 289 - 293

Zusammenfassung

Abstract

Background: Blunt cardiac injury (BCI) is a rare, but life threatening injury. The treatment of BCI is surgical repair. However, in a BCI patient with hypothermia, acidosis, and coagulopathy, an attempt to control the bleeding completely by surgery alone may not be successful. Damage control principles should be used in this situation.

Objective: To study a BCI patient who underwent a successful operation using damage control principles.

Methods: We reviewed and analyzed the patient’s chart, operative notes and follow up visit records. Review of the literature regarding the issue was also conducted.

Results: We report the case of a patient with BCI who developed hypothermia and coagulopathy during surgery. Abbreviated surgical repair was performed with a right pleuropericardial window created to avoid blood accumulation in the pericardial sac. Subsequent aggressive resuscitation was performed in the intensive care unit. We accepted ongoing bleeding through the right chest tubes while correction of hypothermia and coagulopathy was undertaken. The bleeding was gradually stopped once the patient’s physiology was restored. Although the patient developed a retained right hemothorax requiring subsequent video-assisted thoracoscopic surgery on the third postoperative week, he recovered uneventfully and was discharged on postoperative day 36.

Conclusion: In patients with BCI who develop coagulopathy during surgery, terminating the operation quickly and creating a pleuropericardial window is a possible bailout solution because this can prevent postoperative cardiac tamponade without leaving the chest open. Continue bleeding from the chest tubes is acceptable provided that adequate resuscitation to correct coagulopathy is underway.

Schlüsselwörter

  • Blunt cardiac injury
  • damage control
  • pleuropericardial window

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