Volume 11 (2017): Issue 3 (June 2017)

Occupation and working conditions may affect the risk of developing metabolic syndrome (MetS), an important risk factor for diabetes and cardiovascular disease (CVD).

To investigate the prevalence of MetS and its risk factors in employees in an industrial workplace and compare them with those in employees from a nonindustrial setting.

Male employees (n = 757) from a gas-refinery and 2700 adult men from the general population of whom 750 were nonindustrial employees (Khorasan province, Iran), were evaluated for CVD risk factors, including those used to define MetS. Individuals were matched for age and educational attainment, and 670 industrial and 681 nonindustrial employees were included in the final analysis. International Diabetes Federation (IDF) and Adult Treatment Panel (ATP) III criteria were used for diagnosis of MetS. We compared MetS and its risk factors between the two groups.

There were more gas refinery employees with a body mass index > 30 kg/m², abdominal obesity, and a high fasting blood glucose level than nonindustrial employees (P < 0.01). A diagnosis of MetS was significantly more likely in refinery workers than in nonindustrial employees (OR 1.38, 95% CI 1.10 to 1,737; P = 0.005). Scores of IDF and ATP III criteria in the refinery employees were significantly higher than for the nonindustrial employees (P < 0.01). The prevalence of hypertriglyceridemia in the refinery employees tended to be higher than in nonindustrial employees, but the difference was not quite significant (P = 0.052). Blood pressure in nonindustrial employees was significantly higher than in refinery employees (P < 0.001).

The prevalence of MetS among male gas refinery employees was higher than for male nonindustrial employees.

Sepsis pathophysiology includes oxidative stress and inflammatory processes.

To investigate the antioxidant and anti-inflammatory effects of p-coumaric acid (PC) and ellagic acid (EA) in a rat model of sepsis.

Wistar rats were assigned to 5 groups: control (C), sepsis (S), and S with treatment by PC, EA, or PC and EA combined (PCE). We determined the liver and lung tissue levels of pro- and anti-inflammatory cytokines, oxidative stress, and antioxidant markers.

In the model of sepsis, proinflammatory cytokine levels increased, anti-inflammatory cytokines decreased, oxidative stress markers increased, and activity of antioxidant enzymes decreased significantly. In the liver of rats treated with PC, EA, or PCE, TNF-α levels were reduced significantly, whereas IL-1β and IL-6 levels were reduced significantly in rats treated with EA or PCE. Despite an increase in anti-inflammatory cytokines in the liver and lungs in all the treatment groups compared with S, an increase in IL-10 was only found in the liver of rats treated with PCE. The levels of malondialdehyde decreased significantly in the liver and lungs in rats in all treatment groups. The catalase and superoxide dismutase activity increased significantly in rats treated with PCE. While glutathione peroxidase activity in the liver only increased significantly in rats treated with PCE, it increased in the lungs of rats in all treatment groups.

PC and EA treatment had antioxidant and anti-inflammatory effects, which were stronger when these treatments were combined. Combined treatment with these substances may be beneficial in the treatment of sepsis.

Menopausal symptoms can affect the quality of life (QoL) of women.

To determine menopause-related symptoms and QoL in peri- and postmenopausal women in Thailand undergoing various treatment.

A prospective cohort study was conducted at 9 menopause clinics in 4 regions of Thailand. Peri- and postmenopausal women newly registered at the clinics were recruited and followed up for 12 months. A standardized medical record form was used to collect data regarding demographic characteristics, menopause-related symptoms, and treatment. QoL was evaluated using a specific questionnaire.

We included 870 women who were 51.8 ± 5.6 years old. We compared demographic characteristics and baseline health profiles of women with normal QoL and impaired QoL. Women with impaired QoL were significantly younger (51.2 ± 4.4 vs. 52.0 ± 6.0 y, P = 0.035) and included more from northeast Thailand (11.4% vs. 6.6%, P = 0.022). The 3 most common menopause-related symptoms were psychoemotional distress, musculoskeletal pain, and hot flushes. All QoL scores improved with time in both users and nonusers of postmenopausal hormone therapy (pHT), and the scores of both groups converged during months 3 to 12 of the follow-up period.

The most common menopause-related symptom in peri- and postmenopausal women in Thailand is psychoemotional distress. QoL scores of women with moderate-to-severe menopause-related symptoms at baseline improve over time, whether or not they use of pHT. The pHT users had poorer QoL at baseline than nonusers, but their QoL improves and matches that of their peers after 3 months.

Leishmaniasis is endemic in Iraq, where both cutaneous and visceral forms of the disease are reported.

To determine the prevalence of cutaneous leishmaniasis (CL) and to identify associations of CL with age, sex, season, and provinces depending on some demographic and climatic aspects.

This study is retrospective and includes reported cases of infections using the available surveillance database taken from the Iraqi Ministry of Health for the years 2011, 2012, and 2013 for all provinces of Iraq.

Men and boys were found to be at higher risk for CL compared with women and girls. The majority of cases were recorded among those in age groups 5–14 and 15–45 years old. Most cases were recorded from lowland provinces with moderate annual rainfalls and a high rural population.

This study provides initial necessary data for public health specialists working to assess management approaches for the control of cutaneous leishmaniasis in Iraq.

Bacillus Calmette–Guérin (BCG) Tokyo 172-1 strain has been used as a parent strain since 1988 by Queen Saovabha Memorial Institute, Thai Red Cross Society to manufacture BCG vaccine in Thailand. In general, the BCG Tokyo strain includes 2 BCG type populations: types I and II. Several studies have found that the type I population is higher than type II. Polymerase chain reaction has shown the presence of 2 types of subpopulations in the BCG Thai Red Cross Society (TRCS) strain. However, the characteristics of all genes from BCG TRCS have not been studied in depth, including whether or not the original features of the BCG Tokyo 172-1 strain are still retained.

To compare BCG TRCS and BCG Tokyo 172-1 for differences between their genomes.

The whole genome of BCG TRCS was analyzed by next-generation sequencing.

BCG TRCS contained 23 different points and was 4 bases less in length than BCG Tokyo 172-1. However, its main features remain similar to those of the original BCG Tokyo 172-1 strain.

The changes in the genome may be caused by a variety of factors including the strain of Tokyo 172, vaccine processing, storage, and natural changes in the genome.

Free flap surgery is an essential tool in limb reconstruction, but complex and often followed by complications, with many cases requiring additional procedures.

To analyze postoperative complications and need for secondary surgery after free flap surgery over a 10-year period at King Chulalongkorn Memorial Hospital.

We retrospectively reviewed data from a cohort of patients who underwent free flap surgery for limb reconstruction from 2004 to 2014.

We included 35 free flap operations in 29 patients. Mean follow-up time was 6.4 y. Free flap surgical procedures included 7 gracilis transfers, 8 toe transfers, 5 latissimus dorsi flaps, 5 fibular transfers, 4 anterolateral thigh flaps, 2 lateral-arm flaps, 2 radial forearm flaps, and 2 venous free flaps. There were 4 categories of postoperative complications. (1) Patients were those who developed total flap loss after free flap surgery (7/35 flaps, 20%). (2) Patients had major complications requiring additional operations (11/35 flaps, 31%). Major complications included partial flap necrosis, wound swelling with delayed closure, arterial occlusion, postoperative bleeding, infection, and failed implant fixation. (3) Patients had minor complications that required no additional surgical procedures (8/33 flaps, 23%). (4) Patients with no postoperative complications (9/35 flaps, 26%). Secondary surgery after initial free flap was 51% overall (18/35 flaps). The 3 most common secondary procedures included second flap coverage, skin graft, and anastomosis revision. We found free flap surgery performed during the subacute period (14–90 d after injury) to have significantly (P = 0.028) more complications (categories 1 and 2) than surgery performed during the acute period (<14 d) or late reconstruction (>90 d).

Physicians should be prepared for a range of outcomes of free flap surgery and advise their patients of the risk of additional operations accordingly.

An enteroatmospheric fistula (EAF) is a devastating complication of abdominal surgery. EAF wound care is uniformly problematic and burdensome because the fistula effluent is difficult to contain, causing several abdominal skin problems.

To report the case of a complex EAF in a patient in whom conventional wound care techniques failed to contain the fistula.

We reviewed the patient’s medical records and the novel wound care technique used to contain the fistula.

We report the use of a modified vacuum-assisted closure (VAC) technique, the “Wall VAC”, for the wound care of a patient with a complex EAF having large and multiple fistula openings following multiple abdominal operations. The Wall VAC technique consists of (1) leveling the skin surrounding the EAF wound, (2) creating the Wall VAC using a rectangular-shaped VAC sponge with 2 suction systems, and (3) sealing the system with a plastic bag and incise drape. By using this technique, the fistula effluent was effectively contained and the abdominal skin was well protected. The system changed every 3 to 4 days.

Our modified VAC technique, the “Wall VAC”, is simple and effective in containing a large volume (3,000 to 4,000 mL) of fistula effluent and protecting the abdominal skin in a patient with a complex EAF. We recommend this particular technique as an alternative method for managing a complex EAF.