Siriraj Medical Journal

262-266

Authors: Paiboon Tummarintra, M.Sc., Phakrop Kaewbundit, Rasda Boonprasert, M.Sc., Teera Kolladarungkri, M.D.

Objective: To study the effect of temperature on phenytoin concentration in serum and to determine the sample were kept at 2-8°C and 35°C. Methods: Serum samples of patients, who had been treated with phenytoin. had their phenytoin level determined on the first day. The sample was stored for seven days and analyzed on days three, five and seven of the study and divided into three storage concentrations from 2.5-10, 10.1-20 and 20.1-30 µg/ml compared using 50 samples per group. Results: Phenytoin level was found to have increased over time to three days at a temperature of 35°C and five days at 2-8°C. It increased in the level of statistical significance at p<0.05. This study’s data were all well correlated at r2 = 0.9981-0.9999. Conclusion: Collected samples for analysis of phenytoin level must be stored at 2-8°C and stored for at least five days, to prevent degradation of protein which cannot bind to the drug. The phenytoin levels in serum increased to make the diagnosis of dosage mistakes.

273-279

Authors: Suppachai Poolsuppasit, M.D., Poom Tritrakarn, M.D., Shusee Visalyaputra, M.D., Nuchsaroch Pechpaisit, M.D.,Roungsin Choavaratana, M.D., Ladda Phuampolprasert, B.Sc., Pathipa Suksopee, B.Sc.

Objective: Total intravenous anesthesia for uterine curettage with propofol is common in practice. Narcotics are used to decrease movement due to pain during the procedure. But narcotics may cause hypotension, hypoventilation, bradycardia, desaturation and apnea. We hypothesized that the use of ketamine instead of fentanyl can reduce the incidence of patients’ movement and other complications mentioned above. Methods: Eighty-four patients were enrolled into the study. The patients were randomized in to 2 groups: Fentanyl group (Propofol+Fentanyl) and Ketamine group (Propofol+Ketamine). Low dose of ketamine (0.3 mg/kg) or fentanyl (1 mcg/kg) was injected, followed by propofol 1.5 mg/kg, then uterine curettage was started along with propofol infusion of 5 mg/kg/hr. Patients’ movement, respiratory rate, blood pressure, and O2 saturation were recorded every minute. After the procedure, the emergence duration and surgeon’s satisfaction were recorded. The incidence of nausea/vomiting, dizziness and any other complaints were recorded for 24 hours postoperatively. Results: There was no significant difference in patient’s movement, surgeon’s satisfaction and emergence duration between the two groups. Patients in ketamine group significantly showed lower incidences of respiratory depression as shown by less requirement of airway manipulation with assisted ventilation, and lower incidences of hypotension than patients in the fentanyl group (2.4% vs. 19%, p=0.029 and 7.2% vs. 52.4%, p<0.01, respectively). Conclusion: The use of low dose ketamine with propofol in patients having uterine curettage can cause less hypotension and less respiratory depression than using fentanyl with propofol, without any difference in patients’ movements and emergence from anesthesia.

285-291

Authors: Tawatchai Apidechkul, Dr.P.H. (Epidemiology), Sauwaluck Pongwiriyakul, M.Sc., Mitra Cassely, M.D.,Chomnard Pojanamart, Ph.D.

Objective: To identify the risk factors of HIV/ HBV coinfection among HIV persons. Methods: 356 newly diagnosed HIV positive patients had their blood tested for HBV serological markers: HBsAg, HBsAb and HBcAb by immunochromatographic and ELISA methods. Cases were those positive for one or more of the HBV markers, and controls were negative for all HBV markers. All completed questionnaires designed to identify risk factors. Logistic regression statistical method was used to find the associations between demographic and behavioural parameters and the coinfection status. Results: A total of 122 out of 356 cases were suitable for analysis. Fifty percent were male, 40.3% were aged 30-39 years old, 62.9% were married, 18.6% were illiterate, and 10.5% were unemployed. After controlling for possible confounding factors the multiple logistic regression identified two factors associated with HIV/HBV co-infection namely number of years in school and CD4 cell count. The “no education” group had a greater risk of 7.07 times (OR=7.07, 95% CI=1.77-28.24) than the “≥13 years” group. CD4 “≤ 200 cells/mm3” was a protective factor protect for HIV and HBV coinfection when compared to “≥ 200 cells/mm3” group (OR=0.35, 95% CI=0.13-0.94). Conclusion: The study suggests that a good education may reduce HIV/HBV co-infection. A practical approach would be a provision of wide accessibility to quality general and sex education on the risk and prevention of HIV, HBV, and a promotion of HBV immunization.

296-300

Authors: Prapun Aanpreung, M.D., Ananya Pongpaibul, M.D.

Benign recurrent intrahepatic cholestasis (BRIC) is an autosomal recessive cholestatic liver disease. Recurrent self-limited episodes of jaundice and severe pruritus are leading clinical manifestations. We report a 16-year-old Thai boy with three recurrent episodes of cholestasis. The first episode occurred at 30 months old. The subsequent recurrent episodes were at 13 and 16 years, respectively. Investigations including viral study, autoimmune hepatitis markers, abdominal ultrasound and magnetic resonance cholangiopancreatography (MRCP) were negative. Diagnosis of BRIC was made based on specific criteria. He was treated with cholestyramine and ursodeoxycholic acid when the first and second episodes occurred which resulted in good recovery. However, for the last recurrent episode, treatment with ursodeoxycholic acid failed to improve his condition, so his treatment was changed to rifampicin, which resulted in dramatic response. Although BRIC is a rare disease, it should be taken into account in all cases with recurrent cholestasis with normal or minimally elevated GGT level. Currently, genetic study for the mutation of ATP8B1 and ABCB11 genes are crucial for making a definite diagnosis

213-218

Authors: Phuriphong Songarj, M.D.*, Sithichai Veeranachai, M.D.**, Arunotai Siriussawakul, M.D.*

Background: Delays in the detection of endotracheal tube (ETT) misplacement increase morbidity and mortality. Although numerous methods have been suggested to verify ETT position, each method has its limitations in terms of its reliability and applicability. Recently, ultrasonography (US) has emerged to assess the ETT position. Objective: This observation study was designed to assess the role of using ultrasonography for examining the ETT position among intubated patients who were admitted to the emergency department (ED). Methods: The study was conducted in patients at the ED of a university-based hospital from September 2010 to November 2010. The ultrasound was performed after confirmation by a clinical assessment and a portable chest radiograph (CXR) conducted by a second- or third-year, emergency-medicine resident on-call at ED. Results: Eighty patients were enrolled. The average time of US usage (time from turning the US machine on to finishing the confirmation of the ETT position and depth) was149.9 ± 91.7 seconds. The average time of CXR evaluation, which was the gold standard, was 30 ± 10 minutes. Improper position of ETT was detected by CXR in 11 cases and by US in one case. Conclusion: Ultrasonography could be used as the first line non-invasive ETT position instead of using CXR in ED.

227-234

Authors: Pham Le Tuan, M.D., Ph.D., Vu Thanh Nam, M.D., MIT., Tham Chi Dung, M.D., Ph.D., Cao Ngoc Anh, MBA.,Nguyen Thi Huong, M.D., MPH., Nguyen Nam Lien, MBA., Chairoj Zungsontiporn, M.D., Orathai Khioacharoen, Ph.D.,Supasit Pannarunothai, M.D., Ph.D.

Objective: This study aimed to classify all hospital discharges covered by health insurance system into diagnosis related group (DRG) to guide provider payment reforms of universal health coverage roadmap in Vietnam. Methods: Data from Ba Vi hospital from January to December 2012 were grouped into DRGs by Viet-DRG grouper version 1.0 developed based on Thai-DRG version 5 methodologies. The Pearson correlation (r) was used to assess the performance of Viet-DRG grouper as against Thai-DRG grouper. A 5-step trimming of individual inpatient data to achieve the highest correlations was performed. Results: Data of 12,220 inpatient cases were analyzed by both groupers, 84.4% of total cases were classified into 89 DRGs. The five most common DRGs were vaginal delivery without complicating diagnosis (14500); Respiratory infection/inflammation, no complication and comorbidity (04520); Otitis media and URI, no complication and comorbidity (03530); Viral illness except dengue, child, no complication and comorbidity (18610); Bronchitis and asthma, no complication and comorbidity (04590). The performance of Viet-DRG grouper v1.0 compared with Thai-DRG grouper v5.0 for 89 DRGs in terms of relative weights as of 0.4 and length of stay as of 0.5. Conclusion: Validity of the first Viet-DRG was at moderate level compared to Thai-DRG due to the limitation of data availability and quality at the hospital.

241-244

Authors: Teerapong Monmaturapoj, M.Sc. in Pharm, Aimatchara Worrasan, Pharm.D., Suputtra Pumprasert

Rhabdomyolysis is a potentially life-threatening syndrome characterized by muscle necrosis and the release of intracellular muscle contents into systemic circulation. The authors report a rhabdomyolytic patient with chronic kidney disease who had reduction of renal function owing to undiagnosed hypothyroidism, from drug interaction of simvastatin with gemfibrozil and amlodipine.

248-253

Authors: Supawadee Naorungroj, DDS, Ph.D., Thummaporn Naorungroj, M.D.

Oral health related quality of life (OHRQoL) is a multidimensional concept that measures perceptions of oral health and the consequences of oral conditions at individual and population levels. Poor oral conditions are associated with a deteriorating quality of life (QoL) through functional and psychosocial impacts. As the elder population is growing worldwide and the prevalence of oral diseases among older adults remains high, more attention needs to be paid to oral health conditions as well as impacts on QoL. However, there are few population studies regarding OHRQoL in older Thai adults. Apparently, there are several challenges facing the assessment and improvement of the OHRQoL of this aging population. First, effort towards the standardization of instruments and validation of translated instruments is needed. Secondly, a multidisciplinary team, composed of health care providers, dental professionals, and policy makers has to be established. Finally, a holistic oral health care concept must be emphasized in dental educational programs and training. This review presents an overview of OHRQoL and its importance to the elderly and discusses future challenges to this group of the population in Thailand.

160-167

Authors: Anun Chaikoolvatana, Ph.D. (Pharm.D), Penpak Pheunpha, Ph.D., Petchnapa Puchcharanapaponthorn, R.N.,Cholada Chaikoolvatana, RN, Ph.D., Nawaporn Saisingh, M.Sc., Preeyanuch Suwannakoot, R.N., Boonyada Mingkhwan, R.N.

Objective: It aimed to evaluate the effectiveness of the initial smoking cessation services at a military-based hospital in northeastern Thailand. Methods: It was a prospective, descriptive design. Totally, there were 1,094 conscripts who participated in the 6-month cessation program. Patient history data was collected via a patient history record divided into three different periods of time at, 1st visit, 2nd visit (3-months), and 3rd visit (6-months). Each participant underwent ‘going cold turkey’ with tobacco cessation approach. Sociodemographic characteristics and continuous variables (e.g., age, duration of smoking) were analyzed via descriptive statistics. Spearman correlation coefficient was used for the relation between predictor and dependent variables (quit success). The relations between sociodemographic data and the prospects of quitting smoking were analyzed via multiple logistic regression. Results: Most participants were males (99.84%), and regular drinkers (55.50%). They usually smoked 12.37 cigarettes per day. For first visit, every participant underwent ‘going cold turkey’ with tobacco cessation approach to quit smoking (from 1st to 3rd visit). An average CO level was 3.23 ppm. Around twelve percent of participants used 0.5% sodium nitrate mouthwash. At the second visit (3-months), numbers of cigarettes decreased to 5.48 cigarettes per day and numbers of participants were decreased to 792 personnel. Only 150 persons continue to quit smoking (18.95%). At the last visit (6-months), a total number of participants were 688 personnel. Numbers of cigarettes were decreased to 5.48 cigarettes per day. Only 78 persons completely quit smoking (11.34%), and approximately 18.02% of participants still used 0.5% sodium nitrate mouthwash. Additionally, only three sociodemographic data including, CO level, duration of counseling, and use of first line treatment were statistically related to the prospects of quitting smoking (p<.05, .001 respectively). The equation of the prospect of quit smoking was statistically related to those sociodemographic characteristics. Conclusion: Tobacco cessation services in a military-based hospital were well received and short term outcomes of conscripts seeking help was encouraging. The integration of tobacco cessation with existing healthcare services in the military-based hospitals is necessary. Finally, further evaluations of the effectiveness of cessation services among conscripts in the military-based hospitals need to be conducted.

173-180

Authors: Tanyaluck Thientunyakit, M.D., Thonnapong Thongpraparn, M.D., Nopparat Phongsawat, M.D.

Objective: To compare the left ventricular ejection fraction (LVEF) estimation using two commercial software packages used in our hospital and factors which may correlate to LVEF result. Methods: LVEF results using EF analysis (GE Healthcare, Wisconsin, USA) and Syngo MI (Siemens Medical Solution USA Inc., Illinois, USA) in 120 patients were compared. The correlation and difference of LVEF analysis between software packages were evaluated using correlation coefficient and Bland-Altman analysis, respectively. Potential factors for significant difference in LVEF were identified by regression analysis. Results: The mean LVEF estimated by two software packages were highly correlated (ICC =0.853) and statistically significant (p<0.001). Subgroup analysis in each individual software showed slight decrease in correlation of LVEF between software packages (ICC=0.791-0.793), but still had statistical significance (p<0.001). Intraand inter-operator variability assessments showed very high correlation of LVEF obtained from both software packages with statistical significance (p<0.001). Factors correlated with significant difference in LVEF were end diastolic area, end systolic count, end systolic area, and background count. Conclusion: LVEF analysis from GBP study using different software packages is highly correlated with only minimal difference, thus, it may be reasonably interchangeable during follow up without significant clinical impact. However, operators should be aware the importance of precise left ventricular and background region generation to prevent technical errors.

187-191

Authors: Prapun Aanpreung, M.D., Piyavadee Leksrisakul, M.D., Paisal Parichatikanond, M.D.

Neonatal hemochromatosis (NH) is a rare disease causing severe liver failure in neonate. Gestational alloimmune liver disease was recently proposed as an etiology. We present a unique case of a male infant with severe cholestasis soon after birth. Preliminary diagnosis of NH was made by detecting high serum ferritin level along with demonstrating iron deposition in hepatic tissues by magnetic resonance imaging (MRI). Despite being treated with blood exchange transfusions, antioxidant and chelating agents when NH was diagnosed around 2 months of age, he continued to have increasing bilirubin level and worsening coagulopathy. Eventually, he died from severe infection and liver failure at 5 months of age. His autopsy showed siderosis of liver and pancreas, which supported the diagnosis of NH. The specific treatments for NH should be initiated as early as possible once the diagnosis has been made, so that improved clinical outcome may be expected.

196-204

Authors: Aranya Jutiviboonsuk, Ph.D.

Andrographis paniculata (Burm.f.) Wall. ex Nees, commonly known as Fa-tha-lai-jone is an herbal medicine in The National List of Essential Drugs A.D.2013. The aerial part of the plant is used for treatment of non-infectious diarrhea and common cold. A. paniculata extract and its major active component, andrograpolide, have various pharmacological activities. Therefore co-administration of A. paniculata with conventional drugs may cause unpleasant interactions. This article reviews the role of A. paniculata and its active component that influences drug interactions including the effect on phase I and phase II metabolizing enzymes as well as drug transporter protein. Furthermore the data of pharmacokinetic and pharmacodynamic interactions on some clinical drugs are also included.

108-115

Authors: Chinapat Gerawarapont, M.D.

Objective: This study aimed to investigate the prevalence and relationship between the associated factors and slowed forearm median motor and sensory conduction velocity (FMMCV and FMSCV) in the carpal tunnel syndrome (CTS). Methods: The study was conducted from June 2012 to March 2014. There was a total of 69 CTS hands (n = 38) and 13 non-CTS hands (n = 10) from 82 patients’ hands (n = 48). The slowed FMMCV and FMSCV were determined by less than 50 m/s. Demographic and clinical characteristics, FMMCV, FMSCV, and electrodiagnostic (EDX) findings related to the slowed FMMCV and FMSCV were compared and analyzed. Results: The prevalence of slowed FMMCV in CTS was 31.6% and slowed FMSCV was 23.7%, respectively. Correlation between EDX parameters and slowed FMMCV were significantly correlated to the absence of compound muscle action potential (CMAP) amplitude (p-value = 0.006). For the slowed FMSCV, the small sensory nerve action potential (SNAP) amplitude also demonstrated significant correlation (p-value < 0.001). Among FMMCV, the occurrence of retrograde axonal atrophy (RAA) with retrograde conduction slowing (RCS) was significantly associated with the slowed FMMCV (OR 2.100; 95% CI 0.434-3.766; p-value = 0.013). For FMSCV, an increase of small SNAP amplitudes was significantly associated with slowed FMSCV (OR 4.210; 95% CI 2.031-6.390; p-value < 0.001). Conclusion: These results support the hypothesis that slowed FMMCV is significantly ascribed to RAA with RCS and warrants further investigation into the role of the mechanism of slowed FMSCV in CTS. Furthermore, this study supports the findings of other studies that the damage to nerve function does not occur only in segments distal to the site of injury or compression.

123-127

Authors: Phadungsak Silakorn, M.Sc., Wangcha Chumthap, B.Sc., Somchai Chongpipatchaiporn, B.Sc., Arsada Khunvut, B.Sc.,Supenya Varothai, M.D.

The silicone rubber casting material is intended for use as a medical model. Muscle skin and fat which mimic the actual amount of the research done by the chemical stability of selected components and many samples of silicone that are generally sold are adapted and defined by four formulas. Each was subdivided into 10 samples. 5 samples were cast thick and the other 5 were cast thin. Altogether 40 samples were used to measure the stability. At day 1, day 5, day 28, and at 180 days throughout the study were noted, and data collected to measure the degree of a semicircle of wood with vernier calipers and measure the elasticity respectively after 5 days and 180 days with a skin cutometer MPA 580. Comparative analysis of the formula was formulated by program SPSS Data Editor. The results showed that the silicone rubber formula 3 was the most stable formula. At day 180, it had changed into Fixed Stable state by 12.5%, elasticity by 2.7%, and stability was unchanged. In conclusion, the samples of Formula 3 silicone possess three qualifications, stability, steadiness and elasticity, and was suitable to be used as a casting material for our model which was the most practical purpose.

134-138

Authors: Pranya Sakiyalak, M.D., Chor.Wittawas Phetphaisit, M.D., Punnarerk Thongcharoen, M.D., Thaworn Subtaweesin, M.D.

Objective: Thoracoscopic thymectomy has become increasingly popular as a surgical treatment for myasthenia gravis because of its better cosmetic results and comparable efficacy compared with conventional open surgery. We review our outcomes of both techniques. Methods: Between January 2004 and January 2008, 57 thymectomies were performed for myasthenia gravis; 27 by thoracoscopic thymectomy and 30 by transsternal thymectomy. Preoperative classification and Post-operative disease status were compared between the groups. Results: Mean age was 36.6 (thoracoscopic thymectomy) versus 40.0 years (transsternal thymectomy) (p =0.342); the preoperative duration of myasthenia gravis was 15.9 versus 17.4 months (p =0.76) and mean of clinical follow up was 6.5 vs 7.5 years (p =0.0003) respectively. In thoracoscopic thymectomy group, no patient required conversion to sternotomy technique. The median operative time was 165 min (range, 45-255) in thoracoscopic group vs. 135 min (range, 80-190) in transsternal group (p<0.05). Mean length of stay was 3.8 versus 5.2 days (p< 0.05) respectively. Post-operative DeFilippi classification for remission revealed improvement in 88% of thoracoscopic group versus 87 % in transsternal group. (p = 0.81) Conclusion: Thoracoscopic thymectomy is an effective treatment for myasthenia gravis which decreases hospital stay with equivalent clinical outcomes when compared with transsternal thymectomy.

145-148

Authors: Voraphol Vejjabhinanta, M.D., Penvadee Pattanaprichakul, M.D.

A report of a 26-year-old woman with adult-onset Still’s disease (AOSD) presenting with prolonged fever, arthralgia and reticulate papular eruptions on her abdomen and back without typical rash of AOSD. The skin lesion and fever subsided soon after the initial treatment by oral prednisolone of 40 mg/day. Prurigo pigmentosa-like skin rash is an atypical cutaneous eruption which has previously been reported in association with AOSD. We report an unusual case of AOSD presenting with atypical skin rash mimicking prurigo pigmentosa.

53-59

Authors: Kanchana Sujirachato, Ph.D.*, Wisarn Worasuwannarak, M.D.**, Smith Srisont, M.D.**, Jitta Udnoon, M.D.**, Vichan Peonim, M.D.**

Objective: To study the relation between ABO blood group and coronary atherosclerosis in Thais in order to preventing and reducing the death rate. Methods: A total of 217 postmortem forensic cases with age of ≥ 20 years from the Division of Forensic Medicine, Department of Pathology, Ramathibodi Hospital were studied for the relation of ABO blood group and coronary atherosclerosis. Clotted or ethylenediaminetetraacetic acid (EDTA) bloods were used for ABO grouping by standard hemagglutination test. The disease was diagnosed by gross and microscopic examinations. The severity of the disease revealed by occlusion of either 1, 2 or 3 main branches of coronary artery and the degree of occlusion. The risk of ABO blood group in coronary atherosclerosis was expressed as Odds ratio (OR). The OR value of >1, p value of <0.05 and 95% confidence interval were considered to be statistically significant. Results: Coronary atherosclerosis was diagnosed in 101 out of 217 cases (46.5%). The disease found in 50.9% males (86 out of 169) and 31.2% females (15 out of 48). Males had the disease more than females with OR of 2.280, p = 0.0118. Blood group A and O appeared to be risk for coronary atherosclerosis in Thais in both males and females. It was noticed that blood group A had more disease than blood group O (OR = 1.327 vs 1.094) among males whereas blood group O had more disease than blood group A (OR = 1.750 vs 1.199) among females. There were 62.4% sudden death and 37.6% non-sudden death in this study. Blood group A and O were also increased in sudden death with coronary atherosclerosis with ORs of 1.215 and 1.151, respectively (p > 0.05). It was observed that the degree of coronary artery occlusion >75% (severe) was increased in blood group A (57.9%, OR = 1.592) and blood group AB (50.0%, OR = 1.067). In addition, occlusion of 3 main coronary arteries was increased in blood group B (43.8%, OR = 1.369, p > 0.05) and blood group AB (75.0%, OR = 5.455, p = 0.0356). Furthermore, myocardial infarction frequently occurred in blood group A and blood group O with ORs of 1.270 and 1.390, respectively. Conclusion: Blood group A and O probably be involved in coronary atherosclerosis and myocardial infarction in Thais. Blood group A was frequently observed in male while blood group O was frequently observed in female with the disease. To give health education about the risk of ABO blood group that susceptible to coronary atherosclerosis may reduce the death rate of the disease.

66-71

Authors: Penvadee Pattanaprichakul, M.D., Onjuta Chayangsu, M.D., Kamonpan Lertrujiwanit, B.Sc., Manasmon Chairatchaneeboon, M.D.,Sumanas Bunyaratavej, M.D.

Background: Leprosy is diagnosed based on cardinal signs. According to this, patients with one or more of the following characteristic symptoms are suspected of leprosy: hypo-pigmented or reddened skin lesion(s) with loss of sensation and/or involvement of the peripheral nerves and positive slit-skin smear for acid-fast bacilli. Physicians who are not engaged in leprosy work and no experience may fail to diagnosis it. Objective: To evaluate the diagnostic ability for leprosy, by identification of basic investigation and related factors to correct diagnosis, in general practitioners and non-dermatological specialists who attended annual short-course training in dermatology. Methods: During the year 2011-2012, 122 participants who attended in short-course training in dermatology for general practitioners, which was annually conducted by the Dermatological Society of Thailand, were evaluated by pre-test answer sheets which were retrospectively reviewed. These tests were composed of viewing a clinical picture of leprosy with a brief patient’s history. Participants were asked to answer three questions for a diagnosis, physical examinations and further investigations respectively. Results: One hundred and seven physicians voluntarily turned in their answer sheets. Most physicians were female (75.7%). About half of the participants were aged between 26 to 30 years. Eighty-three of them (77.6%) were general practitioners and the rest (22.4%) were non-dermatological specialists. Most of them were able to make a diagnosis of leprosy (60.7%), but only 15 (23.1%) participants could describe physical examinations completely. Only 20 (30.8%) participants documented a slit-skin smear for an appropriate investigation. Conclusion: Most general practitioners and non-dermatological specialists are able to diagnose leprosy. However most of them could not perform physical examinations completely and also had lack of knowledge for a slit-skin smear which is a basic diagnostic tool for making a diagnosis of leprosy.

79-85

Authors: Banu Arslan, Serap Çuhadar, Türkan Yiğitbaşı, Ruhan Uzun, Gonca Örük, Yasemin Baskın, Nesil Gören,Füsun Üstüner

The aim of the study was to evaluate the association between ischemia modified albumin, inflammation markers, and lipids in patients with metabolic syndrome. In this case-control study, serum ischemia modified albumin, uric acid, lipid profile, insulin, fasting and non-fasting glucose, HbA1c, fibrinogen and CRP were measured in 47 patients with metabolic syndrome and 31 controls. International Diabetes Federation criteria were used for metabolic syndrome diagnosis. Ischemia modified albumin, uric acid, fibrinogen, total cholesterol, LDL, triglycerides and HOMA-IR were higher and HDL was lower in the patient group adjusted for body mass index and age. Significant correlations were observed between IMA and total cholesterol, triglycerides, HDL and LDL, fasting glucose, postprandial glucose, HOMA-IR, HbA1c, fibrinogen and CRP. We observed significant correlations also between CRP and fasting glucose, postprandial glucose, HOMA-IR, HbA1c, total cholesterol, triglycerides, HDL, LDL, uric acid and fibrinogen. Uric acid was also found as positively correlated with triglyceride, fasting glucose, HbA1c, HOMA-IR and negatively correlated with HDL. In conclusion, this case-control study has shown that higher levels of IMA and uric acid are strongly related to components of the metabolic syndrome. Both IMA and uric acid are independent risk factors for cardiovascular disease, so these easily measured parameters may add prognostic information to risk prediction. New investigations need to be done.

90-92

Authors: Sunatra Nitayavardhana, M.D., Manasmon Chairatchaneeboon, M.D., Punkae Mahaisavariya, M.D.

Tumor of follicular infundibulum (TFI) is a rare benign follicular tumor typically presenting as a solitary macule or papule on the head and neck area. Our case presented with multiple hypopigmented macules as an eruptive variant that should be differentiated from common skin lesions such as pityriasis versicolor, pityriasis alba and vitiligo. Histopathological study was necessary for definite diagnosis, which revealed horizontal plate – like proliferation of small monomorphic and pale staining epithelium with multiple slender connections with surface epidermis or upper part of hair follicles. TFI is chronic, persistent, and benign in nature, so the treatment should be conservative.