Reference value for C-reactive protein and its distribution pattern in thai adults.

BACKGROUND: To set a reference value for high-sensitivity C-reactive protein (hs-CRP) in a healthy Thai population and study the effect of time, gender and age on that value. METHODS AND RESULTS: Three hundred and sixty-four subjects, aged between 18 and 74 years, comprising 185 men and 279 women, were studied. Another 10 healthy subjects, aged between 18 and 54 years, were recruited for the study of circadian variation in hs-CRP over the days of the week and the months of a year. The reference value for the Thai adults in the present study was 1.8 mg/L, range 0.2-7.9 mg/L. There was no significant difference in the hs-CRP concentration because of region, time, gender or age (p>0.05), nor was the value affected by time. CONCLUSION: The determination of hs-CRP can be performed at any time and the hs-CRP value determined by this study can be used as the reference for Thai adults.     

Feasibility Study on Computer-Aided Screening for Diabetic Retinopathy

Purpose

To conduct a feasibility study of computer-aided screening for diabetic retinopathy by developing a computerized program to automatically detect retinal changes from digital retinal images.

Methods

The study was carried out in three steps. Step 1 was to collect baseline retinal image data of 600 eyes of normal subjects with normal fundi and data of 300 eyes of diabetic patients with diabetic retinopathy. All data were recorded by digital fundus camera. Step 2 was to analyse all retinal images for normal and abnormal features. By this method, the automated computerized screening program was developed. The program preprocesses colour retinal images and recognizes the main retinal components (optic disc, fovea, and blood vessels) and diabetic features such as exudates, haemorrhages, and microaneurysms. All of the accumulated information is interpreted as normal, abnormal, or unknown. Step 3 was to evaluate the sensitivity and specificity of the computerized screening program by testing the program on diabetic patients and comparing the program's results with the results of screening by retinal specialists.

Results

Diabetic patients (182 patients, 336 eyes) were examined by retinal specialists; 221 eyes had a normal fundus and 115 eyes had nonproliferative diabetic retinopathy. Digital retinal images were taken of these 336 eyes and interpreted by the automated screening program. The program had a sensitivity and specificity of 74.8% and 82.7%, respectively.

Conclusions

The automated screening program was able to differentiate between the normal fundus and the diabetic retinopathy fundus. The program may be beneficial for use in screening for diabetic retinopathy. Further development of the program may provide higher sensitivity.?Jpn J Ophthalmol 2006;50:361–366 © Japanese Ophthalmological Society 2006     

Diagnostic performance of quantitative ultrasound calcaneus measurement in case finding for osteoporosis in Thai postmenopausal women

AIM: Dual-energy X-ray absorptiometry (DXA) is currently considered the gold standard for the diagnosis of osteoporosis. Quantitative ultrasound (QUS) can be an alternative method that is less expensive, portable, and can be used at a primary care level to indicate osteoporosis in women. The present study aimed to assess the diagnostic performance of QUS calcaneus measurement in a case finding for osteoporosis in Thai postmenopausal women using DXA as a gold standard. METHODS: Three hundred postmenopausal women, who had not menstruated normally for at least 1 year, were included in the study. To determine the accuracy and reliability of QUS of the calcaneus, calcaneus bone density measurement was carried out using the QUS and left femoral neck bone density was measured using DXA. Bone mass density (BMD) was interpreted as osteoporotic or normal using WHO criteria for determining the performance of QUS. Optimal cut-off values were determined using a receiver operating characteristic (ROC) curve for diagnosing the osteoporosis cases. RESULTS: The number of osteoporosis cases in this study was 107 (35.67%). The sensitivity, specificity, positive and negative predictive values were 39.25%, 91.71%, 72.41%, 73.14%, respectively, when using the T-score of the WHO criteria as a reference. The positive and negative likelihood ratios were 4.73 and 0.66. When using the ROC curve to determine the optimal cut-off values, using the stiffness index of the QUS and categorizing age (<65 years and >or=65 years) before conducting the test, sensitivity and specificity were 77.6% and 59.6%, respectively. CONCLUSIONS: Bone mass density measurement for predicting osteoporosis using QUS had a very low sensitivity and was not good enough to replace the standard tool (DXA).     

The prevalence of an Onodi cell in adult Thai cadavers

Endoscopic sinus surgery in patients who have an Onodi cell (sphenoethmoid cell) carries a high risk for optic nerve injury. We meticulously dissected 65 embalmed cadaver adult half-heads and attempted to identify an optic canal bulge in each with a nasal endoscope. Our aims were to determine the prevalence of an Onodi cell in adult Thai cadavers, to ascertain the prevalence of an overriding ethmoid cell, and to measure the length of an overriding ethmoid cell's superior and posterior extensions in relation to the anterior sphenoid wall. Moreover, we attempted to determine the minimum amount of bone thickness between an Onodi cell and the optic nerve. We found that an Onodi cell was present in 39 of the 65 specimens (60.0%). We also found that an overriding ethmoid cell was present in 14 specimens, which accounted for 21.5% of the total number of specimens and 36.8% of 38 Onodi cell-positive specimens (the presence or absence of an overriding ethmoid cell was not recorded in one of the 39 Onodi cell-positive specimens). The distance of the overriding ethmoid cell's superior and posterior extensions from the anterior sphenoid wall ranged from 3 to 13 mm (median: 7) and from 4 to 16 mm (median: 9.5), respectively. Measurements of the minimum amount of bone thicknesses between each Onodi cell and optic nerve ranged from 0.03 to 0.54 mm (median: 0.08). Our study demonstrated that the prevalence of an Onodi cell in adult Thai cadavers was as great as the prevalence reported in the only other gross anatomic dissection study performed in Asia and much higher than rates generally reported in Western countries.     

Cancer in Noonan, Costello, cardiofaciocutaneous and LEOPARD syndromes

Noonan syndrome (NS), Costello syndrome (CS), cardiofaciocutaneous syndrome (CFCS), and LEOPARD syndrome (now also referred to as Noonan syndrome with multiple lentigines or NSML) are clinically overlapping dominant disorders that are caused by mutations in RAS signaling pathway genes. The spectrum of cancer susceptibility in this group of disorders has not been studied in detail. We identified more than 1900 cases of NS, CS, CFCS, or NSML reported in the literature between 1937 and 2010; 88 cancers were reported. The most common cancers reported in 1051 NS subjects were neuroblastoma (n = 8), acute lymphoblastic leukemia (n = 8), low grade glioma (n = 6), and rhabdomyosarcoma (n = 6). These associations are biologically plausible, given that somatic RAS pathway mutations are known to occur in these specific cancers. In addition, 40 childhood cases of myeloproliferative disease were described in individuals with NS, several of whom experienced a benign course of this hematologic condition. We confirmed the previously described association between CS and cancer in 268 reported individuals: 19 had rhabdomyosarcoma, 4 had bladder cancer, and 5 had neuroblastoma. By age 20, the cumulative incidence of cancer was approximately 4% for NS and 15% for CS; both syndromes had a cancer incidence peak in childhood. The cancers described in CFCS and NSML overlapped with those reported in NS and CS. Future epidemiologic studies will be required to confirm the described cancer spectrum and to estimate precise cancer risks. Published 2011 Wiley-Liss, Inc.     

Factors related to work ability among Thai workers

This study aimed to examine the factors related to work ability among small and medium enterprise (SME) workers in Thailand. The subjects consisted of 845 males and 1,163 females. They were interviewed regarding personal information, working conditions, health status, job stress and work ability. Their blood pressure, body weight and height were also measured. More than half the subjects reported high job stress. Women had higher job stress than men. The work ability index (WAI) results for managers, supervisors and operators were 42.3, 41.4 and 39.8, respectively. Job control of managers and supervisors was higher than operators. The WAI of females decreased with increasing age for those over age 45 years. Factors related to WAI were mental health, social support at work, depression and age. The results suggest job stress reduction programs should be considered to improve work ability among SME workers.     

Systematic review of physical fitness testing to evaluate the physical combat readiness of Royal Thai Armed Forces

Physical combat readiness of military personnel ensures maximal effectiveness of combat forces during wartime. Combat readiness has always been linked to the Army Physical Fitness Test (APFT). Each raw score is converted to a standard score and corrected for age and gender. There is no standard measurement to evaluate combat readiness in the Royal Thai Army. To determine standardized criteria for physical combat readiness of Royal Thai Army personnel through systematic review, the APFT was used to determine fitness levels and to promote health. To pass the test, each soldier in each unit must attain a minimal standard score for each individual subtest. At present, each unit in the armed forces derives its own standard, based on different missions. The APFT might be an acceptable method to measure physical combat readiness. However, no studies have established the general measurements to evaluate combat readiness.     

Curcumin Extract for Prevention of Type 2 Diabetes

OBJECTIVE

To assess the efficacy of curcumin in delaying development of type 2 diabetes mellitus (T2DM) in the prediabetic population.

RESEARCH DESIGN AND METHODS

This randomized, double-blinded, placebo- controlled trial included subjects (n = 240) with criteria of prediabetes. All subjects were randomly assigned to receive either curcumin or placebo capsules for 9 months. To assess the T2DM progression after curcumin treatments and to determine the number of subjects progressing to T2DM, changes in β-cell functions (homeostasis model assessment [HOMA]-β, C-peptide, and proinsulin/insulin), insulin resistance (HOMA-IR), anti-inflammatory cytokine (adiponectin), and other parameters were monitored at the baseline and at 3-, 6-, and 9-month visits during the course of intervention.

RESULTS

After 9 months of treatment, 16.4% of subjects in the placebo group were diagnosed with T2DM, whereas none were diagnosed with T2DM in the curcumin-treated group. In addition, the curcumin-treated group showed a better overall function of β-cells, with higher HOMA-β (61.58 vs. 48.72; P < 0.01) and lower C-peptide (1.7 vs. 2.17; P < 0.05). The curcumin-treated group showed a lower level of HOMA-IR (3.22 vs. 4.04; P < 0.001) and higher adiponectin (22.46 vs. 18.45; P < 0.05) when compared with the placebo group.

CONCLUSIONS

A 9-month curcumin intervention in a prediabetic population significantly lowered the number of prediabetic individuals who eventually developed T2DM. In addition, the curcumin treatment appeared to improve overall function of β-cells, with very minor adverse effects. Therefore, this study demonstrated that the curcumin intervention in a prediabetic population may be beneficial.The impacts of type 2 diabetes mellitus (T2DM) on global health care and economy are enormous (1). According to the World Health Organization, there are ∼311 million people worldwide who live with T2DM. This number continues to rise, especially in the newly developing and poorer countries in Asia and elsewhere. Because T2DM is currently incurable, a common treatment approach is to try to control the disease with lifelong use of antidiabetes drugs. Limiting the number of newly developed T2DM cases should be one of the better key strategies to restrict the global impacts of T2DM (2). In order to limit the number of new T2DM cases, the lifestyle of the prediabetic population has to be changed. However, this has been shown to be challenging (3). One of the alternative approaches to prevent development of T2DM is to intervene with the prediabetic population before disease progresses into fully developed T2DM (3). The intervention approach is appealing. It relies on timely identification of prediabetic individuals and provision of preventive treatment before the disease fully progresses. The intervention represents a chance for the diabetes-prone population to halt the disease progression and maintain a normal and healthy life. In recent years, several effective T2DM intervention regimens have been developed, with encouraging results (3–5). However, these regimens are not usually economically accessible, and they are not well-tolerated because of treatment-related toxicities (4,5). The focus now is to identify new effective therapeutic agents, with relatively low cost and low toxicity, that can be used regularly to control a progression of T2DM in the prediabetic population.Curcumin is the principal curcuminoid found in turmeric (Curcuma longa Linn.), a popular spice in Asian cuisine. It is widely consumed and generally believed to be beneficial for human health (6). Curcumin extract from rhizomes of turmeric has been shown to contain anti-inflammation and antidiabetic properties (7–13). In addition, it could delay development of T2DM, improve β-cell functions, prevent β-cell death, and reduce insulin resistance in animals (8–16). This study aimed to determine the effectiveness of curcumin extract as an intervention agent to prevent T2DM development. We assessed T2DM progression and several indicative T2DM parameters in a large randomized, double-blinded, and placebo-controlled cohort. We found that curcumin extract effectively reduced the number of prediabetic individuals who progressed toward T2DM as well as improved functions of β-cells.     

Cost-effectiveness analysis of various screening methods for osteoporosis in perimenopausal Thai women

OBJECTIVE: To perform a health economics analysis of 5 screening programs for osteoporosis in perimenopausal Thai women comparing two alternatives; without intervention and universal treatment without screening. DESIGN: A decision analysis was performed to evaluate five screening strategies: Dual energy X-ray absorptiometry (DXA), Quantitative ultrasound sonography (QUS), risk index (clinical risk factors), two-step screening with QUS followed by DXA, and screening with risk index followed by DXA, comparing outcomes without intervention and universal treatment without screening. RESULTS: The costs for universal treatment, screening by DXA with treatment, screening by QUS with treatment, screening by Risk index with treatment, screening by QUS and DXA with treatment, and screening by Risk index and DXA with treatment strategies to prevent one fracture were 207.82, 88.42, 147.05, 127.67, 71.33, and 60.30 USD, respectively. The cost for no intervention to prevent one fracture is 8.49 USD (1 USD = 40 Thai baht). CONCLUSION: At present, no intervention is the most cost effective strategy. However, screening with risk index and DXA with treatment became the most cost effective when the patients reached the postmenopausal period and had a high risk index, for which the prevalence of osteoporosis will increase. Cost effective screening guidelines still cannot be explicitly established until further data addressing the association between bone mass measurements in the hip and hip fracture risk, are available.     

A Multicenter Analysis of Immune Checkpoint Inhibitors as Adjuvant Therapy Following Treatment of Isolated Brain Metastasis

BackgroundThe objective of this work was to characterize outcomes of patients with isolated brain metastases managed with local therapy followed by immune checkpoint inhibitor (ICI) therapy.Materials and MethodsPatients from four medical centers were included if they presented with isolated brain metastases treated with local therapy and received adjuvant treatment with ICIs.ResultsEleven patients with median size of largest brain metastasis of 3.9 cm, treated with surgical resection (n = 8) and/or stereotactic radiosurgery (SRS; n = 6), were included. Ipilimumab/nivolumab was the adjuvant ICI used in four patients, of whom one recurred (25%) and none died, compared with three of seven (43%) who recurred and two of seven (29%) who died following adjuvant treatment with ICI monotherapy. All recurrences were intracranial.ConclusionPatients with isolated brain metastases treated with surgery or SRS appeared to benefit from adjuvant ICI therapy, particularly with combination therapy. Recurrences in this setting appear to largely occur intracranially.