Siriraj Medical Journal

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.