Relationships of body fat distribution,insulin sensitivity and cardiovascular risk factors in lean,healthy non-diabetic Thai men and women

In order to study the relationships of body fat distribution, insulin sensitivity and cardiovascular risk factors in lean, healthy non-diabetic Thai men and women, 32 healthy, non-diabetic subjects, 16 men and 16 women, with respective mean age 28.4+/-6.6 (S.D.) and 32.8+/-8.9 years, mean BMI 21.0+/-2.8 and 21.2+/-3.7 kg/m(2), were measured for total body fat and abdominal fat by dual energy X-ray absorptiometry (DEXA), anthropometry and insulin sensitivity by euglycemic hyperinsulinemic clamp. Cardiovascular risk factors included fasting and post-glucose challenge plasma glucose and insulin, blood pressure, lipid profile, fibrinogen and uric acid. For similar age and BMI, men had a lower amount and percent of total body fat, but had a higher proportion of abdominal/total body fat than women. In men, insulin sensitivity, as determined by glucose infusion rate during euglycemic hyperinsulinemic clamp, was inversely correlated with total body fat, abdominal fat, BMI and waist circumference, whereas only total body fat, but not abdominal fat, BW and hip circumference were inversely correlated with insulin sensitivity in women. No cardiovascular risk factors, except area under the curve (AUC), of plasma insulin in women correlated with insulin sensitivity when adjusted for total body fat. After age adjustment, total body fat was better correlated with fasting and AUC of plasma glucose and insulin in men and with systolic blood pressure as well as triglyceride levels in women. Only HDL-C in men was better correlated with abdominal fat. In conclusion, there were sex-differences in body fat distribution and its relationship with insulin sensitivity and cardiovascular risk factors in lean, healthy non-diabetic Thai subjects. Total body fat was a major determinant of insulin sensitivity in both men and women, abdominal fat may play a role in men only. Body fat, not insulin sensitivity, was associated with cardiovascular risk factors in these lean subjects.     

Pacemakers of the 1980s. An overview

Methods and devices for permanent cardiac pacing remained relatively stable for over two decades with use of the single-chamber ventricular demand (VVI) pacemaker. However, changes have occurred in the 1980s and are expected to continue with the availability of more advanced technology and with increasing knowledge about cardiac pacing. The physiologic benefit of the newer dual-chamber atrial synchronous (VDD) and fully automatic, universal (DDD) pacemakers over the VVI pacemaker in patients with permanent complete heart block and normal sinus node function has been established. These newer units not only reestablish atrioventricular synchrony but also are physiologically rate-responsive. The VDD pacemaker is expected to be phased out in favor of the DDD pacemaker. When the atrial rate or interval is lower than the lower rate limit, the VDD pacemaker functions as a VVI, whereas the DDD pacemaker functions as an atrioventricular sequential (DVI) pacemaker to maintain continuous atrioventricular synchrony. Contrary to general belief, patients with complete heart block and normal sinus node function may gain very little physiologic benefit, if any, from DVI pacing. The sinus node will compete with the pacemaker's atrial stimulation when the sinus rate is faster than the DVI pacemaker rate (which usually occurs during activity). Also, the ventricular pacing rate will not vary with physiologic change. The DVI and atrial demand (AAI) pacemakers have been used in some patients with sinus node dysfunction. Increasing exercise tolerance should not be expected in the majority of patients because they are not pacemaker-dependent during activity, ie, their heart rate is higher than the pacemaker rate. However, these pacemakers appear to help in eliminating pacemaker syndrome, which does not infrequently occur with VVI pacemakers. Patients with sinus node dysfunction but without atrioventricular block do not gain more physiologic benefit with a DDD than with a DVI pacemaker. Whether these patients have severe sinus node dysfunction all the time or adequate sinus node function most of the time during follow-up, the DDD pacemaker will function as a noncommitted DVI with atrial sensing (DDI). The early report of DVI pacemaker-induced atrial fibrillation during follow-up has been refuted by more recent works. If the DDD pacemaker is significantly more expensive than the DVI pacemaker, the latter type may be a good alternative for this condition.     

Use of an inspiratory impedance threshold valve during cardiopulmonary resuscitation: a progress report

Building upon studies on the mechanism of active compression-decompression (ACD) cardiopulmonary resuscitation, a new inspiratory impedance threshold valve has been developed to enhance the return of blood to the thorax during the decompression phase of CPR. Use of this device results in a greater negative intrathoracic pressure during chest wall decompression. This leads to improved vital organ perfusion during both standard and ACD CPR. Animal and human studies suggest that this simple device increases cardiopulmonary circulation by harnessing more efficiently the kinetic energy of the outward movement of the chest wall during standard CPR or active chest wall decompression. When used in conjunction with ACD CPR during clinical evaluation, addition of the impedance valve resulted in sustained systolic pressures of greater than 100 mmHg and diastolic pressures of greater than 55 mmHg. The new valve may be beneficial in patients in asystole or shock refractory ventricular fibrillation, when enhanced return of blood flow to the chest is needed to 'prime the pump'. The potential long-term benefits of this new valve remain under investigation.     

Adult-onset atopic dermatitis: a cross-sectional study of natural history and clinical manifestation

The previously reported prevalence of adult-onset atopic dermatitis (AD) varied from 13% to 47%. There were a few reports of clinical features of adult-onset AD. The purpose of this article was to study the clinical features of Thai patients with adult-onset AD. We recruited prospective patients from the outpatient Department of Dermatology, Siriraj hospital, Mahidol University in Bangkok, Thailand, from June, 2006 to May, 2007. The diagnosis of AD was made according to the criteria of Hanifin and Rajka and the severity of AD in each patient was assessed using the Rajka and Langeland score. Fifty nine patients were enrolled. The majority of the patients developed their dermatitis during their third decade. Typical lichenified/exudative lesions were found in all cases. Non-typical morphologic variants were found in 76.3%. The most common were nummular lesions. The main sites of involvement were the flexural area. The common sites of non-flexural involvement were the trunk, extensors and hands. The severity of AD was moderate in 64.4% of cases. A personal history of atopy was found in 84.7% of cases. Skin prick testing showed positive results (mostly to multiple allergens) in 25 of 29 patients (86.2%). Elevated serum total immunoglobulin E was detected in 6 of 10 patients (60%). It is concluded that adult-onset AD is not a rare but under-recognized eczematous condition.     

Seroprevalence of tetanus antibody in the Thai population: a national survey

Tetanus is a disease with high mortality and the most important measure for effective prevention is vaccination. Tetanus immunization has been introduced to Thailand's national immunization program for 30 years. Yet, the coverage and seroprevalence of tetanus antibody in vast parts of the population has not been assessed. This study has been performed on 1,277 subjects aged between 6 months and 60 years or above from four geographically distinct provinces of Thailand. Tetanus antibody levels were measured using a commercially available ELISA kit. Most of the Thai population had immunity against tetanus. The level of antibodies to tetanus, as demonstrated by the geometric mean titer of antibody (GMT) (and 95% confidence interval) was 2.62 (2.34-2.91) IU/ml. The highest and lowest GMT was found in subjects aged between 5 and 9 years, and above 60 years of age with GMT (and 95% confidence intervals) of 3.64 (3.34-3.96) and 1.24 (0.67-2.29) IU/ml respectively. The minimum protective level of antitoxin (>0.01 IU/ml) was detected in 99.7 % of subjects. More than 90% of subjects displayed durable antibody protection levels (DAPL) (> or = 1.0 IU/ml), except for subjects above the age of 60 years (82%). According to this study, the majority of the population expresses tetanus antibody levels that can confer long term protection. Yet, considering the lowest GMT and the highest incidence of tetanus cases found in subjects aged above 60 years, re-immunization should be targeted at this age group especially if they had sustained any tetanus-prone injury.     

Human coronavirus infection among children with acute lower respiratory tract infection in Thailand

OBJECTIVE: This study was performed to further identify the previously uncharacterized human coronavirus 229E (hCoV-229E) and human coronavirus OC43 (hCoV-OC43) in Thailand by using the RT-PCR technique. In addition, we performed this study in order to delineate the prevalence, the potential clinical impacts and evaluation of the genetic characterization of this pathogen in young children who presented with acute lower respiratory tract infections (ALRI). METHODS: We obtained nasopharyngeal secretions (NPs) from 226 children <5 years of age who were either attending the outpatient department or hospitalized with ALRI from March 2002 to July 2003. All clinical, laboratory, RT-PCR, direct sequencing and phylogenetic analysis data were collected and analyzed. RESULTS: Of the 226 NPs samples from infants and young children presented with ALRI, 8 (3.54%) were positive for hCoV-229E, 2 (0.88%) were positive for hCoV-OC43, and 1 (0.44%) had co-infection. The following clinical presentations were noted: fever (100%), rhinitis (44%), acute bronchiolitis (44%), viral pneumonia (33%), viral pneumonia triggering asthma exacerbation (11%) as well as viral pneumonia causing BPD exacerbation (11%). All positive samples were subjected to direct sequencing. The amino acid sequences had 82-99% similarity to previous sequences stored in the GenBank database. CONCLUSION: The molecular technique we applied to detect human coronavirus appears justified as a valuable diagnostic approach to elucidate the prevalence, cause and clinical implications of ALRI among infants and young children.     

Autoimmune and rheumatic manifestations and antinuclear antibody study in HIV-infected Thai patients

BACKGROUND: There have been reports concerning an association between human immunodeficiency virus (HIV) infection and autoimmune and rheumatic diseases. OBJECTIVE: The purpose of this study was to examine autoimmune and rheumatic manifestations in HIV-infected patients and their correlation with antinuclear antibody (ANA) tests. METHODS: The clinical and laboratory results of HIV-infected patients attending the Department of Dermatology, Siriraj Hospital, Bangkok, Thailand, from February 1999 to January 2000, were analyzed. Laboratory studies included serum CD4 lymphocyte count and ANA tests. RESULTS: Sixty-two patients were enrolled prospectively in the study. Myalgia was the most common clinical presentation (50%). Others included photosensitivity (on history) (39%), arthralgia (26%), vasculitis (18%), sicca complex (10%), arthritis (7%), and Reiter's syndrome (2%). A history of hair loss was given by 23% of patients. A positive ANA test was detected in 3%. No cases of systemic lupus erythematosus, scleroderma, or dermatomyositis were seen. CONCLUSIONS: Autoimmune and rheumatic manifestations were not uncommonly detected in patients with HIV infection. HIV infection may sometimes mimic systemic lupus erythematosus clinically.     

C-reactive protein and diabetic retinopathy in Chinese patients with type 2 diabetes mellitus

AIM: To investigate the relationship between C-reactive protein (CRP) and diabetic retinopathy (DR) in a cohort of Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: Community-based observational cohort study. There were 1131 participants recruited from November 2009 to September 2011 in Desheng community in urban Beijing. Patients diagnosed T2DM were recruited and underwent a standardized evaluation consisting of a questionnaire, ocular and anthropometric examinations and laboratory investigation. The presence and severity of DR were assessed by seven fields 30° color fundus photographs. Subjects were then classified into groups with no DR, any DR, or vision-threatening DR. CRP was analyzed from serum of study subjects. RESULTS: A total of 1007 patients with T2DM were included for analysis, including 408 (40.5%) men and 599 (59.5%) women. The median CRP level was 1.5 mg/L for women and 1.1 mg/L for men (P=0.004, OR 0.37, 95% CI 0.18-0.74). After adjusting for possible covariates, higher levels of CRP were associated with lower prevalence of any DR (P=0.02, OR 0.55, 95% CI 0.35-0.89), but not associated with vision-threatening DR (P=0.62, OR 0.78, 95% CI 0.28-2.14). After stratification by sex, the inverse association between CRP and DR was found to be statistically significant in men (P=0.006, OR 0.35, 95% CI 0.16-0.73), but not in women (P=0.58, OR 0.88, 95% CI 0.29-1.16). CONCLUSION: The data drawn from a Chinese population with T2DM suggest that increasing CRP levels may be inversely associated with development of DR.     

Effect of a whey-predominant starter formula containing LCPUFAs and oligosaccharides (FOS/GOS) on gastrointestinal comfort in infants

Development of new infant formulas aims to replicate the benefits of breast milk. One benefit of breast milk over infant formulas is greater gastrointestinal comfort. We compared indicators of gastrointestinal comfort in infants fed a whey-predominant formula containing long-chain polyunsaturated fatty acids, galacto-oligo-saccharides and fructo-oligosaccharides, and infants fed a control casein-predominant formula without additional ingredients. The single-centre, prospective, double-blind, controlled trial randomly assigned healthy, full-term infants (n=144) to receive exclusively either experimental or control formula from 30 days to 4 months of age. A group of exclusively breast-fed infants served as reference (n=80). At 1, 2, 3, and 4 months, infants' growth parameters were measured and their health assessed. Parents recorded frequency and physical characteristics of infants' stool, frequency of regurgitation, vomiting, crying and colic. At 2-months, gastric emptying (ultrasound) and intestinal transit time (H2 breath test) were measured, and stool samples collected for bacterial analysis. Compared to the control (n=69), fewer of the experimental group (n=67) had hard stools (0.7 vs 7.5%, p<0.001) and more had soft stools (90.8 vs 82.3%, p<0.05). Also compared to the control, the experimental group's stool microbiota composition (mean % bifidobacteria: 78.1 (experimental, n=17), 63.7 (control, n=16), 74.3 (breast-fed, n=20), gastric transit times (59.6 (experimental, n=53), 61.4 (control, n=62), 55.9 (breast-fed, n=67) minutes) and intestinal transit times (data not shown) were closer to that of the breast-fed group. Growth parameter values were similar for all groups. The data suggest that, in infants, the prebiotic-containing whey-based formula provides superior gastrointestinal comfort than a control formula.