Predicting fetal anemia by using reference centile charts for liver length, spleen perimeter and umbilical vein maximum flow velocity in Thai fetuses throughout gestation

AIM: To create reference centile charts for liver length, spleen perimeter and umbilical vein maximum flow velocity (UVVmax) in Thai fetuses in order to predict fetal anemia in Thai fetuses. METHODS: The study was a prospective, cross-sectional study, carried out at the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University. A total of 780 pregnant women between 13 and 40 weeks' gestation, who attended the antenatal clinic at Siriraj Hospital, Mahidol University, Bangkok, were recruited. Each fetus was measured only once for the purpose of this study. The mean and standard deviation (SD) were estimated at each week of gestation using linear regression modeling. A total of 752 fetuses were measured for fetal liver length, spleen perimeter and UVVmax. Linear regression models were fitted to estimate the mean 95% confidence interval for liver length, spleen perimeter and UVVmax at each gestational age. The centile charts of those parameters were also presented. CONCLUSION: Reference centile charts for fetal liver length, spleen perimeter and UVVmax of Thai fetuses were created.     

Association of TNF-alpha, TNF-beta, IFN-gamma and IL-1Ra gene polymorphisms with Graves' disease in the Thai population

Cytokines play a key role in the regulation of immune and inflammatory responses. Therefore, cytokine genes are potentially related to susceptibility to Graves' disease (GD). The aim of this study was to investigate the putative functional polymorphisms within tumor necrosis factor-alpha (TNF-alpha), tumor necrosis factor-beta (TNF-beta), interferon-gamma (IFN-gamma), and interleukin-1 receptor antagonist (IL-1Ra) genes, in patients with GD (n = 137) compared to a healthy Thai control group (n = 137). The results showed no statistically significant difference between the study groups for TNF-beta (Ncol site in intron 1), IFN-gamma (+874 in intron 1), and IL-1Ra (variable numbers of tandem repeats in intron 2) gene polymorphisms. Only the -863A allele within the promoter region of the TNF-alpha gene, which may affect the affinity of the promoter nuclear factor (NF)-kappab interaction, was found to be increased in GD patients compared to the controls (p = 0.009, OR = 1.8, 95% CI = 1.15 to 2.84). The effect of the -863A allele of the TNF-alpha gene was similar to the autosomal dominance mode of inheritance (p = 0.01, OR = 2, 95% CI = 1.16 to 3.44). This polymorphism may be involved in the susceptibility to GD in part through its higher promoter activity of TNF-alpha production.     

Significantly increased recovery of intestinal parasites on routine stool specimen evaluation

Three hundred thirty-six stool samples from October 2001 through October 2002 were analyzed for the presence of intestinal parasites. Fifty-six of these (16.7%) were positive for a total of 66 parasites; 65/66 (98.5%) were detected by iodine and dimethyl sulfoxide-modified acid-fast (DMSO-mAFB) stained smears of fresh and formalin-ethylacetate sedimentation concentrated samples. Saline, iodine, and DMSO-mAFB stained smears of fresh stool samples alone detected significantly fewer parasites, finding only 50/66 (75.8%) (p < 0.05). Stool samples analyzed by trichrome stained specimens preserved in Zinc sulfate polyvinyl alcohol (Zinc PVA) detected only 41/ 66 (62.2%) of the parasites. In our study population, it was necessary to perform the National Committee for Clinical Laboratory Standard (NCCLS) recommended to accurately detect intestinal parasites. The concentration technique is simple and significantly increased the detection of intestinal parasites.     

Microalbuminuria—A Biomarker of Renal Microvascular Disease

Microalbuminuria (amount greater than 30–300 mg/day) reflects an abnormal glomerular capillary permeability to protein. It is usually dependent upon three mechanisms. First, loss of negatively charged surface of the glomerular capillary wall secondary to circulating toxic substances injury—namely, oxidative stress and proinflammatory cytokines—allows the albumin with negatively charged surface to freely escape into the urine. Second, intraglomerular hypertension and hemodynamic maladjustment secondary to glomerular endothelial dysfunction increases filtration pressure and enhances sized selective proteinuria leakage. Third, podocyte injury leads to a vicious cycle of hemodynamic maladjustment and endothelial and podocyte injuries. All three of these mechanisms induce glomerular endothelial injury and microalbuminuria, which reflects renal microvascular disease.     

A SPINK1 gene mutation in a Thai patient with fibrocalculous pancreatic diabetes

Fibrocalculous pancreatitis diabetes (FCPD), a late stage of tropical chronic pancreatitis (TCP), is classified as a secondary cause of diabetes mellitus resulting from pancreatic exocrine dysfunction. The distinctive features of FCPD and TCP are young age at onset, presence of large intraductal pancreatic calculi, and reported mainly in tropical developing countries. Their etiology is still obscure, but the autodigestion due to aberrant intraductal activation of zymogens by trypsin is thought to be a primary common event. Recently, mutations in SPINKI gene encoding a pancreatic secretory trypsin inhibitor have been reported in association with an increased risk of pancreatitis. We describe a heterozygous mutation, IVS3+2 T>C, of SPINK1 gene in a young Thai female patient with typical presentation of FCPD. To our knowledge, this is the first report of the SPINK1 gene mutation in a FCPD patient in Southeast Asia.     

Management of developmental anomalies in the maxillary incisors: case report

This report presented a case having a vital maxillary lateral incisor with a talon cusp, dens invaginatus and radicular palatal groove. A periodontal pocket of 6 mm. was found adjacent to the radicular palatal groove. The treatment for this case included the prophylactic grinding of the talon cusp, restoration of dens invaginatus, and filling the supragingival portion of the radicular palatal groove with light-cured composite resin to erradicate plaque retention. Only degranulation and root planing was performed in order to establish the healthy dentogingival unit without any treatment of the subgingival portion of the radicular palatal groove. The patient was motivated to maintain good oral hygiene for preventing or minimizing the recurrence of periodontal disease.     

Thyrotoxic periodic paralysis induced by pulse methylprednisolone

We present a young Thai man who developed acute flaccid paralysis after receiving pulse methylprednisolone for chronic inflammatory demyelinating polyneuropathy. Hypokalemia from intracellular shift was confirmed by calculation of transtubular potassium gradient (TTKG). His muscle strength and serum potassium fully recovered with a small amount of potassium replacement. Graves' disease was subsequently diagnosed and treated with radioactive iodine. We suggest that acute paralysis after the use of steroids should raise a suspicion of thyrotoxic periodic paralysis (TPP). The potential mechanisms of steroid-induced TPP are discussed.     

A high incidence of liver cancer in Khon Kaen Province, Thailand

Based on a population-based cancer registry in Khon Kaen Province, Thailand, data were collected actively and passively from all hospitals, health centers and the office of the Chief Medical Officer of Khon Kaen. The data were collected prospectively for the year 1988 and retrospectively for the years 1985-1987. Liver cancer, especially cholangiocarcinoma, was the leading cancer in both sexes. The age-standardized incidence rates for the year 1988 were 89.2/10(5) in males and 35.5/10(5) in females respectively, which are among the highest rates recorded in the world. The number of reported liver cancer cases increased each year. The observed geographical clusters of liver cancer appear to be associated with the prevalence and intensity of Opisthorchis viverrini infection, as reported in previous studies in this area.