Should the duration of the insulin tolerance test be shortened to 90 minutes?

The insulin tolerance test (ITT) is a standard growth hormone (GH) provocative test to distinguish children with normal variant short stature (NVSS) from those with GH deficiency (GHD). We reviewed ITTs retrospectively in 52 short children using peak GH concentration of 7 ng/ ml as a cut-off level for GHD (peak GH <7 ng/ ml) and NVSS (peak GH > or =7 ng/ml). The average insulin dosage was 0.1 U/kg in children with NVSS and 0.08 U/kg in GHD. Hypoglycemia was achieved in all cases with an average plasma glucose nadir of 1.8 mmol/l (32 mg/dl) occurring between 15 and 45 min following administration. The average peak GH concentration was 12 ng/ml, occurring at 30-90 min. There were no serious adverse effects from the ITT. We conclude that the appropriate duration of ITT should be 90 minutes. The appropriate timing to obtain samples for plasma glucose level is at 0, 15, 30, 45, 60, and 90 min, and for GH concentrations at 0, 30, 45, 60, and 90 min. The shortened duration of ITT to 90 min will reduce the time spent and also the financial cost for unnecessary samples, while still ensuring a correct diagnosis for the patients.     

The clinical course of Hashimoto's thryoiditis in children and adolescents: 6 years longitudinal follow-up

Forty-six children and adolescents with Hashimoto's thyroiditis were followed up for 5.9 +/- 0.3 years. The mean age at diagnosis was 12.4 +/- 1.7 years (range 9-15.4 yr). The patients were divided into three groups according to thyroid function: group 1 (n = 28) included patients who had normal concentrations of free thyroxine (FT4) and thyrotropin (TSH); group 2 (n = 8) included patients who had normal FT4 and elevated TSH, consistent with compensated hypothyroidism; group 3 (n = 10) included patients who had low FT4 and elevated TSH consistent with overt hypothyroidism. After 5.9 years of follow-up, four out of eight patients with compensated hypothyroidism had normal thyroid function and the other four patients developed overt hypothyroidism. Thyroxine therapy was administered in patients with overt hypothyroidism including the four patients with compensated hypothyroidism who later presented with overt hypothyroidism. All patients in both euthyroid and hypothyroid groups had normal growth and puberty. Final adult height was 0.43 +/- 0.80 SDS which was 1.58 +/- 3.03 cm above mid-parental height. The mean age at menarche (n = 43) was 12.4 +/- 1.1 years, which was not different from normal children. The goiter remained the same size in most of the patients with euthyroidism without thyroxine therapy, but decreased in patients with overt hypothyroidism after thyroxine therapy.     

Social attitudes toward shaving for cranial neurosurgery

Unshaved cranial neurological surgery has been successfully performed at Songklanagarind Hospital. However, within the Buddhist community, shaving is one of the traditional procedures for cleanliness and purification, and the unshaved method may have a cultural effect on social beliefs. Knowledge of social attitudes toward shaving or not shaving for cranial neurological surgery has implications for informed consent process prior to cranial operation. The attitudes of shaving were surveyed in the communities of Songkhla Province where Songklanagarind Hospital is situated. Of 1128 respondents, the female to male ratio was 3:2, their age was mostly under 40 years old and 91% were Buddhist. Sixty per cent of the respondents were in favour of shaving. After knowing the equivalent result of surgery either by shaved or unshaved method, the group favouring unshaved cranial surgery increased from 12 to 37%. Statistical analysis, through ordinal and multinomial logit, identified the young age, female and more educated who needed to socialize, and frequently meet many people were the groups who preferred or were ready to change their choice to the unshaved method. The neurosurgeon should give an advice to the patient not only the indications and results of surgery, but also a choice of shaved or unshaved cranial neurological surgery.     

Attitudes towards a smoking ban in restaurants of managers, employees and customers in Kunming City, China

The objective of this study was to investigate the attitudes of restaurant managers, employees and customers towards a total smoking ban policy in restaurants. A restaurant based survey in an urban area of Kunming City, China, was carried out from May to August 2009. One hundred managers, 1,055 employees and 5,213 customers aged 15 years or above were interviewed using a structured questionnaire. The percentage of respondents supporting a total smoking ban in restaurants was 17% among managers, 13.4% among employees, and 16.6% among customers. Multilevel analysis confirmed respondents who did not smoke, who were educated, and who worked or dined at a restaurant with fewer than 200 seats were more likely to support a total smoking ban. A total smoking ban in restaurants is unlikely to be supported by people involved in the restaurant business in the study area. This coincides with poor awareness of the harms of smoking.     

Efficacy of thymosin alpha-1 and interferon alpha in treatment of chronic viral hepatitis B： A randomized controlled study

INTRODUCTION Chronic hepatitis B virus (HBV) infection is a serious problem worldwide and may result in adverse sequelae, such as cirrhosis and hepatocellular carcinoma (HCC)[1-2], which is becoming more prevalent worldwide, especially in HBV-endemic area…     

Effect of viral load on T-lymphocyte failure in patients with chronic hepatitis B

AIM： To investigate peripheral T-lymphocyte sub-population profile and its correlation with hepatitis B virus （HBV） replication in patients with chronic hepatitis B （CHB）.METHODS： Distribution of T-lymphocyte subpopulations in peripheral blood was measured by flow cytometry in 206 CHB patients. HBV markers were detected with ELISA. Serum HBV DNA load was assessed with quantitative real-time polymerase chain reaction （PCR）. The relationship between HBV replication and variation in peripheral T-cell subsets was analyzed.RESULTS： CHB patients had significantly decreased CD3^＋ and CD4^＋ cells and CD4^＋/CD8^＋ ratio, and increased CD8^＋ cells compared with uninfected controls （55.44 ± 12.39 vs 71.07 ± 4.76, 30.92 ± 7.48 vs 38.94 ± 3.39, 1.01 ± 0.49 vs 1.67 ± 0.33, and 34.39 ± 9.22 vs 24.02 ± 4.35; P 〈 0.001, respectively）. Univariate analysis showed a similar pattern of these parameters was significantly associated with high viral load, presence of serum hepatitis B e antigen （HBeAg） expression, liver disease severity, history of maternal HBV infection, and young age at HBV infection, all with P 〈 0.01. There was a significant linear relationship between viral load and these parameters of T-lymphocyte subpopulations （linear trend test P 〈 0.001）. There was a negative correlation between the levels of CD3＋ and CD4＋ cells and CD4^＋/CD8^＋ ratio and serum level of viral load in CHB patients （r = -0.68, -0.65 and -0.75, all P 〈 0.0001）, and a positive correlation between CD8^＋ cells and viral load （r = 0.70, P 〈 0.0001）. There was a significant decreasing trend in CD3^＋ and CD4^＋ cells and CD4^＋/CD8^＋ ratio with increasing severity of hepatocyte damage and decreasing age at HBV infection （linear trend test P 〈 0.01）. In multiple regression （after adjustment for age at HBV infection, maternal HBV infection status and hepatocyte damage severity） log copies of HBV DNA maintained a highly significant predictive coefficient on T-lymphoc     

Factors related to delay in diagnosis of oral squamous cell carcinoma in southern Thailand

The factors related to patient, professional and total delay in 161 oral squamous cell carcinoma (OSCC) patients attending for treatment at a university hospital in southern Thailand were investigated. About 42 and 20% of these patients had a patient delay of more than 1 month and 3 months, respectively. About half of the patients received proper management from health care professionals (HCPs) on their first consultation. Traditional herbal medication use was significantly associated with prolonged patient delay (hazard ratio [HR] 0.46, 95% C.I. 0.28-0.76). None of the variables investigated had a significant association with professional delay. Traditional herbal medication use also significantly prolonged total delay (HR 0.45, 95% C.I. 0.27-0.74). Buddhists had shorter total delay than Muslims (HR 0.68, 95% C.I. 0.49-0.95). The present study indicates that both patients and HCPs are responsible for the diagnostic delay. A health education campaign about OSCC and the use of traditional herbal medication is recommended to shorten patient delay. Continuing education on oral cancer and precancer for HCPs and clarification of the referral system are needed to effect a major reduction in professional delay.