Clinical Factors Predictive of Pneumonia Caused by Pandemic 2009 H1N1 Influenza Virus

Pneumonia was the most common cause of death during the 2009 pandemic H1N1 influenza virus infection. Clinical risk factors for pneumonia caused by this virus are limited. We enrolled consecutive patients treated at the H1N1 Clinic in Thungsong Hospital in Nakhon Si Thammarat, Thailand, during June–December 2009 who had positive polymerase chain reaction results for H1N1 virus. Clinical features for patients given a diagnosis with and without pneumonia were studied. There were 441 patients with positive polymerase chain reaction results for H1N1 virus. Of these patients, 51 (11.56%) had pneumonia. Three independent clinical factors for H1N1 pneumonia were myalgia, dyspnea, and an absolute neutrophil count > 7,700 cells/μL. Adjusted odds ratios (95% confidence intervals) for these three variables were 0.413 (0.173–0.988), 2.625 (1.230–5.604), and 4.475 (1.882–10.644), respectively. Clinical features may be a useful tool for predicting risk for pneumonia caused by H1N1 virus.     

Leptospirosis and its pulmonary complications

OBJECTIVE: The aim of this study was to assess the incidence and factors associated with pulmonary complications of leptospirosis. METHODOLOGY: In a retrospective study, patients with a definite diagnosis of leptospirosis following a 6-week period of severe flooding in Hadyai city, Thailand, were reviewed. Pulmonary complications of leptospirosis were defined as the occurrence of respiratory symptoms and an abnormal CXR. The clinical and laboratory test results for patients with and without pulmonary complications were compared. RESULTS: Among the 157 patients with leptospirosis, eight patients had pulmonary complications. Three patients had acute renal failure (ARF) and pulmonary oedema. One patient had ARF and adult respiratory distress syndrome (ARDS). Two patients had ARF, congestive heart failure and pulmonary oedema. One patient had congestive heart failure and pulmonary oedema. One patient had only ARF. Factors associated with pulmonary complications were delayed antibiotic treatment and thrombocytopenia (platelet count < 100 x 10(9)/L). Three patients developed adult respiratory distress syndrome and one died from respiratory failure. CONCLUSIONS: Pulmonary complications and death occur in a low percentage of patients with leptospirosis. Delayed antibiotic treatment and thrombocytopenia are risk factors for the development of pulmonary involvement in leptospirosis.     

The association between BsmI polymorphism and bone mineral density in young patients with epilepsy who are taking phenytoin

Purpose: This study sought to determine the association between BsmI polymorphism and bone mineral density, 25‐hydroxyvitamin D, and parathyroid hormone levels in patients with epilepsy. Methods: We recruited ambulatory young adults with epilepsy who were taking phenytoin. Data regarding demographics, basic laboratory studies, history of clinical epilepsy, parathyroid hormone, and vitamin D levels, as well as BsmI polymorphism of the vitamin D receptor (VDR) gene, were obtained. The bone mineral density (BMD) of the lumbar spine and left femur were measured using dual‐energy x‐ray absorptiometry. Key Findings: Ninety‐four patients were included in the study. BsmI polymorphism had a statistically significant lower T‐score of the lumbar spine and left femoral neck than patients with wild‐type VDR gene (p < 0.01 and p < 0.01, respectively). In addition, patients with BsmI polymorphism had a statistically significant lower z‐score of the lumbar spine and left femoral neck than patients with wild‐type VDR gene (p < 0.01 and p < 0.01, respectively). The 25‐hydroxyvitamin D level in patients with wild‐type genes was higher than in epileptic patients with BsmI polymorphism (p < 0.01 and p < 0.01, respectively). Parathyroid hormone level in patients with wild‐type VDR gene or patients having BsmI polymorphism was not correlated with BMD at either site. Significance: In patients with epilepsy taking phenytoin, having BsmI polymorphism was associated with lower BMD.     

SLE with diffuse alveolar hemorrhage,microangiopathic hemolytic anemia and acute renal failure

In SLE patients with diffuse alveolar hemorrhage (DAH) and acute renal failure (ARF), the most common associated renal injury is proliferative lupus nephritis. We report a case of a young SLE patient with DAH and ARF who was successfully treated with a course of therapeutic plasma exchange (TPE) plus pulse IV cyclophosphamide. Kidney biopsy revealed an alternative diagnosis. J. Clin. Apheresis 27:263–264, 2012. © 2012 Wiley Periodicals, Inc.     

Randomized,Double‐Blind,Placebo‐Controlled Trial of Spironolactone for Hypokalemia in Continuous Ambulatory Peritoneal Dialysis Patients

The incidence of hypokalemia in continuous ambulatory peritoneal dialysis (CAPD) patients is about 15–60%, leading to significant complications. There is no standard treatment other than potassium supplement in this setting. The aim of this study was to evaluate effect of spironolactone 25 mg/day in CAPD patients who have a history of hypokalemia. This is a randomized, double‐blind, placebo‐controlled, cross‐over study in CAPD patients who had a history of hypokalemia. Study intervention is 4 weeks of oral spironolactone 25 mg/day or placebo, cross‐over after a 2‐week wash‐out period. The primary outcome was the difference of serum potassium before and after 4 weeks of spironolactone treatment. Serum potassium was measured every 2 weeks, serum magnesium, urine and peritoneal fluid potassium measured before and after each treatment period. We enrolled 24 patients, and 20 completed the cross‐over study. Ten patients were anuric. The total doses of potassium supplement were the same during the study period. Serum potassium levels before and after study intervention were not significantly different in both groups (4.23 ± 0.64 vs. 3.90 ± 0.59 mEq/L for spironolactone P = 0.077 and 3.84 ± 0.62 vs. 3.91 ± 0.52 for placebo P = 0.551). Total 24‐h potassium, magnesium, sodium excretion, urine volume and ultrafiltration volume were not affected by spironolactone or placebo. There was one episode of hyperkalemia (5.6 mEq/L) during the spironolactone treatment period. Spironolactone 25 mg/day does not have a significant effect on serum potassium or urine and peritoneal excretion rate in CAPD patients who have a history of hypokalemia.     

Bone mineral density following long-term use of antiepileptic drugs in a tropical Asian country

The objective of this study was to investigate bone mineral density (BMD) in Thai epileptics who had been receiving long-term, antiepileptic drugs. Subjects were epileptic patients aged 15 to 50 years who had been taking antiepileptic drugs for longer than six months. All were free of disease and none was taking any medication that might interfere with bone metabolism other than antiepileptic drugs. BMD at the left femoral neck and spine was measured with dual energy X-ray absorptiometry. Demographic data, basic laboratory studies and history of clinical epilepsy were obtained. One hundred and thirty patients (63 males and 67 females) were included. Mean age (+ SD) was 31.9 +/- 9.7 year. There were 79 patients receiving monotherapy and 51 patients receiving polytherapy. All patients had normal serum calcium. Thirteen patients had slightly low serum phosphate levels. The BMD at the femoral neck had a mean Z-score - 0.15 +/- 1.17 and the mean Z-score at the lumbar spine was - 0.56 +/- 1.03. Thirty one patients had osteopenia at the spine and 30 patients at the femoral neck. Three patients had osteoporosis of the spine and 1 patient of the femoral neck. There was found to be no significant correlation between age, sex, body mass index, duration of treatment and type of antiepileptic drug with bone mineral density at the femur and spine. The mean BMD of long-term antiepileptic users was lower than that of the sex and age-adjusted mean.