- Dettagli della rivista
- Pubblicato per la prima volta
- 01 Jun 2007
- Periodo di pubblicazione
- 6 volte all'anno
- Accesso libero
Pagine: 583 - 584
- Accesso libero
Association of adiposity, measures of metabolic dysregulation, and elevated alanine aminotransferase in subjects with normal body mass index
Pagine: 585 - 596
Background: Differences in body fat (BF) distribution in patients with normal body mass index (BMI) with elevated alanine aminotransferase (ALT) remains poorly described.
Objective: To determine the relationship between total BF, waist circumference (WC), insulin resistance (IR), and cardiometabolic risk profile in subjects with elevated ALT and normal BMI.
Methods: We analyzed cross-sectional data from 4,914 US participants in the third National Health and Nutrition Examination Survey database, who were ≥20 years of age, had normal BMI, and had body composition assessed by bioimpedance.
Results: Mean ± SD age was 41.4 ± 0.3 years, and 58% participants were women. BF was 20 ± 0.1% in men and 29.9 ± 0.1% in women. As total BF increased by tertiles, there was a tendency towards a higher prevalence of nonalcoholic fatty liver disease in men (6.1%, 6.5%, 9.5%, P = 0.13), but not in women (8.7%, 8.2%, 10.7%, P = 0.71). As WC increased by tertiles, there was a higher prevalence of elevated ALT in men (2.6%, 8.6%, 6.6%, P < 0.0001), but not in women. As ALT increased, men had significantly higher levels of nonhigh density lipoprotein cholesterol (HDL-C), increased apolipoprotein B, increased IR, and lower levels of C-reactive protein, whereas, women had higher levels of non-HDL-C and increased IR.
Conclusion: In subjects with normal BMI, increased WC is associated with a higher prevalence of elevated ALT in men, but not in women. Higher levels of ALT correlated with a poor cardiometabolic risk profile.
- Body fat
- body mass index
- elevated ALT
- waist circumference
Brief communication (Original)
- Accesso libero
Pagine: 597 - 602
Background: Cross-sectional studies have linked decreased adiponectin levels with several metabolic traits, including insulin resistance, dyslipidemia, and metabolic syndrome. Previous studies conducted to investigate the effects of acute or chronic exercise on the serum adiponectin have produced conflicting and controversial results.
Objective: To investigate the effect of supervised aerobic training of moderate intensity on the total serum levels of adiponectin and its relationship to insulin resistance and body weight in subjects with type 2 diabetes (DM2).
Methods: Thirty-five patient participants diagnosed as having DM2 mellitus for more than 5 years with normal or near normal body weight took part in this study. The diagnosis of DM was based on the American Diabetes Association criteria for type 2 diabetes mellitus. Serum levels of blood glucose, insulin, total adiponectin, high molecular weight adiponectin, and insulin resistance were determined before and after a 12-week program of supervised moderate intensity aerobic training.
Results: Twelve weeks of supervised moderate intensity aerobic training produced a significant reduction of fasting blood sugar, fasting insulin, glycosylated hemoglobin, and insulin resistance in male subjects with DM2. By contrast, a significant increase in the total serum adiponectin and high molecular weight adiponectin has been reported. There was no significant correlation between the reduction of the body mass index, insulin resistance, and the increase of the total serum adiponectin or high molecular weight adiponectin.
Conclusion: Prolonged exercise training of at least moderate intensity improves levels of adiponectin and insulin sensitivity in men with type 2 diabetes.
- aerobic training
- type 2 diabetes
- Accesso libero
Pagine: 603 - 608
Background: This cross-sectional survey is to our knowledge the first attempt in Malaysia to study forensic entomology knowledge and practices among relevant Malaysian practitioners. Analysis of our questionnaire identified three major themes: understanding of forensic entomology, the acceptance and application of forensic entomology in crime scene investigation, and future directions for forensic entomology in Malaysia. We found that only a few experienced crime scene police officers had a meaningful knowledge of forensic entomology and were involved in maggot collecting during crime scene investigation.
Objectives: To assess knowledge, attitude, and practice of forensic entomology among relevant practitioners in Malaysia.
Methods: A total of 402 relevant practitioners were asked to complete a questionnaire regarding knowledge, attitude and practice of forensic entomology.
Results: Half of the respondents had some understanding that forensic entomology is a study of insects found on a dead human body. The study also found that forensic entomology research in Malaysia is mainly to determine the postmortem interval (PMI), to identify the types of flies, and to study insect maturation and succession; particularly of local species. The Malaysian government should be encouraged to play a role through the Department of Education to attract more students to this field and to support academic institutions to formulate research in forensic entomology.
Conclusions: Forensic entomology in Malaysia needs improvement of technical knowledge and awareness among relevant practitioners through curriculum development, policy, and training programs.
- Forensic entomology
- occupational health practice
- Accesso libero
Prognostic value of the Marshall computed tomography classification for traumatic subarachnoid hemorrhage
Pagine: 609 - 614
Background: The Marshall computed tomography (CT) system for classification of traumatic brain injury (TBI) includes the most important independent prognostic variables except for traumatic subarachnoid hemorrhage (tSAH).
Objectives: To evaluate the prognostic effect of tSAH on different injury types based on the Marshall CT system.
Methods: We performed a retrospective study. All patients with severe closed head injury admitted from February 2011 to July 2012 were included. Their scans were classified into two groups: localized injury and diffuse injury using the Marshall classification. Outcomes were compared between patients with tSAH and those without tSAH among the two groups.
Results: Ninety-six patients were included in this study. Seventy-two (75%) were found to have tSAH, and outcomes significantly negatively correlated with tSAH in both localized injury and diffused injury groups.
Conclusions: tSAH had an important effect on the patients’ outcome. Although the Marshall classification includes important independent prognostic variables, tSAH should also be added.
- Marshall CT classification
- severe traumatic brain injury (sTBI)
- traumatic subarachnoid hemorrhage (tSAH)
- Accesso libero
Survey of attitude towards and understanding of the elderly amongst Chinese undergraduate medical students
Pagine: 615 - 622
Background: Gerontology has an increasing role in medicine and public health. The provision of better medical services to the elderly closely correlates with the attitude towards and understanding of the elderly by medical personnel.
Objectives: We investigated factors affecting a medical student’s choice of gerontology as a career. This included a survey of attitude towards the elderly and understanding of aging among first and third year Chinese undergraduates. Data between students in different streams, at different levels, and between sexes were compared.
Methods: Convenience sampling was used to recruit 335 undergraduate medical students in Sichuan for a survey using Kogan’s Attitudes toward Older People Scale (KAOP) and Palmore’s Facts on Aging Quiz (FAQ1) as tools.
Results: Among undergraduates, 71.3% did not acquire significant knowledge about the elderly (mean KAOP score 139.5 ± 16.0); and had a mean score of knowledge of aging (12.2 ± 2.7). The majority of first year students (98.7%) and third year students (98.8%) had a positive attitudes (KAOP > 102). The KAOP score among first year students was higher than that among third years (P < 0.01). Students with an interest in problems of the elderly had significantly higher scores and were more willing to consider careers in gerontology than students without an interest in the elderly (P < 0.01).
Conclusions: The majority of Chinese undergraduate medical students surveyed had positive attitudes towards elderly. We recommend greater accessibility of courses in gerontology to meet the increasing need for personnel in this health care sector.
- medical student
- Accesso libero
Validation of the Thai version of the Duke Activity Status Index in patients with a previous myocardial infarction
Pagine: 623 - 630
Background: The Duke Activity Status Index is a widely used instrument for measuring functional status in patients with cardiovascular disease. However, items and subscales on this instrument have not been validated for Thai patients with a previous myocardial infarction (MI).
Objective: To test the reliability and validity of the Thai version of the Duke Activity Status Index (DASI-T) in Thai patients with a previous MI using a cross-sectional study design.
Methods: The DASI-T was translated using forward and backward translation methods and administered to 100 MI patients from outpatient departments of two general hospitals in Thailand. Internal consistency was determined to test reliability. Two criterion measures (i.e. Canadian Cardiovascular Society (CCS) classification, SF-36 physical functioning subscale) were used to test the concurrent validity of the DASI-T. Age group and CCS classification were used to determine known-groups validity of the DASI-T.
Results: Cronbach’s α for the DASI-T total score was 0.76. No ceiling or floor effect was detected for the DASI-T total score. DASI-T total score was significantly correlated with the CCS classification (r = -0.68, P < 0.01) and SF-36 physical functioning subscale (r = 0.79, P < 0.01). DASI-T total scores could differentiate MI patients based on age (P = 0.040) or CCS classification (P = 0.000).
Conclusion: The DASI-T is a potentially reliable and valid instrument with which to assess functional status in MI patients and is also useful to evaluate a treatment effect and be a guideline for clinical purposes (i.e. exercise prescription, risk stratification).
- Duke Activity Status Index
- myocardial infarction
- Accesso libero
Pagine: 631 - 635
Background: Antenatal hydronephrosis (ANH) is a condition characterized by fetal renal pelvic dilatation during pregnancy. It is detected in 1%-5% of all pregnancies. Most cases of ANH are physiological in nature, but some are pathological and can cause morbidity.
Objective: To determine: (a) the causes of ANH; (b) the factors associated with complications; and, (c) the factors associated with surgical intervention.
Methods: We reviewed the medical records of infants diagnosed with ANH; defined by a renal pelvic anteroposterior diameter ≥5 mm (based on antenatal ultrasonography) and being followed-up at Srinagarind Hospital.
Results: Forty-six infants (32 boys and 14 girls) with ANH were identified. Over half (57%) were born in our hospital (in-hospital) with the condition. The two most common causes of ANH were ureteropelvic junction obstruction (32%) and transient hydronephrosis (22%). Of the 63 abnormal kidneys, 52% needed surgical intervention. Twenty-two patients (48%) had urinary tract infections and most had more than 1 episode. None of the 46 patients had end-stage renal disease, but one died because of lung hypoplasia during the neonatal period. The severity of ANH and time of first postnatal ultrasonography were related to medical complications, while bilateral ANH and more severe ANH were associated with the need for surgical intervention. A milder degree of ANH and postnatal ultrasound findings were significantly associated with transient hydronephrosis.
Conclusion: Most cases of ANH were pathological and half required surgical intervention. Severe ANH and delayed investigation were associated with poor outcomes.
- Antenatal hydronephrosis
- Accesso libero
PCR amplification of a putative gene for exo-1,3-β-glucanase to identify the pathogenic oomycete Pythium insidiosum
Pagine: 637 - 644
Background: Pythium insidiosum is the etiologic agent of pythiosis, a life-threatening infectious disease. Diagnosis of pythiosis is difficult and often delayed. Early diagnosis can lead to prompt treatment, and therefore a better prognosis for patients with pythiosis. Molecular diagnostic techniques are useful if microbiological and immunological assays are not available, or in cases of suspected pythiosis that test negative by other methods. So far, PCR identification of P. insidiosum has been largely relied on amplification of the rDNA region.
Objective: To evaluate the diagnostic performance of Dx3 and Dx4 primers specific for a putative gene for exo- 1,3-β-glucanase (PinsEXO1), which encodes a specific immunogen of P. insidiosum, for rapid single-round PCR identification of P. insidiosum, in comparison with the previously-reported rDNA-specific primers, ITSpy1 and ITSpy2.
Materials and Methods: Genomic DNA (gDNA) from 35 P. insidiosum isolates and 48 control organisms were prepared to evaluate the diagnostic performance of the PinsEXO1- and rDNA-specific primers.
Results: When amplifying the control gDNA by using the Dx3/4 and ITSpy1/2 primer sets, no PCR product was observed, indicating that both primer sets had 100% detection specificity. When amplifying the P. insidiosum gDNA, the Dx3/4 primers provided an expected 550-bp amplicon for all 35 isolates, while the ITSpy1/2 primers provided an expected 230-bp amplicon for only 32 isolates. Thus, detection sensitivity of the Dx3/4 and ITSpy1/2 primer sets were 100% and 91%, respectively.
Conclusion: By using the Dx3/4 primers, PinsEXO1 was an alternative, efficient, and novel PCR target for rapid single-round PCR identification of P. insidiosum.
- Pythium insidiosum
- Accesso libero
Rheumatic and congenital heart diseases among school children of Khon Kaen, Thailand: declining prevalence of rheumatic heart disease
Pagine: 645 - 650
Background: Rheumatic fever (RF), rheumatic heart disease (RHD), and congenital heart disease (CHD) are still major problems among Thai school children.
Objective: To examine trends in the prevalence of RF/RHD and CHD along with the socioeconomic status of school children in urban Khon Kaen, northeastern Thailand.
Methods: We conducted cross-sectional survey of 8,555 school children aged 5-15 years from 4 schools in urban Khon Kaen from January to March 2006. Pediatric cardiologists examined the school children and all cardiac diagnoses were confirmed by echocardiography. Socioeconomic data were also collected. Schools were divided into high and low socioeconomic status (SES) schools, based on the prevailing levels of parental education and household income. All positive cases of heart disease were followed and reviewed at a university hospital up to December 2013.
Results: Of 8,555 children examined, 2 had RF/RHD, and 10 had CHD. The prevalence of RF/RHD was 0.23 per 1,000 (95% CI 0.03-0.84), and the prevalence of CHD was 1.2 per 1,000 (95% CI 0.56-2.15). Prevalence of RF/RHD among urban school children in the center of northeastern Thailand had declined from 1.13 to 0.23 per 1,000 since 1986. The indices of socioeconomic development revealed marked improvement during this 20 year interim. The prevalence of RF/RHD was higher among low SES schools (4.6 per 1,000) compared with high SES schools (0 per 1,000).
Conclusion: There is a low prevalence of RHD in school children in this region compared with the period before 1986.
- Congenital heart disease
- heart disease
- rheumatic fever
- rheumatic heart disease
- Accesso libero
Potential of bone scaffolds containing vancomycin and bone morphogenetic protein-2 in a rat model of osteomyelitis
Pagine: 651 - 658
Background: Infected bone is often intractable. An ideal approach is to simultaneously eradicate infection and repair the bone defect. The development of osteoinductive bone graft composites to control antibiotic drug release would be useful for the treatment of intractable bone infections.
Objectives: To develop a rat model of osteomyelitis for assessing osteoinductive bone graft scaffolds containing antibiotics and a bone morphogenetic protein.
Methods: Si-imprinted calcium phosphate is a new hydroxyapatite derivative used in fabricating bone scaffolds. Vancomycin and bone morphogenetic protein-2 (BMP-2) were loaded onto scaffolds of Si-imprinted calcium phosphate using an established method. The efficiency of the scaffold as a drug carrier system was assessed in vivo. Osteomyelitis was induced in rats by infection of the tibial epiphysis with Staphylococcus aureus (BAA 1680). The success of inducing disease was checked after 4 weeks using bacterial culture and radiography. A 10 mm metaphysis bone was surgically removed and replaced with a drug-loaded scaffold. Histology and X-ray imaging were used to evaluate the implants at 8 weeks post implantation.
Results: We successfully established a rat model of osteomyelitis. The causative bacteria were effectively eradicated by vancomycin released from the implants. Enhanced bone formation was observed for the implant samples containing vancomycin and BMP-2 compared with those containing either vancomycin or BMP2 alone.
Conclusions: The newly developed bone scaffold has potential as a vehicle for therapeutic agents to treat bone diseases.
- bone defect
- bone infection
- drug delivery system
- Accesso libero
Pagine: 659 - 664
Background: Abnormal lung function has been reported in the obese population and is associated with the severity of obesity.
Objectives: To identify abnormal lung function in obese children and adolescents, and examine the cardiopulmonary response of those who have abnormal lung functions during exercise, and to reveal predictors of exercise intolerance in this population.
Methods: Fifty obese participants aged 8–18 years (56% male; mean age 13.2 ± 2.0 years; mean BMI 33.0 ± 3.6 kg/m2, mean BMI z score 3.1 ± 0.3) underwent spirometry, lung volume evaluation, and a cardiopulmonary exercise test.
Results: Lung function abnormalities and exercise intolerance because of pulmonary limitations were found in 36% and 74% of the participants, respectively. A comparison of participants with normal and abnormal lung functions revealed a lower breathing reserve and a higher ventilatory equivalent for CO2 production (VE/VCO2) during exercise in those who had lung function abnormalities (18 ± 15 vs 30±10%, P <0.001 and 30.3 ± 3.3 vs 29.6 ± 3.1; P = 0.02, respectively). Exercise intolerant participants had a higher BMI z score compared with those who were not (3.1 ± 0.3 vs 2.9 ± 0.3; P = 0.03). BMI z score ≥ 2.84 had an 80% sensitivity and 67% specificity for predicting exercise intolerance in this population.
Conclusions: Evaluations of lung function and exercise capacity should be included in the follow-up planning for obese children and adolescents. A BMI z score ≥ 2.84 was most sensitive for predicting exercise intolerance in this population.
- exercise intolerance
- Accesso libero
Pagine: 665 - 672
Background: Thailand has been facing a gradual increase in use of cross-border health care. Nevertheless, no evidence regarding factors influencing cross-border use of health care by Laotian patients in public Thai hospitals among this group has been established.
Objectives: To assess the use of cross-border health care by Laotian patients, and factors that may influence health services in public Thai hospitals along the border.
Methods: This study consisted of two parts. (1) Site-visits to 53 Thai public hospitals along the Thai-Laos border during May to July 2011 and collection of data regarding the use of health care services by Laotian patients. (2) A structured questionnaire survey was conducted via face interviews by trained researchers. Findings were analyzed using descriptive statistics and multiple logistic regression.
Results: The most common conditions for which treatment was sought were common diseases and basic operative procedures. All hospitals had been facing substantial financial burden, particularly for inpatient care. The analysis of use indicated that a perception of differences in the quality of health services, ability to pay for treatment anywhere, and distance to health services were three major factors affecting the decision of Laotian patients to cross the border to obtain health care in Thailand. Interviews with hospital directors and staff revealed that more financial support and a clear policy for care of Laotian patients was needed.
Conclusions: The perception of better quality of health care in Thailand by Laotian patients was the major factor affecting cross-border use of health care services. Assistance to improve healthcare in Laos and financial support for subsidizing care for the indigent Laotian patients is needed.
- health care services
- Accesso libero
Lower left lung abscess from combined stomach and left diaphragm perforation by an intragastric foreign body
Pagine: 673 - 676
Background: Usually children mistakenly swallow foreign bodies, and most objects are spontaneously discharged through the digestive tract without consequence. However, sometimes the objects can cause gastrointestinal perforation, with serious complications.
Objective: To report the case of a 26-year-old male patient, who mistakenly swallowed a bamboo chopstick 14 years ago. The chopstick eventually perforated the gastric fundus and left diaphragm, pierced the lower left lobe of the lung, and caused a lower left lung abscess.
Method: A thoracotomy was conducted to remove the foreign body and the lower left lobe of the lung, followed by a patch fundoplication.
Result: The object was removed and the patient’s lesions healed after surgery.
Conclusion: The ingestion of foreign bodies rarely causes serious problems, but we should be vigilant to the occurrence of complications, and close follow-up should be conducted. This follow-up should include confirmation that the foreign body has passed through the alimentary tract.
- Foreign body
- gastric perforation
- lung abscess
- mistakenly swallow
- Accesso libero
Progressive outer retinal necrosis in an immunocompromised patient presenting with bilateral retrobulbar optic neuritis
Pagine: 677 - 681
Background: Progressive outer retinal necrosis (PORN) is a necrotizing chorioretinopathy caused by herpes simplex virus, varicella-zoster virus, or cytomegalovirus.
Objective: To describe the clinical morphology of PORN presenting with asymmetrical isolated bilateral retrobulbar optic neuropathy.
Method: The medical records of a 45-year-old human immunodeficiency virus infected patient presenting with bilateral visual loss at King Chulalongkorn Memorial Hospital were reviewed with respect for the privacy of patient.
Result: Gradual visual loss progressed to no light perception in the right eye and 20/200 in the left eye within 1 month. The patient was initially diagnosed with retrobulbar optic neuritis in both eyes. The investigations included MRI, vitreous tapping, lumbar puncture, and serological testing. MRI elicited enhancement around both optic nerves, which suggested optic neuritis. Thereafter, multifocal areas of retinal necrosis developed with rapid progression and additional cutaneous zoster lesions were established. These findings led to a diagnosis of PORN. The patient was promptly treated with intravenous ganciclovir, anti-retroviral therapy, and vitrectomy with endophotocoagulation and silicone injection. Unfortunately, his visual prognosis in the left eye was still poor
Conclusion: PORN was uncommonly present with bilateral isolated optic neuropathy before retinal lesions developed. Retrobulbar optic neuropathy from herpetic infection in immunocompromised patients should be considered despite a normal fundus at initial presentation. Early diagnosis and prompt intervention may preserve vision. This case demonstrates the importance of careful physical examination and follow up of retinal lesions.
- Bilateral optic neuropathy
- HIV infection
- immunocompromised patient
- progressive outer retinal necrosis
- retrobulbar optic neuritis
- Accesso libero
Pagine: 683 - 690